Inspection on 15/04/08 for Brocklehurst Nursing Home

This inspection was carried out on 15th April 2008.

CSCI found this care home to be providing an Good 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

Brocklehurst Nursing Home 17/04/07

Brocklehurst Nursing Home 31/10/06

Brocklehurst Nursing Home 11/02/06

Brocklehurst Nursing Home 04/08/05

Brocklehurst Nursing Home 09/01/05

Brocklehurst Nursing Home 15/07/04

Brocklehurst Nursing Home 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Brocklehurst Nursing Home 65 Cavendish Road Withington Manchester M20 1JG Lead Inspector Geraldine Blow Unannounced Inspection 15th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brocklehurst Nursing Home Address 65 Cavendish Road Withington Manchester M20 1JG 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) 0161 448 1776 0161 434 3795 www.anchor.org.uk Anchor Trust Ms Cathryn Todd Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Brocklehurst Nursing Home DS0000021635.V361815.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 to service users of the following gender: Either (aged 60 years or over) whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 41 17th April 2007 Date of last inspection Brief Description of the Service: Brocklehurst Nursing Home is a purpose built care home of 41 beds providing care for people over the age of 60 years. The home is on two floors with a passenger lift between the two floors. Accommodation is provided in 31 single and 5 double en-suite rooms with a variety of communal space for residents to use. The home is situated in West Didsbury on the site of the old Withington Hospital. The home is situated on a reasonably busy road used by local traffic. The centre of West Didsbury is about a quarter of a mile away. Main roads giving ready access to Manchester and the motorway network are close by. The charges for fees range from £444.40 to £710 per week. There are additional charges for magazines, papers and hairdressing. Brocklehurst Nursing Home DS0000021635.V361815.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 2 star. This means the people who use this service experience good quality outcomes. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 17 April 2007 and supporting information received in Annual Quality Assurance Assessment (AQAA) submitted by the manager prior to this visit. Residents, staff and relatives were sent comment cards. Three resident comment cards, 8 staff comment cards and 2 relative comment cards were received by CSCI and some of their comments are included in the body of the report. This visit was unannounced and forms part of the overall inspection process and took place on 15 April 2008 over the course of 7.5 hours. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS). This report is an overview of what the inspector found during the inspection. As part of the visit we (the commission) spent time examining relevant documents and files. We also spent time talking with several people living at the home, some members of staff, a visitor to the home and a tour of the building was undertaken. What the service does well: Brocklehurst Nursing Home offers a clean and pleasant environment for the people who live there. All residents and a visitor spoken to confirmed that the home was always clean and tidy. All returned resident comment cards stated that the home was always clean and fresh. As reported in the last inspection report the home continues to do a preassessment of needs before a resident is admitted to the home to make sure that it can meet that person’s needs. All returned resident comment cards said they had received enough information about the home before moving in. There are a number of activities provided and on the day of this visit residents were seen be enjoying a singer in the main lounge. A visitor spoken to said that the activities were very good and help keep her mother stimulated. One resident said she had really enjoyed the afternoon entertainment. The comments received from the resident comment cards stated that activities are arranged by the home and one comment was “they are usually very good”. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 6 Residents spoken to said that that staff were “very kind” and they were “well looked after”. One relative comment card stated, “ I have no complaints only praise”. Staff were observed to treat residents with respect and were attentive to individual needs. People spoken to all confirmed that choices are available at each mealtime and any reasonable alternative to the menu can be provided. Drinks and snacks are provided on request. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to make sure that people’s needs are assessed before admission. EVIDENCE: Prospective residents are able to visit the home before making a decision to move in. One visitor confirmed that she did visit the home before making a decision about admission, as her mother was unable to visit. All resident comment cards indicated that they received enough information about the home before moving in. As stated in previous reports a documented pre-admission assessment form is in use to ensure all residents’ assessed needs can be met prior to admission. Residents placed by the local authority had a care manager’s assessment of needs or a funded nurse assessment. Brocklehurst does not provide an intermediate care service. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, social and personal care needs of residents were being met. EVIDENCE: A sample of care plans were seen. Since the last inspection visit new documentation had been implemented. The new care plans were much improved and were organised and easy for staff to use. Some staff spoken to said that they liked the new system as it gave all the information they needed to know about a resident. Generally the care plans seen were person centred and included detailed and individualised information about how those care needs are to be met. For example one care plan contained details of what the resident could do for himself to assist in his personal hygiene and contained details of what he liked for breakfast. It was encouraging that the plans of care contained detailed Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 10 instructions of how to mobilise the resident or which hoist and sling should be used. Appropriate risk assessments had been included, which included a risk assessment for the use of bed rails and the use of wheelchairs. However one of the risk assessments seen relating to the use of a wheelchair had not been fully completed. A daily evaluation is recorded against each individual plan of care, which is seen as god practice. However many of the entries were vague and did not accurately reflect the care given. For example entries included “all assistance given” and “had all personal hygiene needs”. In addition one plan of care stated that the resident was to have alternate days in bed. The daily evaluation did not evidence which days were spent in bed. The daily evaluation notes should include good quality, useful information that accurately reflects the care given. A dietician spoken to during the inspection said that in some cases staff were not always accurately recording the number of water flushes for residents who were PEG fed. In addition a carer spoken to confirmed that one resident had a very poor appetite and was not eating very much but they were not keeping a record of food or drink taken. In order to evidence that residents are adequately hydrated and receiving adequate nutrition an accurate record must be kept of all food and fluids provided. Each resident was registered with a General Practitioner and evidence was seen of referrals to other specialised services according to individual assessed needs, for example, the Tissue Viability Nurse and the Dietician. The returned resident comment cards stated that staff do listen and act on what is said. As detailed in the last inspection report all 4 drug trolleys continued to be stored, secured to the wall, in residents’ bathrooms. This is not an appropriate storage area as it could compromise resident’s privacy and dignity if the trolley needs to be accessed while a resident is in the bath or using the toilet. Also, some medicines may need to be stored in such a way that the products themselves are not damaged by heat or dampness. Therefore those medicines must not be stored in damp or steamy places such as bathrooms. To ensure that medication is stored appropriately and the privacy and dignity of residents is protected, the drug trolleys must not be stored in residents’ bathrooms. The records regarding medication were examined. There were some inconsistencies in the quality of the records. In some instances creams had been prescribed as “apply to affected area” and “use 3 times a day to affected areas”. There were no instructions as to where the affected area was. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 11 Although the nurse could clearly describe where the cream was to be applied the GP’s instructions should be fully recorded. On the whole there were no gaps in the recording of medication, however it was noted in one file that prescribed wound care dressings were not being signed for. The nurse said that the dressings were signed for in the care pans. It is therefore recommended that the medication record sheet cross reference to where the prescribed dressings are being signed for. A tablet count was undertaken on boxed medication for 4 residents. Three counts were accurate, however 1 count was 4 tablets over. This was discussed with the nurse in charge and reported to the manager the day after the inspection visit. As detailed in the last inspection report the nurse in charge confirmed that a prescribed drink thickener, which is used to thicken drinks and soups for residents with a swallowing impairment continues to be signed for on the medication record sheet. This did not accurately reflect the number of thickened fluids given to the resident. It has therefore been recommended again in this report that the medication record sheet cross reference to where there is a signed accurate recording of thickened fluids given to residents. It was of concern that one record sheet detailed that the resident was allergic to soap but this information had not been included in the residents care plan. To ensure that all residents care needs are fully met it is recommended that the individual plans of care include all identified care needs. We saw staff interacting with residents and from talking to residents it appears that the privacy and dignity of the residents is promoted and they are encouraged to exercise choice in their daily lives. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are provided and residents are able to maintain contact with family and friends. Residents have a choice of varied, well-balanced meals. EVIDENCE: A ‘recreation team’ from Withington Community Hospital continues to go into the home to provide a variety of activities. The planned activities are on display in the home and on the day of this visit residents and visitors were seen enjoying a singer. All people spoken to said that the activities were very good and stimulating. One visitor said that in the past her mother had really enjoyed day trips out and it would be nice if there could be a few more of those. All people spoken to confirmed that the home facilitated open visiting and the visitor spoken to said that she is always made to feel welcome and staff keep her informed of any issues relating to her mother. Based on direct observation, the residents and their visitors benefit from relaxed informal contact with the staff. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 13 From speaking to residents, a visitor and staff it appeared that residents are encouraged to exercise choice and control over their lives and that residents are encouraged to bring personal possessions into the home. A weekly menu is on display in the main reception and meals were varied and fresh vegetables are provided daily. A choice is available at each mealtime and everybody spoken to confirmed that any reasonable alternative to the menu could be provided. Snacks and drinks are provided on request. The dining area is clean, bright and inviting. On the ground floor meals are served from a heated trolley and plated as requested by the resident. For residents on the first floor meals arrive via a ‘dumb waiter’ and the food is already plated. Staff confirmed that if residents do not want everything on the plate staff will remove the unwanted item. To promote resident choice it is recommended that all meals are served direct from a heated trolley so that all residents can request what they want to eat rather than some meals being pre plated. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged and supported to raise their concerns and complaints and there are policies, procedures and systems in place to protect residents from abuse. EVIDENCE: There is a complaint procedure, which was seen on display in the main reception. The administrators confirmed that all residents, on admission, are given a booklet on how to make a complaint and the residents and the visitor spoken to knew how to make a compliant. All returned resident comment cards also stated that they knew how to make a complaint and know who to speak to if they are not happy. There were policies and procedures, seen at the last inspection visit, in relation to the protection of adults from abuse and the nurse in charge confirmed that these were still in place. Sine the last inspection the home has appropriately responded to allegations made. Evidence was seen that some staff had received Safeguarding Adults Training and staff spoken to confirmed this. It is recommended that the remaining staff receive appropriate training and a competency assessment is completed following that training. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are safe and the home’s environment, including the standard of hygiene, was well maintained both internally and externally. EVIDENCE: There are a number of communal areas, a hairdresser’s room and an enclosed garden area. As part of this visit a tour of the building was undertaken which included all the communal areas and several bedrooms. The home was clean, tidy, well decorated and furnished to a high standard. There were no offensive odours and residents, staff and a visitor confirmed that the cleanliness of the home was always of a high standard. The received comment cards indicated that the home was clean and fresh and comments and those residents spoken to said that they were very happy with their rooms. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 16 Residents were seen relaxing after lunch in the small lounges either reading or watching television or in the main lounge enjoying the afternoon’s entertainment. There are small kitchens on each floor so that residents and or their visitors can make a drink. We saw supplies of protective gloves and aprons were available to staff. Since the last inspection it was noted that coat hooks had been provided to store hoist slings. However it was noted that several slings were stored on the same hook creating a risk of cross infection. To prevent the risk of cross infection it is recommended that only one hoist sling is hung on each individual hook. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff was sufficient to meet the needs of the residents accommodated EVIDENCE: From direct observation and discussions with staff it appeared that there were sufficient staff to meet the needs of the number of residents accommodated. The completed AQAA stated that 29 care staff are employed. Twelve care staff have successfully completed NVQ Level 2 or above and a further 4 members of staff are currently working towards NVQ Level 2 or above. The recruitment records were looked at for three members of staff. They contained the required documentation as required by Schedule 2 of The Care Homes Regulations 2001. It was noted in all 3 files that no notes had been taken during the interview process. To help evidence that the person is fit to work in the home it is recommended that interview notes are taken and kept on file. Staff files contained photocopied documents, for example passports and certificates. However there was no evidence that the original documents had Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 18 been seen. It is recommended that that all photocopied documents are signed to indicate that the original had been seen. The administrator confirmed that there is a computerised system to identify when nurse PIN numbers are due for renewal and she regularly checks the NMC for nurse suspension, PIN renewals or exclusion from the register. The nurse in charge confirmed that all new members of staff must attend an induction day and complete an induction training booklet that has been developed by Anchor. Evidence was seen of the booklet on 1 of the staff files inspected. The majority of the staff comment cards indicated that induction covered everything that was needed to do their job. However 2 comment cards stated that it only partly covered what was needed and one comment was “I feel I didn’t get a proper induction”. Training records were seen of ongoing training. As previously mentioned there were some gaps in training attended with particular reference to Safeguarding Adults Training. One comment from a relative comment card was “some staff do not appear to be well trained in administrating insulin injections, I feel her diabetics could be monitored better” and in addition one resident comment card stated “I think they should need to know more diabetics”. All staff spoken to confirmed that training was available and staff were encouraged and supported to attend. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems and procedures were in place to safeguard and protect residents’ financial interests and the home was seen to promote the health, safety and welfare of the residents and staff. EVIDENCE: The manager is registered with CSCI and is supported through the organisation by the operations director. She has the skills, experience and qualifications to manage the home. Feedback from care staff was positive about the support they received from the home manger and the unit managers. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 20 Evidence was seen that the systems in place safeguarded resident’s financial interests. The nurse in charge and staff spoken to confirmed that supervision on a 1:1 basis and small group sessions are taking place The administrators confirmed that resident and relative meetings are held and minutes are taken. Some completed quality assurance questionnaires were seen. The comments were positive for example “ “it is a very good home, most staff are wonderful” and “food is very good, very clean, no smell.” The information provided in the AQAA demonstrated that the home’s maintenance certificates and records were up to date. Appropriate fire safety checks are carried out on a regular basis. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 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 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 3 9 2 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 3 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 3 X 3 X 3 X X 3 Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 17 2 Schedule Requirement In order to evidence that residents are adequately hydrated and receiving adequate nutrition a record must be kept of all food and fluids provided. To ensure that medication is stored appropriately and the privacy and dignity of residents is protected the drug trolleys must not be stored in residents’ bathrooms. Timescale for action 16/04/08 2. OP9 12 (4) (a) 13 (2) 30/05/08 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 1. The daily evaluation notes should be reviewed to make sure that good quality, useful information is being recorded and it accurately reflects the care given. 2. To ensure that all residents care needs are fully met it is recommended that the individual plans of care include all identified care needs. Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 23 2. OP9 1. It is recommended that the MAR should clearly cross reference to where there is a signed accurate recording of thickened fluids given to residents. 2. The GP’s instructions should be clearly recorded to ensure that medication is given as intended, with particular reference to topical creams. 3. It is recommended that the MAR sheet cross reference to where prescribed dressings are being signed for 3. OP15 To promote resident choice it is recommended that meals for residents on the first floor are served direct from a heated trolley, as requested by the resident. It is recommended that Safeguarding Adult Training is provided for all staff who have not yet attended and a competency assessment is completed following the training. To prevent the risk of cross infection it is recommended that only one hoist sling is hung on each individual hook. 1. It is recommended that that all photocopied documents are signed to indicate that the original had been seen. 2. To help evidence that the person is fit to work in the home it is recommended that interview notes are taken and kept on file. 4. OP18 5. 6. OP26 OP29 Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brocklehurst Nursing Home DS0000021635.V361815.R01.S.doc Version 5.2 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. 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