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Inspection on 07/12/07 for Ashton View Nursing Home

Also see our care home review for Ashton View Nursing Home for more information

This inspection was carried out on 7th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

There have been major improvements in many areas throughout the home. Corridors, lounges, toilets and bathrooms have been redecorated and refurbished. There has been a big improvement in the amount of nursing and care staff on duty. The staff feel that this gives them the time to do their job properly. Most of the things that needed doing from the last inspection have been done.

What the care home could do better:

The nursing staff must pay more attention to ensuring that the care plans are kept up to date and reflect the health and social care needs of the residents. They must also continually look at anything that may be a risk to the residents. They must then make sure that they write down in the residents` record when they have done this, and what action they have taken to reduce the risk. The choice and presentation of food must be improved so that the residents have food suited to their needs and preferences.

CARE HOMES FOR OLDER PEOPLE Ashton View Nursing Home Wigan Road Ashton-in-makerfield Wigan Lancashire WN4 9BJ Lead Inspector Grace Tarney Unannounced Inspection 7th December 2007 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 Ashton View Nursing Home DS0000005669.V337478.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. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashton View Nursing Home Address Wigan Road Ashton-in-makerfield Wigan Lancashire WN4 9BJ 01942 722988 01942 274896 ashtonview@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Centres Limited 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) ** Post Vacant *** Care Home 55 Category(ies) of Dementia (36), Old age, not falling within any registration, with number other category (19) of places Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 55 service users to include:up to 55 services users in the category of OP (Older People) up to 36 service users in the category of DE (Dementia). Within the 55 places there can be up to 14 older people with dementia requiring residential care, up to 19 older people requiring nursing care, and up to 22 older people with dementia requiring nursing care. The climate to be monitored and alterations made to roof if it becomes apparent heating & ventilation in larger lounge can`t be adequately maintained. The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 9th March 2007 3. 4. Date of last inspection Brief Description of the Service: Ashton View is located in the centre of Ashton-In-Makerfield and is convenient for public transport and shops. There is level access to the front of the home with adequate parking to the front. There are no gardens, only 2 small sitting areas on either side of the car park. A second floor rooftop garden terrace provides residents on Pilling Unit with a safe outdoor area. There are three floors and there is a passenger lift to all levels. The home has three units. On the ground floor there is the general nursing unit (Evans), on the first floor there is a unit for residents with dementia who need specialised nursing input (Gerard), and on the second floor a unit for residents with dementia (Pilling). All 55 bedrooms throughout the home are single and 1 has an en-suite toilet. Bathrooms and toilets are provided on each floor. The provider informed the inspector that the fees within the home ranged from £327.00 to £549.00 per week. The fees charged depend on the needs of the residents and whether they receive the “free nursing care” top up. Additional charges are made for private chiropody, hairdressing and newspapers. This information was received on the 7/12/07 A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed in the reception area. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place although many weeks before the inspection, questionnaires (comment cards) were sent out to the residents and their relatives. The questionnaires that were sent out asked what people thought about the care and quality of the service provided. . 12 comment cards were returned from relatives. What they felt about the care and services provided is written in different sections throughout this report. The Inspector spent 8 hours at the home and during this time she examined care records and medicine records to make sure that the health and care needs of the residents were being met. She also looked around the building at most of the bedrooms, bathrooms, toilets and sitting areas to check if they were clean, warm and well decorated. The Inspector also looked at the menus and looked at what the residents had for their lunch and evening meal. She also checked how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and train their staff. How the home manages the residents’ spending money was also looked at. In order to get further information about the home the Inspector also spent time speaking to 2 residents, 2 relatives, 2 nurses, 1 care assistant and the homes’ Manager. What the service does well: The manager makes sure that the home only cares for those people whose needs the staff can meet. Residents feel that they are well looked after by the staff and the following comments were made both by residents and relatives: • • • • They are lovely to me. Great staff and the nurses do a fine good job. I have nothing but praise for them. Excellent care. Efficient Enough staff are on duty to meet the needs of the residents. The staff make sure that the residents are clean, comfortable and well dressed. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 6 The home makes sure that they check care staff out properly and safely before offering them a job. The Company is making sure that the staff are properly trained. Management are good at checking out the quality of care and the services provided for the residents. 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. The summary of this inspection report can be made available in other formats on request. Ashton View Nursing Home DS0000005669.V337478.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 Ashton View Nursing Home DS0000005669.V337478.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are properly assessed before they are admitted to the home and this gives an assurance to everybody, that a person is only admitted if the home can meet their needs. EVIDENCE: Before any resident was admitted to the home a senior member of staff from the home undertook an assessment of their needs. The assessment looks at what help and support the prospective resident needs in all aspects of daily life. The 2 assessments looked at were detailed and gave a clear indication of the residents’ needs and what they could and could not do for themselves. Standard 6 does not apply. The home does not provide Intermediate Care Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care practices ensure that the residents’ needs are met in a caring and dignified way, however the care plans do not always reflect the needs of the residents or the care that is being provided. EVIDENCE: Individual care plans were in place for each resident. The care plans of 2 of the residents were looked at. They were not however up to date. Although there had been a major change in the condition of one of residents there was no evidence in the care plan to show this. This resident was less mobile than previously and at a greater risk of developing pressure sores but the risks in relation to these had not been reviewed for several months. There was also no pressure sore prevention plan although the resident was being cared for properly on a pressure relieving mattress. The care plan of the other resident showed that whilst this resident had a pressure sore that was being treated properly and the staff had regularly sought the advice of a nurse who specialised in wound care, there Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 10 was no care plan in place to prevent further pressure sores. The care plan and risk assessments had not been reviewed on a regular monthly basis. The Inspector discussed the concerns about the lack of information with the manager and the senior nurse. They agreed to make sure that the care plans would be up to date by the following day. Written daily statements were made in respect of each resident. However whilst they were dated these were not always timed. It is strongly recommended that they be timed so that it gives a clear picture of a resident’s condition at any specific time. Both the care plans gave detailed information about the residents’ religions and whether they practiced their faith. Inspection of the care files showed that the residents had access to health care professionals, such as wound care specialists, dentists, opticians and chiropodists. The following were some of the comments made by relatives: I cannot praise the staff enough for the way they have treated my mother You can tell they really care about them. My relative is always clean, washed and dressed properly. Staff always leave a relative with a comfortable feeling. The medicines were inspected on Evans unit only. A safe system of medicine management was in place. Medicines were stored securely and recorded accurately. However,2 of the residents had been prescribed painkillers 4 times a day but the nurse in charge told the Inspector they were only receiving them as and when they needed to. The nurse agreed to speak to their doctors to have the prescriptions changed to an as and when required basis. Staff were discreet when providing assistance to the residents. Staff demonstrated by example their knowledge of maintaining privacy and dignity, by knocking on doors, closing toilet doors and speaking to residents in a quiet and respectful way. The residents looked clean and comfortable and were suitably dressed. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a choice in how they spend their day and find some enjoyment with the activities available. However there needs to be an improvement in the choice and content of the food provided so that their dietary needs are met. EVIDENCE: The residents’ routines of daily living and their social interests were recorded in their care plans. Throughout the day the Inspector saw that the residents were able to spend their day wherever they wished to. One resident told the Inspector that he preferred to stay in his room. An activities co-ordinator is employed by the home on a part-time basis. A programme of activities, events, and outings was displayed in the reception area. The staff told the Inspector that they felt the activities provided were acceptable for the residents. They said that they also did things with them when they had the time, mainly in the afternoon. One comment received from a relative was that the residents would benefit from being taken out on trips occasionally. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 12 Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were personalised with small pieces of their own furniture, pictures, photographs and ornaments. Relatives told the Inspector that they are able to visit at any reasonable time. One comment was: All visitors greeted with a smile. The staff are always welcoming. The visiting policy is described in the useful and informative Service User Guide that is given out to all relatives and is also displayed in the reception area. The Inspector did not eat with the residents but watched what they were having for lunch. The lunch was served from a heated trolley and the Inspector was told that the residents were asked the day before what they would like to have. Their choice was written down on a list that the staff were following. The main meal is served at lunchtime and the lighter meal in the evening. There were no menus displayed on the unit but later on in the day the Inspector looked at them in the managers’ office. They did not reflect what was actually being served. The manager told the Inspector that he was aware of this and he intended to change things when the new chef arrived. Staff told the Inspector that the evening meal is nearly always soup and sandwiches. They felt that this was not acceptable. They also said that the pureed meal is sometimes mixed together and does not look appetising. On the inspection visit the pureed meal was labelled as meat and the staff serving it did not know what type of meat it was. The Inspector saw evidence of daily food audits that the new manager had introduced. This asked both the staff and residents for their comments on the food being served. Staff felt that this was a positive step forward to improving the meals. Although new dining room furniture had been provided the tables looked very bare. Some of the tables did not have placemats or a tablecloth and the residents were not given napkins. One relative told the Inspector that the staff took their time to feed his mother and that she was fed properly and seemed to enjoy her meals. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. 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 this service. People know how to complain and staff have a good knowledge and understanding of what abuse is, thereby reducing the possible risk of harm to residents EVIDENCE: A detailed complaints procedure was in place and was displayed in the reception area. The complaints procedure was also included in the Service User Guide. It is easy to understand and gives an assurance that complaints will be responded to within 28 days. A record is kept of any complaint made and includes details of the investigation and any action taken One relative told the Inspector: There is an open door here and I can speak to the manager anytime. There is nothing to complain about though A copy of the Local Authorities Vulnerable Adults Procedure was in place and a discussion with the senior staff identified that they were very aware of the procedure to follow in the event of any allegation of abuse. Training in the protection of vulnerable adults has been undertaken by staff and is ongoing. Records of training were kept on file. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 23 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in suitably adapted, clean and comfortable surroundings that are continually being improved. EVIDENCE: The Inspector visited each unit, walked around most of the building and looked at several bedrooms, the lounges, the dining rooms, bathrooms and toilets. The corridors throughout the home had been redecorated and carpeted and looked very pleasant. The lounges and dining rooms throughout had also been redecorated and refurnished and new floor covering had been fitted. They looked clean and welcoming. There were enough toilets and bathrooms to meet the needs of the residents. Toilets were close to bedrooms and communal areas. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were clearly marked. The toilets were clean and were suitably adapted for disabled use. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 15 The shower room off the downstairs corridor was out of use and the manager told the Inspector that they were waiting for the contractors to sort out the problem. A new shower room had been built on the Gerard Unit and it was almost ready for use. Staff told the Inspector that they felt this would be a very useful facility. A new assisted bath has also been provided on the Pilling Unit (top floor) . Most of the bedrooms were decorated to a good standard. They were clean, warm and suitably furnished. They remained however, without an overriding door lock. Three new bedrooms have been constructed on the Pilling unit and en-suites have been provided in some of the other bedrooms. These have yet to be registered for use, as further work needs to be done. The patio area on Pilling is now covered with artificial grass and there is a seating area on some decking. This looks a very pleasant area for the residents to sit out in. All the rooms throughout the home were centrally heated with radiators that were suitably protected. Thermostatic control valves were in place on immersion baths and showers. The home was clean and free from offensive odours. Hand washing facilities were in place in bedrooms, bathrooms and toilets. The laundry was not inspected on this visit. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are cared for by sufficient staff that are safely recruited and properly trained. EVIDENCE: Inspection of the duty rotas and a discussion with staff, relatives and residents showed that there was enough staff on duty over a 24-hour period to meet the needs of the residents living in the home. On the Evans and Gerard Units 24-hour nursing care continues to be provided by suitably qualified nurses who are supported by trained care assistants. The Inspector was given a copy of the training list that showed 65 of the staff had achieved their NVQ level 2 or above in care. This is good progress. The personnel files of 2 staff members were inspected. All were in order and these staff had been properly and safely employed. This helps protect residents from being cared for by unsuitable people. Induction training is provided for all newly employed staff. This is to make sure that they understand what is expected of them and that people are cared for properly and safely. Also a wide range of appropriate and ongoing training in moving and handling, detection of abuse, basic food hygiene, fire safety and other relevant topics are Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 17 provided to staff at the home. Training provided to individual staff is recorded in detail in their file and reviewed at frequent intervals. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and practices within the home protect the health, safety and welfare of the people using the service. EVIDENCE: The manager has been in post since October 2007. He is a Registered Mental Nurse (RMN), has a law degree and a diploma in management. He told the Inspector that he has spent several years in a general management position. Staff told the Inspector that they felt very supported by him and that they could see improvements already in the way that the home was being managed. The Manager has to do a monthly check of lots of things in the home. He has to check to make sure that there are no hazards around the building and also Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 19 check the records about care, medicines and any accidents that have happened. Every 6 months management send out comment cards to residents and relatives asking what they think of the quality of the care and the facilities. The comments are received by the company’s’ head office and then shared with the home. In this way the home can take steps to put into practice what has been said about what could be improved. The system for the safekeeping of residents’ finances was good. The management of residents’ finances are generally undertaken by their families or designated representative. Generally only personal allowances are held by the home in a residents’ account. Individual computer records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any “spending money” for their relative. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. Any accidents that happen are properly recorded and monitored. Information taken from random checking of servicing records showed that the homes fixtures, fitting and equipment are properly maintained and regularly serviced. Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 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(1) Requirement Staff must make sure that care plans are up to date and reflect the care that is being provided. Staff must continually look at the changing needs of the residents and review the care plan at least on a monthly basis. (This was a previous requirement following the inspection of the 4/01/07 and 9/3/07) To make sure that the residents are provided with a varied and nutritious diet, management must make sure that the content and choice of the food provided is suitable for their needs. (This was a previous requirement following the inspection of the 9/3/07) Timescale for action 08/12/07 2. OP15 16(2)(i) 31/01/08 Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 22 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. Refer to Standard OP7 Good Practice Recommendations Staff should make sure that daily statements about the care and condition of the residents are always dated, timed and signed. If staff are of the opinion that a certain medicine is not required as prescribed, then they should contact the GP to have the prescription changed accordingly. This will ensure that the resident receives the medicines as prescribed. To make meal times more pleasant, consideration should be given to setting the tables with placemats or tablecloths and providing napkins for the residents. Pureed food should also be served in individual portions so that it looks more appetising for the residents. To ensure the privacy of the residents, over riding locks should be fitted to bedroom doors and the residents provided with a key unless their risk assessment indicates otherwise. 2 OP9 3 OP15 4 OP24 Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ashton View Nursing Home DS0000005669.V337478.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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