Inspection on 20/07/05 for Court House Residential Home

This inspection was carried out on 20th July 2005.

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

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

Other inspections for this house

Court House Residential Home 20/01/10

Court House Residential Home 06/08/07

Court House Residential Home 23/05/06

Court House Residential Home 06/01/06

Court House Residential Home 11/03/05

Court House Residential Home 10/11/04

Court House Residential Home 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Court House Residential Home Station Road Cullompton Devon EX15 1BE Lead Inspector Louise Delacroix Unannounced 20 July 2005 9.45 am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Court House Residential Home Address Station Road Cullompton Devon EX15 1BE 01884 32510 01884 32510 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) Mrs Manjula Odedra No manager at present. Care Home 23 Category(ies) of OP Old age (23) registration, with number PD(E) Physical dis - over 65 (23) of places Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 March 2005 Brief Description of the Service: Court House is a large detached and extended property with attractive gardens. It was bought by the owner in January 2004.The home has twenty bedrooms, fifteen of which are en-suite. There is a through lift to the first floor, although the layout of this floor may make it unsuitable for people using a wheelchair or for those who have difficulty with steps. The owner has undertaken to re-decorate, re-carpet and refurbish the communal areas of the home, with the involvement of the residents in choosing colours and fabrics. Court House is a short walking distance from the town of Cullompton and has parking space for visitors. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and began in the morning. It lasted five and a half hours. A pharmacy inspector also took part in the inspection during which he concentrated on the storage and administration of medication. There is currently no manager in post, which has been the case since April 2005. Currently two experienced senior carers on a temporary basis are sharing the responsibility of running the home with the owner. The owner is trying to address this situation through the recruitment of a new manager. On arrival, four people were sitting in the two lounges while other people were in their rooms. During the day, a number of people said they generally preferred to stay in their own rooms but chose to come down for meals. Ten residents contributed to the inspection through individual discussion and one visitor. Five staff also took part in the inspection and were spoken to individually. As part of the inspection, staff files, care plans, fire records, quality assurance questionnaires and the staff rota were looked at. What the service does well: What has improved since the last inspection? The fire door in the second lounge now has a fire door guard fitted to stop it being wedged open, which had in the past caused a fire hazard. The fire door guard on the laundry room has now been removed to promote better fire safety. Appropriate locks have now been fitted on toilet and bathrooms to maintain the safety and dignity of residents. Work has taken place to repair a window with draughts and written confirmation has been given to confirm that two windows identified on the last inspection have been restricted. Care plans are now written soon after a resident’s move to the home and entries in the daily records has improved. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 EVIDENCE: These standards will be inspected on the next inspection. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 The care plans do not adequately provide staff with the information they need to satisfactorily meet residents’ needs. This includes a lack of guidance on preventative measures and a lack of recording to demonstrate that residents’ health needs are met. Most medicines are stored securely, but some medication practices have the potential to place residents at risk. EVIDENCE: Care plans are reviewed monthly by care staff and are now written soon after a resident has moved to the home. Some care plans have begun to be updated and a new care planning system has been bought but staff have not yet had time to implement them. Three care plans were inspected; the resident or their advocate had signed none of them. Communication needs are not identified. For example, there is no guidance for talking with a resident with hearing loss, who stated during discussion that they feel isolated because of their impairment. Daily records are more informative than on the previous inspection but do not provide an audit of care. For example, whether the district nurse had called and whether their advice had been followed. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 10 The care plans do not contain screening tools to assess the risk of pressure sores and nutritional screening. Staff commented that many of the residents are becoming frailer as they become older and less mobile. Residents’ weights have not been recorded since 2003. Gentle exercise classes took place between March and early July, which a resident said they enjoyed. Risk assessments did not contain all the identified risks. For example, pressure area care or the accessibility of the call bell for a resident who is frail, partially sighted, who had recently fallen and who spends a large amount of time in their own room. All staff administering medicines have received training on the safe handling of medicines and are assessed for competence before being allowed to administer medicine. Residents looking after their own medication all have individual lockable storage, and risk assessments have been carried out. Controlled Drugs are stored securely and a register is in use. The name of the drug is not at the top of each page. Several gaps were seen on the Medication Administration Record charts and hand written entries did not all have two signatures or dates of making the entry. Products with a reduced shelf life after opening did not have the date of opening or discard recorded on them. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 11 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) 12,15 The home does not provide an activity programme to meet the needs of residents. Generally residents are satisfied with the quality and quantity of meals, with staff aiming to address the concerns raised by those who are dissatisfied. EVIDENCE: The home does not have regular activities either arranged internally or by external people coming to the home. Many residents commented that the time dragged. One person said, ‘I just sit around’ and there’s not much to do. They said they used to enjoy playing games. Two people said they were grateful they were still fairly physically well and mentally able so that they could occupy themselves with reading but both said there was little to do, with one commenting that it was ‘boring’. Another person said that because they were still mentally able they were able to operate talking books and enjoyed listening to the radio. However, another person with sight loss said they felt ‘dead’ and were desperate to be ‘mentally stimulated’. Two other people said they just sat and were seen during the day snoozing in armchairs. Staff said they had tried to arrange activities but it was hard to balance with other duties. Neither of the activities that had been discussed at the last inspection in March 2005 had taken place. There are records of some gentle exercise classes but daily records do not evidence other activities taking place. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 12 The dining room was attractively furnished and decorated with fresh flowers on the tables. Three people out of seven expressed unhappiness about the food, two with the teatime meal. Compliant records and discussion with staff showed that complaints had tried to be resolved by asking for suggestions and increasing amounts of food. A member of staff acknowledged that portions had been increased for some of the male residents. One person found the breakfast monotonous but had not conveyed this to staff. Other people said that the food was ‘OK’, ‘very nice’ and that the lunchtime meal was ‘jolly good’. Drinks were seen being offered throughout the day. After the lunchtime meal, people were seen sitting and talking in a relaxed manner. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 13 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 Complaints when they are received are responded to but some residents are unclear who to go to with problems or concerns. EVIDENCE: A complaint was received by CSCI against the home but the outcome was that it was unsubstantiated. In the last year, two complaints have been recorded by the home. These have both been connected to the quality of the food. Staff were clear about action taken and the outcome was clearly recorded showing a commitment to address the complaint. A visitor said they were confident in the staff addressing problems and found that communication was good. However, as there is no manager currently in post a number of residents spoken to were unclear about who they would complain to if they had a problem. The current complaint procedure displayed in the hall still contains the previous manager’s name. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 14 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) 19,21,22,23,24,26 Major investment has been made to the home in the last year to improve the communal areas and some bedrooms, as well to the facilities. This investment has resulted in an attractive and clean home. However, the communal bathrooms have deteriorated in appearance. EVIDENCE: The provider is to be commended for her commitment to improving the maintenance of the home in such a short space of time. For example, improving the access to the lift, which a resident said was very helpful. The provider has purchased new lighting, armchairs, dining room chairs, a new call bell system, new carpets in communal areas, lockable storage cupboards, paper towel dispensers for all residents’ rooms and invested in the garden. Communal areas have been re-decorated and room 5. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 15 On previous inspections, the owner has said that longer-term plans include upgrading the decoration in the communal bathrooms, re-fitting the kitchen, fitting a shower/wet room and replacing some windows at the front of the building. However, the two of the communal bathrooms are now looking increasingly tired and one has mould marks on two walls. Appropriate locks have now been fitted. There are seventeen rooms with en suite facilities and four additional communal toilets. Seven bedrooms have en suite baths. Some rooms on the first floor do not have an en suite toilet and residents have to negotiate five steps to visit the nearest toilet or bathroom. Bedrooms have been personalised with residents’ own furniture and belongings. All bedrooms are carpeted. Lockable space for the resident’s use is now provided in their room. There are no double rooms. There are grab rails and raised toilet seats as appropriate. There is a fixed Arjo chair in the downstairs bathroom and two portable electric seats. Due to the different floor levels, parts of the first floor would not be suitable for residents who use a wheelchair or have difficulty in managing stairs. One resident with a visual impairment and who lived on the first floor has now moved to the ground floor. There is a new call bell system in every bedroom and communal room; this includes a facility to speak to the service user as well as physically answering their call. Two residents said that it was a much better system. However, a resident, who is partially sighted, fallen recently and is frail, was seen in their bedroom searching for a call bell. They were upset as they were disorientated and could not find the call bell, which had slipped behind the bed. Staff said it was always placed on the bed but this is across the room requiring the resident to get up by himself or herself to access it. Staff said that another resident who is partially sighted also had similar problems accessing a call bell when they were in the communal rooms. The inspection was unannounced and the home was found to be clean and odour free. A resident said the home was ‘very clean’ and other people agreed. A member of staff said that the home was well equipped and that carpets were regularly cleaned. The provider has invested in a new washing machine with a sluicing facility. Hand washing facilities are available in the laundry area. Liquid soap, gloves and paper towels were seen in residents’ rooms to prevent cross infection. Soiled laundry does not need to be carried through areas where food is prepared, stored, cooked or eaten. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 16 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) 27,29,30 The staff team have shown a commitment to maintaining staffing levels, although these currently operate at a minimal level, which has the potential to put residents at risk. Staff recruitment practices are poor with the required checks not taking place at the appropriate times, which has the potential to place residents at risk of harm or abuse. New care staff are well supervised by more experienced and trained members of staff and receive training appropriate to the needs of residents. EVIDENCE: On the morning of the unannounced inspection, there was a deputy cook an assistant and one of a team of two domestics working at the home. Plus a staff team of a senior and three care assistants. The senior said that the hours in the morning were to cover managerial duties. In the afternoon, there was two staff on duty from 2pm. The rota showed that two care staff were on due to work in the evening until 10pm with one waking night carer and one person sleeping in. A staff member confirmed that no one under the age of twentyone was left in charge of the home and the above staffing levels. There has been no increase in staffing levels to reflect an increase in residents. Currently one resident is very frail and needing care in bed awaiting a hospital admission. A staff member confirmed that this happened on the evening of the inspection. There are also a number of residents with sensory impairments. Since the last inspection, the numbers of residents have increased. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 17 Staffing levels on the day of the inspection were operating below the recommended levels of four in the afternoon, four in the evening and two awake night staff. Staff explained that they have covered any gaps in the staff rota whilst new staff are being recruited. They said that staffing levels had been maintained, although this has resulted in split shifts and extra hours. Residents’ perception was that there had been staff shortages but they felt that their care had not been directly affected, although some felt this may account for the lack of activities and staff having less time to stop and chat with them. Staff have shown a commitment to maintaining staffing levels at the home. Three staff files were looked at. None of them contained all of the required information. One file had only one written reference rather than the required two. A CRB check was in place but the person had started work before the date on the CRB and there was no evidence of a clear POVA check being received prior to the CRB. A second file did not contain either a POVA check or CRB. The employment history contained gaps. There was only one written reference in place and this had been received after the person had commenced employment. In the third file, there were two references but no photo and no form of identification, and no CRB. Two of the applicants had not signed their application forms. Three members of staff explained that they had received recent manual handling training. One person was a qualified first aider and another had received medication training. Two said they had recently had external fire training. Certificates on the wall showed that two seniors had attended infection control training and the three staff spoken to all demonstrated good knowledge of infection control, including an awareness of the needs of residents and precautions that need to be taken. All three spoke about shadowing experienced staff as part of their induction, which they had found a positive experience. They described their mentors as being approachable and able to give guidance. Staff files showed monitoring of care practices, which are signed off by an experienced member of staff. This is good practice. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 18 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) 31,32,33,34,38 The home does not have a manager but steps are being taken to address this, although some residents have been left feeling unsettled and uninvolved in the home. Some fire training for staff does not happen at the advised intervals, potentially putting residents at risk. Other fire checks are up to date, although two other safety checks require further attention. EVIDENCE: The home currently has no manager. Some residents and staff expressed concern about this situation. The owner has kept the CSCI up to date with how they are trying to address this through recruitment. Two senior members of staff are sharing the responsibility of overseeing the running of the home on a temporary basis. This cannot continue as a long-term option. Staff commented that they were approachable, despite the extra pressure on them, and had made some positive changes i.e. bringing in name badges for staff so they can be more easily identified. However, a few residents voiced their concerns about Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 19 the current lack of leadership, although they recognised that the owner visits on a weekly basis, and described how they felt ‘vulnerable’. However, one person felt that the home was ‘well run’. Since April, seven quality assurance questionnaires have been returned and were looked at during the inspection. These were sent to residents and representatives and could be anonymous. They all contained positive comments about the service provided at the home. The outcome has not been fed back to residents yet. Staff and residents said there is no longer a newsletter and a residents’ meeting has not taken place recently. Fire safety checks were inspected and were seen to be up to date. A discussion took place with a member of staff about a greater clarity of recording. Fire training records showed that an external fire trainer had visited the home in October 2004 and May 2005. The majority of staff have received their six monthly training but this had not happened for three members of staff. Bank staff do not receive up dating in their fire training to refresh their memory of the drill of the home. At the last inspection, it was requested that documentation be sent to show the date of the last electrical wiring check. This has not happened. A window restrictor in one room opened further than the HSE recommendation. The home is appropriately insured. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 20 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 3 1 3 3 x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 2 2 3 x x x 1 Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 21 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 9 Regulation 13(2) Requirement 1)The registered person must ensure that a record is made of all administrations of medicines to service users, and steps must be taken to monitor this recording. 2)The registered person must ensure that medicines are only used within their expiry dates. Timescale for action 20/9/05 2. 12 3. 22 4. 27 The registered person shall 1/11/05 consult service users about the programme of activities arranged by or on behalf of the care home.(Provide a regular programme of activities to meet the needs of all residents, including those people with a sensory impairment). 13(4) ( c ) The registered person shall 1/9/05 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated.(Accessible call bells must be provided to vulnerable residents). 18(1) (a) The registered person shall, 1/9/05 having regard to the size of the care and the number and needs of service users ensure that at all times suitably qualified, D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 22 16(2) Court House Residential Home 5. 29 19 Schedule 2 6. 38 23(4) competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not 1/9/05 employ a person to work at the care home unless he/she has obtained in respect of that person the information and documents specified in paragraphs 1to 9 of Schedule 2.(Staff files must contain all the required checks and information i.e two written references). The registered person shall after 1/9/05 consultation with the fire authority make arrangements ofr persons working at the care home to receive suitable training in fire prevention. 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 7 Good Practice Recommendations Residents or their advocates should sign care plans to evidence their agreement to the content. Risk assessments should the accessibility of call bells for frail and /or visually impaired residents.Communication needs should be addressed. Residents should be weighed, particularly if they are frail or their health has deteriorated. Nutritional screening should be introduced. A screening tool should be implemented to monitor tissue viability. 1)It is recommended that items not be refrigerated unless specifically required to do so by the manufacturer. 2)It is recommended that the competence of staff administering be regularly reviewed as part of the supervision process. 3)In order to protect the service users and the home it is recommended that for all hand-written entries the person making the entry signs and dates the entry and then a D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 23 2. 8 3. 9 Court House Residential Home second person checks and signs the entry. 4. 5. 6. 7. 8. 9. 10. 16 19 32 33 38 38 Information should be provided to residents about who to contact if they have a complaint or concern. For example, the complaints procedure should be updated. Two communal bathrooms should be redecorated. The owner should consider ways of involving residents in affecting the way in which the service is delivered. Outcomes of satisfaction questionnaires should be made available to residents, their representatives and the CSCI. The CSCI should be provided with a copy of the latest electrical wiring certificate. Window restrictors should be checked to ensure that they comply with the guidance of 4 inches by HSE. No recommendation made. Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Court House Residential Home D54 D06_s55579_courthouse_v231758 200705 stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!