Inspection on 03/01/06 for Austenwood Nursing Home

This inspection was carried out on 3rd January 2006.

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

Austenwood Nursing Home 29/10/08

Austenwood Nursing Home 12/11/07

Austenwood Nursing Home 22/11/06

Austenwood Nursing Home 14/03/06

Austenwood Nursing Home 25/05/04

Austenwood Nursing Home 17/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Austenwood Nursing Home 29 North Park Gerrards Cross Bucks SL9 8JA Lead Inspector Mr Guy Horwood Unannounced Inspection 3rd January 2006 12:00 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 Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Austenwood Nursing Home Address 29 North Park Gerrards Cross Bucks SL9 8JA 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) 01753 890134 01/01/1901 Westview Limited Mrs Jeanette Gittens Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Elderly Mentally Impaired (organic) Date of last inspection Brief Description of the Service: Austenwood Nursing Home is situated a short distance from the town centre of Gerrards Cross, which provides a variety of shops and local amenities. The town is served by public transport networks, and possesses a main line train station. The home has parking for several cars. The premises consist of an older two-storey building, and a more recent ground floor extension. The home has extensive grounds to the rear, and a large enclosed patio. The home is registered to provide care with nursing for up to 30 elderly people, who can be accommodated in one of 18 single or 6 shared rooms. Of these rooms, 11 possess en-suite facilities. The home has 4 bathrooms for communal use, all of which enable disabled bathing. In addition to the en-suite facilities there are a further 4 toilets, situated at convenient positions around the home. Toilets and bathrooms contain grab rails. The home’s communal areas comprise of a large lounge, which opens out onto the attractive patio, and a well-presented dining room, which can seat all Service Users at one time. Both levels of the home’s main house are accessible by a through floor lift. A registered nurse is to be found on the premises 24 hours a day, and is supported by a team of carers, housekeeping, administrative and catering staff. All Service Users are registered with a General Practitioner, and access to other healthcare professionals is either by direct contact or through G.P. referral. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Austenwood Nursing Home, carried out on the 3rd January 2006, between 11.45am and 3.30pm. The inspector was Mr Guy Horwood. The inspector was met by the nurse in charge on the day of the visit, Mrs Heather Norris, who was able to assist in the inspection process where requested. The inspector’s findings were fed back to Mrs Norris at the conclusion of the visit. The home manager was not present on the day of the inspection, but the findings of the inspection were discussed with her the following day by phone. The inspection consisted of meeting with residents and staff, witnessing staff care practices, viewing selected care records and touring the premises. The inspector found staff polite and helpful, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents and their visitors for their time, and the residents for allowing the inspector into their home. What the service does well: Resident’s comments during the inspection included that the “staff are attentive” and that they felt “well cared for”. Residents appear to be well cared for in a clean, warm, pleasant and homely environment, by a team of caring staff. Residents cared for in bed appear to be equally well cared for and attended to. Residents are offered a choice in their meals, and receive well-presented and well-cooked meals, which take into account personal preferences. Residents are provided with a variety of drinks in quantities sufficient to ensure that they are adequately hydrated. Staff liase with healthcare professionals external to the home promptly and appropriately. Staff actions take into consideration the privacy and dignity of residents in their provision of care. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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 Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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 admissions procedure appears to enable the home to make an informed decision as to whether they can meet resident’s needs, and as a consequence, residents appear to be placed appropriately. EVIDENCE: The home has a pre-admission procedure, which involves meeting the resident prior to admission. The pre-admission assessment for a recently admitted resident was seen. Although this was not hugely detailed, the assessment covered the information required under this National Minimum Standard. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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 Residents appear well cared for by a team of caring staff. Care plans are working documents, are up to date and subject to regular review. This ensures residents identified health care needs are known to staff to enable them to provide the appropriate care. However, care plans do not appear to include the same level of detail pertaining to residents social needs, and this has the potential that residents may not be provided with sufficient stimulation in the way of appropriate activities. Staff liase with appropriate healthcare professionals external to the home promptly and appropriately, thus ensuring residents health care needs are attended to. Medication appears to be received, stored, administered and disposed of in a satisfactory manner, and residents appear to receive their medication as prescribed. EVIDENCE: At the time of the visit residents appeared dressed in co-ordinated, weather appropriate clothing and their glasses, where worn, were clean. The home was Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 10 comfortably warm throughout, with the majority of residents possessing additional blankets over their knees for added comfort. Call bells and drinks were to hand for all residents, and those spoken with said that staff usually answered call bells promptly. Jugs of fresh water were present in all rooms, and hot drinks were provided during the visit. Residents being cared for in bed appeared clean, appropriately dressed and comfortable, and to be well cared for. A selection of residents care files were viewed including a recent admission. These records included tissue viability and moving and handling assessments; records of healthcare professional visits including General Practitioner’s; risk assessments including falls, tissue viability and use of cot sides; details as to gastrostomy and catheter care. Nurses had developed care plans within these records identifying resident’s care and health needs and how theses needs were to be met. These care plans were detailed, informative and subject to review. Care plans relating to residents social care needs were not as detailed as these health care records and in some instances were incomplete. Two daily report sheets are held within the resident’s case files, these records are both titled “Daily Statement of patients condition”. The daily report, where completed by nursing staff, provides a detailed and informative account of the resident’s condition and welfare. The report completed by care staff, however, only records the care provided that day in the way of “washed and dressed” or “bath given”. A number of pressure relieving mattresses were noted during the visit, as were a large number of height adjustable beds. The providers are reminded that where nursing care is provided all beds are required to be height adjustable, (National Minimum Standard 24(3)). From returning to residents being cared for in bed, it was apparent that their position was changed on a regular basis. The nurse-in-charge stated that turn charts are only kept for residents where they are identified as being at high risk of developing pressure ulcers. At the time of the visit one resident had been identified with a small skin abrasion and as a result a turning regime and chart had been commenced. Care plans viewed contained regularly reviewed tissue viability assessments, and care plans held details as to pressure ulcer prevention measures to be taken by staff. Details as to the settings of pressure relief mattresses were not recorded within individual care plans. Resident’s weights are monitored, although from records viewed this is only undertaken every 4 to 6 months. This would not be frequent enough to promptly identify weight loss or gain in order to take effective action. Fluid balance charts were noted for residents receiving gastrostomy feeding and these were well completed. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 11 Resident’s blood pressure, pulse and temperature are not monitored on a regular basis unless particular medication has been changed. This means that in the majority of cases, no baseline observations are available to compare vital signs against where a resident becomes unwell or has an accident. It was noted that where blood glucose levels were being monitored for a diabetic resident, this was always taking place pre-breakfast. In light of some fairly high morning readings, it was recommended that the testing of this residents blood glucose levels be varied to include other times of the day. The nurse-in-charge stated that the residents General Practitioner had been liased with as to these high blood glucose levels, and this was seen as recorded in the residents care plan. Satisfactory records and plans of care were in place detailing gastrostomy feeding of residents. Evidence of liaison with dieticians was present. Residents appeared to be adequately hydrated, (drinks were to hand / provided; staff assisted with drinks where required; residents skin appeared in good condition - moist and elastic; catheter bags, where apparent, contained good amounts of clear urine). A risk assessment pertaining to falls had been undertaken for a resident with a known history of falls, and they had been seen by a representative of the local PCT falls team with follow up arranged. Medication is stored securely within the home, with trolleys secured to wall brackets and controlled drugs within double locked cabinets. The home has agreed a list of homely remedies with attending General Practitioners. Medication Administration Records, (MAR charts), were viewed. Evidence of General Practitioner review of medicines was available, charts were orderly, and no gaps were noted as to administered medications. Where handwritten instructions as to medication administration had been entered onto MAR charts, evidence as to the General Practitioner confirming the original prescription could be produced in all but one instance. It is recommended that where handwritten instructions are entered onto MAR charts from prescriptions, photocopies of the prescription is held with the MAR chart until the details are printed on to the chart at the pharmacy. Staff were noted as knocking at doors prior to entering, spoke politely and kindly to residents and were said to be attentive and caring. Where personal care was provided staff took steps to ensure privacy, i.e., taking residents to their bedrooms, closing doors. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The dietary needs of residents are catered for with a balanced and varied selection of food and drinks, which are well cooked and presented, and take into account residents tastes and choices. EVIDENCE: Lunch was served during the visit. This consisted of a homemade steak pie, noisette potatoes and 2 vegetables. The lunch was well presented, and resident’s comments on meal provision ranged from the food being “average” to “good” and “tasty”. Where a pureed lunch was provided, this was seen as being presented in separate portions to provide different tastes and textures. Lunch was accompanied by a variety of drinks as chosen by the resident. Where staff were seen to assist residents with their meals, this was done in a considerate and unhurried fashion. The kitchen was viewed and appeared orderly. Food in fridges, freezers and the pantry appeared to be stored appropriately, and of a good standard. The inspector was informed that an Environmental Health Officer had visited recently, with recommendations as to record keeping having been actioned by the chef. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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): 18 The safety of residents is compromised through poor practice, thus having the potential to place residents at risk of abuse. EVIDENCE: When touring the premises, the rear extensions external fire door was found held open with a brick. This exit leads out onto a side passageway, which runs parallel to a public footpath. Residents accommodated in rooms next to this exit were being cared for in bed at the time of the visit and appeared extremely frail and vulnerable. The nurse-in-charge informed the inspector that this door had been opened earlier in the morning for the removal of carpeting from a bedroom. Staff are reminded of the need to ensure the security of the home at all times, especially in light of the vulnerability of residents accommodated at the home. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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): 19,26. The home is decorated in a homely fashion, kept clean and is maintained to a satisfactory level, thus providing a pleasant and homely place for residents to live. Where problems arise affecting the condition of the building, the home is prompt to take action to deal with these issues. EVIDENCE: At the time of the visit the inspector was made aware of the occurrence of 3 leaks within the home affecting residents bedrooms. Two of these leaks were as a result of water entering through the roof, and one from a problem with a sink. Action to rectify these problems was in hand, with action to repair damage underway. One of the residents involved had been moved to an alternative empty bedroom room while the leak in their room was repaired; one was able to remain in their room, with their bed being moved away from the affected area. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 15 The third resident had to have their bed moved to the lounge at night due to extensive water damage to their room making it unsuitable for them to sleep in. The nurse-in-charge informed the inspector that the resident in question and their relatives had been consulted in this action. Through discussion with the homes manager following the inspection, it was ascertained that the family had rejected an offer to relocate the resident to another care home while the damage was repaired, and that new carpeting was due to be installed within the next few days to make this room habitable again. The above incidents were not reported to the Commission for Social Care Inspection as required under Regulation 37 of the Care Homes Regulations 2001. The repair of these leaks will be monitored at the next inspection. Bedrooms and communal areas appeared decorated in a homely fashion with suitable furnishings provided. Resident’s rooms contained personal possessions, which reflected the character and interests of the individual. All bedrooms possessed call bells, and these were seen to be close at hand to residents sitting in their rooms. An area of wall within room 24 has been damaged and is in need of redecoration. The manager later confirmed that this action is in hand, and the inspector will review this situation at a later date. The home was comfortably warm throughout, and radiators were seen as fitted with individual temperature controls. At the time of the inspection the home was clean and tidy throughout, with the only unpleasant odour resulting from water damage following a leak, and confined to a single bedroom. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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): 27,29,30. The home is staffed in sufficient numbers to meet resident’s needs. The homes recruitment procedures, where followed, ensure the safety of residents. Staff receive training appropriate to their role in order to enable them to provide appropriate care to residents. EVIDENCE: At the time of the visit the home appeared to be staffed in sufficient numbers to meet residents needs. Care staff were seen to work in pairs for a number of tasks including moving and handling, did not appear rushed where assisting residents with their meals, and residents appeared well cared for. A selection of staff personnel files were viewed. All files held evidence of Criminal Record Bureau and PoVA checks prior to commencement of employment; the completion of job application forms; the provision of proof of identity and where required proof of permission to work within the UK. Original Criminal Record Bureau checks were seen, and these are held securely. Where the employee was a trained nurse, proof of current registration was evident. The application form of one carer contained little information as to their employment history and experience, and references for a trained nurse did not include sufficient information in the way of professional references. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 17 A list of staff with up to date certificates in basic food handling and hygiene was seen. The chef stated that only staff with this certificate were involved in food preparation and service. Evidence of staff training and updates in fire safety, moving and handling, infection control and gastrostomy feeding were noted within staff files viewed. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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): 38 Staff are not consistent it adopting measures to safeguard the health, safety and welfare of residents and visitors to the home. EVIDENCE: Upon arrival at the home, it was noted that a number of wheelchairs, which were being used for the transfer of residents, did not have footplates attached. This was also noted by the nurse-in-charge who directed staff to find and attach said footplates. The laundry room door was noted as held open on a magnetic catch linked to the fire alarm system. Although no chemicals were left out within the laundry room itself, the lockable cupboard holding cleaning and laundry chemicals was found ajar within the laundry. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 19 A bottle of disinfectant was found in the sluice on the first floor despite a notice stating no chemicals were to be left there. The temperature of running hot water was tested and was found to be at a safe temperature, (41°C). Records were seen of bath water temperatures being tested prior to residents entering the bath. Electrical hoists used for the moving and handling of residents were noted as being charged in corridors. This presents a potential fire risk, and following previous consultation with fire officers on this subject, it is strongly recommended that the charging of such equipment be undertaken behind a closed fire door. Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 1 Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 21 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 2 Standard OP8 OP8 Regulation 12(1) 12(1) Requirement Monthly weights are to be recorded for all residents. Monthly observations, (blood pressure, pulse, temperature and respirations), are to be undertaken and recorded in respect of all Service Users. Staff are to take every reasonable precaution through the locking of external doors, in order to ensure the safety of residents and persons within the home. The damaged area in room 24 is to be made good and redecorated. The manager is to ensure that room 12b is repaired, and that it is free from offensive odours following its repair and recarpeting. Wheelchairs are to be fitted with footplates, which are to be used when residents are transferred in wheelchairs. Chemicals are to be stored securely within the home and with regards to appropriate guidelines, (e.g.,COSHH) DS0000019177.V274460.R01.S.doc Timescale for action 01/02/06 01/02/06 3 OP38OP18 13(4) 01/02/06 4 5 OP19 OP26 23(2) 23(2) 01/03/06 01/02/06 6 OP38 13(4) 01/02/06 7 OP38 13(4) 01/02/06 Austenwood Nursing Home Version 5.1 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 2 3 4 Refer to Standard OP7 OP8 OP8 OP9 Good Practice Recommendations As a measure of good practice with regards to pressure relief care, it is recommended that a record is kept detailing the turning of residents cared for in bed. It is recommended that the settings of pressure relief mattresses be recorded within care plans. It is recommended that staff vary the time of monitoring resident’s blood glucose levels and liase with the diabetic specialist nurse for advice as to current best practice. It is recommended that where handwritten instructions are entered onto a MAR chart, a copy of new prescriptions is held with the charts until the pharmacist prints the prescription on the chart. It is strongly recommended that the charging of electrical hoists be undertaken in a closed room behind a 30-minute resistant fire door. 5 OP38 Austenwood Nursing Home DS0000019177.V274460.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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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