Inspection on 10/09/07 for Gorsefield Residential Home

This inspection was carried out on 10th 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

Gorsefield Residential Home 24/08/09

Gorsefield Residential Home 09/09/08

Gorsefield Residential Home 29/09/06

Gorsefield Residential Home 22/02/06

Gorsefield Residential Home 17/08/05

Gorsefield Residential Home 30/03/05

Gorsefield Residential Home 03/11/04

Gorsefield Residential Home 25/02/04

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

CARE HOMES FOR OLDER PEOPLE Gorsefield Residential Home 306 High Lane Burslem Stoke-on-trent Staffordshire ST6 7EA Lead Inspector Peter Dawson Key Unannounced Inspection 10th September 2007 09:00 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 Gorsefield Residential Home DS0000008233.V346306.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. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gorsefield Residential Home Address 306 High Lane Burslem Stoke-on-trent Staffordshire ST6 7EA 01782 577237 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) Mr David John Hood Mrs C Bhalla, Mrs Janet Hood Mrs Shirley Grainger Care Home 17 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (5) Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2006 Brief Description of the Service: Gorsefield is situated on the main road in High Lane, close to Burslem and directly on a bus route allowing easy access for visitors. The home is a large detached property which has been extended and provides good spacious accommodation. The building and location are quite impressive, well presented and well maintained. There are attractive gardens to the front and rear with good parking facilities. Accommodation for residents is on 2 floors with shaft lift access to the first floor. On the ground floor there are 2 lounges, separate dining room, kitchen and 5 single bedrooms, there is an assisted bathing facility also on this floor. On the first floor there are 10 bedrooms, 2 are shared rooms and have en-suite facilities, some with shower. On this floor there are 2 bathrooms, one has an assisted facility. There are separate toilets, office and storage facilities. There is a small lounge/recessed area with kitchenette, allowing space to receive visitors. The home has registration to provide accommodation for up to 17 older people 5 of whom may have a physical disability and 8 may have dementia care needs. There is presently no registration for people with mental health needs. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by one inspector on one day from 8.30a.m. – 4.00 pm. The National Minimum Standards for Older People was the basis for the inspection. The last key inspection in September 2006 generated several requirements that had been made but not addressed on previous inspections. Therefore, a subsequent random inspection was carried out in Feburary 2007 to monitor progress and review possible enforcement action. With the exception of one the previous requirements had been satisfactorily addressed, the outstanding one was partially addressed and was completed at the time of this inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the Manager and received from the service prior to the inspection and provides some information contained in this report. The Registered Manager was not present during the inspection as she was on holiday. The inspection was carried out with assistance from the Senior Carer on duty in the morning and Senior on duty on the afternoon shift and other staff present. All residents were seen and most spoken with. Two visitors were seen and spoke positively about the care provided at Gorsefield for their relatives. Residents were spoken with individually and in small groups independently of staff. They all said that staff were caring and considerate, were aware of their needs and were committed to their care. One person resident for a few months said “I really enjoy living here, it’s like being back at home”. The daughter of a resident with dementia care needs said that staff understood the particular needs of her mother and deal with potentially difficult situations which arose, sensitively and successfully. What the service does well: A small home providing individual, close relationships with residents and relatives. Relatives are warmly received at all times and their role in the care process considered an integral part of care. They are kept informed of any changes in the health or welfare of the resident. This was confirmed in discussions with relatives seen previously and on this visit. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 6 There is a very positive working relationship between care staff and health care professionals, this includes GP’s, District Nurses and other nurse specialists. This has been observed over many inspections of the home. The home offers a “Home for Life” wherever possible – borne out by the excellent care provided for a bedfast totally dependent resident over the past 2 years. What has improved since the last inspection? What they could do better: Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 7 Whilst there is a positive approach to meeting health care needs some shortfalls exist: It is important to establish food/fluid intake charts to monitor the progress of people at nutritional risk. Also, all resident should be weighed monthly and those where there are concerns about weight loss should be weighed weekly – this also improves the monitoring of nutritional and general health care needs. A resident who sleeps consistently throughout the day (and night) should be referred to the GP/Consultant/CPN for medication and treatment review. Her present quality of life is poor and should be improved. The door to the laundry area should not be propped open to over-ride the selfclosing device. This area has a particularly high risk of fire and open doors would put residents at considerable risk in the event of a fire. Serious complaints of possible abuse of residents must be referred immediately to CSCI under Regulation 37 and to Social Services under the Safeguarding Procedures (Adult Protection). If insure of the latter advice should be sought from CSCI. A record of the details of investigations of all complaints and allegations must be kept in detail and available for inspection. The Medication Reference book available in the home is dated and does not include medication introduced in recent years. This should be replaced with a current edition. 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. Gorsefield Residential Home DS0000008233.V346306.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 Gorsefield Residential Home DS0000008233.V346306.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): Quality in this outcome area is good. Satisfactory information is available to prospective residents who are assessed by the Manager prior to admission. Contracts are now provided for all selffunding residents soon after admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose/Service Users Guide available in the home for visitors and a copy is given to all residents/relatives. The information is readily available to prospective residents and their carers. Contracts are provided by the Local Authority for funded residents. Selffunding residents are now provided with a contract with the home following previous requirements. A recently admitted self-funding resident was found to have a private contact with the home. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 10 Pre admission assessments are carried out by the Manager in the persons current location, these were evidenced in the records of recently admitted residents and a copy of the Care Management Assessment had also been obtained prior to admission. Prospective residents are invited to visit the home but often due to other factors (in hospital etc) this is not always possible. Relatives visit, approve the home and negotiate admission. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Care plans reflected the health, personal and social care needs of residents. Health care needs are usually fully met, although minor shortfalls were identified on this visit. There is a safe system of medication in the home. The principles of privacy and dignity were observed to be practised during this inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are in two parts. There is a summary of assessed needs readily available outlining the actions required to meet needs. These are available to staff in the working situation and also more detailed records for each person Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 12 available for reference where more detailed information is needed. The system generally works well. Care plans have all be updated/re-written by the Manager and contain only current information . The care plans of 2 people recently admitted accurately reflected the assessed needs defined the in the home pre-admission assessment and the Care Management Assessment co-ordinated by Social Workers. Care plans of long-term residents were also inspected and found generally to be informative and accurately reflect needs. There were 2 exceptions to this – One relates to a resident who had not been eating/drinking in the days prior to the inspection. Staff had been attempting to encourage food and fluids and intake was minimal – it is important where this occurs that a food and fluid intake chart is established recording daily inputs as evidence of the efforts made and a means of assessing the hydration status of the person. In this instance the GP had been called and visited during the inspection. He was able to advise staff on details of actions and monitoring. The home are pro-active in the area of referring to health care professionals where there are concerns. However in relation to another resident who was constantly sleeping throughout the day this had not happened. The person had diagnosed mental health needs and also dementia care needs, she was constantly asking each day to go to bed from lunch-time and woke only for her lunch. This was discussed with the Manager who will make an urgent referral for medication and treatment review via the GP/Consultant psychiatrist in an effort to improve the health and quality of life of this resident. A totally dependent resident who has been bedfast for the past 2 years and overseen by the District Nursing Service continues to receive excellent care from the home. The Nursing Service no longer visit weekly the home closely monitoring diet, pressure area management and general care with instant access to the Nursing Service if her needs change. Her continued, sustained care is to the credit of staff. A visiting District Nurse was spoken with and confirmed there was a very positive dialogue and cooperation with care staff. Relaxed, friendly but professional communication seen was clearly the normal mode of communication. It was noted that some residents had not been weighed on a monthly basis. One resident had not been weighed since May 2007. – All residents must be weighed monthly and weekly if there are concerns about weight loss. The medication system was inspected and records showed accurate recoding of the management of medication in the home. An up to date medication reference book should be provided, the one currently in use is a 1994 edition and does not have recent medication listed. Gorsefield Residential Home DS0000008233.V346306.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): Quality in this outcome area is adequate. Routines are flexible to accommodate choice. Daytime activities are few and could be improved. A positive move to access community facilities has recently been made and very successful. Contacts with family/friends and encouraged and visitors welcomed into the home at any time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence of flexible routines in the home to accommodate chosen lifestyles. There are examples of late rising and retiring, bathing on demand and early morning visitors being received and some resident going out with relatives on a regular basis. Staffing is the required minimum throughout the waking day, with 2 staff on duty, sometimes including the Manager who works mainly on the rota. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 14 Opportunities for staff activities with residents are therefore limited. There is no activities programme but regular 2 weekly music/movement, hairdresser and musical entertainment approximately monthly. One resident when asked what she does all day says that she is “bored”. TV seems to be the main perceived occupation. Both lounges had TV on at the start of this inspection (8.30a.m.) although one lounge is classed as the “quiet” lounge and 4 residents there were later seen not watching and 2 saying that they did not like TV. One said she “goes to her bedroom early” because she has “had enough of TV”. The home need to take account of these views and consider one communal area where residents can escape compulsory TV, sit quietly, chat together perhaps with no more that background music. This was the expressed view when discussed with this small group. Recently 9 residents were taken to the private social club next-door to the home and had a thoroughly enjoyable social evening of entertainment, returning at 11 pm. All enjoyed this and have talked about it consistently since. Clearly a success - there are plans to make more regular visits, having received very positive invitations from the clubs resident managers. This is a positive move to access community facilities. Food provision is good. All residents spoken to were happy with the quality, quantity and choice of food. Whilst there is one hot choice from the menu for the main meal, an alternative menu is constantly available. There have been changes to the menu recently to provide greater variety staff having listened to the views of residents. For example there is more fresh fruit and greater cooked choice at breakfast-time. Gorsefield Residential Home DS0000008233.V346306.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): Quality in this outcome area is adequate. Complaints are listened to and acted upon but procedures not correctly followed to ensure the ongoing protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a satisfactory complaints procedure available in the home for both residents and visitors. No complaints have been recorded by the home since the last inspection (although a complaint was received from residents – see below) and no complaints have been received directly by the Commission. During the inspection a resident commented that a member of staff had been “cruel” to a resident. This was pursued later in the inspection and it was found that a member of staff had been suspended. Residents had been interviewed by the provider and Manager, the member of staff ultimately resigning. This was not notified as required under Regulation 37 to CSCI and not referred to Social Services under the Safeguarding procedures (Adult Protection) currently in operation. There was no record or details of the investigation in the home. Investigations of serious complaints must be recorded in the home and notified Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 16 to the relevant persons as they occur. Whilst the desired outcome was achieved the procedures in place had not been followed. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. The environment is safe, generally well maintained and to a good standard. Providers have been slow to ensure some replacements/renewals previously but all have now been satisfactorily addressed. Fire doors must not be propped open. Residents bedrooms are adequately equipped and meet the needs and choices of residents. There are good standards of hygiene in this home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 18 Whilst the general environment is to a good standard there have been instances where the providers have been slow to act upon requirements made in relation to the environment, staffing and providing contracts. These were identified in the last key inspection of the home on 29th September 2006 and monitored on a random inspection to the home in January 2007, when most had been addressed or partially addressed. At the time of this inspection the outstanding requirement to provide an operational call alert in the ground floor toilet area had been addressed. Improvements have been made to the garden area providing a pleasant safe area for residents to use in the summer months. The home is clean and hygienic and there are no mal-odours, any accidents or issues being addressed/resolved immediately. Standards are consistently good. All communal areas are bright, pleasant, well furnished and comfortable. They meet the needs of residents. Risk assessments ensure a safe environment with equipment in place to support those with mobility and physical dependency needs. Bedrooms are well furnished with adequate furniture and comfortable décor. All seen reflected the individuality of residents with evidence of personal effects brought from home. It was reported by staff that the majority of beds have recently been replaced. It was noted that the door accessing the laundry area and the laundry door were both propped open. The laundry is a potentially high risk fire area and doors must be kept shut to ensure protection of residents in the event of fire. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. The numbers of care staff are minimal and adequate. NVQ training has been stepped-up and considerably improved the knowledge and skills of staff. 50 of staff should be NVQ trained in the near future. Recruitment procedures were good, all documents required were present on staff files. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The minimum staffing level of the home continues. There are 2 carers on duty throughout the day and 1 waking night care staff and 1 person sleeping-in on call at night. Several requirements to provide CRB checks for new and existing staff were eventually actioned at the time of the last key inspection. A sample of staff files seen during this inspection including new staff all had POVA/CRB checks provided prior to employment. Staff files contained other required information, checks and references as needed. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 20 There has been an improvement in NVQ training in the home. Two staff have completed NVQ training to level 2, three are presently studying NVQ 2, others going on to Level 3 study. The required number of 50 of care staff trained to NVQ2 or above will be met in the near future. The NVQ trainer was seen in the home at the time of this inspection and commented upon the positive attitude and progress being made. Staff members spoke with enthusiasm about their NVQ training and the increase in knowledge and skills it had provided them with. It was not possible to assess aspects of other statutory and professional training in the home at this time. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. The Manager provides a positive lead in the home. There are no formal means of residents having an input into the daily running of the home but their views are sought individually Staff supervision meets required standards. The health safety and welfare of residents are promoted with good risk assessments. Fire doors must not be propped open. This judgement has been made using available evidence including a visit to this service. . EVIDENCE: Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 22 The Manager is competent to manage the home although she has not obtained the Registered Managers Award. Her experience in providing a service to older people is considerable. More recently she has been able to work 1 day per week supernumerary (not on the staff rota) allowing her time to spend on management duties. There is now a computer, fax and copier in place and the telephone system has been improved which ensures improved communication within the home at night times. There is a relaxed atmosphere between staff and residents. Visitors are received warmly and have a good dialogue with staff. There are no residents meetings or quality assurance process in place but the Manager has regular individual discussions with all residents and with relatives as a means of assessing satisfaction with the service. Staff are regularly supervised and records seen support this. Record keeping is satisfactory although some improvement could be made in terminology used in daily recording of information. The Fire Officer has confirmed in writing that the previous requirements made in relation to fire safety have all been satisfactorily addressed. Fire records were inspected and satisfactory. A requirement is made to ensure that fire doors are not propped open as this increases the risk to residents in the event of fire. All deaths, accidents, injuries or incidents affecting the well-being or safety of any resident must be reported to the Commission without delay. This had not happened in relation to the treatment of a resident by a member of staff which was reported in July 2007. This must now be notified to the Commission in writing with details of the investigation into the incident. Individual risk assessments for residents were in place and seen to cover all aspects of daily living. There are risk assessments in place also relating to the building and fire safety. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 3 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 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X 3 2 2 Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 24 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 OP8 Regulation 12(1) Requirement Food/fluid intake charts must be established for residents unable to eat to, record and monitor progress. All residents must be weighed monthly and weekly where there are concerns about weight loss Ensure early review of medication & treatment of resident identified with constant sleep pattern. Fire doors must not be propped open. This presnts a serious risk to residents in the event of fire. Incidents of abuse by staff must be notified immediately to CSCI and detailed records of events recorded and available for inspection. Timescale for action 17/09/07 2 3 OP8 OP8 12(1) 12(1) 17/09/07 17/09/07 4 5 OP38 OP38 23(4) 37(1)(e) 10/09/07 10/09/07 Gorsefield Residential Home DS0000008233.V346306.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. 1 Refer to Standard OP9 Good Practice Recommendations An up to date Medication Reference book should be provided. Gorsefield Residential Home DS0000008233.V346306.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Local Office Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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