Care Home: Avondale Nursing Home

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What the care home does well The home has a good system in place for assessing the needs of potential residents, planning their care and working to meet their health and personal care needs. A varied range of suitable activities are offered to residents and there is some contact maintained with the local community. Visitors are welcomed to the home and residents enjoy a good amount of contact with their family and friends. The complaints procedure is readily available in the home. In addition staff are trained in how to deal with any potential abuse The home carries out a number of audits and quality checks to ensure that the home is run in the best interests of the residents. In addition staff training in safe working practices along with safety and maintenance checks ensure a safe environment for residents. What has improved since the last inspection? Medication practices have improved both in relation to record keeping and guidelines for staff when giving medication prescribed on an `as required` basis. The home has updated its medication policy and kept this under review. Activities have been introduced that are suitable for residents with dementia including `SONAS` sessions. There are more accurate records kept of meals provided to residents. There has been an improvement in the environment with the completion of major refurbishment work. This has included improvements to bathrooms and toilets and the installation of ceiling tracking for moving residents. in addition more adaptations have been made suitable for residents with dementia. Induction training for staff is now in line with national standards and the level of staff with an NVQ has increased. The storage of cleaning materials has improved. What the care home could do better: Checks must always be made and recorded on medication storage temperatures. Some improvements should be made to the homes adult protection policy. Staff working in the laundry must ensure that the hand washing facilities are accessible at all times. Risk assessments need to be carried out on any potential staff member where information is found during a Criminal Records Bureau check. There should be checks made to ensure that there is a record of all valuable items held in safekeeping for residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avondale Nursing Home 21 Eldorado Road Cheltenham Glos GL50 2PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Adam Parker     Date: 1 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Avondale Nursing Home 21 Eldorado Road Cheltenham Glos GL50 2PU 01242232012 01242232012 sherie.wright@ehguk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : European Healthcare Group plc care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Additional conditions: 20 0 The maximum number of service users who may be accommodated is 20. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Avondale is an extended house in a residential area outside of Cheltenham town centre. It is close to the main bus routes and railway station. Accommodation is across four levels and consists of single bedrooms with wash hand basins and ample communal space. A shaft lift allows access for wheelchair users to the upper floors; there is also a stair lift and an internal wheelchair lift. An outside ramp gives access to the lower ground floor level as two steps separate this internally. At the front of the house is parking for several cars and a lift platform for wheelchair access to the front door. Care Homes for Older People Page 4 of 28 Brief description of the care home There is an enclosed garden at the rear of the home. The home provides nursing care for elderly persons with dementia. Current fees for nursing care are 516.00 pounds to 750.00.pounds per week. Hairdressing, chiropody, alternative therapies,hydrotherapy and visitors lunches are charged extra. The home makes information about the service, including Inspection reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was carried out by one inspector over two days in June 2009. One resident was spoken to during the inspection visit to gain their views on the service provided as well as two visitors. The manager of the home was present for the both days of the inspection visit which consisted of a tour of the premises and examination of residents care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a case tracking exercise. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedure ensures that all residents are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. Evidence: The home had produced a well presented Statement of Purpose and Residents guide both illustrated with colour photographs of the home and containing a wealth of information. The assessment documentation for a number of residents recently admitted to the home was looked at. These had been completed following an assessment of the persons needs recorded on a comprehensive pre-admission assessment document. This is carried out by the manager. In addition where residents had been discharged from hospital to the home, information had been obtained from this source. The home Care Homes for Older People Page 10 of 28 Evidence: had obtained information from where the local authority were were funding a particular resident, information had been obtained prior to the resident moving into the home in either the form of a copy of the needs assessment or the care plan. It was noted that one pre admission assessment document had not been dated by the person completing it. The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home works well to meet residents health, personal care and medication needs whilst upholding their privacy and dignity. Evidence: Care plans for a number of residents were looked at, these were detailed and individualised and gave clear instructions for staff to follow to meet residents needs. As well as physical needs, care plans focused on the mental health needs of some residents covering such areas as behaviour and emotions. Care plans were also in place where any specific care needs had been identified at night. There was evidence of residents having input from health care professionals such as General Practitioners (GPs) and specialist nurses. One resident was having their weight and physical observations recorded on a weekly and a monthly basis and this was in line with their care plan. Risk assessments had been completed for pressure areas, moving and handling, use of bed rails and nutrition with a record of residents weights Care Homes for Older People Page 12 of 28 Evidence: being kept. One resident had a pain assessment chart completed and a pain management plan. Risk assessments were in place for residents who wandered and use was being made of a specific assessment tool for wandering. The arrangements for medication storage, administration and recording were checked. The homes new policy on medication was available being completed in September 2008 and reviewed in May 2009. Medication was stored securely in one location in the home with a trolley in another area. However there were no records of storage temperatures for the medication storage room or the trolley situated in another part of the home. It was reported that this had been taking place although there was no thermometer in the storage room and no recent records could be found. By the second day of the inspection visit the practice of monitoring and recording storage temperatures was in place again. Regular checks were being made on the refrigerator used to store some medication and records showed that temperatures were within the correct range. Bottles of liquid medication had been dated on opening as an indication of the expiry date. Medication Administration Records (MAR) were in good order with no gaps in the recording of administration seen. Handwritten entries in medication administration sheets had been signed and dated by the staff member making the entry with a second signature by the staff member that had checked the entry. There were protocols in place to guide staff in giving medication prescribed on an as required basis. Some good examples were seen of protocols for medication prescribed for anxiety and for pain relief. However one residents eye drops had the printed instruction as required and so it was not clear when and how this should be given and the home would need to refer back to the GP for clearer directions. Residents allergies and sensitivities to medication had been recorded on the MAR. The controlled drug record was checked and this was in order with consistent times of administration of medication given for pain relief which would be in line with good pain management. Since the previous inspection there were more thorough checks being made on the details of residents prescribed medication when they were being admitted to the home. Of the care provided in the home one relative of a resident stated You wouldnt get better care anywhere else. Staff were observed treating service users with respect and shared rooms had curtains in place to maintain privacy. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A varied and appropriate range of activities are provided so that residents with dementia enjoy various types of stimulation. In addition residents are offered a varied diet with good attention to their nutritional needs. Evidence: Since the previous inspection and in line with changes to the homes registration categories, the home had introduced new activities more suitable for the needs of people with dementia. This included a new group activity called SONAS. In addition a number of tactile boards and cushions have been introduced as well as various memory boxes and rummage bags with items of interest that could be used on an individual or group basis. The home was also making use of the enclosed garden with vegetables being planted and tended by residents in raised beds. Some of the produce had been used in the homes kitchen. A new television had been installed in one communal lounge and DVDs of films were reported as being popular as well as visits from a music entertainer. A recently introduced activity was where various animals were being brought in to the home for residents to see, this was in addition to the arrangements already in place for dogs to visit residents. Outings were also taking place and on one of the days of the inspection visit a group of residents were being Care Homes for Older People Page 14 of 28 Evidence: taken out to a local park and tea rooms. The home also had the use of a wheelchair accessible car on one day a week. Holy Communion is provided in the home monthly by the Church of England and it was reported that a Roman Catholic Priest was available to visit. During the inspection visit a number of residents were receiving visitors. Some were assisting residents at mealtimes and when spoken to they confirmed how they were made to feel welcome when they visited the home and how friendly the staff were. The home had information about local advocacy services available for residents. Evidence was seen of residents having brought in their own furniture and electrical equipment into the home. Any issues regarding a residents nutrition or needs regarding eating and drinking were highlighted for staff on a noticeboard in the kitchen. A record had been kept of any special diets or alternatives provided for residents. The menu was changed every four weeks and included a daily vegetarian option for lunch. Supper was a cooked snack with a dessert. In addition various snacks were on offer at times such as chocolate, fruit and milkshakes. Breakfast choices also included a cooked option. One relative of a resident described the food as fantastic and also made positive comments about the activities provided. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are acted upon in the interests of residents and the homes approach to training staff in safeguarding vulnerable adults should ensure that residents are protected from any possible abuse. Evidence: The home keeps a log for recording complaints, two recent complaints were looked at both of which we were aware of and the investigation of these had been fully documented. Staff had received training in the Mental Capacity Act 2005 and information relating to this was recorded on residents individual care plan files. Training for staff in measures to protect residents from abuse starts as part of the induction training which includes the whistle blowing policy and the no secrets guidance. This initial training is followed by annual updates. It was noted that the Alerters Guide from the local authority adult protection unit was displayed in the home. The homes adult protection policy was looked at. This needed improving with the inclusion of specific contact details for relevant agencies. One member of staff spoken to recalled the training they had received regarding the different types of abuse and how any abuse should be reported. The home has individual plans in place to deal with a small number of residents who Care Homes for Older People Page 16 of 28 Evidence: may exhibit challenging behaviour and specific training in this has been given to staff. The general approach being that staff should respond to challenging behaviour as opposed to reacting to it. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of living in a well-maintained, clean, environment which has been adapted in places to meet their needs. Evidence: Following completion of the building work carried out in 2007 and 2008 there has been an improvement in the environment of the home. A tour of the premises was undertaken. All areas of the home inspected were found to be clean, well maintained and decorated and smelt fresh throughout. Outside there was an enclosed garden with chairs, tables and raised beds for gardening. Some adaptations had been made to the improve the environment of the home. These included pictorial signs and different coloured door surrounds for individual rooms to make these easier to find. In addition a number of tactile boards had been positioned on the walls in the corridors to provide an activity for more mobile residents with dementia. These adaptations gave the home the look of a service designed for the needs of residents with dementia. The entrance hall contained information about the home and about planned activities. Throughout the home hand cleansing gel dispensers were available for staff to aid infection control. The laundry was checked and the sink for hand washing was not readily accessible. Care Homes for Older People Page 18 of 28 Evidence: Issues regarding the laundry had been raised at a previous inspection. Staff working in the laundry need to take more responsibility to maintain the environment in the interests of infection control and hygiene. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are deployed and training is undertaken in a number of areas to meet residents needs with generally robust recruitment practices in place. Evidence: Staffing in the home consisted of one registered nurse for the day shift with four care assistants in the morning and three in the afternoon. The activities organiser worked on week days from 11am to 4 pm. At night there was one registered nurse and one care assistant. Ancillary staff consisted of a cleaner, a cook and a kitchen assistant. The kitchen assistant was working in the afternoons to support care staff at supper time. The home had recently made arrangements with a funding authority to provide a higher level of staff input for one resident and this was reported as being successful in managing certain behaviour. The home had five care staff out of eleven with an NVQ level 2 or above. One member of staff had also commenced work on an NVQ. This was an improvement on the numbers with an NVQ at the previous key inspection although the home should continue to work towards achieving a higher ratio of staff with the qualification. Records for recently recruited members of staff were examined. All the required Care Homes for Older People Page 20 of 28 Evidence: information and documentation had been obtained including an employment history. Checks against the Protection of Vulnerable Adults list were being made as well as with the Criminal Records Bureau. However one member of staff had been employed without a risk assessment being carried out regarding information on their Criminal Records Bureau Disclosure. Such risk assessments should form part of the recruitment procedure in the interests of protecting residents. New staff in the home received induction training in line with the nationally recognised Common Induction Standards. The induction work books for two new members of staff receiving induction to the standards were looked at. In addition training has been undertaken in a number of other areas such as nutritional screening, helping people to eat and drink, various levels of dementia training and a falls workshop. One member of staff spoken to confirmed the training that they had received since starting work in the home. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite the lack of a registered manager the home has been well managed in the interests of residents with actions carried out to ensure their safety and the quality of the service. Evidence: At the time of the inspection visit the home did not have a registered manager. The home was being managed by a deputy manager from another home run by the registered provider. In this role she was being supported by the groups operations manager based at a nearby home and visiting on a regular basis. The home has been trying to recruit a manager although no suitable applicant had been found so far. An administrator is in place at Avondale to assist with the running of the home. The home carries out a number of audits to ensure that the home is run in the best interests of the residents. These included audits of accidents and incidents, health and safety, medication and facilities. A care audit had also been carried out which Care Homes for Older People Page 22 of 28 Evidence: examined such areas as wound care, pressure area care and infection control. Surveys had been sent out to residents, their relatives, other visitors and staff to gain their views on the home. Responses received so far were currently being examined and it was reported that practice would be changed if any issues were raised. The home had developed a pictorial survey to assist in gaining the views of residents with dementia. Three monthly meetings were being held for residents and their relatives where issues about the service could be raised. In addition visits had been carried out and reports completed by a representative of the registered provider in line with the requirements of the Care Homes Regulations 2001. The reports showed that during the visits, residents and visitors had been asked about their views on the service provided. The home provided secure facilities for residents money and looked after money for a number of residents although others have their financial arrangements taken care of by family members. Appropriate records were kept for any residents money held and each resident had a clear plastic wallet which was a useful way of checking the amount held. The home does not pay any money into bank accounts on behalf of residents. One valuable item held for a resident did not have a separate record. It was explained by the acting manager that this was not in line with normal practice and another example was shown where a record of the safekeeping of a valuable item had been recorded in the residents care plan file. Staff had received training in first aid, moving and handling, health and safety fire safety and food hygiene. During the inspection visit staff were observed using a hoist appropriately and it was noted that where overhead tracking was in place in one bathroom, clear instructions had been posted nearby as a reminder of the correct procedures to follow. Accidents and incidents are appropriately recorded and as mentioned above subject to an audit which along with a number of other issues looks at the time of the accident and where it took place. Monthly checks are carried out and recorded on temperatures from hot water outlets and on window restrictors. Checks were also in place on wheelchairs in addition to an annual service carried out by an outside contractor. Servicing has been carried out on lifts, the central heating system and electrical wiring with an annual check being made on portable electrical appliances. The home has used a specialist consultant to undertake a risk assessment in relation to Legionella, this is comprehensive and takes into account older people in the home. In relation to this risk assessment work has been carried out and a number of control measures are in place to minimise the risk. The safe storage of cleaning materials has been maintained with all substances kept in correctly labelled containers. Staff had also undergone training in handling hazardous substances. The home had completed a fire risk assessment in 2007 and this had been reviewed in 2008. It was reported that there had not been a recent visit from the fire safety officer. In April 2009 there had been an incident in the home where a resident in bed had been Care Homes for Older People Page 23 of 28 Evidence: scalded after tipping a hot drink over themselves which had been given to them by another resident who had wandered into their room. This was discussed with the operations manager, since the incident a protocol had been put in place in the home for the safe management of hot drinks. The resident chose to spend some of the day in bed with the door open and so it was not possible for staff to observe this resident all of the time. A risk assessment should be completed regarding this with regard to any possible risk from other persons entering the residents room. This would need to consider the type of monitoring or checks that may be needed. In addition the reporting of the incident to us was discussed due to some delay. With a serious incident verbal contact should be made initially with a written report following this up. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 9 Pre-admission assessment documents should be dated by the person completing the assessment. Checks should be made to ascertain the exact directions for residents medication where this appears as as directed on the medication administration record. Checks should be made to ensure that the monitoring of medication storage temperatures is carried out. The specific contact details for relevant agencies should be included in the homes adult protection policy. There should be clear access to the hand washing facilities in the laundry at all times. Continue to seek a suitable manager for the home. Checks should be made to ensure that there is a record of all residents valuables held in safekeeping by the home. Consideration should be given to the seriousness of any notifiable accident or incident and verbal notification should be made and followed up in writing. A risk assessment exercise should be carried out regarding the resident who spends some of the day in their room with the door open. This should consider any possible risk from Page 26 of 28 3 4 5 6 7 8 9 18 26 31 35 38 9 38 Care Homes for Older People other persons entering the room and any checks or monitoring that may need to be made. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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