Inspection on 13/01/06 for Cambridge Nursing and Residential Care Home (The)

This inspection was carried out on 13th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Cambridge Nursing and... 12/09/06

Cambridge Nursing and... 04/06/05

Cambridge Nursing and... 24/02/05

Cambridge Nursing and... 09/09/04

Cambridge Nursing and... 10/12/03

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Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Cambridge Nursing and Residential Care Home (The) 61 Cambridge Park Wanstead London E11 2PR Lead Inspector Ms Gwen Lording Announced Inspection 13th January 2006 10:00 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 Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 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. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cambridge Nursing and Residential Care Home (The) 61 Cambridge Park Wanstead London E11 2PR Address 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) 020 8989 1175 Cambridge Nursing Home Ltd Mr Abdool Rashid Mahmadkhan Ebrahimkhan Care Home 49 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (9), Old age, not falling within any other of places category (32), Physical disability (8) Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th June 2005 Brief Description of the Service: The Cambridge Nursing and Residential Care Home is a privately owned care home with nursing for 49 people. It is registered to provide nursing and personal care and accommodation for both younger adults (18 to 65) and older people (65 plus). It is situated in Wanstead close to local shops and other amenities, and is well served by public transport. The home is a large, detached property, set back from the main road with parking to the front, and an enclosed garden to the rear. The accommodation is spread over three floors, which are accessed by both stairs and lift. The ground floor houses the kitchen and laundry, together with 17 bedrooms, a lounge, dining room, and conservatory. The first floor has 23 bedrooms, a lounge and a dining room, and the second floor has 9 bedrooms and a lounge. There are toilets and bathrooms, with assisted baths, on each floor. Thirty-five of the bedrooms are single, with 28 having an ensuite toilet. There are also 7 double bedrooms, each with an ensuite toilet. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day, commenced at 9.30am and lasted six hours. Two inspectors undertook the inspection. This was the second statutory inspection visit in the inspection programme for 2005/2006. Three additional unannounced visits (8/08/05, 3/10/05 and 8/12/05) have been made since the last statutory inspection visit in June 2005, to undertake additional monitoring further to outstanding requirements from previous inspections. Letters sent to the registered person following those visits can be obtained from the CSCI office on request. In addition a Statutory Requirement Notice was issued on 25/10/05 for breach of Regulations in relation to the management of medication. At the additional visit undertaken on 8/12/05 the registered providers were able to evidence that the Statutory Requirement Notice had been complied with in full. Discussion took place with the home’s proprietors, one of which is the registered manager; catering, laundry and domestic staff; and several members of nursing and care staff. The Inspectors spoke to residents on all three floors, both in the lounges and residents who were in their bedrooms. In addition the relatives of residents visiting the home were interviewed to get their views and comments about the care in the home. Written feedback was also received from seven residents and five relatives of people using the service. A tour of the home was made and a number of staff and care records were looked at. This was the second statutory inspection visit in the inspection programme for 2005/2006. Over the course of these two visits and the additional visits, all key standards have now been assessed. The Inspector would like to thank the staff, residents’ and their relatives/ visitors for their input during the inspection. What the service does well: Those residents who were able to express a view, were very happy with the care they were receiving in the home. Several residents spoke very favourably about the nurses and care staff. During the inspection staff were seen to be providing good personal care and all residents appeared well groomed. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 6 There is a relaxed atmosphere in the home and residents appeared unhurried and are given sufficient time and support in their everyday activities. One resident commented: “My carer always makes me look nice. I have been in this home for 10 years. The staff look after me well” The relative of another resident commented: “The nurses and carers are very good. His mobility has improved a lot recently”. What has improved since the last inspection? What they could do better: New areas in which the home needs to improve were discussed and agreed with the registered providers and are detailed in this report. The home must provide a more varied programme of activities for those residents with a specialist need such as dementia. All complaints whether verbal or written must be recorded and include details of investigation, any action taken and the outcome for the complainant. Full details must be recorded when fire drills are undertaken. The temperature of all hot water outlets must be tested regularly and recorded to ensure safe water temperatures are being maintained. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 7 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. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Appropriate pre-admission assessments are carried out for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident. A total of eight files were examined. Two on the top floor, and three on both the first and ground floors. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents, where capable and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also on file. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 10 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): Standards 7, 8 and 10 Residents’ health, personal care and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. Standard 9 was not tested at this visit. However, following the Statutory Requirement Notice issued on 25/10/05 and the additional visit undertaken by the Pharmacy Inspector on 8/12/05, the registered providers were able to evidence that the Statutory Requirement Notice had been complied with in full. EVIDENCE: Standard 9 was not specifically tested on this visit, as there were no outstanding requirements in relation to Standard 9. At the time of the last additional visit, all of the outcome standards were assessed as met. This standard will be re-tested at a future inspection. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 11 Individual plans of care were available for each resident. The records of eight residents in total were examined. Two on the top floor, and three on both the first and ground floors. All the care plans seen were found to be generally detailed and comprehensive. There was evidence that care plans were being reviewed on a monthly basis and updated to reflect changing needs. The documentation/ health records relating to wound management, the management of a service user with diabetes and the management of a resident with an infected wound, were detailed and being adequately maintained. The records indicated that residents are seen by other health care professionals such as chiropodist, optician, dietician, dentist; specialist nurses, for example Tissue Viability and Respiratory Nurse and doctors. The home has engaged the services of a physiotherapist who visits the home once a week. As a result of previous concerns, the registered providers and the Commission have worked closely to ensure an improved quality of care for residents living in the home. The lead inspector is pleased to report that at this announced visit, it was evident that improvements to the standard of care planning have been maintained, the mobility of individual residents and the general well being of all residents had improved and residents appeared well groomed. One resident commented: “My carer always makes me look nice. I have been in this home for 10 years. The staff look after me well” The relative of another resident commented: “The nurses and carers are very good. His mobility has improved a lot recently. If something is wrong we speak to the staff and it’s done”. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 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): Standards 12, 14 and 15. There is a programme of activities available and the lifestyle within the home matches the expectations and preferences of individual residents. More consideration needs to be given to planning individual and small group activities which are suitable for those residents with specialist needs such as dementia to ensure that all residents have a sufficiently stimulating and varied choice of activities. The meals in the home are well-presented and individual preferences and specialist dietary needs are catered for. Residents on the dementia unit may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Standard 13 was not tested on this visit. However, evidence from the last inspection was that: • The home has an open policy in relation to visitors, who are free to visit in the lounges, conservatory or bedrooms. EVIDENCE: Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 13 The above standard was not specifically tested on this visit, as there were no outstanding requirements in relation to this standard. At the time of the last inspection, all of the outcome standards were assessed as met. This standard will be re-tested at a future inspection. One of the full time members of care staff is designated as the activity organiser from 10am to 4pm, three times a week. The home has undertaken a review of the activities programme and the activity organiser has taken into account the needs, preferences, expectations and capabilities of all residents in the home. There are a variety of small and large group activities and visits by outside entertainers. Several residents like listening to old time music and some of the younger adults enjoy playing board games such as scrabble, dominoes and draughts. Other residents were seen to be pursuing their own interests such as playing computer games, watching DVD’s and listening to music in their rooms. One resident says that he prefers “to spend time in his own room”. The activity organiser has made a lot of progress in persuading another resident, who previously spent all day in her room to meet with another resident with similar interests. They now spend time together in one of the small lounges during the day. One resident now attends Link Place a personal development centre for people with a physical/ sensory disability. There is still a limited programme of activities available for residents on the dementia unit. More consideration needs to be given to planning individual and small group activities which are suitable for those residents with a specialist need such as dementia to ensure that all residents have a sufficiently stimulating and varied choice of activities. A routine visit was made to the home on 4/01/06 by the Public Protection Department. They undertook an environmental health inspection of the kitchen premises and the report stated: “Very good levels of hygiene observed. Well done”. Pest control inspection report stated: “Good standard of hygiene – no pests”. A recommendation was made for two members of kitchen staff to undertake an update in food hygiene training and the registered providers are arranging this. The cooker has also been replaced. Meals are served in the lounges or residents may choose to eat in their rooms. More use is now being made of the separate dining rooms on the ground and first floors and offers residents more choice as to where they wish to eat. Staff are on hand to assist individuals with eating when necessary and staff where observed to be offering assistance appropriately and residents were not being rushed. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 All complaints made whether verbal or written must be recorded to ensure that any trends are identified and that residents and their relatives feel confident that their complaints and concerns are listened to and will be acted upon. Staff working in the home have received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure and the records inspected indicate the number of complaints received and includes details of investigation and any action taken. In discussion with the registered providers and inspection of the complaint record maintained, it was evident that only formal written, or serious complaints are being logged. The inspectors discussed with the registered providers as to what constituted a “complaint” to be logged. This must include verbal complaints via telephone or face to face, and expressions of concern or dissatisfaction with the service. Those relatives spoken to considered that the staff were always very responsive to any concerns or issues of dissatisfaction raised. One relative commented:”If something is wrong we speak to the staff and it’s done” There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. There is an ongoing programme of training in Adult Protection/ Abuse Awareness and this is extended to all staff working in the home including administrative and ancillary staff. Those staff spoken to during Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 15 the inspection were aware of the action to be taken if there were concerns about the welfare and safety of residents. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 16 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): Standards 19 & 20 More use is being made of all communal areas of the home. This means that residents can choose to sit in one of the large lounges or make use of smaller quieter areas, within the home. Whilst improvements have been made to the dementia unit, residents would benefit from further improvements in order to meet the specialist needs of people living with dementia. Standards 21, 23, 24 and 26 were not tested on this visit. However, evidence from the last inspection was that: • Residents live in a safe environment with access to comfortable indoor and outdoor communal facilities. There are sufficient suitable lavatories and washing facilities. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to these standards. At the time of the last Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 17 inspection, all of the outcome standards were assessed as met. These standards will be re-tested at a future inspection. The home has recently employed a full time maintenance person and there is an effective system in place for staff to report for any items requiring repair or attention. There is a book to record all maintenance issues however, not all items recorded were being “signed off” as having been actioned. The registered manager stated that the recordings noted by the inspector had been actioned. He will ensure that the new maintenance person is aware that all items recorded must be signed off and dated when actioned. Since the last inspection all the lounges in the home have been re-decorated and carpets replaced. There is an ongoing programme for the decoration of all bedrooms. More use is being made of the small lounges and separate dining rooms on both the ground and first floors. The programme for the ongoing replacement of divan beds with specialist nursing beds continues. A number of pressure relieving mattresses have also been purchased in preference to hiring this equipment when required. There are very few residents currently on the dementia unit who are independently mobile. However, as the ability of people with dementia to communicate with words decreases, the use of non-verbal cues and the environment is important in enabling them to cope better with daily life. The general environment on the dementia unit must reflect good practice on dementia care within care homes. Consideration must be given to utilising the existing design and layout of this unit to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. There are “memory boxes” fitted to each resident’s bedroom door that have some significance to them and assist in them locating their rooms. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 18 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): Standards 27 and 30 Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Resident’s benefit from a committed staff team who have the skills and training to meet their needs. EVIDENCE: In addition to qualified nurses and care staff the home employs catering, domestic, administrative and maintenance staff. The home now has a relatively stable workforce and staff were seen to be working as a team. Staff retention, particularly the retention of trained nurses, has had a positive impact upon the quality of the service. In discussion with both nurses and care staff it was evident that they understand, and are committed to and fully support the main aims and values of the home and good residential care. One of the senior nurses works as a supernumerary member of staff twice a week. The focus of her work is to look at clinical issues and develop consistent and good quality nursing and care skills. The registered providers have purchased resource materials from the Alzheimer’s Society to train all staff in caring for people living with dementia. It includes a workbook and video and this training is being cascaded to all staff working in the home. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 19 A more structured training programme has been developed and update mandatory training is being undertaken at the required intervals. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 20 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): Standards 31, 32, 35, 36, 37 and 38 The manager is a very experienced and well-qualified person. The lines of accountability within the home have improved and are robust enough to ensure that the manager is, at all times, fully appraised of any issues relating to the day to day management of the home, and of the specialist needs of residents. EVIDENCE: The manager has put in place a number of systems to improve and monitor the standard of care provided in the home. This includes regular staff meetings with the manager and their peers, formal written supervision, random and more formal auditing of care plans and related care documentation by the manager, and the supernumerary role of a senior nurse to address clinical issues and develop consistent practice. Improvements noted in previous unannounced visits have been sustained. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 21 Resident’s financial affairs are managed by their relatives/ representatives and the home holds no valuables or personal monies on resident’s behalf. A wide range of records were looked at, including fire safety, recording of water temperatures, gas and lift maintenance certificates. These records were detailed, up to date and accurate with the exception of the following, which were discussed with the manager: • Fire drills are held at regular intervals and the list of staff in attendance is recorded. The manager must ensure that details are recorded around time of day and any comments about how the drill was carried out with any problems encountered. Water temperatures are being checked and recorded but must include all hot water outlets and the action taken to adjust water temperatures where necessary. The person undertaking the temperatures was also unsure of the correct safe water temperatures to be maintained. • Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 22 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 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 2 2 Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 23 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 OP12 Regulation 16 Requirement The home must provide a more varied programme of activities for those residents with a specialist need such as dementia. All complaints made whether verbal or written must be recorded and include details of investigation, any action taken and the outcome for the complainant. The existing layout and design of the environment on the dementia unit must reflect good practice guidance on dementia care within care homes, to ensure that the specialist needs of residents on this unit are met. When fire drills are carried out the registered providers must ensure that the records include the time of day, and any comments about how the drill was carried out, and any problems encountered. The temperature of all hot water outlets must be tested regularly and recorded to ensure safe water temperatures are being DS0000037315.V272121.R01.S.doc Timescale for action 31/03/06 2 OP16 22 28/02/06 3 OP19 23 31/03/06 4 OP37OP38 17 & 23 28/02/06 5 OP37OP38 13,17 & 23 13/01/06 Cambridge Nursing and Residential Care Home (The) Version 5.0 Page 24 maintained. 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 OP15 Good Practice Recommendations Residents on the dementia unit may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times, to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Cambridge Nursing and Residential Care Home (The) DS0000037315.V272121.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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