CARE HOMES FOR OLDER PEOPLE
Cartmel Grange Nursing Home Allithwaite Road Grange Over Sands Cumbria LA11 7EL Lead Inspector
Marian Whittam Unannounced 09 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cartmel Grange Care Home Address Allithwaite Road Grange Over Sands Cumbria LA11 7EL 015395 32028 015395 35438 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brancaster Care Homes Ltd Vacant Care Home 60 Category(ies) of OP - Old Age registration, with number PD - Physical Disability of places Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 60 service users to include: up to 60 service users in the category of OP (Older people not falling within any other category) 2 named service users in the category of PD (Adults with physica disabilities) 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. This to be achieved by 1 September 2005. 3. The second floor of the premises must not be used to accommodate service users until refurbishment is completed and has been inspected by the Commission for Social Care Inspection. Date of last inspection 19th April 2005 Brief Description of the Service: Cartmel Grange Nursing Home is a care home on the on the edge of town of Grange-Over-Sands, within walking distance of the town and local amenities. The house is set in large gardens overlooking Morecambe Bay and has large gardens withs seating for residents. The Home has a lounge on each floor, and one large main dining room on the ground floor. There is a passenger lift to allow residents access to all three floors. The Home is registered to offer nursing care for up to 60 older people, including two named people under the age of 65 years. The home has three floors but was only the ground and first floor are in use at the time of the inspection; the top floor has just been extensively refurbished. Brancaster Care Homes Limited owns and runs the home and a new manager has recently been appointed. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 9th August 2005. The inspection focussed on how well the home was meeting the needs of the people living there and on outstanding requirements form previous inspections. This was assessed by speaking to residents, care staff and the manager, observing activity in the home, making a tour of the premises and reading a sample of the records which care homes are required to hold. The inspectors also inspected the third floor against the National Minimum Standards following its refurbishment to meet conditions of the home’s registration and before that floor can be used for residents. What the service does well: What has improved since the last inspection?
Due to the completion of the refurbishment of the second floor the environment has improved considerably for residents who will live on that floor. The refurbishment is of a good standard and rooms are bright and light
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 6 with plenty of room for residents and equipment. The bedrooms are also spacious and conducive to meeting the specific needs of residents. Repairs have been made to the lift floor, the roof repaired, the gutters cleaned and leaks and dampness are being dealt with to considerably improve the premises for those living there. Although there is still a lot of work to be done on the premises the state of repair has improved notably on catching up with maintenance work and stopping leaks and dampness in the building. Catering resources have improved along with the standard of cleanliness in the kitchen and some new equipment is in place with the rest on order. New hot trolleys make it easier to keep residents food hot and covered in transit. Maintenance and renovation planning is greatly improved from the previous inspections and have been fully budgeted for. The work is proceeding on schedule and work is being done to find solutions to heating and temperature control in all bedrooms. Audits had been done to improve forward planning for redecoration and refurbishment highlighting the work needed to improve bedrooms. Gardens have been tidied and are being used by residents and local people who come to play croquet. Although there were some issues with medication overall the standard has improved since the last inspection and recording is more consistent. What they could do better:
Whilst care plans were adequate the home could do better on ensuring that pre admission assessments were done thoroughly to make sure the home can fully meet the needs of people coming into the home. Some new residents had some specialised needs due to levels of dementia and the home must be able to demonstrate it can meet these. Substances that could be hazardous to the health and safety of some residents were observed in the unlocked sluice. These substances must be stored securely at all times. Used disposable razors were found in the ground floor bathroom and these must be disposed of appropriately. Water temperatures were found to be very hot in resident’s bedrooms and in bathrooms and posed a risk of scalding to residents and must be regulated to prevent this. Also some radiators were not covered over properly and this must be improved to protect residents. The new owners have identified what needs to be done to upgrade the bathrooms and this must be done as planned on the renovation schedule to improve the bathing facilities for residents. Some bedrooms had push down taps that were hard for residents to use and needing replacing. Medication omissions need to be signed for and say why the omission has occurred and staff must make sure that there is a continuous supply. The controlled drug register index could be made clearer to reduce the risk of error. Activities are being provided but not tailored to meet individual needs. A record of what was done and by whom needs to be kept to see if it is beneficial and
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 7 meets individual choice. An activities coordinator overseeing and planning should improve this. Although staff respected individual’s privacy the communal telephone facilities needed improving to give more privacy to residents using them. The home has recruited a new manager and they should be registered with the CSCI as soon as in post to improve management stability and consistency for residents and staff. 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. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 standard(s) 3 and 4 The standard of the pre admission assessments done by the home is not always sufficiently detailed to ensure individual needs will be met on admission. Without this there is no assurance that the needs of all residents can be met when they come into the home. EVIDENCE: Individual care plans are kept for each resident and inspection of the pre admission assessments for 7 residents showed one recently admitted resident did not have full pre admission assessment information recorded for them. More detailed and dated information is needed to assess if needs are to be properly met and managed when a resident comes in the home. This was evident as this resident had particular needs due to their confused mental state and the hospital assessment that EMI nursing was required. There were other residents who had been admitted, two in the last 4 months, where levels of confusion and dementia and the resources needed had not been considered prior to admission. This was despite individual records stating that one person had Alzheimer’s disease and another dementia. They were unable to give the inspectors a clear opinion of whether they felt their needs were being met in
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 10 the home. The home is not registered for residents diagnosed with dementia, however the new owners are applying for this and putting resources in place to demonstrate they can meet such needs. There was information provided by other agencies at admission on the files and there was evidence of the involvement of other services in care, where a need had been identified and stated in the plan. Despite some resident’s assessments lacking detailed information the inspector spoke with residents who were able to express an opinion and felt that their needs were being met, as they wanted. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 The staff are aware of resident’s needs and health and personal care needs were being identified and met. Medication practices were generally satisfactory however improvement to some record keeping was needed to safeguard residents and staff. Staff treat residents with respect and take appropriate actions to protect their privacy and dignity. EVIDENCE: All residents have an individual plan of care that was satisfactory, setting out health and personal care needs and appropriate risk assessments that had been reviewed. Healthcare needs were being identified and met and there was evidence of working with other healthcare agencies. Psychological health and changes for those with levels of dementia were not detailed to allow for monitoring and staff relied heavily on the daily report records for information. Discussions with staff and residents and observation of practices suggested that staff were aware of such needs because of their familiarity and knowledge of particular residents or because changes had been gradual. Residents spoken with said that they felt they were well cared for and that they were treated with respect and courtesy by staff. One resident told the
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 12 inspector that the home was “very congenial” and another that “the staff are all very friendly” and that they “had no problems with the staff ”. The communal telephones offered little privacy for residents using them. Residents said that they saw personnel from health care services in their own rooms when they needed to. There were medication policies and procedures in place and medication practices have improved to safeguard residents but practices for recording reasons for omissions must improve and ensuring sufficient stock at all times. The controlled drugs register was hard to follow and identify individual’s medication due to poor indexing and not carrying page numbers forward and needs to be clearer. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 standard(s) 12, 13,14 and 15 The home has a programme of activities and staff supported residents to make choices about their daily life. Food in the home offered variety and choice and catered for special dietary needs. EVIDENCE: The home had a programme of daily activities and organised social and musical events. The programme was on display. Resident’s hobbies and interests are recorded and how they liked to spend time. Some residents spoken with said they preferred not to join in and “did not feel that they had to”. One said that they did go to the musical events and found them “quite nostalgic”. One said that taking part in some activities was difficult because so many residents found it “hard to communicate” and if you “tried to have a chat and make a joke no one responded”. The activities on offer did not reflect individual capabilities of residents or give particular attention to those with levels of dementia. Residents said that they could come and go as they pleased and see who ever they wanted to. There was no information easily available on getting an advocate if a resident wanted one.
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 14 Activities were provided by the care staff and coordinated by them but records were not kept on who took part and if it was meeting resident’s expectations and capabilities. Residents spoken with made a variety of comments about the food in the home. One said that there was not always a lot of variety but there were “no bones or problems cutting it up” which was “probably just as well”. This resident said the food came to them hot and they had a choice and that the home catered for vegetarians. A resident said they enjoyed the vegetarian food even though they were not a vegetarian and had not tried “that sort of thing” before coming in. A new ‘hot cupboard’ has been bought to make sure that meals are kept hot whilst being delivered to residents in their rooms. The menus provided by the home showed a nutritious diet with lunch as their main meal. A planned programme of improvements is underway for the kitchen with new equipment on order and some already in place to provide a better service for residents. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 standard(s) 16 The home has a satisfactory complaints system that was displayed in the home. Residents felt confident that the staff would listen to them and act to deal with their concerns. EVIDENCE: The home has a complaints procedure and logged formal complaints for investigation and the procedure was available to residents. The complaints procedure was displayed on the home’s notice board. Residents spoken to said they were confident that the staff and owners would listen to them and deal with any complaints they made. Some residents were not able to express their opinion on this. No complaints had been made to the CSCI about the home. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24 and 25 Extensive redecoration and refurbishment of the top floor of the home has taken place. Maintenance and repairs are being done. There are a number of matters still outstanding on other areas of the environment that reduce comfort and safety for residents and do not provide a homely, well furnished and comfortable environment. EVIDENCE: Since the last inspection the home has been improving maintenance and planning, had been continuing refurbishment and repair as planned and budgeted for on its written schedules. Timescales for work to be done were in place and in some cases work was ahead of the written schedule supplied to the CSCI. Leaks form the roof had been attended to and damaged plasterwork was being repaired and the damage to the lift repaired. The second floor accommodation was inspected and has been refurbished to provide a good standard of accommodation for residents and this refurbishment and improvement is scheduled to continue throughout the home to improve the environment and facilities for residents.
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 17 The grounds were tidy and residents had seating, some residents said that they sat out there and some were seen doing this. There was sufficient communal space for the residents with a lounge on each floor and a large dining room on the ground floor. A number of areas of the home still needed upgrading and refurbishment. The ground and first floor still needed to be significantly improved to provide a well maintained, homely and comfortable environment for residents. • Heating in bedrooms could not be temperature controlled by residents. • There were areas on the first floor where wallpaper and paintwork still needed repairing or replacing. • The first floor lounge had wash hand basins in it that detracted from the domestic environment. • Bathing facilities on the lower floors still needed upgrading and some rooms had push down taps that have to be held down to use. • Refurbishment of bedrooms and replacement of carpets was still needed in bedrooms and communal areas on the two lower floors. The homes maintenance and renovation schedule showed that the planned improvements to address these outstanding matters were proceeding on schedule to improve the general state of repair of the entire home and this must be done. Equipment and adaptations were provided to help residents get around the home and a call bell system. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The home was adequately staffed with residents’ needs being met by staff who are trained in their roles. Staff training was established in the home and training provided to promote a competent staff group to care for residents. Satisfactory procedures are in place for recruiting staff to protect people living in the home. EVIDENCE: The rotas showed that the staffing levels were adequate and that there was a skill mix of staff on duty. NVQ and ongoing training and updates are provided and continuing to develop in the home. Staff spoken with said that there were opportunities for training and development and for registered nurses to update their practice. After a period of change and uncertainty in the home staff spoken with felt that things were more stable and staff morale good. Residents looked well cared for and those spoken with said that they were. Staff receive an induction to the home and to their role, and on going training covers relevant topics. Staff are supported with training such as NVQ level two in care. The recruitment and selection procedures of recently appointed staff had been followed and satisfactory checks in place but records needed to contain a recent photograph of staff members. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The home does not have a permanent manager in post and the management systems in the home are not clearly defined with no clear leadership resulting in some poor practices that do not promote the safety and welfare of residents. EVIDENCE: There is no registered manager in post; only acting managers and this has been the case for 12 months before the new owners took over. The new owners have recruited a new manager who is due to take up the post in September and must then apply for registration with the CSCI. Hot water temperatures tested in resident’s rooms and first floor bathrooms were very hot and over 43 degrees centigrade posing a risk of scalding. This must be addressed to protect residents and staff. As an interim measure to protect residents while this work is done thorough risk assessments must be done for this and an action plan developed to minimise risk. This must be forwarded to the CSCI.
Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 20 Hazardous cleaning, deodorising, sanitising, polishing and cleansing fluids were not stored securely and locked away when not in use. This must be attended to immediately to protect residents. Disposable razors were found left in a bathroom and these must be disposed of appropriately following use. Creams, lotions and powders were found in bathrooms and should be safely stored away when not in use. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3
COMPLAINTS AND PROTECTION 3 2 1 3 3 1 1 x STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x x x x 1 Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement A full needs assessment must be undertaken and recorded before admission to ensure residents needs can be met in the home before they are admitted. The home must demonstrate it can meet the specialised needs of residents coming into the home with dementia. Psychological health must be monitored and recorded according to individual need and preventative and restorative action taken. Reasons for the ommission of prescribed medication must be recorded on the MAR chart. This was to have been met by 1.6.05 A continuous supply of prescribed medication must be provided. This was to have been met by 26.4.05 Particular consideration must be given to providing opportunities for recreational activities for residents with levels of dementia. Bathing facilities on the ground and first floor must be upgraded Timescale for action 9.9.05 2. OP4 12 (1) 9.9.05 3. OP8 13 (1) 1.9.05 4. OP9 13 (2) 1.9.05 5. OP9 13 (2) 1.9.05 6. OP12 12 (4) 9.9.05 7. OP21 23 (2) 17.10.05
Page 23 Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 8. OP25 23 (2) 9. 10. 11. OP25 OP29 OP31 13 (4) 19(1) Schedule 2 8 and 9 12. 13. OP38 OP38 13 (4) 13(4) 14. OP38 13 (4) as stated in the renovation schedule timescales and push down taps replaced. Solutions must be implemented so that residents are able to control the heating in all their bedrooms. All radiators must be guarded or have guatenteed low temperature surfaces A recent photograph of persons working in the home must be kept as part of proof of identity. The home must at all times employ a suitably qualified and experienced manager who is registered with the CSCI. This was to have been met by 1.10.04 and then 31.1.05 and then 31.3.05. All hazardous substances and items must be securely stored and/or disposed of. Hot water temperatures must be regulated to provide water close to 43 degrees centigrade and design solutions found to control the risks from scalding. Risk assessments must be carried out on the provision of hot water in residents rooms to minimise risk whilst permenant solutions are found to temperature regulation. This to be forwarded to the CSCI. 11.11.05 30.8.05 30.8.05 1.9.05 10.8.05 6.9.05 12.8.05 15. 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 OP9 Good Practice Recommendations The indexing of the controlled drugs register should be
F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 24 Cartmel Grange Nursing Home 2. 3. 4. 5. 6. 7. 8. OP10 OP12 OP12 OP14 OP20 OP24 clear and easy to follow. Privacy should be improved for residents using the communal telephone. Records should be kept of the activities residents joined in and if they were meeting their expectations and capabilities. The home should consider employing a suitably trained activities coordinator to develop activities suited to individual needs and abilities. Information on how to contact and get the services of an advocate should be easily available for anyone that wants it in the home. Wash hand basins in the first floor lounge should be removed to provide a more homely environment. Doors to residents private accommodation should be fitted with locks suited to their capabilities. Cartmel Grange Nursing Home F58 F10 s64543 cartmel grange v235902 090805 ui stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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