Inspection on 03/10/05 for Ashlands

This inspection was carried out on 3rd October 2005.

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

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

Other inspections for this house

Ashlands 17/11/08

Ashlands 08/01/07

Ashlands 02/12/05

Ashlands 31/08/05

Ashlands 01/03/05

Ashlands 09/08/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Ashlands 152 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EH Lead Inspector Jayne Hilton Unannounced Inspection 3rd October 2005 10:50 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 Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashlands Address 152 Southwell Road East Rainworth Mansfield Nottinghamshire NG21 0EH 01623 792711 01623 792711 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) Mrs M Wragg Manager post vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Ashlands is a two storey detached building converted and adapted to provide care for older people. There is sufficient space for dining and lounge for the number of people the home is registered for. The home is sufficiently adapted to meet the needs of service users with a physical disability. Adaptations/equipment include bath hoists, mobile hoists, handrails, grab rails and a passenger lift. The home has large pleasant gardens, which are secure and well maintained. The home is Registered for 21 beds, with bathrooms being located on both floors and some rooms having en-suite facilities. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken by, Regulation Inspector Jayne Hilton on 3rd October 2005 at 10.50am. The inspection concluded at 12.50pm. The Acting Manager was on leave however the registered provider was in attendance The methodology used included a tour of the building, the examination of two care plans and associated records. Medication procedures were assessed, the staff files examined, the Statement of Purpose, Health and safety records, policies and procedures etc were all assessed. Two staff were spoken with and two service users. The main focus of the inspection was to check whether the previous inspection requirements and recommendations had been met and to cover those standards not covered at the previous inspection where possible. What the service does well: What has improved since the last inspection? Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 6 Minor amendments have been made to the statement of purpose and service user guide. The registration certificate was now fully displayed and some minor areas have been addressed in the assessment and care plans particularly regarding updates of the changing needs of service users and regarding challenging behaviour of service users. Recruitment practices are once again back on track and in line with current legislative expectations. Evidence regarding the management systems for the running of the home is now satisfactory. The homes record keeping and policies and procedures are assessed as satisfactory. Since the last inspection the registered manager has resigned and a new acting manager employed. The acting manager has been working to meet the requirements set at the previous inspection and is committed to raising the standard of care provision in the home. What they could do better: 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. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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 Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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): 1.3,4 Prospective service users have much of the information they need to make an informed choice about where they live. The registration certificate is now fully displayed. Service users have their needs assessed and these are updated as required. The needs of the service users appear to be met. EVIDENCE: The homes Registration certificate was displayed fully. A statement of purpose and service users guide is provided. The inspection reports were displayed on the notice board. Two care plan files were examined. The care package documentation includes a pre assessment document, which is completed prior to admission. The owner or the manager goes out to undertake the pre assessment or sometimes they go together. A further assessment and care plans are implemented on the day of admission, which covers all issues as Required by St 3.3. Service users have locks on their doors, but there was no evidence of a key being offered or issued in the care assessment. A section for issuing of keys to Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 9 bedroom doors and lockable facilities should be included. The assessment documentation provides a personal history and medical profile, social and recreational needs profile, which included the likes and dislikes of service users. There was no evidence of signature of service users or their representatives evident within the care package documentation examined that service users involved in their assessment and plan of care. A section has been devised for service users and their representatives to complete regarding this, however none have yet been completed. The registered provider reported that the issue above will be discussed with relatives at the next relatives meeting and that this is planned on the return of the acting manager Service users reported that they were happy with the care offered and say they are well looked after. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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): 7,8, 9, 11 Service users health, personal and social care needs are set out in a comprehensive care package. Medication administration was generally satisfactory, however there were some issues identified for improvement of practice. Information for dealing with dying and death still requires some minor updating. EVIDENCE: As reported in Standard 3 of this report the pre-assessment, care plans and reviews provide a total package, which meets the requirement of the standard. The inspectors overall assessment was that the care that was being provided was satisfactory. The manager writes detailed paragraphs of service users progress on a monthly basis and there was evidence of service user involvement within the care plan but no signature of agreement. Risk assessments were evident for mobility and the prevention of falls and stated if the service user had a history of falls recorded in the care plan. Daily records were observed to be neat and holistically written. One service user was noted to have some challenging behaviour, there was now a general risk assessment for dealing with this and the registered provider reported that each individual will have a personalised risk assessment and care plan once the acting Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 11 manager returns from holiday. Staff, need to have clear direction in how to be consistent with managing the behaviour on an individualised basis. It was reported that a couple of service users had problems taking medication, therefore this should be written as a care plan for this issue. The healthcare needs of service users appear to be well met with good detailed records of health checks, weight and nutritional screening. Medication systems were assessed. A new system fro Boots has recently been installed. The medication record sheets [MAR] were completed satisfactorily. Staff reported that they have undertaken medicines management distant learning training however there was no evidence of competency assessments being carried out. A check was made on the controlled drugs held in the home and the balance of tablets did correspond with the balance recorded in the Controlled Drugs record book. There were two prescriptions of eye drops opened and in use, one had the date when opened written on them and one did not. The trolley was secured to the wall. A medication round was partly observed. Tablets were noted to be left with a service user to take and signed for as taken. This practice is not appropriate as there is danger of other service users sitting at the table picking them up and medication must only be signed for when visibly observed as taken. A better routine of administration is advised. The inspector also observed the staff member placing a tablet directly into a service users mouth with her fingers, which again is not appropriate practice. If service user cannot handle the container or take the tablets by normal means alternative methods must be explored such as using a spoon Policies and procedures are in place for dealing with dying and death. The manager obtains information from service users/relatives where possible on their wishes for the end of life. The religious and cultural needs of service users are included in the documentation held in the files. The policy for palliative care now includes that the home is not registered to care for terminally ill service users and where medical/nursing input is required, that service users may wish to remain in the home, however a commitment from the GP will be needed that he will provide support from the primary Care services to support the staff in the home in caring for the dying individual. There should be an addition that care plans will be reviewed and that care charts will be implemented. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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, 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 are generally helped to exercise choice and control over their lives and enjoy a nutritional and balanced diet. EVIDENCE: The documentation in the care package format does assess service users preferences and choices about their daily routines. Service users confirmed they could get up and go to bed when they choose. There was evidence of a written activities programme in the home. A staff on duty board is provided in the hallway to inform service users of who is on duty each shift, which is good practice, photos would be a useful addition for those service users who are unable to read Service users and care plans provided evidence that service users preferences and choice was respected, and the menu does now offer an alternative option for lunch and teatime, however only one option was recorded on the menu board in the dining room on the day of the inspection. A record had not been made of what choices service users had made for two days and a service user Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 13 confirmed that she had not been offered two choices that day. Bedrooms that were examined were observed to be well personalised. The menus were devised over a 4 weekly cycle. The menu appeared to be nutritious and varied. Service users reported that the food was nice and the meal served was observed to be presented well. The provision of menu cards on the tables would be a bonus. Service users praised the quality of the meals. One service user prefers a vegetarian option. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 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): 16,17,18 Service users know how to make a complaint. Service users right to participate in the civic process must be upheld. Policies are in place for protecting service users from abuse, however staff have not yet been provided with training in this area. EVIDENCE: A complaints procedure was displayed in the entrance and copies included in the service user guide, Staff, were not able to locate any complaint records on the day of the inspection. The complaints folder was no examined at this visit. There was no evidence regarding whether service users were able to use their right to participate in the civic process but the registered provider reported that this will be dealt with at the next resident /relatives meeting. Relevant policies and procedures were noted to be in place. A copy of the Nottinghamshire Committee for Vulnerable Adults Procedures [NCVAP] guidance manual was observed in the office. Staff have not undertaken training in abuse awareness and this should be provided. A sample of service users personal monies and their financial records were not examined at this inspection. Policies for restraint and dealing with violence and aggression were seen in the policy file. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 15 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 Overall the environment appears well maintained, safe, clean and comfortable, with service users needs being met by the facilities provided. Bedrooms appear personalised, adequately furnished and pleasantly decorated. There are some areas to address regarding the regulation and monitoring of water outlet temperatures and re-decoration of the laundry room. EVIDENCE: The home appeared well furnished and comfortable on the day of inspection and the building appeared to be maintained to a satisfactory level. There is some damp and crumbling plaster noted in the staff toilet, steps have been taken to remedy this but the work is not yet finalised. Communal areas comprise of a small lounge, large lounge and dining room, which appear to be adequate in meeting space requirements. The lounge areas have large windows almost ceiling to floor, which enable good views of the extensive and well - maintained gardens, from all seating areas. Dining tables were sufficient and were pleasantly adorned with pretty tablecloths. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 16 There are assisted bathing facilities on each floor, 3 contain toilets and there are 3 other separate toilets as well as some en-suites in rooms. All bathrooms and toilets appeared clean and smelled fresh on the day of the inspection. Bathrooms were nicely personalised and homely touches were evident. The home is sufficiently adapted to meet the needs of service users with a physical disability. Adaptations/equipment include bath hoists, mobile hoists, and handrails; grab rails and a passenger lift. Call alarms were in place and reported to be working ok. A handrail in the ground floor bathroom has the plastic coating peeling off and tape wrapped around as an interim measure, however this needs to be replaced. Bedrooms examined on the day of inspection were decorated to a satisfactory standard personalised, clean and smelled fresh. Bedrooms had lockable doors but there was no evidence that service users were provided with keys. Lockable facilities are provided but there was no evidence that service users had keys for these. A sample of hot water in a bedroom outlet was tested for temperature and found to be above 43 degrees. Lighting is domestic in character. There was evidence that water storage temperatures were monitored for prevention of legionella however the records showed that water outlets in the home were monitored at 50 degrees centigrade throughout. Service users room numbers are indicated however and individual temperatures of each room must be specified and where tested as above 43 degrees centigrade the action taken to remedy the situation, documented also. This was recommended at the previous inspection. There was evidence that some radiators had been covered but there was evidence of risk assessments for surface temperatures. All the central heating radiator risk assessments should be regularly reviewed as part of health and safety monitoring. There were still areas in priority areas such as bathrooms without covers and this must be completed to ensure service users health and safety is safeguarded The laundry systems appear to be satisfactory and there is now a policy in place for infection control. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 17 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, 29, 30 Service users needs appear to be met by the number of staff provided. The training provision needs to be improved to meet current standards. Recruitment practices are now improved. EVIDENCE: The home appears to be adequately covered during the day and night to care for the number of service users the home is registered for. There are 3 care staff on morning and afternoon alongside the manager who works 40 hours supernumery. The manager was on leave on the day of the inspection. 2 waking staff support service users through the night. A handyman works 8 hours a week and there are 42 domestic and 42 catering hours provided. Afternoon staffing provision has been reviewed to allow for catering hours to be provided. An immediate requirement was set at the previous inspection regarding poor recruitment practices and which is now met. Two new staff have been employed and have not been allowed to commence work until the relevant documentation is obtained and assessed as satisfactory. The inspector has been monitoring the practice of the home in relation to the breach in legislation identified at the previous inspection. A follow up visit was made on the 9/9/05 to monitor progress of the completion of existing staff personal files. This work is ongoing and not yet fully completed. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 18 There was still no evidence of Skills for work Standards being used for induction. Induction and foundation standards need to be addressed and training programmes developed for staff to include regular updates of mandatory training and in meeting the needs of individual service users, such as diabetes, mental health issues and complex needs of older people. Staff reported that the manager, the owner and the deputy manager had attended training in dementia care and that all staff had undertook training in first aid. A training programme for all staff should be devised for 2004/2005 and 2005/2006, which should be available for inspection and which details the training that staff have attended and where training needs to be arranged. Evidence of staff attendance at training must be kept. Staff should undertake training in dealing with challenging behaviour. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 19 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): 31,34, 36, 37, 38 Evidence regarding the management systems for the running of the home is now satisfactory. Staff, are not being appropriately supervised. The homes record keeping and policies and procedures are assessed as satisfactory. The health and safety of service users may be compromised by the lack of training provision for mandatory training. EVIDENCE: Since the last inspection the registered manager has resigned and a new acting manager employed. The acting manager has been working to meet the requirements set at the previous inspection and is committed to raising the standard of care provision in the home. As the acting manager had a holiday booked some of the intended work has not been fully completed. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 20 The acting manager must submit an application to be registered with the CSCI without delay. The registered provider has now provided regulation 26 reports for the home. Evidence was seen of the financial management systems and business plan to demonstrate financial viability of the home. The registered provider has been granted planning permission to extend the home to 30beds and intends to submit a variation application to CSCI to register the beds and to include the service user category of Dementia. The registered provider reported that the formal supervision programme had not been reinstated yet but that this was planned on the acting managers return. A sample of records was examined as part of the inspection, including medication charts, staff personal files, fire safety records, care plans and associated records. The requirements of Regulation 37 have been met. Service users individual personal files were stored securely. Policies and procedures for health and safety were in place including infection control. Generic risk assessments were also seen but a fire risk assessment must be undertaken [obtain the template from the fire authority website]. The COSHH file [Control of substances hazardous to health. The accident records were not examined but the manager should obtain the new tear out record book, which complies with the Data Protection Act 1998. Fire alarm test records were in order. Training provision for staff is now crucial to meet the needs of service users and this must be provided in food safety, health and safety and infection control. Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 21 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 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 2 3 3 2 3 3 3 2 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 3 X 2 3 2 Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 22 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 OP9 Regulation Requirement Timescale for action 2 3 OP9 OP25 Medicines Ensure that the safety of service 12, 13, 16 users is not compromised when 02/12/05 dispensing medication as described within the report Medicines Ensure eye drops are dated upon 02/12/05 12, 13, 16 opening 16, 23 Ensure water outlet 02/12/05 temperatures are regulated to 43 degrees. 19 Ensure training records are available for inspection. [This is a previous requirement set target date 31/9/05 not met] The acting manager must submit an application to be registered with CSCI Ensure formal supervision is provided for all staff [This is a previous requirement set target date 31/9/05 not met] Ensure fire risk assessments are carried out. [This is a previous requirement set target date 31/9/05 not met] Ensure all staff are up to date DS0000060714.V253759.R01.S.doc 4 OP30 02/12/05 5 6 OP31 OP36 8 19 02/12/05 02/12/05 7 OP38 16, 23 02/12/05 8 Ashlands OP38 19 02/12/05 Page 23 Version 5.0 with mandatory training provision such as food hygeine, health and safety, infection control, manual handling etc. 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 6 7 8 9 10 11 12 13 14 Refer to Standard OP3 OP7 OP8 OP9 OP9 OP14 OP17 OP18 OP26 OP25 OP25 OP30 OP30 OP38 Good Practice Recommendations Ensure documentation is evident in care plans to demonstrate service users have the opportunity to have a door key and to their lockable facility. Ensure service users or their representative sign to agree the care plan. Where service users regularly refuse medication this should be detailed within a care plan The registered manager should ensure staff are assessed for competency in medicines administration and that this is documented. Ensure that policy for dealing with dying includes the revising of care plans and implementation of care charts. Ensure that service users are given a choice of menu item and that this is recorded Ensure there is evidence that service users right to participate in the civic process is upheld. Provide training in abuse awareness for all staff Complete the repair damage in the laundry room Ensure that the water temperature records are completed as specified in Standard 25 of the report. Regularly review the risk assessments of surface temperatures and fit radiator covers to priority areas. Training should be provided in diabetes care, mental health issues, abuse awareness and the complex needs of older people. Provide training in dealing with challenging behaviour. Obtain an appropriate and up to date[Data Protection Act 1998] accident record book Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Ashlands DS0000060714.V253759.R01.S.doc Version 5.0 Page 25 - 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!