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Inspection on 18/04/07 for Courtenay House Nursing & Residential Home

Also see our care home review for Courtenay House Nursing & Residential Home for more information

This inspection was carried out on 18th April 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 relate well to the residents and have a good understanding of their needs. The community health care team work well with the staff at the Home to offer a good health care service. The Home offers a food that is enjoyed by the residents. The Manager will act quickly over any concerns/complaints and ensure the outcome is in the best interest of the resident.

What has improved since the last inspection?

The Home has refurbished the lounge, which has improved the area greatly. The Manager has improved the office system to ensure all personnel files are easy to find. The Care Plans have improved but still have some improving to be done. The environment is cleaner than previously found.Some improvement has been made to ensure privacy for all residents when they are in their bedrooms by placing a heavy curtain across the door. The Home now has designated staffing hours for activities during the week.

What the care home could do better:

The daily records completed by staff could be more informative and reflect more on the person. The residents should have more stimulation/activities available at all times and not just when the designated 15 hours of staff time is happening. The internal environment could be improved with some bedrooms decorated and some vanity/sink units replaced. The garden needs to be weeded and tidied and the outside of the property painted.

CARE HOMES FOR OLDER PEOPLE Courtenay House Nursing & Residential Home Fakenham Road Tittleshall Norfolk PE32 2PF Lead Inspector Ruth Hannent Key Unannounced 18th April 2007 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 Courtenay House Nursing & Residential Home DS0000015629.V336797.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. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Courtenay House Nursing & Residential Home Address Fakenham Road Tittleshall Norfolk PE32 2PF 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) 01328 700646 01328 701320 courtenay.house@fshc.co.uk None provided County Healthcare Ltd, a wholly owned subsidiary of Four Seasons Health Care Ltd Manager post vacant Care Home 51 Category(ies) of Dementia (51), Old age, not falling within any registration, with number other category (51) of places Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Fifty-one (51) older people may be accommodated. Fifty-one (51) older people with dementia may be accommodated. The total number of services users not to exceed fifty-one (51). Date of last inspection 21st June 2006 Brief Description of the Service: Courtenay House is a large detached property in the village of Tittleshall. Bedrooms are on the ground and first floors and consist of six double and thirty-nine single bedrooms, some of which have en suite facility. The home has a variety of communal rooms for the use of residents. There are gardens with a car park to the rear of the property. Email Courtenay.house@fshc.co.uk Fees £385 - £537 Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been completed after a visit to the Home. We have also looked at all the information sent to the Commission that includes a pre inspection questionnaire completed by the Manager, notifications of incidents and complaints and information sent prior to the visit received from relatives and residents. (In total 18 were received.) On the day of the visit records were looked at that included care plans, medication record charts, fire servicing records, personnel files, training records and menus. A tour of the building took place, residents were observed and staff were spoken to. Two visitors were seen and the District Nurse was spoken to. The majority of the time was spent with the Manager over a period of five and a half hours. What the service does well: What has improved since the last inspection? The Home has refurbished the lounge, which has improved the area greatly. The Manager has improved the office system to ensure all personnel files are easy to find. The Care Plans have improved but still have some improving to be done. The environment is cleaner than previously found. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 6 Some improvement has been made to ensure privacy for all residents when they are in their bedrooms by placing a heavy curtain across the door. The Home now has designated staffing hours for activities during the week. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents have an assessment of need to ensure the service is able to meet that need. EVIDENCE: The Four Seasons company have a detailed format that is taken by the Manager to assess a potential resident. Three assessments were seen that held enough relevant details to ensure the care needs of the person could be met by the Home. Two of those residents were seen and the care appears to be appropriately met by the Home. One resident remembers the manager visiting them at home, talking about ‘the way I needed help’ and discussing Courtenay House to give a picture of the care service offered. The service does not offer intermediate care so this standard was not inspected. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the health and personal care for residents is met however some improvement in the daily records to evidence the care practise given should be in place. EVIDENCE: The Home has continued to improve the care plans with folders in place in each person’s bedroom. Again Four Seasons have introduced new recording formats that give lots of scoring charts to identify needs for the individual. The actual care plans were seen of four residents. The information is in place and reviewed regularly. A concern shared with the Manager is the lack of information in the daily progress reports that would evidence the care plans are being followed and met. The Home has planned care plan training for all staff (dates seen) to improve the way care plans are written and how to be used as a positive tool. The Staff do need to improve what they write to show that care needs are person centred and not just comments that state ‘ate Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 10 breakfast’ ‘up and dressed’. (Recommendation). Comments written in the reply’s from residents all said their care needs were met. Many of the residents could sign and show active involvement with the reviews of their care plans and this was not always evident. (Recommendation). The Home has good regular support from GP’s and District Nurses who visit when requested. (DN was in the building during this inspection. (The Home has been working closely with the nurse team to manage a pressure sore, which with joint working is now improving). This was discussed with the Deputy Manager on the inspection visit and the correct action and recording appears to be taking place. The residents have a record within their care plans of when the Dr visits and the action required to follow through. Although no comments have been received at the Commission from the health care professionals a GP seen on a visit in 2006 was very happy with the working relationship and had no concerns about the health care practise within the Home. The medication storage room was seen and the records of medication, temperature of the room and fridge were seen as correct. The medication was all stored in locked cupboards and trolleys with the Deputy Manager holding the keys. The charts do have PRN medication recorded on the front but no record is kept to show that someone has been asked if they wish, for example, pain relief tablets. (Recommendation). It was also suggested that creams and lotions are placed on a chart in the person’s bedroom to be completed on the application of the medication by the carer offering personal care at the time. (Recommendation). Throughout the day residents were spoken to and treated with respect by all staff who were observed. Particularly noticed was the handyman, cook and domestic who all spent time talking on a one to one with residents. No room was entered without being knocked and one resident was noted locking their door as they so wished. One person talked about the post she receives that is taken to her room. No one shares a room at present and all bedroom doors have a heavy lined type curtain (replacing the original flimsy curtains) on the glazed panel to ensure privacy at all times. (Still awaiting blinds.) Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 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. 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 available evidence including a visit to this service. The daily life and social activities is in place on occasions but more effort is required to ensure people are not just ‘sitting’ a lot of the time. The meals are good and will be improved further with the introduction of the new menus. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 12 EVIDENCE: The comments received from residents and relatives mostly state the activities provided in the Home have improved. A designated staff member is now employed and is starting to find out more details about each resident to enable stimulation and activities more relevant to the individual to take place, however on the day of the inspection many residents were just sitting. The TV is on in the corner of the two lounges with no one facing the set. All chairs are in a row and nothing is placed in front of the resident’s that might be of interest to them. Long periods of time were noted when nothing was happening. The Home either fortunately or unfortunately has lounges that are also corridors that staff pass through regularly so residents are seen and the odd conversation in passing occurs. (Recommendation). Two visitors were in the building on the day of the inspection visit. Each one was happy with the care and visited at any time. All relatives comment cards were also returned to the Commission with positive comments of how they were welcomed. ‘Always a good atmosphere when I visit the Home’ was one comment. The Manager was also holding a relatives meeting on the evening of the visit so would be updating the families on how the inspection had been. The resident’s meal was taken in the one lounge with lots of conversation. The menu’s are in display stands on the table so all people could read the meal of the day. The food is brought on a hot trolley and served at the table. The choice is a little limited but after seeing a new nutritional menu in guidance from Four Seasons the menus are to be developed to include more choice in the near future. Resident’s who have liquidized meals were offered the food in individual portions to show colour and taste variety. Staff who were assisting residents in their rooms were speaking in an appropriate, encouraging manner but needed to sit down and be at the same level as the person while assisting with the meal. (Recommendation). Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 186and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are listened to and acted upon. Residents are protected from abuse. EVIDENCE: 11 Relatives comment cards reflected well on concerns/complaints that are taken to the Manager. She deals with them quickly and thoroughly ‘I tell the Manager who immediately amends the problem’ ‘ I speak to the manager’. The Home has the Complaints procedure posted on the notice board and also in the brochure of information offered to new residents. Staff do have training on the protection of vulnerable adults The home has a whistle blowing policy and noted in staff meetings minutes were discussions around this subject. The Home also has future training dates planned to ensure all staff have full awareness. Each staff member has been police checked prior to working alone with a resident. Those who are awaiting this check are always working under supervision. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some environmental areas of the Home have improved some areas are in need of improvement. EVIDENCE: This site visit confirmed the opinion of a few relatives. The Home is in need of many areas, especially in some bedrooms and bathrooms of redecoration. The lounge is much improved with new carpet, curtains and chairs that gives a warm feel to this area. The Manager needs to look more at the state of the bedrooms were many vanity units are in need of replacing and many walls are chipped and without paint where furniture has rubbed against them. (Requirement) Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 15 The fire records are current (seen) and all extinguishers have been serviced in the last year. The outside of the building is in need of repainting (Requirement) and the gardens are untidy. The Manager has applied for a grant to improve the outside areas but something needs to be done soon. (Requirement). The Home appeared clean and tidy when walking around and the carpets in the corridor were being shampooed as the Inspector arrived. There is unfortunately a slight odour that lingers in the entrance, which has been noted on many visits and although the Home has shampooed, replaced the carpet and added a neutraliser the problem is still there (although to a lesser degree). Some commodes were noted to be in a poor condition and needed replacing, due to rust or badly chipped paint. (Requirement). The laundry has two washing machines with sluice cycles and two tumble dryers that adequately manage the amount of laundry. The staff member spoken to feel the washing is handled appropriately and there is hand washing facilities in all areas (including alcohol type hand dispensers). Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff are carry out their duties to ensure residents needs are met and are recruited safely by procedures being followed. Training is taking place but monitoring that all staff are up to date needs to be put into practise. EVIDENCE: The Staff on the day of the inspection appeared suitable with 1 nurse, 5 carers, the manager, 1 domestic, 1 cook, 1 kitchen assistant all on duty for 31 residents. No one appeared hurried and comment cards from relatives stated the care needs were met by some staff, but not always so good by others. This was discussed in detail with the Manager who has recently had a change in the staff team and who now feels the problems with staff not being so good should now be different. The atmosphere on the day of the inspection was good with lots of staff interacting appropriately and care tasks carried out well. All residents appeared neat and tidy and were smiling and responsive. The Home has recently lost some NVQ qualified staff and needs to work with the new staff to achieving this qualification. The Manager was able to show an email from head office on the move to gain more NVQ placements once an assessor problem has been resolved. (Recommendation). Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 17 The Manager has made a great improvement since the last inspection in the method of filing the personnel information of each staff member. The two recently recruited staff member files were looked at and had all the correct information stored that included the application form, 3 forms of identification with a photograph, two references, a copy of the contract, CRB application and POVA clearance. A new Deputy Manager has only been in post for four weeks but is beginning to get a system in place that will ensure all staff members are trained and updated at appropriate intervals. A training matrix is being devised to assist with this and should be up and running in the next few weeks. The training already taking place and dates seen were for POVA, care planning and moving and handling. At present all training certificate copies are held in one folder making it difficult to check who has and hasn’t completed training. With the new filing system now up and running for staff records it may be more appropriate for certificates to be held for each individual in their personnel folder. (Recommendation). Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Management of the Home has improved with a now Registered person being accountable. A quality assurance system is now in place and staff supervision is now taking place showing an improvement in management responsibilities. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 19 EVIDENCE: The Manager has now been interviewed and is about to be sent a certificate that will now show her as the Registered Manager. She has been in post for two years and has slowly built the Home up in the standards required and although some areas are still to be improved there has been steps taken in the right direction. She is a qualified nurse and is able to carry out supervision with the nursing staff at the Home. The Home has recently carried out a quality assurance survey with many questioning being asked and analysed by Four Seasons. The results, now returned (April 07), need to be used to move forward and improve the service wherever possible with an annual development plan created. (Recommendation). The comments received by the relatives also state the Home has improved and that ‘The manager and staff should be complimented on the improvement’. On this occasion the residents financial records were not see. The administrator spent quite a long time with the inspector on the last visit where all transactions were carried out thoroughly and safely. With this standard covered well and with the administrator not on duty the day of this site visit this standard has been met over the last few inspections. The Manager has had a long gap between formal supervision with staff but with the recruitment of a new Deputy Manager, supervisions have just been carried out with all staff. (seen). A pattern needs to be in place to ensure at least 6 supervisions are happening per year for each staff member. (Recommendation). The Home Manager monitors safe working practise by being actively involved in the practise daily. The training programme is in place for all statutory training but some delay on infection control training needs to be rectified. (Requirement) along with a system that ensures all staff receive the compulsory training. The Home has safety data sheets in place for all cleaning chemicals. (A staff member spoken to is clear about the potential hazards and understands risk assessment). All chemicals are locked away when not in use. (Doors tested). The servicing of the boiler is overdue as written on the pre inspection questionnaire and as the contract with one company is stopped and a new company found the service has been delayed but should be happening very shortly as a contract has been agreed with a new contractor and this was verified by the Homes Maintenance Officer. (Recommendation). Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 20 The Manager informs the Commission of all deaths and notifiable incidents by sending information that is requested under Care Homes Regulation 37. Risk assessments are carried out and since the last inspection it was noted that information of risks in each room of a trailing wire has been posted on each bedroom door. The risk is still not eliminated but people moving into the rooms should be aware. Four Seasons have just introduced a comprehensive induction pack that is now in situ within the Home. The first one is being used by a new staff member and overseen by the Deputy Manager as they both are new staff members to the company. The booklet in progress was not in the building but a new copy was seen and appears very comprehensive. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23.2 (b) Requirement The Home should be decorated internally especially in bedrooms where walls are damaged and vanity/sink units are in a poor state. The Home should be externally decorated and in good state of repair. The Home needs to improve the gardens around the Home to ensure they are safe and suitable for residents to enjoy. The Home must ensure that all commodes are safe and in a good condition. The training and awareness of all health & safety within the home must be up to date and include Infection Control. Timescale for action 01/09/07 2 3 OP19 OP19 23.2 (b) 23.2 (b) (o) 13.4 (c) 23.2 (c) 18.1 c (i) 01/09/07 01/09/07 4 5 OP19 OP26 OP38 01/06/07 01/06/07 Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 23 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 2 3 4 5 6 7 8 9 10 Refer to Standard OP7 OP7 OP9 OP9 OP12 OP15 OP28 OP30 OP33 OP36 Good Practice Recommendations The staff should be able to complete daily records in a more appropriate person centred way to evidence the service offered to the individual person. Care plan reviews should be signed, (where possible), by the residents or relative. PRN medication should be offered to residents and a code recorded on the chart to show the person has been asked if EG they have any need for pain relief. The staff could have a recording chart held in the residents room so recording of external medication can be placed on the record on application. The residents should be offered more stimulation when placed in their chairs and if watching the television have suitable seating to do so. When residents are being assisted to eat their meal the staff should sit at the same level and not stand over the person. The home should find an assessor for NVQ as soon as possible to allow staff the opportunity to gain the qualification. The methods of evidencing training that has been carried out for staff need to improve. The quality assurance monitoring now needs an action plan. The supervision of staff must continue to achieve the recommended 6 times a year. Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Courtenay House Nursing & Residential Home DS0000015629.V336797.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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