Inspection on 16/06/09 for Ashwood Lodge Care Home

This inspection was carried out on 16th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ashwood Lodge Care Home 05/05/10

Ashwood Lodge Care Home 27/06/08

Ashwood Lodge Care Home 29/06/07

Ashwood Lodge Care Home 04/07/06

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Ashwood Lodge Nursing Home Bedale Avenue Billingham Stockton-on-Tees TS23 1AJ Lead Inspector Sue Lowther Key Unannounced Inspection 16th June 2009 09:00 DS0000066294.V376025.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashwood Lodge Nursing Home Address Bedale Avenue Billingham Stockton-on-Tees TS23 1AJ 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) 01642 361122 01642 363710 ashwoodlodge@hotmail.co.uk Nationwide Healthcare Ltd Manager post vacant Care Home 27 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (27) of places Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home, with nursing - Code N Whose primary need on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP, maximum number 22 2. Dementia, Code DE, maximum number 5 The maximum number of service users who can be accommodated is 27 27th June 2008 Date of last inspection Brief Description of the Service: Ashwood Lodge is a care home registered to provide both personal and nursing care for 27 older people. The home is situated in a residential area of Billingham. All rooms used and occupied by the residents are on the ground floor. The home provides both single and shared bedroom accommodation. Two of the bedrooms have en suite toilet facilities. Both lounge and dining areas are provided for those residents who wish to socialise. The home has a lawned garden, and has external areas accessible to residents. The home provides car-parking facilities for visitors. The fees at this home are between £370 and £477 per week. This does not include the cost of newspapers, hairdressing and chiropody. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection of Ashwood Lodge was carried out by two inspectors on 16th June 2009. During the visit to the home records were examined and a tour of the building took place. Time was spent talking to people living at the home, staff and visitors. The manager supplied some information before the inspection on a form called an AQAA. This is an annual quality assurance assessment for home’s to provide information about their service. The inspection focussed on key standard outcomes for people living at the home. We also checked whether requirements and recommendations from the previous report had been met. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People said that they are generally satisfied with the level of care provided at Ashwood Lodge. One person wrote on a survey, “The home looks after me well. All of my needs are taken care of very well”. The response to the question about what the home could do better was “Nothing I know of”. Another person spoken with during the inspection process said “You can’t beat it here, all of the staff are great, they are kind and can’t do enough for you”. Another person said of what the service does well, “It is all of the staff and the people in charge, they make you feel welcome, feel that you are with your family”. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: All areas of need identified in the assessment should have a care plan in place to make sure that all of the needs of people are met. The assessment process also requires to be fully completed as there were care plans in place which were not mentioned throughout the assessment process. Daily records should be kept about each person to demonstrate that staff are continually monitoring all of the people who live in the home. The assessment with regard to the use of bedrails needs expanding to make sure that this is the most suitable management method for individual people. These assessments need to be signed by the assessor and the person or his/her representative to make sure that the use of bedrails has been agreed. Where medication is administered by district nurses, appropriate records should be maintained within the home. The bedroom furniture should be kept under constant review to make sure that it is suitable and safe. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 7 Whilst care staff are given an appropriate induction, there was no evidence to confirm that this is the case for qualified nurses. Qualified nurses should be given a suitable induction to make sure that they are aware of the policies and procedures specific to Ashwood lodge. The manager said that she had audited staff files and was addressing the shortfalls. The manager must make an application to the CQC to be the registered manager of Ashwood Lodge. Weekly checks should be carried out on the fire alarm system to make sure that it is operating correctly. There is the need to ensure that staff are aware of what needs to be notified to the CQC under regulation 37. These are events which may affect the health, safety and wellbeing of the people who live in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 8 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 Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is available for people to decide whether they would like to live in the home. Assessment procedures are in place to ensure that the home can meet all of the needs of the people who go to live there. EVIDENCE: People are only admitted after a full assessment of need is carried out by an appropriately trained person. This is to make sure that the home can meet the care needs of the people who go to live there. The family of one person who had recently gone to live in the home confirmed that they had looked around the home and had been supplied with all of the information they needed to make a decision about whether or not their relative would like to live there. Most of the people who responded to the survey said that they had received enough information about the home before they went to live there. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 10 The home does not admit people for intermediate care therefore assessment of Standard 6 is not required. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receiving the service are happy with the way in which care is delivered by staff. However records detailing how health and personal care is delivered and associated risks are not detailed enough. The way in which medication is managed is in the main good. EVIDENCE: The manager said that all of the people who live in the home have care plans so that staff know how to look after people on an individual basis. The care records of three people living at the home were looked at. There was a range of assessments in place, which included physical and social assessments along with a number of risk assessments such as moving and handling and nutrition. The last inspection report contained a requirement about the need to have a care plan when a risk is identified so that staff know what they must do to meet the needs of the person. These were found to be in Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 12 place. However there is the need to develop some of the care records further. Areas that were identified in the needs assessment, that should have a specific plan of care in place for, did not. This included for example, someone who displays challenging behaviour, did not have a care in place to address this specific area of need. Other examples were shared with the manager during the inspection. There is also the need to ensure that the assessment of need is fully and accurately completed, as one person had a care plan for an area of need that is not identified or mentioned through the assessment process. In one of the records looked at there were incidents for which risk assessments and risk management strategies should have been in place. Immediate action was taken to address these. It was also identified that care is needed with the daily record of care as one person had gaps in their records and there had been no entries for nearly two weeks. The assessment with regard to the use of bedrails needs expanding to make sure that this is the most suitable management method for individual people. These assessments need to be signed by the assessor and the person or his/her representative to make sure that the use of bedrails has been agreed. Care is needed to ensure that the care records of people who have been living at the home for some time are up to date and reflect their current needs. Records examined showed that people receive visits from other healthcare professionals. These include district nurses, doctors, and care managers. Medication is administered by qualified nurses . An incident had occurred in regard to one person’s medication, which they had obtained from the GP. There is the need to explore this matter further. One person has a regular injection by a community nurse, however there are no records in the home to detail that this had been administered. The manager said that the home had recently had a medication audit by the Primary Care Trust and that all of the recommendations made had been implemented. People said that staff are polite and always teat them with dignity and respect. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and people are given a choice. EVIDENCE: The manager said that she had recently discussed the activities with the people who live in the home and their relatives. People spoken with said that staff speak with them about what they would like to do. One person who returned a survey indicated that there are always suitable activities available. Staff said that the activities that took place depended upon the numbers of people living at the home and they were hopeful that as the numbers increased there would be more opportunities for activities. They confirmed that there were visits from the local clergy. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 14 People said that they have a choice about how they like to spend their day. They can also choose what time to get up and go to bed and when they would like to have a shower or bath. However they said that they might have to wait a while if staff are busy. The last inspection report contained a requirement about the need to keep food provision under review to make sure that it is balanced and nutritious. The manager said that these had recently been reviewed and discussed on an individual basis with people. One person spoken to said that they were quite satisfied with the meals and that they join in what ever activities are going on although did not say what they were. Another person spoken to about the meals, “They are alright, they are suitable for old people, they like stewed stuff, I like fish, chops and curry and they do it for me”. Staff said that the menu is a four week plan and that people are offered a choice. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An accessible complaints procedure is available. People can be confident that good systems are in place to protect them from abuse. EVIDENCE: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the ‘Service Users Guide’. The manager stated on the AQAA that there had been two complaints since the last inspection. Evidence was available to confirm that these had been addressed. The last inspection report contained a requirement that people should be given a clear explanation about what is being done when they make a complaint. The manager said that she involves people at every stage of the investigation process and keeps them as up to date as possible whilst maintaining confidentiality. People living at the home said that if they were unhappy they would go to any of the staff and tell them. One member of staff said, “I would always report to the manager any concerns voiced to me from any client or relative. The staff are always willing to listen to any concerns the clients or their families may have and we give them our support”. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 16 The home had a comprehensive adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. All said that they would tell someone, for example the manager, or make a referral themselves if this was more appropriate. Training is provided for all staff in adult protection. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is furnished to an adequate standard in the rooms which are occupied. However some furniture in the empty bedrooms is shabby and in need of replacement. EVIDENCE: During a tour of the building the inspector saw that many of the rooms are decorated to the person’s own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. However some of the furniture in the empty bedrooms was broken and shabby. The manager said that furniture is replaced in each room prior to it being occupied. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 18 It was noted that the environmental health officer had recommended replacement of the kitchen flooring. The manager said that this was on order There was a range of equipment seen around the home to support people with bathing and mobility. The flooring in one toilet required urgent attention to make sure that it was not a tripping hazard. This was addressed during the course of the inspection. The inspector found the building to be in the main clean, tidy and free from offensive odours. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by the staff, who have the skills required, although update training is needed. People are protected by the way the home recruits staff. EVIDENCE: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. The manager said that there is always one qualified nurse and two care staff available during the day and one qualified nurse and one carer during the night. When the manager is on duty she is additional to these numbers. People said that staff were usually around and answered the call bells quickly. One person said, “The staff come quickly when I need them, they are no bother”. The home had staff files in place, which provided evidence that the appointment of a new staff member is made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. However, whilst Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 20 care staff are given an appropriate induction, there was no evidence to confirm that this is the case for qualified nurses. The recently appointed manager said that she has carried out an audit of staff files and is addressing the shortfalls. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are happy, there is the need for the continued development effective management systems to be in place to ensure the welfare and wellbeing of people living at the home. EVIDENCE: Since the last inspection a new manager has been appointed. She has managed a care home in another area and was registered with the Commission for Social Care Inspection previously. She must now apply to the Care Quality Commission to be the registered manager for Ashwood Lodge. She is not a Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 22 qualified nurse but a clinical lead has been appointed to oversee clinical issues and to provide some support to other qualified nurses. There was an open and friendly culture between the management team and staff working at the home. One staff member said, “The present manager has only been with the company for a short time. However she is willing to listen to any concerns”. Another member of staff said, “I feel that I have been well supported, I have noticed a difference with the new manger, the home is settled and more focused, think there is a commitment to improvements”. The manager has introduced a system for staff supervision and has confirmed that these will be carried out at least six times a year. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. In the main health and safety checks are carried out regularly to safeguard people living and working at the home. However weekly checks should be carried out on the fire alarm system to make sure that it is operating correctly. On the day of the inspection it had not been done for several weeks. The manager confirmed that this would be addressed immediately. Through an examination of care records it was identified that there had been incidents for which CQC should have been notified about and had not. There is the need to ensure that staff are aware of what needs to be notified under regulation 37. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 23 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 2 X 3 X 3 X X 2 Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP31 Regulation 8 Requirement The manager must make an application to the CQC to be the registered manager of Ashwood Lodge. Notifications must be made to CQC about incidents that effect the welfare and wellbeing of people living at the home. Timescale for action 30/09/09 2. OP37 37 16/06/09 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 All areas of need identified in the assessment should have a care plan in place to make sure that all of the needs of people are met. Daily records should be kept about each person to demonstrate that staff are continually monitoring all of the people who live in the home. The assessment with regard to the use of bedrails needs DS0000066294.V376025.R01.S.doc Version 5.2 Page 25 2. OP7 3. OP8 Ashwood Lodge Nursing Home expanding to make sure that this is the most suitable management method for individual people. These assessments need to be signed by the assessor and the person or his/her representative to make sure that the use of bedrails has been agreed. 4. 5. 6. 7. 8. OP8 OP9 OP19 OP30 OP38 Risk assessments and risk management strategies should be developed, following incidents of challenging behaviour. Where medication is administered by district nurses, appropriate records should be maintained within the home. The bedroom furniture should be kept under constant review to make sure that it is suitable and safe. Qualified nurses should be given a suitable induction to make sure that they are aware of the policies and procedures specific to Ashwood Lodge. Weekly checks should be carried out on the fire alarm system to make sure that it is operating correctly. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 26 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Ashwood Lodge Nursing Home DS0000066294.V376025.R01.S.doc Version 5.2 Page 27 - 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!