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Inspection on 15/08/06 for Carlton Nursing Home

Also see our care home review for Carlton Nursing Home for more information

This inspection was carried out on 15th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team has remained fairly stable throughout a difficult period. This has allowed a degree of continuity of care for service users. The new manager has started to make a number of significant changes at the home. He has included the staff team in most of the decisions made. Regular staff meetings are held for qualified staff, the senior care and the whole staff team.The pre-admission assessment format is detailed and allows staff to determine that the placement is appropriate and within the categories on the registration certificate.

What has improved since the last inspection?

The home now has a fulltime manager in place. He is currently completing a 3month trial period. If the trial period is successful he will then be put forward for registration with CSCI. The refurbishment of the home is continuing. New curtains, bedding and carpets have been provided and a number of bedrooms and the communal areas have been redecorated. The dining area is due to be redecorated in the near future. The provider has employed an operations manager to undertake the Regulation 26 monthly visits to all their homes and provide the monthly reports. This has improved the link between the registered managers and the providers. A new care planning system has been introduced. The care records are now much better organised and information is easier to locate. There are some teething problems keeping information up to date, however the records do form the basis of an effective system. A system of recording and monitoring any complaints made has been introduced. The storage, recording and availability of service user personal allowances have improved. Adult protection training has been organised for approximately 50% of the staff team. Training for the remaining staff is being organised in the near future.

What the care home could do better:

Staff who are under 18 years old must not be employed to provide personal care. The care records must kept up to date. The assessments must be fully completed and any risk areas must be included in the service users care plan. An audit of the training undertaken by the staff team must be completed. Any gaps in the training must be filled and NVQ training must recommence for the care staff. Contact information for the local adult protection units must be provided for staff. The wardrobe in bedroom 4 must be secured. The hoist in the bathroom on the ground floor must be repositioned nearer to the end of the bath to improve access for service users. The statement of purpose and service user guide must be up dated. The service user guide must include the new complaints procedure. The policies and procedures must be organised and only the up to date information should be available to the staff team. The health and safety information should be prioritised. A staff supervision system must be put in place. The recruitment procedure must be improved to include confirmation of current NMC registration pin numbers for the qualified nurses. Lockable facilities must be provided in bathrooms for the safe storage of chemicals.

CARE HOMES FOR OLDER PEOPLE Carlton Nursing Home Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ Lead Inspector Michael Smithson Key Unannounced Inspection 15th August 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 Carlton Nursing Home DS0000001326.V303973.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. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Nursing Home Address Rawdon Cragg Woodlands Drive Rawdon Yorkshire LS19 6JZ 0113 2509633 P/F 0113 2509633 N/A 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) Mr John Lamb Mrs Helen Lamb Care Home with Nursing 29 Category(ies) of Dementia (29), Mental disorder, excluding registration, with number learning disability or dementia (29) of places Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 Years and Over Date of last inspection 24th January 2006 Brief Description of the Service: The Carlton Nursing Home is a converted Victorian building situated in a residential area on the borders of Leeds and Bradford. Personal care with nursing is provided for older people with dementia or mental disorder. Both men and women are catered for in this 29 bedded home which can provide single bedrooms as well as shared accommodation. The home is set in large grounds, which are not accessible to service users without close supervision. The area is purely residential and as such there are no convenient local shops or other amenities. The home is not accessible by public transport. The current fees are £520 per week. Fees do not include personal newspapers and magazines, hair dressing, private chiropody and some outings. (This information was provided by the manager.) Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) will be inspecting homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. All regulated services will have at least one key inspection between April 2006 and June 2007. This is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using it. All the key National Minimum Standards are assessed and this forms the evidence of the outcomes experienced by service users. On occasions it may be necessary to carry out additional site visits, some visits may focus on a specific area and are known as random inspections. This was the first inspection of this home during the 2006 to 2007 period. The visit was unannounced and completed by 1 inspector. The inspection was undertaken over 1 full day. Feedback was provided for the manager at the end of the inspection. Copies of reports for this and previous inspections are available either from the home or can be found on the CSCI website. A total of 3 service users were case tracked. Case tracking is the method used to assess whether residents receive good quality care that meets their individual needs. The key standards from the Care Homes for Older People National Minimum Standards were assessed as well as other relevant standards. What the service does well: The staff team has remained fairly stable throughout a difficult period. This has allowed a degree of continuity of care for service users. The new manager has started to make a number of significant changes at the home. He has included the staff team in most of the decisions made. Regular staff meetings are held for qualified staff, the senior care and the whole staff team. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 6 The pre-admission assessment format is detailed and allows staff to determine that the placement is appropriate and within the categories on the registration certificate. What has improved since the last inspection? What they could do better: Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 7 Staff who are under 18 years old must not be employed to provide personal care. The care records must kept up to date. The assessments must be fully completed and any risk areas must be included in the service users care plan. An audit of the training undertaken by the staff team must be completed. Any gaps in the training must be filled and NVQ training must recommence for the care staff. Contact information for the local adult protection units must be provided for staff. The wardrobe in bedroom 4 must be secured. The hoist in the bathroom on the ground floor must be repositioned nearer to the end of the bath to improve access for service users. The statement of purpose and service user guide must be up dated. The service user guide must include the new complaints procedure. The policies and procedures must be organised and only the up to date information should be available to the staff team. The health and safety information should be prioritised. A staff supervision system must be put in place. The recruitment procedure must be improved to include confirmation of current NMC registration pin numbers for the qualified nurses. Lockable facilities must be provided in bathrooms for the safe storage of chemicals. 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. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The admission procedure includes a detailed pre-admission process, which confirms that the home can meet the needs of the prospective service users. The statement of purpose and service user guide is not up to date with current information about the home. EVIDENCE: The statement of purpose and service user guide still need to be up dated to reflect the recent changes at the home. This is outstanding from the last inspection. The records for the last 2 admissions to the home were checked. Both had preadmission assessments completed by the staff at the home and included assessments completed by the placing agents. The assessments included Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 10 information regarding a diagnosis of Dementia and helped to determine that the home can meet their needs. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The new care planning system is an improvement on the old care records. If the health care assessments and care plans are kept up to date they should be an effective tool for the staff. EVIDENCE: The manager has recently introduced a new care planning format at the home. The records are currently being transferred to the new system. The new format includes all the information required and is easily accessible to the staff team. The case records for 2 service users were checked. Both were using the new format. The information provided a reasonable picture of their needs. Preadmission information, assessments and care plans were available. The assessment information for the service users did contain some gaps, specifically around social care issues and a lack of completed scoring for risk assessments. The care plans were informative, however they did not fully Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 12 match issues highlighted in the assessments. Examples of this were a service user who had become doubly incontinent over a 4-week period. This was not included in the care plan. A service user who was assessed as high risk on the nutritional assessment. Again this was not included in the care plan and no record of the service users weight was available. The feedback from staff regarding the new care planning format was positive. The qualified member of staff and the senior care, both said they had been involved in the consultation about the new care planning format. They felt once all the information was transferred and one or two teething problems were sorted out it would be a good system. Health care information is recorded, this includes, manual handling, pressure care and nutrition. The information does need to be kept up to date to make it effective. One service user is a diabetic and requires regular blood sugar level checks. It was noted there were 2 different systems of recording this information. This made it confusing to know which was accurate and up to date. One system for recording this information must be agreed. A spot check of the medication was undertaken and it was found to be in order. A monitored dosage system is being used and accredited training is being organised for the staff. Medication administration is the responsibility of the qualified nurses, however the care staff often assist them. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using the available evidence. A reasonable range of activities is offered and service users are able to make some choices in there daily lives. The menus and quality of the food meets the needs of the service users. EVIDENCE: During discussions with staff it was evident that they see providing service users with a range of activities as part of their daily routines. The afternoon and the early evening is the time when most activities take place. These tend to include, sing a longs, quizzes and games. Some service users do like to walk in the grounds and a small number go out shopping with staff and relatives. An activity organiser visits the home every 2 weeks to provide a range of different activities. The informed choices service users can make are limited by their condition. However service users are free to use all the communal areas and can spend time with whom they wish. The service users do not normally have access to the bedrooms on the first floor. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 14 The relationship between staff and service users was observed to be positive and friendly. Any potential conflict between service users was quickly diffused and staff appeared to be fairly skilled at putting service users at ease. The menus are organised on a 4-week basis. They are produced following discussions with the staff and from what meals prove successful with service users. The cook is kept informed of any special diets required. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The complaints procedure and a programme of adult protection training have been put in place, which will provide greater protection for service users. EVIDENCE: The complaints procedure has recently been up dated. The information must also be included in the service user guide. No complaints had been made since the last inspection. A procedure for dealing with complaints is available. Some information regarding adult protection is available, however the information needs to be improved. Local contact information for adult protection units and other agencies must be more accessible to staff. Training has been provided for approximately 50 of the staff team and arrangements for training for the remainder are being organised. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 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): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The refurbishment of the premises has improved the environment for service users. EVIDENCE: A tour of the environment took place during the inspection. The refurbishment of the home is continuing. A number of the bedrooms have been completed and new bedding and curtains have been provided in others. The standard of decoration of the communal areas, corridors and landings has improved. The dining area is due to be redecorated the week after this inspection took place. The conservatory area will then be the only area outstanding. The seating in the lounge has been reorganised to provide more intimate seating arrangements. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 17 The bedrooms are a mix of single and double rooms with a small number of en-suite facilities provided. The majority of the wardrobes have been secured since it was highlighted at the last inspection. This only one still requiring securing was Bedroom 4. The bathrooms and toilets are maintained to a reasonable standard of decoration and hygiene. However a number were noted to contain chemicals, which may be hazardous. Lockable facilities must be provided if chemicals are to continue to be stored in these areas. The hoist in the ground floor bathroom was sited too much towards the middle of the bath making it difficult for service users to use. It must be refitted nearer to the end of the bath to allow better and safer access. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The staff numbers are adequate, however the staff training records do not provide adequate information of the training completed. The levels of NVQ training for staff need to be improved. The recruitment records do not provide adequate confirmation of NMC pin number checks for all qualified nursing staff. EVIDENCE: The staff team has remained fairly stable, which has provided a degree of continuity over the last 2 years. The home is fully staffed and has a pool of bank nurses who can cover any shortfalls in the nursing staff. The recruitment records were checked for the last 2 staff employed. One was a qualified nurse and one a care assistant. All the required information was provided for the care assistant. The qualified member of staff had all the information except for evidence of confirmation of the NMC pin number. During discussions with staff it was noted that one care assistant was due to turn 18 years old the weekend after the inspection took place. The previous manager had recruited the member of staff. The new manger was not aware of Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 19 the care assistant’s age. However he was reminded that young persons under the age of 18 years old must not provide personal care. The manager is currently undertaking a full audit of the training completed by the staff team. Once completed training will be organised to bring all staff up to date. Some training has been provided around adult protection, infection control and dementia awareness. The NVQ training for care staff has been put on hold due to problems with the training provider, however once a new NVQ training provider has been found it will resume. Discussions took place with 3 staff that work at different levels and have different responsibilities. Two were experienced workers and had a good level of experience and training. The third member of staff was fairly new and still needed to complete a proper induction. All the staff felt that staff morale had improved of late and they are regularly consulted regarding planed changes. A new key worker system is being put in place which they feel will benefit the individual care of service users. The staff demonstrated a good knowledge of the needs of service users and the daily routines. Their responsibilities were for providing care for service users, however a small amount of cleaning is undertaken to assist the domestic staff. The daily routines do allow for staff to spend time with service users, they said many service users like their nails and hair doing and to go out for a walk in the local area. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 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): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using the available evidence. The home does not have a registered manager. The proposed manager has made a number of improvements and has consulted well with the staff team. The policies and procedures could be improved by using just one up to date system. EVIDENCE: The current manager is new to the service and still working a 3-month trial period. The trial period will be completed approximately 2 weeks after the inspection took place. Discussions took place with the manager and the provider to remind them that if the trial period is successful an application for registration must be completed and returned to CSCI. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 21 The manager is making a number of changes at the home and more are planed, however he is aware that these may take some time to implement and be fully effective. He is keeping the staff fully involved in the changes and arranges regular meetings with the qualified nurses and the remaining staff team. A programme of staff appraisal and individual supervision is being organised and should commence in the near future. Money is held on behalf of service users using a general float system and individual safe keeping for 6 service users. A spot check of the monies held for a service user was undertaken and was well recorded. Health and safety policies and procedures are available, however there was some confusion as to which are current and which should be available for the staff. The manager must decide which information is to be used and make it available. The staff should then sign the information to confirm they have read it. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 2 3 Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation Reg 4 Reg 5 Requirement The statement of purpose and service user guide must be reviewed and up dated. (Previous timescale of 01/05/06 has not been met) 2. OP7 Reg 15 The care plans must kept up to and related issues identified in the health care assessments 01/10/06 Timescale for action 01/11/06 3. OP8 Reg 11 The health care and risk 01/10/06 assessments must kept up to date and the scoring system fully completed. Adult protection training must be provided for all staff. (Previous timescale of 01/05/06 has not been fully met) Contact information for the local adult protection units must provided for the staff. 01/12/06 4. OP18 Reg 13(6) 5. OP19 Reg 13(4) Lockable facilities must be provided in bathrooms for the safe storage of chemicals. DS0000001326.V303973.R01.S.doc 01/10/06 Carlton Nursing Home Version 5.2 Page 24 Reg 13(4) The wardrobe in Bedroom 4 must be secured 6. OP19 Reg 13(5) The hoist in the bathroom on the ground floor must be repositioned to the end of the bath to improve access. Staff under the age of 18 must not be employed to provide personal care. 01/11/06 7. OP28 Reg 19 01/10/06 8. OP29 Reg 19 All the required recruitment 01/10/06 checks for the qualified nurses must be completed. This includes confirmation of the NMC registration pin number. The staff training audit must be completed and any training required undertaken. (Previous timescale of 01/05/06 has not been met) Local adult protection unit contact information must be available to staff. 01/12/06 9. OP30 Reg 18 10. OP30 Reg 18 50 of the care staff must achieve NVQ level 2. A new registered manager must be recruited. (Previous timescale of 01/05/06 has not been met) 31/12/06 11. OP31 Reg 8 01/11/06 12. OP36 Reg 21 A staff supervision system must be implemented. (Previous timescale of 01/06/06 has not been met) 01/11/06 Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 25 13. OP37 Reg 10 The policies and procedures must be reviewed and up dated where required. Staff must be made aware of the information contained in the policies and procedures. (Previous timescale of 01/06/06 has not been met) 01/11/06 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 OP19 Good Practice Recommendations The windows in the dinning room are scratched and unsightly. The providers should consider replacing them. Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Carlton Nursing Home DS0000001326.V303973.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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