Inspection on 26/09/07 for Crossways Nursing Home

This inspection was carried out on 26th September 2007.

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

Crossways Nursing Home 23/09/08

Crossways Nursing Home 24/05/07

Crossways Nursing Home 19/09/06

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Crossways Nursing Home Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ Lead Inspector Val Sevier Key Unannounced Inspection 11:00 26 September 2007 th 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 Crossways Nursing Home DS0000066923.V344855.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. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Crossways Nursing Home Address Greywell Road Up Nately Basingstoke Hampshire RG27 9PJ 01256 763405 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) S.E.S Care Homes Ltd Post Vacant Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2007 Brief Description of the Service: The home is owned by S.E.S. Care Homes Ltd who bought the home in May 2006. The staffing structure at the home including the registered manager has been unchanged from what it was with the previous homeowners. The home is situated in a quiet village near to Basingstoke. The home provides accommodation, personal and nursing care for up to eighteen persons aged 65 and over. The home can accommodate persons suffering from dementia type illnesses. Accommodation is arranged on two levels. The home has a pleasant lounge and dining room for the use of the residents. A large garden with an orchard is accessible to the residents. There are ten single rooms and four shared rooms; the majority of the rooms have en suite bathrooms. Fees for residency at the home range from £515 to £630 per week. Items not included in the fee include chiropody, hairdressing, taxi fares and newspapers. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 26th September 2007, during which the inspector was able to have discussions with staff and have interaction with the residents at the home. During the visit the inspector looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and residents, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? The new manager has worked on two care plans and these two are centred on the individual and their needs and how staff can support them. Staff recruited to the home have had all the checks carried out on their background to keep people safe. The home has provided a safer means of holding doors open that protect people from fire. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 7 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. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process. EVIDENCE: There have been no new admissions to the home since the inspection in May 2007,on that occasion the manner in which the home assessed needs was considered to be good. The inspector looked at the assessments as part of the care planning process, as they had not changed the judgement for this section has not altered. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new care plan records seen ensure that the personal and healthcare needs of two individuals are met safely and effectively. However the inconsistency in recording and documents used could place others at risk. There was inconsistency in the management and recording of medication, which could place people who use the service at risk. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. EVIDENCE: The care plans sampled by the inspector were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals. Since the last inspection the manager left and a new manager was appointed, who began working at the home in August 2007. The inspector was able to discuss with her the changes that she has made. One has been the introduction of new care plans. There are currently 13 people living at the Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 11 home the manager has written two care plans in the new format. The inspector sampled one of the original care plans and two new ones. The older style care plan contained little information on how to meet the needs of the individual. The reviews of the care plans and assessment tools had been undertaken for that individual but they did not match the daily notes. For example the nutritional screening tool last completed August 2007: information was that the individual was frequently sick, and needed guidance and assistance with food and a soft diet. These had not been identified on the screening tool, which if they had would have placed the individual at risk. There was also a note in the medical report part of the plan for the doctor to be contacted on the 17th September regarding the individual and their sickness; there was no record to say that this had been done. The two new plans had an information front sheet with brief information on how to meet the needs of the individuals. This included physical and social assessment, communication, working and playing and self-image and self worth. There are several assessments of risk and tools to monitor them such as dependency assessment, behaviour and pain, Waterlow, falls, moving and handling, nutrition and pressure care. These tools indicate the need for an individual care plan of support. The manager has also introduced as part of this new care panning process an ‘Activities of daily living checklist’ which assists in planning individual care. The documents examined and the plans were based on the assessments the home carried out in order to identify what help individuals needed. Assessments included a range of potential risks to residents e.g. pressure sores; falls; moving and handling; malnutrition; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid. The two care plans were seen to be individual with full instructions for staff in how to support the individual. For example: ‘able to eat but on occasion does not – usually when withdrawn’; planned care includes: ‘encourage to eat with others, find out likes, offer finger food to eat on the move, offer supplemental nutritional drinks, offer food in between meals, record and monitor’. There was information about preferred bedtimes and getting up with a note as to the effects for the individual if staff alter these times. The care plan also drew staffs attention as to how the individual liked to present themselves to others ‘Likes to be feminine wearing a dress, beads and other jewellery, perfume and likes to have nails done’. The second care plan explained that the individual had indicated their desire to die and the care plans were written so that staff could support the individual whilst still offering care, support, nutrition and fluids. One line in the care plan staff recalled easily when the inspector spoke with them was, ‘to be able to talk to staff without being judged’. They said they found this difficult whilst still respecting the individual’s wishes. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 12 It was seen in the two new care plans that physical health needs are also addressed with information from health and other specialists; this information has been incorporated into those two care plans. It was also seen that residents have access to opticians and dentists as needed. Notes regarding physical health indicated that other professionals had been involved as necessary. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked and secured medicine trolley and cupboards and where required in a medical refrigerator. Controlled drugs were stored securely and appropriately. The home dispenses all medication from blister packs and the only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were registered nurses. The inspector was assisted in looking at the medication records and stock by one of the trained staff, the inspector as able to discuss with her the recording. It was noted that there was an inconsistency in the records regarding ‘as required’ medication, with staff not always indicating why it had been given or whether it had worked. The inspector also explained that creams and lotions that are applied in peoples rooms or when bathed should also have a record. The record of signatures for staff able to give medicine needs to be updated. It was also noted that there were some medications that are prescribed to be given every day but the staff are using them as, ‘as required’ making a judgment about the individuals needs based on their knowledge of them. Staff were observed speaking and assisting the residents with dignity and respect. Affection was given appropriately to those residents who sought it. It had been seen on the care plans that the preferred choice of name had been recorded and staff were heard to speak to residents by the name they wished. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do have some opportunity to engage in meaningful activities that meet their needs, however this could be more individualised. Meals are provided based on a menu that has not been chosen by people who live in the home and the quality of this food needs to be explored further by the provider. EVIDENCE: The new care plans seen indicate the interests and hobbies of the individuals; as yet this has not been transferred into an activity programme that addresses those individual interests. The home has an activities person, who works term time only, she has begun to keep daily records of the activity carried out who was involved and whether the individual appeared to enjoy it. This does not currently record individual or one to one activities. The manager said that she understands the importance of noting whether someone actively participates in the activity or watches others, or is withdrawn. The activities recorded so far have been chats, discussions, films, music appreciation / discussion, cards and Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 14 games. There has been concern in the past that the activity person is used as a member of care staff if there are staff shortages; the manager stated that at least 90 of time is on activities. Staff at the home commented on the menus and the amount of waste. The menus it is said are ones that are used in all the homes owned by the provider and are not based on the choices likes and dislikes of the individuals who live at Crossways. However it was observed at afternoon tea that staff assisted individuals where appropriate and supported individuals dignity. A relative visiting on the day said that the food had been an issue but it had gotten a little better. It was noted that the food stuffs bought were of a supermarket value line, as there have been concerns raised under safeguarding adults and at the last inspection regarding nutrition and diet at the home it is required again that the provider review the nutritional value of the foodstuffs purchased. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staff’s knowledge and understanding of Adult protection issues. EVIDENCE: There have been ongoing issues for the home with social services visiting monthly to support the home make improvements in the care provided. The new manager is aware of these issues and has undertaken some of the training for staff herself for example safeguarding adults. She is aware of the vulnerability of the people who live at the home particularly where there are communication issues and is organising other training for staff to help address these issues. The relative seen during the visit indicated that they knew how to complain and felt able to speak with the new manger or other staff members if they had concerns. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and comfortable service however work is required to make sure the health and safety of the service is maintained. EVIDENCE: The inspector looked around some of the home and was able to see communal areas such as the dining room, bedrooms and bathrooms. The dining room carpet has not been replaced as agreed at the last visit in May 2007. All of the bedrooms seen were brightly decorated and had evidence of individual personalities with pictures and residents photographs on the walls, and other personal effects. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. Consideration is given to the support of needs with the use of equipment. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 17 Specialist beds are available at the home for those that are assessed as needing them. The bedrooms nearest to the original front door were felt to be very cold at the time of the visit and the two individuals who were having a rest after lunch with just a blanket over them, were cold to the touch. The manager adjusted the thermostat for the heating, which was very low. The hallway in between the two rooms had a musty odour, a combination of cold and damp. The inspector viewed the communal bathroom it has a low bath, which is fixed to the floor and a gap in the side of the bath where the hoist fits underneath. This is the only communal bathroom and there is just one hoist that fits it and the baths in the ensuites. The home has a laundry room and a sluice facility. The washing machines have just been serviced however they are very old and new repairs may not be possible. The laundry is looking tired with peeling paint. The home only carries out personal laundry with heavy items such as bedding being sent to an external laundry. There is no work area for the staff when doing the laundry for example nowhere to fold things. The home was free from unpleasant smells and this was mentioned by a number of visitors. Staff were seen wearing gloves and aprons and cleansing gels were regularly used by staff to limit the possibility of spreading infection. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by staff who have had some training however there remains concern that there is no formal supervision /appraisal and that staffing levels may still not be sufficient to meet the needs of people who use the service. The recruitment process for those files seen seemed to indicate that people who use the service are protected. EVIDENCE: The information regarding the number of staff and the number of people living at the home is the same as at the last visit in May 2007. The inspector examined the rota and this was discussed with the manager. At the time of the visit thirteen people are living in the home and the manager stated that in the morning one trained nurse and four care staff are on duty. This reduces to one trained nurse and two carers in the afternoon. One trained nurse and one carer cover night duty. The care staff carry out the laundry within their care hours although the manager did say it was possible that extra staff may be employed if the home increased in its number of residents. The new manager is currently working on several areas of improvement and working with staff on these. She is a trainer and is able to carry out some Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 19 training herself. She has looked at the training files and needs for staff, the staff have undertaken moving and handling and 7 staff have undertaken food hygiene training. The manager is going to do training with the staff on safeguarding adults; she is also arranging training in dementia. The manager explained that she is looking at each staff member and will be undertaking supervision with all staff to establish their competencies skills and training needs. At present she is spending some time working alongside staff getting to know the home. The inspector sampled two staff files one of a new member of staff and it was seen that all checks hade been carried out. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are living in a home that has undergone some changes however there remains further changes to be made for the service that is offered to be of full benefit to them in meeting their needs and safety. EVIDENCE: The manager is new to the home having started in August 2007. She is a qualified nurse with 20 years experience of nursing; she has also had her own training company and been a manager in other nursing homes. A number of areas were highlighted at the last visit and remain an issue in this report including the effectiveness of care planning, management of medication and staff allocation. These and in addition staff skills and training are directly Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 21 related to the management of the home and need to continue to be addressed to demonstrate that the home is effectively managed. The home’s last quality assurance audit and survey was undertaken with the last provider. At the last inspection the area manager confirmed that a process exists and they would talk to the manager at that time, about starting this process. The manager at that point left shortly after the inspection and there is no evidence that a quality assurance system has been put into the home. The current manager stated that she is aware that one needs to be in place however she is responding to the requirements of Adult services as part of the ongoing safeguarding adults issues and on the requirements from the commission’s last inspection. The home does not hold for safekeeping or manage any monies for people who use the service and any additional costs such as hairdressing or chiropody are invoiced to the individual or their representative. It was noted that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. It was noted that environmental health had been to the home in December 2006 and required several pieces of work to be carried out. One of those being that within three months the kitchen units were to be repaired or replaced. It was noted that one kitchen cupboard came away compete with hinges. It was seen that a note hade been taped over a socket in the kitchen following the fitting of a small hand sink and other note stating that tiles were to be replaced these notes are dated April 2007. The records indicated that the fire equipment safety checks had been carried out monthly, the last training for staff was in August 2007 and the last weekly test was carried out on 13/9/07. The manager currently carries out the tests. Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement People who use the service must have a care plan that accurately reflects their assessed needs and shows the support that is to be given by staff. This is a repeat requirement. Fluid and nutritional charts must be completed fully to ensure people are receiving adequate intake of fluids and food. The use and response to this record must be accurately documented in the individual’s care plan. This is a repeat requirement. The moving and handling guidelines must have clear information on the type of hoist and sling to be use for each person. This is a repeat requirement. Medication administration records must be recorded accurately at all times. This is a repeat requirement. People who use this service are provided with activities and stimulation to meet their assessed needs. DS0000066923.V344855.R01.S.doc Timescale for action 26/10/07 2 OP7 12 (1) 26/10/07 3 OP7 13 (5) 26/10/07 4 OP9 13(2) 26/10/07 5 OP12 16 (2) (m) (n) 26/10/07 Crossways Nursing Home Version 5.2 Page 24 6 OP15 16 (2) (i) 7 OP25 23 (2)(P) 8 OP26 16 (2)(j) 9 OP30 18 (1) (a)(b)(c) 24 (1)(a)(b) 10 OP33 11 OP36 18 (2) 12 OP38 16 (2) (g) The agreed activities and strategies to achieve this must be documented in the person’s care plan. This is a repeat requirement. The current foodstuffs purchased to provide meals is reviewed with the dietician to ensure it meets the nutritional needs and expectations of people who use the service and their representatives. This is a repeat requirement. The heating of the home must reflect the weather and individual needs and requirements. The home must replace the damaged flooring in the dining room to make it safe and hygienic for people who use the service. People who use the service must be supported by staff that are skilled and competent in meeting their needs. The home must have a quality assurance programme that ensures people who use the service and their representatives can contribute to the running of the service. This is a repeat requirement. Staff must receive supervision and appraisal of their skills and competency to ensure that they are able to meet the needs of people who use the service. The kitchen equipment and facilities used for the preparation of food must be safe. 26/10/07 26/10/07 26/10/07 26/10/07 26/10/07 26/10/07 26/10/07 Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Crossways Nursing Home DS0000066923.V344855.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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