Care Home: Maristow House Nursing Home

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What the care home does well The service employs motivated staff, who are keen to ensure that residents` individual needs are met. Night staff have a good rapport with residents, responding to their wishes and endeavouring to ensure that their individual needs are met. Staff are not expected to perform additional roles at night and are able to concentrate on providing care to residents. Residents can get up when they wish and are not got up at an earlier time than they chose. The atmosphere in the home at night was calm and supportive of frail residents. At 5:30am, both staff were fully awake and able to perform their roles, responding to what people wanted and able to meet their individual needs on request. Observations of practice showed that staff understood the importance of conforming to a range of areas, including fire safety, ensuring that people were not put at risk by the use of bed rails when not indicated and that communal use of topical creams were not taking place. The home has safe systems for the documenting and storing of medications. Records to support the provision of nursing and care are being developed and are kept close to residents, to support ease of information and ensure that documentation can be promptly completed at the time care is given. Some assessments, care plans and daily records were clear and completed in detail, to provide all the information that a person might need to know about how to meet peoples` individual nursing and care needs. The provider investigates matters reported to them by us and draws up clear policies and protocols accordingly. The home has full written evidence from the Nursing and Midwifery Council (NMC) that all registered nurses employed by them have maintained their registration. What the care home could do better: Management of the home needs to put in systems to ensure that staff have all the information that they need to direct them on how to meet individual residents` needs. They need to ensure that all residents have prompt and full assessment of all their needs and if needs or risk are identified, that a care plan is always put in place to direct staff on how they are to meet peoples` individual needs. All records need to be fully available to staff. Care plans need to be fully up-dated to reflect residents` individual needs and be followed at all times by staff. Requirements relating to assessment of individual need were identified at the inspection on 9th July 2009, when the home was assessed as providing poor outcomes for residents. By the time of the next key inspection of 26th November 2009, this had been addressed. This inspection indicated that the home have lapsed to the situation prior to the inspection on 9th July 2009, in relation to assessments. Requirements relating to the development of care plans were identified at the key inspection of 26th November 2009, with a compliance date of 15th January 2010 for plans relating to prevention of pressure ulceration and 29th January 2010, for other care plans and evaluations of care plans. It is of concern that neither requirement had been addressed by its due date and/or the provider has not advised us of why this was. Records relating to meeting residents` needs must be completed in full, this is to ensure that there is evidence that care is being given to people with complex needs, when they need it. Observations at this inspection of inadequate record-keeping is of concern as such issues were identified at the inspection of 9th July 2009, when the home was rated as providing poor outcomes for residents, and it appears that the home have regressed from the inspection of 26th November 2009, when such charts were observed to be being completed in full. Daily records of people`s conditions need to document all relevant matters relating to meeting individual nursing and care needs. As carers are at times counter-checking controlled drugs, a signature sheet should be maintained for them, as well as for registered nurses. An observation of the use of a free-standing radiator was noted in the home`s inspection report of 9th July 2009 and a requirement set in relation to practice and equipment which had the potential for risk to a resident. No free-standing radiators were observed at the previous inspection, however we again observed a free-standing radiator in use at this inspection, with no risk assessment to reduce potential risks to the resident. This inspection also showed evidence that staff were not following a residents` care plan in relation to ensuring that their room was uncluttered, which could present a health and safety risk to the resident. A requirement relating to this had been set at the last key inspection, with a compliance date of 29th January 2010. This inspection shows that it has not been addressed within timescales. Where residents have prescribed items, including appliances stored in their room, in order to prevent risk of cross-infection, they should be placed on shelving, not placed on the floor of the en-suite. Evidence from this inspection shows that the home have not complied with our Regulations by ensuring that a registered nurse is on duty at all times. We advise that if evidence is identified that they do not in future always comply with this key area, we will need to consider if they can be regarded as a "fit person" to be the registered manager and/or provider, under our legislation. We would also need to consider making a referral to the Nursing and Midwifery Council (NMC) of any registered nurse who authorised the home not to have a registered nurse on duty. Additionally we are concerned that there is no information that any of the registered nurses had brought up this issue either with managers, the NMC or to us, as some of them must have known that they were handingover or taking over the clinical care of the home from a non-registered nurse. This indicates that such registered nurses need to ensure that they fully review their individual personal responsibilities under their NMC Code of Conduct. All requirements from the previous inspection, apart from one, which was not reviewed, remained un-met at this inspection. In order to ensure the health, safety and welfare of residents, management needs to ensure that it meets our requirements identified during inspection or to inform us in a prompt manner if they are unable to meet requirements and why. Under our Regulations, and to provide evidence that they are working with us in an open manner, the home needs to ensure that they always inform us promptly of certain specific events which has the potential to seriously affect residents. At the inspection of 9th July 2009, when the home was rated as providing poor outcomes to residents, our records of the inspection showed that w Random inspection report Care homes for older people Name: Address: Maristow House Nursing Home 16 Bourne Avenue Salisbury Wiltshire SP1 1LS one star adequate service 26/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susie Stratton Date: 2 5 0 2 2 0 1 0 Information about the care home Name of care home: Address: Maristow House Nursing Home 16 Bourne Avenue Salisbury Wiltshire SP1 1LS 01722-322970 01722337485 maristow16@hotmail.co.uk 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) : Mrs Lindsey Jayne Wallace care home 17 Number of places (if applicable): Under 65 Over 65 17 0 2 old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 17 2 No more than 2 service users with a terminal illness may be accommodated in the home at any one time The maximum number of service users who may be accommodated in the home at any one time is 17 The minimum staffing levels set out in the Notice of Decision dated 16 January 2004 must be met at all times Date of last inspection Brief description of the care home Maristow House Nursing Home is a large town house, located in a residential area, which has been converted for use as a care home. The home is situated in the city of Care Homes for Older People Page 2 of 16 2 6 1 1 2 0 0 9 Brief description of the care home Salisbury, Wiltshire and is within easy reach of the city centre. The accommodation is provided over two floors of the home, with the majority of the bedrooms provided being single. Maristow House is registered to provide nursing care for 17 people. The home is privately owned by Mrs Lindsey Wallace who is also the registered manager. She leads a team of nursing and care staff; a cook and adminstrator are also employed and Mr Wallace, Mrs Wallaces husband, is actively involved in the running of the business. The fee range is 600 pounds to 850 pounds a week. Care Homes for Older People Page 3 of 16 What we found: Following information gained about service provision from different sources, which indicated that there was the potential for risk to residents, we decided that a random inspection of this service was indicated, to assess if there was risk for residents. The inspection commenced at 5:25am and completed at 7:15am, on Thursday 25th February 2010. Following the inspection, we required the provider to forward certain information to us within two weeks, so that it could be included in this random inspection report, which they did. The inspection was performed by two inspectors, one of whom was a pharmacist inspector. Inspectors are referred to as we throughout the report, as the inspection was performed on behalf of the Care Quality Commission (CQC). At 5:25am we observed that while a few lights were turned on in areas of the home such as sitting rooms, residents rooms remained without lights or or with dimmed lights, and all window curtains were closed. All residents were still in bed at that time and many were asleep. There were two waking staff on duty, a registered nurse and a care assistant; both were permanent members of staff. The senior carer/administrator came on duty before 7:15am and we were able to discuss a range of issues with them. We observed that the staff were expected to devote themselves to the nursing and care of residents and not to perform routine household chores such as domestic or laundry duties. We observed that no fire doors were held open and all fire exits were clear. The medicines trolley was locked in the clinic room with the medicines administration records (MAR). No medicines had been given or signed for at the time we arrived in the home. There was no evidence that the registered nurse had pre-dispensed medication prior to administering the medication (this is regarded as highly unsafe practice). The signature list at front of MARs included nurses, agency nurses and the senior carer/administrator. This latter member of staff does sign as a check to medicines received and stock checks; they are not a registered nurse. The registered nurse stated that the night nurse does the morning medicines, starting around 7:15 unless someone wants something earlier, which was rare. During the inspection the registered nurse was observed to give a resident a tablet to ease their breathing, when they requested it. The medicines round was observed to commence at 7:10am. The medicines and the trolley were checked, all medicines were recorded in and out, with signatures for administration and codes for non-administration, for example one resident was in hospital when we visited. The controlled drugs cupboard and register were checked and found to be correct. There was evidence that two carers had signed for controlled drugs on two different night shifts, with no supporting signatures from a registered nurse. We toured the home with the carer. We found that the care assistant showed a good knowledge of the individual needs of their residents. For example, they were able to describe to us how they performed personal care for a very dependant resident, including which creams the person needed to have applied, and where. This conformed to the persons care plan. The carer knew how much thickening agent a person with swallowing difficulties needed adding to their drinks, and this reflected what was documented in the residents records. The carer was aware of different peoples preferred night routines and the importance of meeting individual peoples needs and wishes. They reported that the home had a good supply of disposable gloves and aprons to enable them to safely perform personal care. Care Homes for Older People Page 4 of 16 Some residents were awake and they were observed to have a good rapport with the carer. We went into the room of one resident who was awake and looked at their ensuite. We observed that all of their prescribed creams were correctly named for them. This was also reflected in another persons en-suite. The first resident had a range of items such prescribed appliances stored on the floor of their en-suite, rather than being placed above floor level, on shelving. We observed that a wide range of equipment was provided to prevent risk of pressure ulceration, including some high-tech beds which automatically change a persons position on a regular basis. The home keeps care plans for residents in the office and provides brief outline care plans, room risk assessments and monitoring charts in folders close to residents rooms, for staff to both access and document in. We observed that all residents had such records in place. The outline care plans were on one page and provided a short summary of individuals needs. These were a useful document for staff, however as they were brief, they could not detail all of a persons needs, for example they did not document how often a person needed to have their position changed or the fluid intake aimed for on a 24 hour basis. The standards of completion of monitoring records was variable, while some records provided full evidence that residents had had their positions changed in accordance with their degree of risk, others did not. For example, one person who was assessed as being at high risk of pressure ulceration only showed evidence of four changes of position in the previous 24 hours and it appeared that they had been cared for on their back all night. Records of dietary intake were also variable and one person had no records that they had had any lunch or supper for the previous day. The carer confirmed that this person had difficulty in communicating, so they would not be able to inform staff if they had eaten or of what they had eaten. A person who needed to have all of their personal care needs met by staff did not have any evidence that they had had any mouth-care for the previous two days. This could have made them uncomfortable. The home also maintains daily records of residents care and condition. These were variable, some were completed in detail, showing full records of how the home had met the individuals needs, others were very limited and did not provide evidence if the home had met the individuals needs. A person had a risk assessment in relation to falls. This assessment concluded that they were not at risk of falling out of bed and so did not need bed rails. We observed that this person was being cared for in a bed without rails in place. A person was observed to have a free-standing radiator in their room. A risk assessment in relation to this had not been included in their individual room risk assessment. Free standing radiators are regarded as a risk to both health and safety and fire safety. A person had a care plan which stated that they needed an uncluttered and tidy bed space. We observed that their variable height bed had been left in a raised position, with a crash-mat to the side, which this had been pushed back, so that an over-bed table could be placed by the resident; the bed table showed a range of items, including a receptacle for their knitting needles and wool. The space round the persons bed was cluttered and indicated that their care plan to meet their health and safety needs was not being followed by staff. We reviewed residents care plans in the main office. We noted that the home had admitted two new residents recently. Both of these residents had had a pre-admission assessment of their needs completed, prior to admission. One of the assessments was completed in more detail than the other. For example the latter persons assessment made reference to the use of oxygen before admission, but there were limited records Care Homes for Older People Page 5 of 16 relating to this, their assessment also stated that they wore glasses but did not document what they needed to wear glasses for. The homes post admission clinical assessments for these residents had largely not been completed a fortnight and week respectively after admission. One of these residents condition indicated they would be at risk of pressure ulceration, but they had not had an assessment of risk of pressure ulceration completed. This was despite references to red areas over pressure points in their records at and after admission, and bruising on admission, which concerned the provider to the extent that they formally notified us of their concerns. The National Institute for health and Clinical Excellence (NICE) guidelines state that assessments for risk of pressure ulceration need to be completed within a very short time-frame of admission, this is to ensure that risk of pressure ulceration is reduced. Neither person had any clinical risk assessments relating to common risks for elderly persons such as falls or nutritional risk. One person had a clear manual handling assessment, but the other person did not. As well as neither newly admitted person having full clinical assessments, they both largely had no care plans to direct staff on actions to take to meet their individual needs. This is of concern, as one of the residents was not able to converse and inform people of how to meet their needs and so needed full care plans in place. The carer had informed us that they had found that meeting this persons needs could be difficult, as the person could not converse with them to inform them of what they needed, and as they were a new resident, they did not yet know them well. This persons only care plan related to their night nursing and care needs; this was very detailed. No other care plans were in place, including directions on how the person was to have risk of pressure ulceration reduced or how their nutritional needs were to be met. The other person had a manual handling care plan but no other care plans. This was of concern, as reports from the senior carer/administrator indicated that the person had a complex medical condition which had the potential to be unstable. When we discussed the lack of assessments and care plans with the senior carer/administrator, they offered to use their keys to look in the managers locked office. We advised that assessments and care plans always needed to be fully available to staff, for them to be fully directed on how they were to meet residents individual nursing and care needs. We also reviewed records relating to a resident who had been in the home for an extended period. At the previous key inspection, the home had been introducing personcentred care plans. The home reported that they anticipated that all people would have had their care plans reviewed and developed by the end of January 2010. At the previous inspection, the person was assessed as being at high risk of pressure ulceration. When we looked at their records, the persons care plan did not direct staff on how they were to be protected from risks of pressure ulceration, including when they were out of bed. This continued to be the case at this inspection. At the previous inspection, we welcomed the change to the new format of care plans, as they were much more person-centred. However at this inspection, we continued to observe directions in this persons care plan such as maintain frequent check without stating how often the person was to be checked upon or that they were to use a variable height bed if appropriate without documenting why it was appropriate for the person. We discussed information that we had been given and evidence from this inspection that they had occasionally worked as a registered nurse, with the senior carer/administrator. The person reported that this had been when no other registered nurse could be identified and that they had not been willing to do so. We advised that as Maristow is a care home with nursing, they are required to have a registered nurse on duty at all times, Care Homes for Older People Page 6 of 16 to oversee the clinical needs of residents. The lack of a registered nurse on duty on any occasion is of particular concern as the provider has reported to us several times that they are prepared to admit residents with highly complex clinical needs; we are also aware that there was one resident who had the potential to require a drug by an invasive route in an emergency to stabilise a complex medical condition. We had not been formally informed of these occasions by the provider, as is required. We also discussed with the senior carer/administrator, reports that a child/children had been allowed to sleep in on the premises whilst a parent was working in the home. This person reported that they were aware of this matter, but that it had now ceased. We wrote to the provider about this matter after the inspection, asking them to respond within two weeks, which they did. They reported that relevant permissions had not been sought from the directors about the matter, that they had performed a full investigation, had taken relevant management action and had ensured that the practice had now ceased. They also enclosed detailed policies on children visiting the home as requested. We also discussed reports of a dog being allowed in the kitchen. The senior carer/administrator reported that this had happened very occasionally in the past but that steps had been taken to prevent this from happening. We had been informed of a similar matter before the last inspection and had asked the provider to investigate the allegation, which they had done. We are not clear if reports we have had related to the same or different occasions. During this inspection, we were informed that a resident had been admitted to hospital. We have not been informed of the circumstances relating to this, or any other matters detailed above, as is required. What the care home does well: What they could do better: Care Homes for Older People Page 7 of 16 Management of the home needs to put in systems to ensure that staff have all the information that they need to direct them on how to meet individual residents needs. They need to ensure that all residents have prompt and full assessment of all their needs and if needs or risk are identified, that a care plan is always put in place to direct staff on how they are to meet peoples individual needs. All records need to be fully available to staff. Care plans need to be fully up-dated to reflect residents individual needs and be followed at all times by staff. Requirements relating to assessment of individual need were identified at the inspection on 9th July 2009, when the home was assessed as providing poor outcomes for residents. By the time of the next key inspection of 26th November 2009, this had been addressed. This inspection indicated that the home have lapsed to the situation prior to the inspection on 9th July 2009, in relation to assessments. Requirements relating to the development of care plans were identified at the key inspection of 26th November 2009, with a compliance date of 15th January 2010 for plans relating to prevention of pressure ulceration and 29th January 2010, for other care plans and evaluations of care plans. It is of concern that neither requirement had been addressed by its due date and/or the provider has not advised us of why this was. Records relating to meeting residents needs must be completed in full, this is to ensure that there is evidence that care is being given to people with complex needs, when they need it. Observations at this inspection of inadequate record-keeping is of concern as such issues were identified at the inspection of 9th July 2009, when the home was rated as providing poor outcomes for residents, and it appears that the home have regressed from the inspection of 26th November 2009, when such charts were observed to be being completed in full. Daily records of peoples conditions need to document all relevant matters relating to meeting individual nursing and care needs. As carers are at times counter-checking controlled drugs, a signature sheet should be maintained for them, as well as for registered nurses. An observation of the use of a free-standing radiator was noted in the homes inspection report of 9th July 2009 and a requirement set in relation to practice and equipment which had the potential for risk to a resident. No free-standing radiators were observed at the previous inspection, however we again observed a free-standing radiator in use at this inspection, with no risk assessment to reduce potential risks to the resident. This inspection also showed evidence that staff were not following a residents care plan in relation to ensuring that their room was uncluttered, which could present a health and safety risk to the resident. A requirement relating to this had been set at the last key inspection, with a compliance date of 29th January 2010. This inspection shows that it has not been addressed within timescales. Where residents have prescribed items, including appliances stored in their room, in order to prevent risk of cross-infection, they should be placed on shelving, not placed on the floor of the en-suite. Evidence from this inspection shows that the home have not complied with our Regulations by ensuring that a registered nurse is on duty at all times. We advise that if evidence is identified that they do not in future always comply with this key area, we will need to consider if they can be regarded as a fit person to be the registered manager and/or provider, under our legislation. We would also need to consider making a referral to the Nursing and Midwifery Council (NMC) of any registered nurse who authorised the home not to have a registered nurse on duty. Additionally we are concerned that there is no information that any of the registered nurses had brought up this issue either with managers, the NMC or to us, as some of them must have known that they were handing Care Homes for Older People Page 8 of 16 over or taking over the clinical care of the home from a non-registered nurse. This indicates that such registered nurses need to ensure that they fully review their individual personal responsibilities under their NMC Code of Conduct. All requirements from the previous inspection, apart from one, which was not reviewed, remained un-met at this inspection. In order to ensure the health, safety and welfare of residents, management needs to ensure that it meets our requirements identified during inspection or to inform us in a prompt manner if they are unable to meet requirements and why. Under our Regulations, and to provide evidence that they are working with us in an open manner, the home needs to ensure that they always inform us promptly of certain specific events which has the potential to seriously affect residents. At the inspection of 9th July 2009, when the home was rated as providing poor outcomes to residents, our records of the inspection showed that we discussed their responsibilities for doing this under our Regulations. At that point, we were advised that discrepancies in informing us, related to previous administrative staff and that it would be addressed in full, with the appointment of a senior carer/administrator. Evidence from this inspection indicates that managers are still not ensuring that we are informed of all matters required under regulation. Managers are advised that if we have any further evidence that they have not informed us of matters which may affect residents in the home, we will consider commencing a review of their fitness to provide this service and depending on circumstances, may need to consider referring any registered nurse involved to the NMC. The provider is advised that we may have decided to perform a key inspection after this random inspection to fully review their quality rating, however we did not do this because of the ways the staff were effectively managing the home at the time of our random inspection, which did not put residents at risk. Therefore, due to their failure to comply with a range key areas, the providers have been requested to attend a formal meeting with us, to discuss their breaches in compliance with regulations. After that, we will expect that they must always ensure that in future they act in a fit manner to ensure the health, safety and welfare of residents in the home or we will reserve the right to review their current quality rating. 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 2. Care Homes for Older People Page 9 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 All residents must have full individualised care plans. These must be regularly evaluated. Requirement un-met Care plans ensure that people have their needs met and in a consistent manner. 29/01/2010 2 8 12 Where a person is at risk or shows evidence of pressure ulceration, a care plan must be developed. Records of changes of position to prevent risk of pressure ulceration must be made when a person being cared for sits out of bed most of the day. Requirement un-met. Risk of pressure ulceration can affect a persons health and well-being, therefore full care plans are needed to ensure that risk of pressure damage is reduced. Risks do not change when someone sits out of bed, therefore documentary systems are needed to show that the person is receiving the care that they need. 15/01/2010 Care Homes for Older People Page 10 of 16 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 3 29 19 Staff files must be audited and any deficiencies in documentation relating to the recruitment process be rectified. Not reviewed at this inspection. Staff files need to include all relevant pre-employment checks, to ensure that only who are people suitable to work in the home are employed. 29/01/2010 4 38 13 Where practice or equipment 29/01/2010 has the potential to present a risk a resident, relevant action must be taken to prevent risk of injury. This must be supported by documentation. Requirement un-met. Staff need to be able to take action to prevent risk to residents. Staff need to be fully directed by documentation in how to do this. Care Homes for Older People Page 11 of 16 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, 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 1 7 12 All of a persons needs must 31/03/2010 be assessed prior to or immediately after admission. Where needs are identified, prompt action must be taken to address these needs. This requirement was identified at the inspection of 9/7/09, to be addressed by 31/7/09. The inspection of 26/11/09 showed it had been addressed but it has since lapsed. People need full assessments so that the home can plan how to meet their needs. If a persons condition changes immediately after admission, prompt action must be taken to meet these changed needs. 2 8 12 Where a person has a 31/03/2010 monitoring chart, charts must provide evidence that the person is receiving the care that they need. Records must be accurate and completed at the time care Page 12 of 16 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 was given. This requirement was identified at the inspection of 9/7/09, to be addressed by 31/7/09. The inspection of 26/11/09 showed it had been addressed but it has since lapsed Monitoring charts enable staff to know what care has been provided and are particularly important where a person is unable to communicate effectively. They also enable managers to verify that care has been given as required. 3 27 18 A registered nurse must be on duty at all times. This is to ensure that the clinical needs of residents can be met. 4 31 37 The provider must ensure that the CQC is fully informed of all matters required by regulation. This is to provide evidence that residents health safety and welfare needs are being met and that they are working in an open and honest manner with us. 5 31 12 The providers must ensure that all registered nurses in its employ conform to the NMCs Professional Code of Conduct, at all times. 31/03/2010 31/03/2010 31/03/2010 Care Homes for Older People Page 13 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This is to ensure that residents health, safety and welfare is up-held. 6 33 24 The provider must ensure 31/03/2010 that it complies with requirements set by us within timescales, or if it is not able to do so for any reason, that it contacts us to discuss the reason and review the timescale for compliance. This is to ensure that the health, safety and welfare needs of residents are met in a managed and timely manner. 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 7 Care plans should always use clear, precise measurable language, wording such as frequent, if appropriate, should be avoided unless they are fully described. This recommendation was identified at the inspection of 9/7/09. 2 3 4 8 9 33 Guidelines from NICE relating to assessments in clinical areas should always be followed. A signature sheet should be completed for carers, similar to that for registered nurses. The provider should audit all documentation relating to residents and ensure that it is completed by its staff in a consistent manner. Care Homes for Older People Page 14 of 16 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 5 38 Above-floor shelving should be provided for all prescribed items which need to be stored in residents en-suites. Care Homes for Older People Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 16 of 16 - 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. 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