Inspection on 07/06/05 for Balmoral Court

This inspection was carried out on 7th June 2005.

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

Other inspections for this house

Balmoral Court 17/07/07

Balmoral Court 02/05/07

Balmoral Court 23/05/06

Balmoral Court 04/10/05

Balmoral Court 13/03/05

Balmoral Court 10/09/04

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Balmoral Court Ayton Street Byker Newcastle upon Tyne NE6 2DB Lead Inspector Aileen Beatty Unannounced 7 June 2005 09:30 th 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 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 and Care Homes for Adults 18 – 65*. 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. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Balmoral Court Address Ayton Street Byker Newcastle upon Tyne Tyne & Wear NE6 2DB 0191 265 2666 0191 265 2777 N/A Mr Baldev Singh Ladhar Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr John Werner Hindmarsh CRH 62 Category(ies) of DE(E) Dementia - over 65 registration, with number of places Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: One resident category OP as per variation application 41598, received 24/12/02 may be accommodated. Should this resident leave the home, the Commission for Social Care Inspection must be notified. Three named persons under the age of 65 in the DE category are accommodated in the home. Should any of these residents leave the home, the Commission for Social Care Inspection must be notified. Date of last inspection 13/03/05 Brief Description of the Service: Balmoral Court is a purpose built home providing nursing and social care to elderly people suffering from Dementia. It is a large home providing 62 beds. The home is set in a traditional community In Byker close to local shops and other public amenities. There are good transport links. The home is within easy reach of the busy Shields and Chillingham Roads. The home adjoins Kensington, a general nursing care home owned by the same propreitor. Both homes share joint laundering and catering facilities. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 07/06/05 at 09.30 a.m. Two inspectors conducted a tour of the premises and reviewed records. Residents, staff and relatives were spoken to. What the service does well: 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. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, and 4. Residents are not given information they need to make an informed choice about moving into the home. It is not possible to judge standard 3 as all admissions have been suspended to the home. The home does not satisfactorily meet the needs of residents. EVIDENCE: The statement of purpose remains out of date although there has been only one admission since the last inspection. There is evidence that in the past residents have been admitted without satisfactory assessment information being available. As there have been no admissions for some time, it is not possible to assess progress in this area. Staff in the home are not always able to show that they have the necessary knowledge and skills to care for the people living there. General nurses and Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 8 Registered Mental Nurses are employed in the home. Despite this, mental health care plans are generally of a poor standard and interventions, for example with residents with challenging behaviour are not always appropriate. The standard of physical nursing care is not always satisfactory. See standard 8. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,and 10. The health social and personal needs of residents are not effectively set out in individual care plans. There are some developments relating to therapies helpful to residents with dementia. The health needs of residents are not fully met. Appropriate procedures are in place for the administration of medicines. Residents are not always treated with respect. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 10 EVIDENCE: Care plans have been audited by the manager. This was following the previous inspection and subsequent vulnerable adults strategy meeting, which required all care plans to be up to date by 30/04/05. This target was set by the home. Audit sheets were observed but no action had been taken upon finding that they were not satisfactory. Care plans still have not been reviewed on a regular basis, although some improvement was noted in some files. The majority remain out of date, and where the care plan is no longer relevant, they remain in the file therefore there is not an accurate picture of the current status of residents. Some dressings and bandages were found to be badly marked or soiled. One bandage in particular had been applied incorrectly and was causing some constriction. A wound beneath this which should have been covered, was exposed. It was MRSA positive, (which is a serious antibiotic resistant infection, also referred to as a “superbug”). Where assessments have been carried out that show for example a person is at high risk of developing a pressure sore, no preventative care plan has been put in place. Some care staff spoken to appear knowledgeable about the needs of residents but carry this information in their head. This causes a breakdown in communication and affects continuity of care. All qualified staff have received training in care planning. Some care plans sampled during the inspection found that the standard has not improved despite this. Where there are pressure sores, there is not always a description, measurement or (with permission) a photograph of the wound, although this is expected practice. Nursing staff have been visiting the home to carry out reviews as agreed at the Protection of Vulnarable Adults (POVA) strategy meeting. They too have expressed concerns about the standard of recording in care records. Medication procedures have improved since the last inspection. Records were checked and only one gap found. Records have been checked weekly, and all qualified staff have received refresher training. The clinical room was found to be clean and tidy, and medication stored appropriately. Some staff were observed knocking on bedroom doors and being discreet when offering help with personal care. Some staff were noted to talk about residents in front of them and to speak about them as though they were not there. Some staff tend to use terms of endearment excessively, which some residents may find offensive. In particular, referring to people as “lads and lasses” was heard a number of times and is not good practice. A positive development is that the home is exploring the use of “doll therapy” which has been used very effectively elsewhere with people with dementia. Following the inspection, some very positive feedback was received by a Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 11 behaviour nurse specialist from the General Hospital. She is working closely with one staff nurse to promote a problem solving technique used to resolve difficulties with residents in a positive way. She has been impressed with progress made. There has been a general improvement in the appearance of residents. People are wearing tights or socks, and while sitting, have the use of a blanket over their knees to preserve their dignity if required. There was also a noticeable difference in the number of people with food left on their face and clothing after meals although this could improve further as this definitely compromises dignity. Faeces was found in a number of areas in the home, which was also the case at the last inspection. Apart from the clear hygiene implications of this, the fact that it is found everywhere including on beds, bedding, carpets curtains and people, implies that some staff think it is acceptable for residents to live in this environment. The fact that it is so widespread and obvious, leads to the belief that some staff ignore it. This belief is further supported by the fact that a badly marked pillowcase was left in the middle of the bed by inspectors and was deliberately turned over and placed back on the bed. Mattresses heavily smeared with faeces, were covered by clean sheets. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13,14, and 15. The social, cultural religious and recreational interests and needs are not fully met in the home. Contact is partially maintained with family and friends but not the local community. Residents are sometimes helped to exercise choice and control over their daily lives. a wholesome appealing diet is not always provided at times convenient to residents. The dining area is pleasant. EVIDENCE: Some new activity equipment has been purchased. There is an activity programme pinned onto the notice board. No activities were observed during the inspection although some residents were taken outside into the grounds for a short walk. There is no record of activities that have taken place, or trips out of the building. Social care plans are not always completed and are not personalised. Relatives and friends are able to visit at any reasonable time. Pleasant music was playing in the corridor on the top floor. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 13 Some staff demonstrate a genuine affection towards residents and have clearly formed good relationships. Relatives also confirmed this. Staff were heard to offer choices. Due to communication difficulties, this is not always easy. Mealtime choices are not always met. Second Inspector Suzanne McKean inspected the kitchen area and no major deficits were noted. The kitchen staff have all had basic food hygiene training since the last inspection. The cook has been booked on a more advanced course. A number of relatives have complained about the standard of the food. These comments have been passed to the Operations Director. It has been reported that some of the choices on the menus that were previously not available, have now been provided. This includes milk shakes. The dining areas have been redecorated. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. Residents and relatives are not always confident that their concerns will be acted upon. Residents are not always protected from abuse, neglect or harm. EVIDENCE: The complaints records contain very minimal information. A number of complaints have been made and the Commission for Social Care Inspection had asked the home to investigate these. These have not been appropriately recorded. The manager has still not maintained a record of all concerns expressed or how he has dealt with these. Relatives continue to describe the Manager as defensive in attitude, and say that despite promising to address their concerns he does not in fact appear to do so and does not feedback any action he has taken. There are adult protection and whistle blowing procedures in place. A lack of risk assessments and preventative action, means that residents are not always protected from harm. Staff have received additional training in adult protection since the last inspection. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25, and 26. The environment is well maintained, but not always safe. Some bedrooms are not safe or comfoprtable. People can have their possessions around them. The home is not clean and hygienic. EVIDENCE: The home is generally well maintained. Some areas have been redecorated since the last inspection, including dining areas. New kitchen units and worktops have been provided but these were found to be dirty and stained already. Some carpets are due to be replaced. The malodour identified at the last inspection and on further visits has improved. Some bedrooms are very comfortable personalised and homely. Those residents who do not have visitors or families should be assisted in making Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 16 their rooms more homely. It is very obvious that some rooms are extremely bare. Staff need frequent reminders that heavy objects must not be stored at height, and this must be monitored. There remains a problem with faeces around the home (as previously mentioned). It is clear that care staff do not pay adequate attention to ensuring the environment is left clean after attending to the personal needs of residents. Rooms must be inspected and those staff neglecting this basic essential must be identified and appropriate action taken. An infection control audit was carried out by a Communicable Disease Control Nurse at the end of March. It found that the standard of hygiene and infection control is very poor. In particular, there were no adequate cleaning schedules in the home, soiled chairs and carpets were observed, mattresses are heavily stained, the clinical room was dusty and full of clutter, clinical waste disposal was not satisfactory, linen was not stored appropriately. Staff were not trained in effective hand washing and qualified staff spoken to did not know the correct procedure to follow following an outbreak of infection. Numerous other areas were identified. Training has been carried out for 19 staff members by the nurse, and a follow up audit will be carried out soon. It was noted during a visit to the home on 10/05/05, that the clinical room in particular was clean and tidy and dust free. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30. Service users are not supported by an effective staff team at this time. Staff are not all trained and competent to do their jobs. Staff are not well supported or supervised. EVIDENCE: Training records were not available at this inspection, which was a requirement of previous inspections. There is a list of training that has been provided, but not who attended. A number of training courses have taken place, including in infection control. (See below) Poor clinical practices (dressings) and care planning would demonstrate that some staff are not satisfactorily trained to do their jobs. Refresher training is required for qualified staff, and care staff must be properly supported and supervised. There are no clear lines of accountability in the home, and staff have not received formal supervision which is an outstanding requirement. The qualified Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 18 staff have not been given adequate direction from the manager, and this affects the care staff who are not supported appropriately by the nursing staff. Staff need to have clarity of their roles and responsibilities to enable them to care for people effectively. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 38. The home is poorly managed and is not run in the best interests of service users. Staff are not appropriately supervised. The health, safety and welfare of service users is not adequately protected. EVIDENCE: The management in the home remains poor. Despite a generous timescale to improve the standards of care, record keeping and staff supervision and support, there has been very little improvement since the last inspection. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 20 Care plans have been audited and found to be lacking, yet this has not been followed up. Some care plans have improved and some information is kept up to date. There still needs to be a major improvement in the standard of these. Training records were not available at the last inspection. A lot of training has been arranged in response to the last inspection, which is good. No formal records have been maintained of these sessions or any plan to identify the staff with outstanding training needs. The environment is clearly not being monitored by the manager. Follow up visits since the last inspection found that items were still being unsafely stored, the home was not satisfactorily clean, and kitchen cupboards and fridges (in remote dining areas) are often dirty. There is little evidence that the manager spends much time working alongside staff to supervise and model good practice. Staff are still not effectively supervised. A programme of formal staff supervision has not been put in place. The manager has not held regular meetings with staff to support them and keep them motivated following what must have been a very demoralising inspection in March. Due to the poor progress made in most areas the management of the home is currently under review. The Operations Director is currently overseeing the management of the home. Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 x 3 x 4 1 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 x x x x 2 2 1 Score Standard No 7 8 9 10 11 Score 1 1 3 2 x Standard No 27 28 29 30 1 x 1 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 1 x 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 x 33 1 34 x 35 x 36 1 37 x 38 1 Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? 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 OP30 Regulation 18(1)(a) Requirement Qualified nursing staff are suitably trained to meet the assessed needs of residents with regard to tissue viability All staff receive training in caring for residents with dementia Key staff are suitably trained in care planning processes All staff are trained in acceptable standards of care practice especially in respect of dignity by supervision of staff is undertaken at least 6 times per year or as identified as required by the individual. Carpets must be cleaned or replaced by the 15 July 2005 and maintained in a good state of cleanliness in the future. 1. seek input and advice from the local tissue viability nurse 2.You are required by the 1 July 2005 to provide the Commission with a summary report of the skin conditions of all existing service users, their pressure sore risk assessment score and the type of any pressure relieving mattresses and cushions in use. Timescale for action 30 November 2005. 30 August 2005. 31 July 2005 31 August 2005 1 July 05 to commence 15 July 2005 1 July 2005 2. 3. 4. 5. OP30 OP7 OP30 OP10 OP36 18 (1) (a) 18 (1) (a) 18 (1) (a) 18 (2) (2) 6. OP19 23 (2) 7. OP8 12 13(1) 14 (1) Schedule 3 Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 23 3. You are required by the 1 July 2005 to introduce and utilise an accredited pressure sore risk assessment tool that is considered suitable by the tissue viability nurse. 4. You are required by the 1 July 2005 to ensure with the agreement of the tissue viability nurse, that the use of any pressure relieving equipment meets the individual needs of the service user. 5. You are required by the 1 July 2005 to identify wound care in care plans including use of photographs and measurements. Care plans must be reviewed regularly and audited to reflect the changing needs of residents at all times. Service users must be socially stimulated in accordance with their wishes and preferences. All concerns and complaints and action taken must be recorded. 8. OP7 15 (2) 1 July 2005 9. 10. OP12 OP16 16 (2) (m) 22 (3) 1 July 2005 1 July 2005 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 Good Practice Recommendations Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Balmoral Court B53-B03 S493 Balmoral Court V226386 070605 Stage 41.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!