Inspection on 24/10/05 for Ashley Down Nursing Home

This inspection was carried out on 24th 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

Ashley Down Nursing Home 11/06/08

Ashley Down Nursing Home 03/07/07

Ashley Down Nursing Home 22/01/07

Ashley Down Nursing Home 24/04/06

Ashley Down Nursing Home 02/06/05

Ashley Down Nursing Home 06/12/04

Ashley Down Nursing Home 05/08/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ashley Down Nursing Home 29 Clarence Place Gravesend Kent DA12 1LD Lead Inspector Elizabeth Baker Unannounced Inspection 24th October 2005 09:30 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 Ashley Down Nursing Home DS0000061039.V257920.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. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashley Down Nursing Home Address 29 Clarence Place Gravesend Kent DA12 1LD 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) 01474 363638 01474 325460 Ashley Down Care Home Ltd Vacant Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2005 Brief Description of the Service: Ashley Down is a care home providing nursing care for 19 Older People (Old Age), not falling within any other category. Ashley Down Care Home Limited is the registered provider. Mr R Mahomed is a Director of the Company and is the named Responsible Individual for regulatory purposes. Bedroom accommodation comprises 17 singles and one double room. Ten single rooms have ensuite toilet and washbasin facilities. There is an eight-person passenger lift. All rooms used by residents are connected to the nurse call alarm system. Communal accommodation comprises of a day room, a separate dining room and a reception room. The home, which is a Grade II listed building, is located in a conservation area near to the town centre of Gravesend. Shops, pubs, a main post office, banks, places of worship and other amenities are easily accessible. There is a small, secluded patio garden at the side of the property, which is accessible to physically disabled residents. Car parking is limited. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours on the 24 October and almost two hours on 25 October 2005. A separate pharmacy compliance inspection by Pharmacy Inspector Jane Vaughan took place on 24 October 2005. Lead inspector Elizabeth Baker, accompanied by Registered Nurse, regulatory inspection Justine Williams carried out the inspection on 24 October 2005. A partial tour of the home took place. Three residents and three visitors were spoken with in private. A number of staff were spoken with. At the time of the visit there were 17 residents requiring nursing care, residing at the home. Some judgements about the quality of care, life and choices were taken from conversations with residents, visitors and staff, as well as direct and indirect observations. Some care records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspections. Non-care records could not be inspected, as the nurse in charge was unable to access the office. This situation necessitated the return visit on 25 October 2005. There have been five inspection visits to the home for the year 2005/06. Visits have comprised of a routine announced inspection 2 June 2005, a pharmacy announced inspection 27 June 2005, an unannounced additional compliance visit 4 October 2005, an unannounced pharmacy compliance visit 24 October 2005 and routine unannounced inspections 24 and 25 October 2005. All visit reports are available from the Provider. Although there have been no formal complaints made to the Commission for this inspection year to date, the additional visit carried out on 4 October 2005 was made following concerns passed to the Commission from a relative and local authority in respect of inadequate heating and lack of available hot water. The Commission is also aware of a complaint just having been made directly to the home by a Continuing Care Nurse in respect of poor care. In the absence of a Registered Manager, the registered nurse on duty Ms S Medari assisted in the inspection process. The Director Mr Mahomed was on site at the 25 October 2005 inspection. What the service does well: Two of the 17 requirements made at the last inspection have been complied with. Areas inspected were generally warm and clean, although two particular bedrooms were notably cooler. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Ashley Down Nursing Home DS0000061039.V257920.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 Ashley Down Nursing Home DS0000061039.V257920.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): 3 The information gathered during the pre admission assessment process does not ensure prospective residents’ complete needs will be met. EVIDENCE: The assessments seen for four residents were not complete and were not signed or dated consistently. The assessments are tick box style, which do not allow for the recording of the complex and lengthy needs of the residents admitted to Ashley Down. The home is not registered for intermediate care therefore Standard 6 is not applicable. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 9 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, 10 and 11 Residents are at risk as care records are not adequately maintained and medications are not properly supported. EVIDENCE: The care records of four residents were inspected, one of whom had recently been admitted to the home. The care plans still do not reflect the current needs of the residents. The failure to address this issue could lead to a decline in residents’ health and wellbeing. One care plan contained only one element of care regarding nutrition. This failed to detail the complicated care required around nutrition. All other aspects of care the resident required were not addressed at all. Another care plan failed to reflect the most recent advice and prescribed diet from the NHS dietician, thus the potential for errors being increased. This resident had suffered from a pressure sore, there was no mention of how the sore was being cared for or whether it was healed since August 2005. A further care plan failed to detail the care regarding the resident’s sore sacrum. Fortunately the resident and staff spoken with were aware of the care Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 10 required. This resident’s pressure relieving mattress was sounding an alarm and had been for some time, which indicated that it might not be working correctly. The resident already had some soreness to the sacrum. Similar care record inadequacies were identified during a recent Registered Nursing Care Contribution assessment carried out by a Continuing Care Nurse of a local Primary Care Trust. Three of the four care plans had not been reviewed since August 2005. The Waterlow assessment for one resident failed to include a score for neurological deficit despite the resident suffering from hemiplegia following a CVA. A wheelchair user indicated they were uncomfortable sitting in their wheelchair, however staff seemed unaware of this. None of the care files contained any risk assessments other than moving and handling. Disclaimers were seen with regard to the use of “bed rails” or “cot sides”. Information regarding bowel movements and bathing of residents were in folders in the reception room. A sign prominently displayed over a resident’s bed detailed their personal care needs. Such information must be kept securely and preferably within the residents’ care files. These are institutional practices and compromise residents’ privacy and dignity. Pharmacy Inspector Jane Vaughan carried out a separate inspection of Standard 9. This refers to the administration and storage of medications. The findings of the visit have been reported back to the Provider separately. However, that inspection resulted in five requirements and four recommendations being made. Wishes regarding death and dying were not recorded An immediate requirement notice was issued in respect of care plans and the administration and storage of medications. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 11 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 and 15 The meals supplied to residents are not always to their liking and choice. Residents’ occupational preferences and choices are restricted because of the lack of programmed activities. EVIDENCE: The home does not have a dedicated activities co-ordinator. Information regarding the week’s activities was seen on the notice board in the lobby. Out of date information was seen in two of the resident’s bedrooms. Some information regarding hobbies and interests was seen in the care assessments. Social history was frequently left blank. One resident complained about the quality of the food served. The puddings served on the day of inspection were not on the menu. The cook had been unable to serve these puddings, due to lack of ingredients. The cook was unable to confirm when food would be delivered, as the owner has recently changed the ordering system. The cook stated that the following days meals would not be those from the menu either as the ingredients were not at the home. Alternatives would be served. A written record of foods ordered when and by who is strongly recommended. Other strategies should be developed to avoid shortages of ingredients. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 12 Dried food provisions are currently kept in a cupboard, which also stores the carpet-cleaning machine, cleaning agents, incontinence pads, syringes and oral hygiene packs. This is poor practice and leads to cross contamination. The storage of food must be reviewed. Advice should be sought from Environmental Health Officer in this respect. Milk was not in the fridge due to lack of space as vegetables, which may not require refrigeration, were being stored in the fridge. The cook stated that she had received advice and a book recommended by a dietician, had been purchased. This book was not available at the home on the day of the inspection. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 13 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 Residents and their advocates cannot be sure their complaints and concerns are taken seriously and acted upon. EVIDENCE: Concerns have been passed to the Commission from an advocate about poor care and lack of appropriate heating and available hot water. The home’s complaint book did not reflect the information as provided to the Commission. Indeed the nurse on duty at the time of this inspection was not aware of the need to record complaints and concerns in the home’s complaints book, but said she would make a note in the home’s diary. This practice does not allow for proper auditing. The home’s complaint’s procedure requires complainants to contact the Registered Manager about any issues. The home has not had a Registered Manager since September 2004. To ensure all complaints and concerns are properly dealt with all staff must receive appropriate training. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 14 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, 21, 24, 25 and 26 Not all residents’ bedrooms present as homely and comfortable environments for them to live in. Residents are at risk due to poor infection control practices. EVIDENCE: An advocate contacted the Commission in respect of concerns about available hot water and heating in residents’ bedrooms. This resulted in an additional inspection being made to the home on 4 October 2005. That visit identified intermittent water flows in some ensuite rooms and room temperatures which ranged from 60F to 73F, depending on the room’s situation within the home. At this inspection it was again noted that water flows from some hot water taps was intermittent and very hot, and some bedrooms were still notably cooler than others. This was not the residents’ choice. In one of the rooms adversely effected daylight could be seen through a particular window frame. The radiator is situated directly under the window. To compensate for inadequate central heating some bedrooms have been provided with additional portable heating appliances. Trailing leads were visible in these rooms. Most of the bedrooms visited were poorly decorated. Walls had not been made good following the installation of a new nurse call system in November 2004. Walls Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 15 looked dirty particularly above radiators and picture hooks had been left in place, despite the pictures having been removed. A broken bedside lampshade was seen in one room and broken glass in a picture frame in another. Carpets in the reception room and landing area were rucked and presented trip hazards. Soiled linen, clothes, an incontinence pad and net knickers had been left in the hand wash sink in the ground floor bathroom. Dirty water and a bar of soap had been left in the wash hand basin of a particular bedroom; long after the personal care had been given. A filthy broom marked “kitchen” was standing in the dirty sink in the laundry. The racking in the ground floor sluice room is in a poor condition and does not allow for effective cleaning. Doorframes and walls throughout the home have been damaged by wheelchair contact. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 16 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 and 30 The procedures for staff recruitment are still not sufficiently robust to provide protection to residents living at the home. Residents are at risk because of lack of staff supervision. Staff do not have a good understanding of residents’ individual needs. EVIDENCE: The home continues to run on the minimum staffing levels set by the former regulatory authority in 1998. These figures were based on a formula devised by a working party in the 1980s, when dependencies of residents entering nursing homes were considerably lower. In addition to care, it is proposed that health care assistants prepare breakfasts and serve suppers. Health care assistants were not required to undertake these duties when the staffing notice was originally issued. Of the five registered nurses who appeared on the duty rota for the week commencing 24 October 2005, only three are permanently employed, and one of them has resigned and is now off sick. At the time of this inspection the registered nurse on duty had worked at the home for only three weeks and had no nursing experience of working with older people. The nurse’s experience being medical and surgical in hospital settings. Residents said they have different staff almost every day, they don’t know who is in charge and they have to keep explaining their specific needs to get the care and support they require. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 17 Two staff files were inspected. References had been provided in both cases. However two “to whom it may concern” references had been accepted in one case. In the other case the two reference request letters referred to the post in question being “senior registered nurse” whereas the post was actually for “senior registered nurse/manager”. In both cases there were no detailed job descriptions. This may have been a factor in the later case of the employee now having tendered her resignation; part of the reason being “the position carries too much responsibility”. Only one of the files contained an induction programme. Indeed it was evident at the 24 October 2005 visit that the registered nurse on duty had only limited knowledge of the workings of the home. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 18 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, 32, 33, 36, 37 and 38 The home is not being managed and there is no leadership, guidance and direction to staff to ensure residents receive consistent quality care. This results in some practices that do not promote and safeguard the health, safety and welfare of the residents receiving the service. EVIDENCE: The home does not have a Registered Manager. Formal supervision does not take place. This situation potentially places residents at risk. A recent incident took place at the home resulting in raised voices and the instant dismissal of a member of the care staff. The Commission has not been formally informed of this occurrence under regulation 37. The incident affected some residents. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 19 Effective quality monitoring and internal auditing is not being undertaken; as a result the care files seen were inadequate and incomplete. Registered Nurses must be reminded to maintain care records in accordance with their professional body’s requirements. Residents expressed concern at the difficulties they encounter when they require to talk with someone in charge, including the owner. As mentioned previously, the food storage provision is in adequate and must be rectified to eliminate cross contamination. Care records inspected did not contain environmental risk assessments in respect of trailing flexes seen in numerous bedrooms. This is potentially hazardous to both residents and staff. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 20 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X X 1 2 2 Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 21 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 All residents must be provided with a care plan detailing full details of current needs, wishes and problems. (Timescale 30/06/05 not met). Registered Nurses must maintain accurate medication administration record charts. (Timescale 02/06/05 not met) Appropriate facilities for the secure and hygienic storage of medicines and associated nursing aids and sundries must be available. (Timescale 30/06/05 not met) Resources to provide meaningful activities, occupation and stimulation must be available to meet the needs and capabilities of all residents. (Timescale 30/06/05 not met) Residents must be provided with meals as per their individual preferences and needs. (Timescale 30/06/05 not met) All complaints must be recorded and investigated and the outcome conveyed to the complainant. (Timescale DS0000061039.V257920.R01.S.doc Timescale for action 24/10/05 2 OP9 13 24/10/05 3 OP9 13 31/01/06 4 OP12 16 31/12/05 5 OP15 16 31/10/05 6 OP16 22 30/11/05 Ashley Down Nursing Home Version 5.0 Page 22 7 OP21 23(2)(j) 8 OP27 18 9 OP29 19 10 OP30 18 11 OP32OP31 8 12 OP32 24 13 OP33 24 14 OP36 18 15 OP3 14 30/06/05 not met) All wash hand basins must be provided with an appropriate supply of hot water. (Previous timescales of 30/01/05 and 30/09/05 not met) Staffing levels must be appropriate to meet the assessed needs of the current residents. (Previous timescales of 31/12/04 and 02/06/05 not met) Care staff must not commence employment at the home until all satisfactory references have been obtained. (Previous timescales 31/12/04 and 02/06/05 not met) Staff must be suitably qualified, competent and experienced to ensure all residents assessed needs are met. (Not inspected) A Registered Manager who has the appropriate skills, competencies, qualifications, effective leadership and experience must be appointed. In the interim period appropriate and sufficient management cover must be provided. (Previous timescales 31/01/05 and 31/08/05 not met). Quality assurance systems must be introduced to ensure residents’ views are sought and acted upon to improve services and facilities. (Previous timescale 31/08/05 not met) A quality assurance system must be introduced. (Previous timescales 31/03/05 and 31/08/05 not met) Formal supervision must be introduced. (Previous timescales 31/03/05 and 31/08/05 not met). Comprehensive pre-admission assessment information must be DS0000061039.V257920.R01.S.doc 30/11/05 30/11/05 30/11/05 31/01/06 31/01/06 31/01/06 31/01/06 31/12/05 27/10/05 Page 23 Ashley Down Nursing Home Version 5.0 16 17 18 19 20 21 OP8 OP8 OP10 OP9 OP15 OP15 17 17 12 13 16 16 22 23 24 25 26 OP19 OP24 OP25 OP26 OP30 23 16 23 13 13 27 28 29 30 OP37 OP37 OP38 OP38 15 and 17 37(1)(e) 13 13 obtained in order to inform the care plan Full details of pressure sores and treatment thereof must be kept Care plans must contain full nutritional details Personal care details must be kept in residents’ individual care records. Nursing sundries must not be stored with food items and cleaning items. Food stocks must be appropriately stored. Adequate stocks of food must be kept at the home. Residents must be provided with meals of their choosing and liking. Residents’ bedrooms must be kept in a good decorative state. Special mattresses must be fit for use. Residents’ bedrooms must be heated to their preferred choice. Soiled linen must not be kept in wash hand basins All care staff must receive comprehensive induction training, appropriate to their roles and responsibilities All records relating to residents must be complete, up to date and appropriately stored The Commission must be informed of any incident adversely affecting residents Rucked carpets must be repaired or replaced. Environmental risk assessments must carried out in respect of all bedrooms 24/10/05 24/10/05 30/11/05 31/10/05 31/10/05 24/10/05 31/01/06 24/10/05 31/10/05 24/10/05 31/10/05 31/10/05 24/10/05 31/12/05 30/11/05 Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 24 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 Refer to Standard OP11 OP12 OP15 OP15 Good Practice Recommendations Care records must contain details of residents’ wishes and preferences in respect of death and dying. Full biographical and social preferences must be obtained in respect of all residents and recorded in their respective care records. Appropriate cookery books must be available in order to ensure nutritional menus are devised A method of recording food stocks must be introduced. Ashley Down Nursing Home DS0000061039.V257920.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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