Inspection on 27/06/05 for Frithwood Nursing Home, The

This inspection was carried out on 27th June 2005.

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

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

Other inspections for this house

Frithwood Nursing Home, The 31/07/06

Frithwood Nursing Home, The 03/11/05

Frithwood Nursing Home, The 29/09/04

Frithwood Nursing Home, The 06/04/04

Frithwood Nursing Home, The 25/09/03

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

CARE HOMES FOR OLDER PEOPLE The Frithwood Nursing Home 21 Frithwood Avenue Northwood Middlesex HA6 3LY Lead Inspector Clare Henderson Roe Unannounced 27 June 2005 10.20am 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. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Frithwood Nursing Home Address 21 Frithwood Avenue, Northwood, Middlesex, HA6 3LY 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) 01923 820955 01923 842684 MD Homes Ms Carolyn Estabilla Care Home 20 Category(ies) of Physical Disability, Physical Disability- over 65 registration, with number and Terminally ill. of places The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Adults over 55 years old in need of general nursing care and palliative care. 2. Minimum Staffing Notice. Date of last inspection 29th September 2004 Brief Description of the Service: Frithwood Nursing Home is a converted detached house situated in a residential area of Northwood. It has a well-maintained private garden at the rear of the property. The accommodation consists of fourteen single and three double rooms. There are three bathrooms, one shower room plus toilet facilities throughout the home. There is a day room and a dining room for service users to utilise. Local transport facilities are available in the form of buses and Northwood Underground Station. The Registered Manager deals with the care management for the home. The Operations Manager deals with the financial and personnel management of the four homes within MD Homes. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 8 hours were spent on the inspection process. The Inspector carried out a tour of the home, and inspected service user plans, policy and procedure documentation, staff training files and maintenance files. 6 service users, 5 visitors and 4 staff were spoken with as part of the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Shortfalls in falls management recording need to be addressed. There were some outstanding environmental requirements from the last inspection and it is important that requirements are met within the agreed timescales. Where a problem arises with meeting a timescale, this must be communicated to the CSCI so that any extension on the timescale can be discussed. In addition there have been some long-standing issues, for example, structural and water surveys, where it is reported that further information is awaited, but has not been received. Action to conclude these situations needs to be implemented. There is a programme of maintenance and refurbishment for MD Homes, identifying the work required in each home. Some of the timescales for completion for areas of work planned for Frithwood Nursing Home had expired. It is important that the programme be kept up to date and to have evidence to The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 6 substantiate the reason for delays in completion of any elements of the programme. 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 Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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 The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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) 1, 2, 3 & 4. The home does not provide intermediate care. Service users and their representatives are provided with information about the home and all service users have a written contract agreement in place. Service users are assessed prior to admission to ensure the home can meet their needs. Staff are receiving training to meet service users specialist needs. EVIDENCE: A copy of the Service Users Guide was available at reception and copies of the Service Users Guide were seen in service users bedrooms. These documents were up to date and informative. For service users who are self-funding, individual contracts are issued. For service users who are funded by Social Services or the Primary Care Trust, the service users receive a copy of the services contract and a copy of the homes terms and conditions is contained in all the Service Users Guides. Two sets of pre-admission documentation were viewed. Copies of the homes’ assessment had been completed, one more comprehensively than the other. In both cases supporting assessment documentation from the funding Authority were available and gave a clear picture of the service users needs. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 9 Assessments for nursing care funding are carried out by an NHS registered nurse. The Registered Manager is undergoing a recognised qualification in palliative care. Some of the staff had undertaken day courses in palliative care awareness. The Operations Manager has a qualification in palliative care. Input is accessed from the Macmillan nursing service and also support from the hospital medical team is provided for service users with palliative care needs. Staff also manage the care of one service user with a degree of dementia, who tends to call out for attention. The need to keep the situation under review to ensure that this behaviour does not impact on other service users was discussed with the Registered Manager. Staff had received training in several topics relevant to the care needs of the service users. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Service user plans are generally well constructed enabling staff to provide the service users with the care they need. Shortfalls in falls management recording could pose a risk to service users. The medication at this home is well managed promoting good health. Staff are courteous to service users and personal support is provided in such a way as to promote and protect the service users privacy, dignity and independence. EVIDENCE: Individual service user plans were available and samples were viewed. Overall these were generally comprehensive and detailed how the service users’ identified health and personal care needs would be met. Monthly reviews had been carried out, but care plans had not always been appropriately updated to reflect the current situation, for example, where bedrails were no longer being used, the care plan needed updating to reflect this. Where service users have specialist care needs, these are recorded and a plan of care to meet them drawn up. A new, comprehensive risk assessment document for falls had been introduced. These had not all been fully completed, and also had not always been reviewed and updated following a fall. For one service user who had a fall an accident form was not available, and for another who had required hospital The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 11 intervention following a fall, a Regulation 37 notification had not been submitted to the CSCI. These findings were discussed with the Registered Manager who said that she would follow this up with staff, and information to address both issues has been forwarded to the CSCI following the inspection. Assessments for pressure sore risk, continence, moving & handling and nutritional screening had been carried out, and where a need was identified, a care plan had been formulated. Pressure relieving equipment was in use and no service users had pressure sores or wounds. Physiotherapy input has been accessed for service users requiring assessments and all service users are encouraged to join in the in-house exercise sessions. Regular input is received from the GP and there was evidence of input from other healthcare professionals, to meet the needs of the service users. The management of medications was viewed. The medication administration record (MAR) charts had been fully completed and all receipts, administration and disposal of medications had been recorded. The stock control of medications is well managed in the home. Where available, liquid medications had been prescribed for service users who are nil by mouth and are being fed via a percutaneous endoscopic gastrostomy (PEG) tube, and the Registered Manager said that for other medications which require dissolving in water prior to administration, she has ascertained that they are suitable for administration via a PEG tube. For one service user on warfarin, blood test results were available and the warfarin dosage had been altered in accordance with the instructions from the Hospital. The prescription on the chart should be rewritten in a new section of the MAR chart each time a dosage changes. This was discussed with the Registered Manager. A minimum/maximum thermometer had not yet been obtained, and was requested by the home at the time of inspection. The home has confirmed that this was received and put in place the same evening. Daily minimum and maximum temperatures must be recorded. An audit had been carried out by the dispensing pharmacist following the last inspection and as a point of good practice, these audits should be arranged on a regular basis. Medications are stored securely and are well managed in the home. Staff were seen to address service users in a gentle and courteous manner. Service users and visitors spoken with were satisfied with the care given and attitude of staff. Service users preferred term of address is recorded and used, and service users waking and retiring preferences are also recorded, although this is also monitored on a day-to-day basis, so that service users have an ongoing choice. The home has a cordless telephone, which service users can use, plus service users can have private landline or mobile phones. Policies and procedures for service users rights are comprehensive. Healthcare visits are carried out in the privacy of the service users own room. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Work is in progress to improve the social activities provision for service users, thus improving their quality of life at the home. Visiting is encouraged and this enhances the service users lives and keeps them in touch with their families and friends. Service users are encouraged to exercise their independence wherever they are able to maintain their quality of life. The meal provision is good, with alternatives being available, thus meeting the needs of the service users. EVIDENCE: MD Homes have employed an activities co-ordinator who works in each of the 4 homes each week. Activities were in progress and service users were enjoying the group and one-to-one activities. The activities co-ordinator said that she is working on gaining social history information for each service user so that she can build up a picture of their individual social and leisure interests. The care plans for social and leisure activities still required more personalisation to reflect service users individual needs, and the activities coordinator should be involved in this. There is an activities programme written out each week on display by the clinical room. The activities co-ordinator was enthusiastic and obviously enjoys her work, and service users were interacting well with her. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 13 The home has an open visiting policy and service users receive visitors in the day rooms or in their bedrooms, depending on their preference. Service users can choose whom they wish to see and if any issues arise then these are discussed and addressed. Information regarding maintaining relatives and friends contact with service users in the home is included in the Statement of Purpose. Service users are encouraged to bring in some possessions from home to personalise their bedrooms, and this was evident in some of the rooms viewed. The kitchen was clean and tidy and daily fridge and freezer temperatures are recorded. Cleaning records were up to date. The menu reflects the preferences of the service users and offers a choice of two main meals. The lunchtime meal to include liquefied food was well presented and service users spoken with said that they enjoyed the food provision at the home. The meal sampled was well cooked and tasty. There were no service users requiring a special diet for cultural or medical reasons, and the Registered Manager said that she would assess service users dietary needs prior to admission to ensure that the home could meet them. The home does not serve pork and this is made clear to service users and their representatives prior to admission. The cook was very aware of the correct cooking procedures and presentation methods for different foods. The lunchtime meal was unhurried and staff were available to assist service users as required. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 14 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, 17 & 18 The home has a satisfactory complaints system and service users concerns are listened to. Service users rights are protected and service users are able to exercise their legal rights directly. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a clear complaints procedure which states complaints will be addressed in 20 days, and also including contact details for the CSCI. No complaints had been received since the last inspection. The home has information regarding advocacy services. At the recent election, postal votes were arranged for some of the service users. The home has a copy of the Hillingdon Multi-Agency Adult Protection procedures and also has its’ own POVA policy and procedure which dovetails with the Hillingdon documentation. Policies and procedures for the management of service user aggression and for handling service users finances, plus a ‘gratuities to staff’ policy were seen and are clear. Staff spoken with were clear on the procedures to be followed for the protection of vulnerable adults, to include ‘whistle blowing’, and training had been carried out by the Hillingdon Adult Protection Co-ordinator. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 15 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, 22, 25 & 26 Overall the standard of décor and cleanliness was of good quality, thus providing a pleasant and homely environment for service users. A programme of maintenance and refurbishment is in place, and ongoing review and updates to this would continue to maintain a good environment for service users. Some environmental issues are taking some time to resolve, and this could pose a potential risk to service users. EVIDENCE: There is a programme of maintenance to cover all the 4 homes in the group, with timescales for completion. Some of the timescales had expired and the need to update the programme was discussed with the Operations Manager. One of the radiators in the sitting room was out of order and additional heating appliances were seen. The need to ensure that the whole heating system is in full working order was discussed and a timescale of 01/09/05 agreed. A survey of the hot water had been completed and also one for the driveway, as there has been a large pothole in evidence for some years. The Operations Manager said that these issues were being followed up, but the delays were of concern. An Environmental Health Officer inspection had been carried out in September 2004 with no issues identified. The emergency check lighting records indicated The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 16 a repair was needed, however on following this through the repair had been carried out and evidence of this was seen on a separate file. The need to ensure that repairs are recorded in the documentation was discussed. Fire drills had been carried out every 3 months with a list of attendees. The timing of these drills needs to be recorded, and the need to ensure that drills are carried out for all night staff and all day staff at the required intervals was discussed. Risk assessments for the use of the baths/showers had been formulated. It was reported that one of the first floor bathrooms is to be converted into a shower room in line with the needs and wishes of the service users, and this is to be done in September 2005. Requirements for environmental shortfalls identified in the last inspection report had not all been met. It was noted that the pipe work leading to and from the radiators is still not boxed in or covered, and could pose a risk should someone fall against it. The need to carry out risk assessments and provide protective coverings on those pipes where any risks to service users are identified was again discussed. There was still no evidence of the mixer valves being adjusted to produce hot water at 43º centigrade, and regular recordings between 32º and 39º centigrade were seen. The home was clean, tidy and free from odours at the time of inspection. The laundry room was clean and tidy and risk assessments had been carried out for the equipment in use. The home contracts out the flat laundry. Cleaning records were signed and up to date. Infection control policies and procedures were in place. The home has two washing machines one of which is industrial and has appropriate wash programmes for infection control purposes. There is a separate sluice room with an electronic sluicing disinfector. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 17 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 The home is appropriately staffed to meet the needs of the service users. EVIDENCE: The staffing roster indicates that there is one registered nurse and a minimum of four care staff on each day shift, and often there are additional staff on duty, such as those on supervised placements. At night there is one registered nurse and one carer on duty. All the staff are over 21 years of age. The home was clean and visitors commented on the consistent good standard of cleanliness. One of the evening care staff with a food hygiene certificate serves the evening meal. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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 & 33 The manager is supported by senior staff in providing clear leadership throughout the home, with staff demonstrating an awareness of their roles and responsibilities. Systems of development and review are in place and provide information as to any future development within the home. EVIDENCE: The Manager has completed the CSCI registration process since the last inspection. She is a first level registered nurse and commenced the NVQ level 4 managers award in April 2005. The Registered Manager has approximately 6 supernumerary hours per week, and said that there are no problems should she ever require more time. This would be beneficial to ensure that the Registered Manager can work with the necessary staff to ensure that all requirements are met within the timescales set. There are clear lines of accountability within the home and the management structure of MD Homes. Quality assurance monitoring is in place at the home. A quality assurance audit is carried out annually. Surveys of service users representatives are carried out The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 19 every 3 months and the results collated. Copies had not been received by the CSCI and the Registered Manager agreed to forward these in future. The formulation of surveys for stakeholders in the community was discussed. There is also an annual business and development plan and the Operations Manager was in the process of updating this. The homes policies and procedures are reviewed and updated by the Operations Manager annually. Regulation 26 unannounced visits by the Responsible Individual are carried out and copies of the reports are forwarded to the CSCI. The need to ensure that requirements set in inspection reports are addressed within the timescales set, and for the Registered Manager to contact the CSCI should there be any concerns regarding delays in addressing requirements, was discussed. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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 3 3 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 x x 2 x x 2 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x x x x x The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 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 4 Regulation 12, 14 Requirement Where the behaviour of one service user is impacting on other service users, this must be kept under review and appropriate arrangements made to address the situation. Risk assessments for falls must be fully completed and must be updated following a fall. All accidents in the home must be recorded in line with CSCI and health & safety requirements. The care plans for each service users social and leisure interests must reflect their individual needs and identify how these are to be met. (previous timescale 01/11/04 not met) The heating system must be reviwed and restored to full working order. The issues with repairs for the water system and the driveway must be satisfactorily resolved. An action plan to show how these issues are to be addressed must be forwarded to the CSCI. Records for fire drills must evidence that all staff have attended fire drills at the Timescale for action 01/08/05 2. 3. 7 7 13(4) 17(2) 08/07/05 08/07/05 4. 12 15(1) 01/08/05 5. 6. 19 19 23(2)(b) 23(2)(b) 01/09/05 01/09/05 7. 19 23(4) 20/07/05 The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 22 required intervals. 8. 25 12, 23(2)(c) The mixer valves on the hot 20/07/05 water outlets must be reviewed and water produced close to 43º centigrade. These must be adjusted whenever the water temperature checks reveal a lower or higher hot water temperature. (previous timescale 10/11/04 not met) The hot pipes leading to and 01/09/05 from the radiators must be risk assessed and action taken to minimise the risks identified. (previous timescale 01/12/04 not met) 9. 25 13(4)(c) 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. Refer to Standard 9 12 19 31 33 Good Practice Recommendations Whenever a dosage of medication changes, that a new entry be made on the MAR chart and signed by the GP. That the individual interests of service users be considered in conjunction with the activities provision so these are reflected in the activities programme. That clear records be kept for repairs such as emergency lighting for swiftness of identification. That the manager ensures that she has sufficient supernumerary hours to include time for working with staff on meeting the requirements from inspection reports. Copies of the results of satisfaction surveys carried out by the home be forwarded to the CSCI. The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 23 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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 The Frithwood Nursing Home G61-G10 S10931 Frithwood V229485 27.6.05 Stage 2.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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