Inspection on 12/04/05 for Winstonian House

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Winstonian House 11/05/09

Winstonian House 20/05/08

Winstonian House 29/05/07

Winstonian House 24/07/06

Winstonian House 19/10/05

Winstonian House 22/11/04

Winstonian House 01/06/04

Winstonian House 04/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Winstonian House 42 All Saints Road Cheltenham Gloucestershire GL52 2EZ Lead Inspector Ruth Wilcox Unannounced 12 April 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winstonian House Version 1.10 Page 3 SERVICE INFORMATION Name of service Winstonian House Address 42 All Saints Road Cheltenham Gloucestershire GL52 2EZ 01242 577927 01242 577927 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CTCH Ltd Mrs Sally Bonner Care Home 18 Category(ies) of Old Age not falling within any other category registration, with number (18) of places Winstonian House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22 November 2004 Brief Description of the Service: Winstonian House consists of three terraced houses, which includes an end of terrace; all have been modified to create one property. The home is in the All Saints residential area of Cheltenham, close to local shops and the parish church, and is part of the C.T.C.H. Ltd group of homes. The centre of Cheltenham and Pittville Park are close by. It is registered to provide personal care to eighteen service users over the age of 65 years, and can provide respite care if this is wanted. Any elements of nursing care that may be needed are sourced from the local community nursing service. Accommodation is on three floors all served by stairlifts, though the stairlift from the lower ground floor rooms, despite being replaced since the last inspection, continues to be out of action. Fourteen bedrooms have en-suite facilities. The lower ground floor has two bedrooms, a bathroom and a small lounge/diner; people who smoke use this room. The remaining bedrooms are located on the ground and first floors. The communal accommodation consists of two open plan lounges leading to two dining areas. Patio doors from the lounge provide access to the small garden. There is a pond, flowerbeds and a paved area where service users can sit. The front of the house has a ramp for easy access and a few parking spaces. Winstonian House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours, on one day in April. The Registered Manager was not available, and the designated carer to deputise in her absence was present throughout the inspection. Informal interviews were held with three other staff members, and eight of the fourteen service users in residence were spoken to directly to gain their views of the service and care they receive. The home’s progress towards making improvements that were required at the last inspection was assessed, and it is of some concern that there are a number of those, which have not been met within the timescales. Care records and the management of medications were inspected, as were records pertaining to the safekeeping of service users’ valuables. The care of three service users in particular was looked at. A tour of the premises took place, and staff were observed going about their daily work, interacting with the service users. The lunchtime meal was observed. Systems for recruiting and training staff were inspected. What the service does well: The home has produced a very detailed and informative brochure for service users and their families, which enables them to learn about the home whilst making their choice about moving there. A full assessment is done before moving in, to ensure that the home will be able to fully meet the person’s needs. This home has a long serving and stable staff team, with good training opportunities available to them, to develop and increase their professional abilities. Staff are mindful of the need to respect the choices made by the service users, and there are written policies and procedures for the protection of vulnerable service users, with staff well able to demonstrate their awareness of these issues. The Deputy and all other staff were most helpful and cooperative with the inspection process. Winstonian House Version 1.10 Page 6 Meals are varied and of a good standard, with service users saying that they were generally very satisfied with them. What has improved since the last inspection? What they could do better: Despite the great improvements that have been made in the environment, there remain a number of areas that have gone unattended, and these must be addressed. In addition to these there have been a number of other maintenance issues identified as needing attention at this inspection also. All of these issues have been listed for the home’s attention in this report. More attention is also needed to get rid of the offensive odours that exist in isolated areas of the home. Although the standard of meals is good, the home must improve two particular hygiene issues in the kitchen, and also staff should be on hand to provide assistance to service users during the meal times. A staff rota must be maintained consistently, and greater focus is needed in asking service users and visitors about their views of the service, as part of their commitment to ensuring quality. Winstonian House Version 1.10 Page 7 Although there is generally a good and safe system for managing service users’ medications, staff must be sure to apply all safety measures regarding recording and usage, in accordance with their training and policies. Risk assessments must be carried out for those service users who are inclined to fall, or who wish to smoke, with clearly recorded measures necessary to protect them. Due to the stable staff team there has been no need to employ anyone recently. However the home must fully understand the necessity for a thorough approach when doing all of the pre-employment checks that are required, before employing anyone in the future. Despite the improvements made in the home since the last inspection, it is of some concern that it has been necessary to require a significant number of improvements again on this occasion. Staff should recognise their progress, though it is important that what has already been achieved is sustained, with attention to the remaining shortfalls as well. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Winstonian House Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Winstonian House Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 5 Service users have access to a good amount of detailed and useful information about the home, which enables them to make a choice about it. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, and enables them to visit the home and stay on a trial basis before making their final choice. EVIDENCE: The home has a written Statement of Purpose and Service User Guide, both of which are available in the home. Each service user is issued with their own copy of a Service User Guide, and signed acknowledgements of their receipt were seen. Each service user is admitted to the home on the basis of an assessment of their individual needs. Winstonian House Version 1.10 Page 10 Assessments are recorded on the basis of the Activities of Daily Living model, plus supplementary information, such as medication usage and specific personal likes and dislikes. A copy of the Social Services care plan is obtained where applicable, plus any other useful information from other health care professionals involved in the person’s care. Two staff said that they have accompanied the home’s Manager when going out to assess a prospective service user on previous occasions; this had involved going to different locations such as the person’s own home or in the hospital. Service users are able to stay in the home on a trial basis, the time of which can be made flexible to suit individual needs. Winstonian House Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 & 10 An overall improvement in the standard of care plan recording since the last inspection is clearly evident. However, more comprehensive detail in one particular case could still have provided clearer information, and improvements to the recording of risk assessments are required, so as to be fully reflective of service users’ needs. The systems for managing medications are good, though isolated shortfalls in staff practice to employ these fully may compromise the safety of it. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Each service users’ care plan was available for inspection, and three were chosen at random to form a case tracking exercise. Care plans were generally well written, and were evidently linked to assessed needs. They were informative, reviewed at least monthly, and the service Winstonian House Version 1.10 Page 12 users concerned had been consulted and involved in their care planning process. In two cases the service user concerned could be identified as being at risk of falls. In another case the service user concerned was a smoker. Despite two statutory requirements being issued at the last inspection to conduct and record risk assessments in such cases, these had not been done; this must be addressed. In one case an assessment had identified the person as being at risk of developing pressure sores. A care plan was in place for this, with necessary support equipment introduced. However, further detail regarding the manual actions needed by staff to relieve pressure in the action plan would have made a more comprehensive care plan in this case. During the case tracking it was noted that the support equipment had not been introduced in accordance with the plan, and the staff were asked to address it immediately. The majority of medications are managed in a monitored dosage system and items, including boxed and bottled ones, are stored safely. A very small quantity of external medications (eye drops) requiring cold storage is stored in a locked box in a domestic refrigerator, where temperatures are at appropriate levels. Eye drops should be dated on opening, to ensure that they are never used beyond their expiry time of 28 days. Medication Administration Records are printed by the supplying pharmacist, and in the main are well maintained by the staff. However, some areas for improvement were identified. There was an isolated administration signature gap on the record; an audit trail of the associated drug showed that the drug had been given. Two discontinued items were identified by the transcribed word ‘NO’ next to them. Staff should record properly that the drug has been ‘discontinued’, with the date and person responsible for it. There was one handwritten entry for a mild analgesic, which did not appear to have been prescribed by the Doctor. The author did not sign this entry, and the home remedy policy was not available to confirm that this drug was included in it. In such cases of a regularly needed drug, it would be pertinent for the Doctor to review and prescribe the person’s own supply. One service user was self-medicating, and a fully documented risk assessment was in place, with appropriate control measures in place. Staff with responsibility for managing medications have received accredited training with a local college. Winstonian House Version 1.10 Page 13 There is an emphasis in the home’s information guide on staff respecting service users’ choices, and their privacy and dignity in all aspects of their daily lives. During interview staff were fully aware of such issues, and appeared sensitive to them. Service users spoke positively about the ‘kind staff’, with one saying that ‘I have everything I need, and couldn’t wish for anything better’. Another said ‘we couldn’t do without the girls here – they are very good’. Service users confirmed that staff were mindful of their privacy, and that they knocked on their door before entering. Winstonian House Version 1.10 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 & 15 Opportunities for social activities have improved, with a diary of events including the range of activities available. Service users are able to exercise their choice regarding their participation with this, as with all aspects of their lives. The standard of the meals is good, offering choice and variety for service users, however, greater attention to service users’ needs during the meal is needed from staff. Specific issues relating to hygiene in the kitchen require some improvement, so as to prevent any contamination occurring. EVIDENCE: All staff take some responsibility for planning and organising social activities for service users. A monthly diary of events is now produced for each person, with a range of opportunities identified. Service users are consulted about their preferences and ideas for activities, and most of those spoken to said that they particularly enjoy the games sessions and the music entertainment. One person said she ‘liked the bingo very much’. A concerted effort has been made regarding the observances and celebration of calendar dates and festivals, with special themed decorations and menus to coincide. Service users’ comments indicated that staff are mindful of individual Winstonian House Version 1.10 Page 15 choices, including a choice not to participate socially. During interview staff clearly felt that Winstonian House is very much the ‘resident’s home’, and that service users are free to choose how they spend their time. This view was borne out by observations and service users’ comments during the inspection. One person said that there was little to do, apart from watching television. Further investigation discovered that this may be due to this service user being unable to use the stairs up to the ground floor where group activities are held, whilst the stair lift is out of action. There is clear evidence that service users can exercise choice in their rooms, and that respect is shown towards those who wish to continue managing their own affairs. The Service User Guide contains information about advisory, advocacy and support services for service users and their relatives, should this be wanted. Service users, without exception, confirmed their satisfaction with the good choice, quality and quantity of food provided for them. The service of the lunchtime meal was observed, and the food appeared wholesome, appetising and nutritious. The dining room was pleasantly laid with tablecloths, drinks condiments and napkins. Service users were left unattended for some time whilst eating their meal, and three people needed help and attention during this time. All staff were in the basement, and were asked to come and assist in the dining areas. A staff presence at meal times would benefit the service users, particularly those in need of a degree of supervision. The kitchen was orderly, with a fully recorded cleaning schedule and record of refrigerator temperatures available. The carer designated to cook on this day, though wearing an apron, was wearing her carer’s uniform whilst cooking; an alternative uniform must be worn on occasions such as these. At the last inspection the Manager said that the damaged and rusted refrigerator shelves were to be replaced; these remain in use at this time, and could pose a significant hygiene risk to the food stored in there; this must be addressed. Winstonian House Version 1.10 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home’s Adult Protection policies and staffs’ knowledge and awareness of them helps to provide a safe environment for the service users. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults. Staff have received training in abuse, and each of those spoken to demonstrated their awareness and understanding of what may constitute abuse, and the Whistleblowing procedures to follow if they had any concerns. Systems are in place to allow service users to place money with the home for safekeeping if they wish, with records kept, to which they can have access. Staff are not permitted to be involved in the making of, or the benefiting from any service user’s will, and all are informed of this, including the service users themselves in the Service User Guide. One particular service user has consultations with her solicitor for managing all her affairs, and staff are also able to call on the solicitor if needed. Winstonian House Version 1.10 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 25 & 26 Recent investment has improved the appearance of certain areas of this home, and has increased the safety of it. However there must be continued emphasis in this area in order to address all that is required in terms of maintenance and repair. Service users are able to personalise their rooms, by having their own possessions around them. EVIDENCE: There is regular maintenance support in the home, for repairs and cyclical maintenance. Since the last inspection there has been a significant amount of work undertaken to enhance and improve the environment, though unfortunately there are a small number of repairs that were required at the last inspection which have gone unattended or have not been resolved satisfactorily. Winstonian House Version 1.10 Page 18 The communal areas have benefited from redecoration and new carpets, and some new pictures have been purchased. Decorations, when undertaken, are of a good standard, and this is particularly so in the lower ground floor lounge. Repairs unresolved to date relate to the ill-fitting kitchen glazed door into the lounge, a leaking en-suite toilet in Room 18, a plumbing and drainage problem in the lower ground floor bathroom, and the ‘out of use’ chair lift also at this level. Although this lift has only recently been installed, it is not yet functional, reportedly due to a fault, and is awaiting a new mechanical part. On this occasion the extractor fans in the toilet opposite room 4 and in the lower ground floor bathroom were not working, and require attention. Despite some repairs to the bathroom hoist, this remains unsafe for use in its current condition; it is unsteady and mechanical parts are exposed. This must be removed from use, until it can be made absolutely safe; the hoist must be serviced and checked for safety by a qualified engineer. Work to make hot radiators safer has been completed, and the Registered Provider is to be commended for the efficient way in which this work has been completed since required by the Commission for Social Care Inspection, and for the aesthetically high standard to which it has been done. It has been confirmed that hot water temperatures are made safe by blending valves; random monitoring looks for any anomalies. Isolated hand checks during this inspection raised slight concerns about some of the temperatures, particularly in rooms 6, 11, 12 and 20. Service users’ rooms are furnished to a satisfactory standard, with a lockable drawer provided in each. A number of service users have chosen to introduce their own items, making their room appear more individual and homely. The standard of cleanliness in the home is fair, with care staff taking responsibility for domestic tasks as part of their duties. Only partial progress has been made to address offensive odours, and two rooms in particular smelled very strongly of urine. The laundry room has been fitted with new wall finishes, which are more practical, particularly from an infection control viewpoint. The washing facilities have yet to be upgraded, due to the lack of a sluicing facility and adequate temperature control system. Personal protective equipment is provided for staff, with liquid soap and hand towels available. Urgent attention must be given to the laundry room sink however, as there is no water supply to either the hot or cold taps at this time. Winstonian House Version 1.10 Page 19 Winstonian House Version 1.10 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The service users benefit from a stable and committed team of staff. Good training opportunities enable staff to demonstrate a clear understanding of their roles. The standard of pre-employment checks on staff must be improved for future recruitment, to ensure that service users are not placed at risk. EVIDENCE: Four care staff were on duty on the day of this inspection. This reduced to three during the afternoon, and two during the evening. Two carers, one of which provides a sleep-in cover, are on duty overnight. The carers undertake domestic and catering tasks as part of their regular duties. The staff team has regular and consistent hours of work, and there have not been any changes to the staff team for some considerable time. Staff and service users indicated the value and worth of having consistency and continuity amongst the staff. Staff said that they knew their shift patterns, as these rarely changed; there was no recorded rota of staffing in the home that was available for inspection. Winstonian House Version 1.10 Page 21 Service users spoken to spoke very positively about the staff team, confirming that their needs were being met in accordance with their wishes. It was not possible to inspect the recruitment procedure and pre-employment checks that have been required since 26 July 2004, as there has been no recruitment for some considerable time. One old record seen contained very little, apart from a personal details form and a Criminal Records Bureau disclosure, as the person had been employed for twenty years. The record of another person who had been employed in 2003 contained all that was required prior to July 2004, though one of the references did not appear authentic, and had not been confirmed as such. Another record contained a birth certificate, a Criminal Records Bureau disclosure and certificate copies of training undertaken; there was no application form, no written references, and no medical statement. This person was employed prior to the Care Standards Act 2000. The home is aware of the new requirements regarding employment for any future recruitment. A recorded training programme includes a structured induction programme and foundation training, and also demonstrates the range of supplementary training that is available for staff as part of their professional development. Staff spoke very positively about the training opportunities that are available to them, and three of the four staff on duty on this day were qualified to NVQ standard. Winstonian House Version 1.10 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 The home has not made full use of the established quality assurance systems, and consequently views of service users and relatives have not been sought for some time. Safeguards are in place to protect the interests of service users who place valuables with the home for safekeeping. EVIDENCE: The home has written a statement in the Service User Guide that they will employ an internal quality assurance system, issuing service user satisfaction questionnaires with published results, however there was no evidence that this had been carried out for some considerable time. A self assessment tool has been introduced, in order that the Manager can assess the home’s progress against the National Minimum Standards in a Winstonian House Version 1.10 Page 23 number of areas; again this has not been carried out for some considerable time. It is recognised that greater focus is needed with the quality assurance processes. There are no less formal systems either, such as service user meetings, though these are apparently planned for the future. Service users are able to place money and valuables with the home for safekeeping. The associated record keeping, which has been changed since the last inspection, contains details of transactions, running balances, and two staff signatures in cases where the service user is unable to sign their own records. Receipts for expenditure are kept, though there were no receipts for recent hairdresser transactions, and this should be addressed for each individual. The service user or their representative signs records to acknowledge the return to them of any money or valuables. Winstonian House Version 1.10 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x x 2 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x 3 x x x Winstonian House Version 1.10 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13(4.c) Requirement Care plans must contain a risk assessment, with particular reference to falls, and include details of actions taken to reduce or eliminate the degree of risk identified, which must be subject to regular review. (previous timescale of 31 October 2004 not met) Staff must assess and document the degree of risk posed to service users who choose to smoke in the home. (previous timescale of 31 December 2004 not met) Staff must write a full care plan to meet all the needs of a service user at risk of developing pressure sores, to include all preventative actions needed by staff. Staff must ensure that they sign medication charts consistently, for every drug administered. Discontinued drugs must be clearly identified as such on the medication charts, with the date and name of the person responsible recorded. Hand written entries on medication charts must be Version 1.10 Timescale for action 31 May 2005 2. 7 13 (4.b) 31 May 2005 3. 7 15(1) 31 May 2005 4. 5. 9 9 17(1.a. Schedule 3. 13(2) 31 May 2005 31 May 2005 6. 9 13(2) 31 May 2005 Page 26 Winstonian House signed in full by the author. 7. 15 12(1.b) A staff presence must be maintained in the dining areas at meal times, in order to provide help and supervision where needed for service users. An alternative uniform must be worn by carers who are allocated to meal preparation. The rust damaged refrigerator shelves must be repaired or replaced. The Registered Person must ensure that repairs are implemented in the following areas:· 1. The door between the kitchen and lounge/dining room on the lower ground floor must be adjusted so as to fit and close properly 2. The leaking en-suite toilet in Room 18 must be repaired 3. The water drainage problem between the lower ground floor sink and bath must be resolved. (previous timescale of 28 February 2005 not met) The extractor fans in the toilet opposite room 4 and in the lower ground floor bathroom must be repaired to working order. The Registered Person must take steps to ensure that the lower ground floor chairlift is maintained in good working order. (previous timescale of 31 January 2005 not met) The ground floor bath hoist must be removed from use until serviced by a qualified engineer, and deemed fit and safe for use. The blending valves to the hot water supply must be checked to ensure that safe temperatures are achieved in all areas Version 1.10 31 May 2005 8. 9. 10. 15 15 19 16 (2.j) 16 (2.g) 23(2.b) 30 April 2005 30 June 2005 30 June 2005 11. 19 23(2.c) 31 May 2005 31 May 2005 12. 22 23(2.c) 13. 22 13(5) 30 April 2005 31 May 2005 14. 25 13(4.a) Winstonian House Page 27 accessible to service users. 15. 26 16(k) The Registered Person must take appropriate measures to ensure that the home is kept free of offensive odours. (previous timescale of 31 December 2004 not met) The Registered Person must effect repairs to the hot and cold water taps in the laundry room, in order to resume the supply to the hand basin. A staff rota must be consistently maintained and kept in the home. The home must obtain two written references and be satisfied as to their authenticity, prior to employing someone, as part of the pre-employment checks. The Registered Person must maintain the quality assurance system for reviewing and improving the care and services at the home. 31 May 2005 16. 26 16 (2.j) 30 April 2005 17. 18. 27 29 17(2) Schedule 4. 19. Schedule 2 30 April 2005 30 April 2005 19. 33 24(1) 31 July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 9 35 Good Practice Recommendations Staff should date external medications on opening to ensure that they do not get used beyond their expiry date. A second person should countersign handwritten entries on medication charts as a witness. The home should obtain a receipt from the hairdresser for all monies given to her by, or on behalf of, service users. Winstonian House Version 1.10 Page 28 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Winstonian House Version 1.10 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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