Inspection on 05/09/06 for Ashgate House Nursing and Residential Home

This inspection was carried out on 5th September 2006.

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

Ashgate House Nursing and... 10/05/07

Ashgate House Nursing and... 19/04/06

Ashgate House Nursing and... 22/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ashgate House Nursing and Residential Home Ashgate Road Chesterfield Derbyshire S427JE Lead Inspector Bridgette Hill Key Unannounced Inspection 5th September 2006 09:05 X10015.doc Version 1.40 Page 1 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 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 2 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. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashgate House Nursing and Residential Home Address Ashgate Road Chesterfield Derbyshire S427JE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01246 566958 01246 566216 Ashgate Care Limited Vacant Care Home 34 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (29), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (29) Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration of the MD category is to Room 18 - Single Room, Room 19 - Double Room, Room 20 - Double Room. A total of 5 places. 19th April 2006 Date of last inspection Brief Description of the Service: Ashgate House is situated on the western outskirts of Chesterfield, within the area of Ashgate, Chesterfield. It is a large converted building, rather than purpose built. The bedrooms are of various sizes and situated on the ground and first floor. The lounges and dining room are located on the ground floor. The company applied for and was granted a variation in the registration. The home now provides accommodation for 29 older people with Dementia and has accommodation for 5 older people with Mental Disorder and is registered to provide personal and nursing care. The fees charged at the home range from £280.70 - £469.80 per week extra charges apply for chiropody, hairdressing, toiletries and personal newspapers. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit which focused on assessing compliance to previously listed requirements and on assessing all key standards. As part of the inspection a sample of 3 service users care files and a range of documents were examined. A partial tour of the building was conducted. During the visit opportunity was taken to have discussions with staff, service users and visitors. Many of the service users in the home were unable to participate in the inspection process due to memory impairment. The acting manager Angela Hoskin was on duty during the inspection. What the service does well: What has improved since the last inspection? What they could do better: There has not been any supervision offered to staff. Appraisals have been completed and there now needs to be work on developing regular and structured supervision to staff. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 6 Whilst there has been some improvement in the provision of staff training some areas of training have still not been addressed and are overdue. There is not a skills based induction package in place for staff and moving and handling training is overdue. One occurrence of poor moving and handling was observed during the visit which had the potential to place the service user at risk. An immediate requirement was issued regarding this during the visit. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 8 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 the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Procedures were in place and implemented to ensure service users needs were assessed and information sought from other professionals on service users needs prior to admission. EVIDENCE: The acting manager said that all service users were assessed prior to being admitted. Not all service users visits had opportunity to visit the home prior to be admitted due to location or being in hospital. In these circumstances relatives and family were reported to have visited the home and advocated for the service users. Care files seen also contained assessments by Care Managers and Free Nursing Assessors. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 9 The home does not offer intermediate care as defined by National Minimum Standards 6. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 10 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 the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Whilst the majority of care plans examined were detailed and informative there was one care plan that had deficits that had the potential to adversely affect the care delivered to the service user. EVIDENCE: A sample of three service users care files was examined to assess how standards were being met. Some were assessed in part to explore different aspects. A new care plan format was in the process of being trialled. This had been sourced from the Alzheimer’s Society and positively identified areas of strengths and needs. The form completed for one service user gave a very good detailed overview of the service user and strongly included preferences and abilities. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 11 One care plan examined was generally poorly completed with complete sections of the care plan being unwritten. There was also a lack of detail in the care interventions and monitoring of a healthcare condition that may adversely affect the service user. There was space on formats for recording service users preferences and routines. Two out of the three care files had this information completed. A range of risk assessment tools were available including nutrition, tissue viability, moving and handling, falls risk assessment and dependency. These were found to be reviewed, as were the plans of care. The storage and administration of medicines was examined at his visit. A monitored dosage system is in use at the home. There was an audit trail possible of medications received into the home and those disposed of n the appropriate receptacles. The medication administration records were fully signed. Where variable dosages were prescribed not all records indicated the actual dosage administered. Handwritten entries on the medication administration records were doubly checked and verified by staff. It was observed that oxygen was being stored in a room but no alert sign was evident on the outside of the door. Care files examined contained details of the visits made by GP’s, chiropodists and other healthcare professionals such as the speech and language therapist. Some service users attended outpatient appointments where referrals had been made. An optician visited the home to provide regular checks to service users. A letter from the Provider had been received since the last inspection expressing concerns that there were problems securing the services of NHS dental provision. Emergency dental services were accessed where required. Monthly monitoring of weights and blood pressure were recorded. It was observed that some service users were not wearing any foot covering and had bare feet. This was discussed with the acting manager who said did not regard this as typical practice. Later observations were that the service users were wearing socks. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service There have been positive steps taken and progress made to improve the social and recreational activities offered to service users. EVIDENCE: Since the last inspection an activities coordinator had been employed for 30 hours. Some work into assessing the previous social interests of service users had taken place and a schedule of activities was available. Individual sheets to document participation in activities had also been introduced. A coffee morning had been held to introduce the activities coordinator to relatives. On the day of the visit a sing-along session and nail painting activities were organised. Work was underway to organise large print books and there was an outing being arranged for service users. Whilst not being long in post it was evident that a very positive start had been made to improving the provision of activities to service users and ensuring that Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 13 they were based on previous interests and assessed needs. Discussions with the activities coordinator confirmed that she was experienced for the role in which she has been employed. Visitors spoken to said staff welcomed them. Discussions with staff revealed that some service users have a number of regular visitors. At the lunchtime meal, which was the main meal of the day a choice of foods, was offered. The homogenised diet was served as separate portions of pureed food but it was observed that this was mixed together by staff before being served to service users. This was therefore presented as a brown paste like meal and not stimulating to look at and did not provide a variety of separate tastes to service users. Generally however the food served appeared to be appealing and well presented. Discussions with staff on the care of service users confirmed that there was some uncertainty regarding one service users dietary requirements. This had the capacity to adversely affect the service user. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Complaints procedures were in place. Progress was being made to ensure staff had received safeguarding adults training. EVIDENCE: A complaints procedure was available and displayed. Since the last key inspection one complaint had been received at the home, this concern had also been raised with the Commission for Social Care Inspection but the complainant had approached the Provider directly with their concerns. Records of this could not be located in the home although the content and outcome was discussed with the manager who said that the complaint had not been substantiated. Relatives spoken said they were unaware of the complaints procedure but would approach the acting manager if they had any concerns. A procedure was in place on how to handle any allegations of abuse. This referred to locally agreed safeguarding adult procedure. Since the last key inspection there have two safeguarding adult referrals. One has been resolved with no evidence of the wrong doing by the home. One is currently in the process of being investigated. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 15 A previous requirement is listed regarding staff receiving training in the safeguarding of adults. The acting manager has completed a trainer’s course to allow them to train the staff group and so far 9 staff have been trained. The timescale for all staff to receive training has not yet passed and the acting manager said that they were confidant the timescale would be met. Staff spoken to say they had received safeguarding adult training. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The communal areas of the home were found to be clean and comfortable for service users. EVIDENCE: The communal areas of the home, laundry and kitchen were viewed at this visit. Samples of bedrooms were also viewed. Since the last inspection overgrown bushes in the garden have been cut back to allow more light into the home. A secure garden area was available with seating The communal areas of the home were generally well maintained apart from odd patches of damage to the walls from the food trolley and furniture. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 17 It was noted that the Fore equipment had not been serviced since October 2004 this is overdue. The laundry area was not accessible for service users and had two washers and two dryers. The washing machines had sluicing programmes available. Samples of commodes were viewed as these had been identified as not being clean at previous visits. This had been rectified. Relatives spoken said that the home was also found to be clean and without unpleasant odours. Gloves and aprons were available for staff to use and observations were made of these in use. One bedroom viewed did have an unpleasant odour and the carpet was worn. Other bedrooms viewed were found to be acceptably maintained. Toilets and bathrooms were not assessed at this visit however there was refurbishment of one toilet viewed. This was nearly complete and further refurbishment of toilet and bathrooms was being planned. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Some minor deficits were found in the recruitment files. There is evidence of some training being organised but the lack of training in some areas and supervision of staff may adversely affect the care delivered to service users. EVIDENCE: The occupancy of the home on the day of the visit was 22 service users. 19 service users required nursing care, 3 service users required personal care only. The typical staffing levels at the home were 1 nurse on duty for all shifts with 4 care staff for morning shifts, 3 care staff in the afternoons. At nights there was one qualified nurse and 2 care staff. Agency staff covered some shifts although reports from the acting manager and staff stated that this was becoming less frequent. There were currently two student nurses on placement at the home. Since the last inspection an activities coordinator had been employed for 30 hours per week working 30 hours Monday – Friday. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 19 A handyman was employed at the home and did routine maintenance, decorating and some routine safety checks such as water temperatures. There were 13 care staff employed at the home. Two staff had completed at least NVQ (National Vocational Qualification) level 2 in care. Two more staff had recently enrolled on courses. The acting manager also said that some staff had completed units but the company verifying the training was no longer providing this. Alternative training providers were being explored. There had been a range of training offered this included health and safety, Basic Food Hygiene, fire safety and Protection of vulnerable adults Training in continence and Control of substances hazardous to health was being planned for the coming weeks. Moving and handling training had not been completed since February 2004 and was overdue. For new staff employed there also no documentary evidence of any induction or moving and handling training being completed prior to care practices being undertaken. Poor moving and handling practice was observed with wheelchairs being without footplates being fitted with service users heels dragging on the floor. An immediate requirement was issued at the time of inspection regarding this practice and a separate letter to the Provider regarding this. One staff member also expressed concern that some footplates did not fit onto the wheelchairs. Discussions were held with the acting manager regarding first aid training. It was stated that the nurses were responsible for first aid but had not received formal training in this. No staff in the home had received training in infection control. There were two staff at the home who were in the process of completing a moving and handling trainers award to allow them to train others. There was not a skill based induction package available for staff and no documentary evidence that recently appointed staff had completed an induction. Samples of three staff personnel files were examined to assess recruitment standards. Whilst Pova First checks had been completed the full Criminal Records Bureau checks had not been returned by the Criminal Records Bureau. The files contained references, applications and photographs of staff but one file did not contain proof of identity. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 20 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 21 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service There was evidence that some review of care planning and quality assurance was underway and improved consultation with relatives regarding the quality of the service offered. EVIDENCE: There is an acting manager in post at the home. The acting manager said they had submitted an application form to become formally registered with the Commission for Social Care Inspection as manager of the home and were currently waiting for the Criminal Records Bureau check to be returned. Staff spoken spoke positively of the approachability of the acting manager and said that monthly staff meetings were held. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 22 There were some documented monthly visits made on the Providers behalf but the dates of these did not meet the frequency required of monthly visits. This was discussed via telephone with the Director who completes these. It stated that a new quality assurance system was being introduced which would address this and the lack of qualitative aspects recorded in the available recorded visits. This is an outstanding requirement from previous inspections that quality assurance need to be implemented. Since the last inspection there had been some questionnaires sent out relatives. So far 6 had been returned. The feedback given on the returned forms was typically very good/good. Some monies are stored safely in the home on service users behalf. Records of these were examined. A balance sheet was in place that was doubly signed for each transaction. Some monies are held in cash and some monies were held within a bank account. The acting Manager was unaware if the bank account was the company’s bank or a service users joint bank. Audits of balances had been carried approximately 3 monthly to check accuracy. Since the last inspection there had been two notifications to Commission for Social Care Inspection of service users money going missing where they were carrying it with them. The police were notified of these incidents. Discussions were held with the acting manager to ensure that service users had access to lockable facilities to use where it was assessed that they had the capacity to hold monies and use the facility if they wished. The acting manager said that the two service users had been given the key to lockable drawers in their rooms. Discussions with the acting manager and examination of records confirmed that whilst staff had received appraisals in the past few months that there was not regular supervision being completed. This is an outstanding requirement from previous inspections. A range of service records for equipment were viewed. The gas installation safety certificate indicated that the boiler in the cellar was potentially unsafe due to poor ventilation. Discussions were held with the handyman who stated that the boiler was being used and ventilation had been improved. This had not been rechecked by an appropriately trained engineer however and was not covered by a current gas safety certificate. All other service checks were completed appropriately. Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 23 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 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. 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 2 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement The care plans in place must be personalised and detail all assessed needs Previous timescale 30/08/06 2 OP9 13,17, Schedule 3 18 Where a variable dosage of a drug is prescribed the actual dosage administered must be recorded The registered person must ensure that all staff receive training on Adult Protection. Previous timescale 19/06/06 4 5 OP19 OP28 23(4) 19 The fire equipment must be serviced in accordance with the manufacturers guidelines The Provider must ensure that at least 50 of staff hold NVQ (National Vocational Qualification) level 2 in care qualifications Timescale not yet passed 6 OP29 19 The registered person must ensure that all staff have the DS0000066966.V309575.R01.S.doc Timescale for action 30/10/06 30/09/06 3 OP18 30/09/06 30/10/06 30/10/06 30/10/06 Ashgate House Nursing and Residential Home Version 5.2 Page 26 required checks prior to commencing employments and that these documents are kept on site for inspection. Previous timescales 19/05/06 & 30/07/06 7 8 OP30 OP30 18 18 All care staff must be competently in moving and handling techniques All staff must receive a skills based induction in order to ensure they have the skills to care for service users appropriately The registered person must ensure that a registered manager is in post. Application has been submitted The registered person must ensure that a quality assurance system with a systematic cycle is in place and being operated. This must include documented monthly visits made on the Providers behalf Previous timescale 19/07/06 All staff must receive regular supervision. Previous timescales 30/06/06 & 30/08/06 The gas boiler in the cellar must be checked by an approved and competently trained person to ensure and certify it is safe to use 30/10/06 30/11/06 9 OP31 8 19/10/06 10 OP33 24 19/11/06 11 OP36 18 (2) 30/11/06 12 OP38 23 30/09/06 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 27 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 4 5 Refer to Standard OP9 OP9 OP33 OP33 OP35 Good Practice Recommendations Medication policies and procedures should be updated to reflect changes in disposal procedures The room where oxygen is stored should have an alert notice placed on the entry door The Regulation 26 visits forms must contain information detailing qualitative aspects of the service The meetings between the Acting Manager and Provider should be minuted. Confirmation should be given that service users monies are not being held in the Providers bank accounts Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Ashgate House Nursing and Residential Home DS0000066966.V309575.R01.S.doc Version 5.2 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. You have been warned!