Inspection on 01/06/06 for Grantley Court Nursing Home

This inspection was carried out on 1st June 2006.

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

Grantley Court Nursing Home 28/01/08

Grantley Court Nursing Home 01/11/05

Grantley Court Nursing Home 18/07/05

Grantley Court Nursing Home 22/11/04

Grantley Court Nursing Home 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Grantley Court Nursing Home 22 York Road Sutton Cheam Surrey SM2 6HH Lead Inspector Margaret Lynes Key Unannounced Inspection 1st June 2006 09:30 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 Grantley Court Nursing Home DS0000044083.V297555.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. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grantley Court Nursing Home Address 22 York Road Sutton Cheam Surrey SM2 6HH 020 8661 0273 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 Soondressen Cooppen Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Grantley Court is a home registered to provide nursing care, for up to thirty adults over the age of sixty-five, with dementia or other mental health disorders. The Registered Provider, Mr Coopen, who also owns three other homes in the area, bought the home in July 2003. The home is a large detached house situated in a quiet area in Cheam, well served by public transport links and there is off street parking to the rear of the property. Accommodation is provided in twelve single and nine double bedrooms all of which have been fitted with washbasins, some have en-suite facilities. There is a large open plan lounge and separate dining room, and a small smoking area has been provided for residents use. There are sufficient numbers of toilet facilities conveniently located throughout the home and kitchen and laundry facilities are clean and well equipped. There is a pleasant back garden which includes flower beds, fruit trees and a patio area which is well maintained and enjoyed by residents in the summer months. The home provides information about its services in a Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. The current weekly fees (as provided at the time of this inspection) range from £550– £700. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over the course of 8.5 hours. It included examination of documents; meeting with service users and staff; talking with relatives and a tour of the premises. All of the aforementioned are thanked for their assistance during the course of the day. The manager was not on duty at the time of this visit, but able assistance was given by the nurse in charge at the time. The last inspection visit, which was in addition to the two statutory inspections, and conducted in response to concerns that service users were being neglected, took place in March of this year. While there was no evidence to suggest that residents were being or had been neglected, two recommendations were nevertheless made. Part of this inspection was to determine if action had been taken to meet those recommendations, and also to determine if the requirements contained in the last inspection report had been met. Of the two recommendations from the additional visit, there was little to evidence that action had been taken to either put into place a process for staff to follow should they need to call an emergency ambulance, or that staff had introduced a method to monitor the healing process of any wound. These recommendations will therefore be repeated in this report. The last inspection report contained five requirements. Just one of these has been met, and the remainder are repeated in this report. This inspection visit has resulted in a further 20 requirements being made. An Immediate Requirements Notice was also left with regard to inaccurate medication administration records; emergency call bell cords being tied up and out of easy reach; and the lack of testing of the fire alarms. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: The home provided a comfortable and generally safe environment for its service users. While most of the current residents are in the advanced stages of dementia, a number were able to comment on the care they received. They all stated that they were treated well, that the staff were kind, that the accommodation was good and that the food was satisfactory. These views were generally supported by the relative who kindly spent a few minutes with the Inspector during a visit. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is N/A) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home either obtains an assessment from the placing authority or conducts it own pre-admission assessments so that the needs of potential service users are identified. This means that each service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of five service users were examined. Each one contained a nursing needs assessment, which was, in some cases supported by an in-house preadmission assessment. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the general hands on care was satisfactory, the poor documentation relating to a number of these Standards means that it is possible that service users are not receiving care that is specific to them, and which should have been identified in each service user plan. EVIDENCE: While each of the files inspected contained a service user plan, the plan did not cover the social care needs. Therefore, while the personal and health care needs were actually satisfactorily covered, the plans could not be said to be meeting the required Standard. What was good, however, were the monthly reviews where staff took the time and effort to comment on each of the identified health and personal care needs, and to state if any revision to the planned care was needed. The health care records in the main were also good. Unfortunately, on the files inspected one did not contain a risk assessment, and a manual handling assessment was missing from another. These omissions have contributed to Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 10 the overall poor rating of this section. Previous recommendations regarding putting into place a process for staff to follow should they need to call an emergency ambulance, and the introduction of a method to monitor the healing process of any wound have been repeated. The most notable failing however, was with the medication administration records where there were a number of gaps found. In addition, where medication was omitted, staff were rarely recording the reason for omission. Tippex was also found on one chart, while there were a number without a photograph of the service user. The service users spoken with were unanimous in their praise of the staff team, commenting that they found them helpful, kind, and respectful. There was no evidence that staff were seeking and then recording resident’s wishes in the event of their serious illness and death. This is important information and staff must make every effort to obtain it. The home also needs to have in place a resuscitation policy and procedure. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an activities co-ordinator who visits twice a week and provides a number of recreational activities. This means that on these occasions at least service users are provided with something of interest and stimulation. Service users receive well-presented meals, however more consideration needs to be given to staffing levels at lunchtime as a number of service users had to wait some considerable time to be given assistance. Visitors are made welcome. EVIDENCE: The twice-weekly activities co-ordinator carries out a variety of activities and encourages all of the service users to participate. Outside of these visits, staff are allocated on a daily basis to undertake activities with the residents. This having been said, on the afternoon of this inspection visit there was little evidence of any organised activity, and when asked, service users were vague about what they were enabled to do during the afternoons. It was evident, from observation, that at least one service user needed to be provided with more stimuli than they were receiving. It would be good practice to review the activities on offer to determine that they are both sufficient and appropriate. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 12 This review would tie in with the service user plans, which should (see Standard 7) contain an assessment of social care needs. The main meal on the day of the inspection was sampled, and the Inspector had to concur with one of the service users in that the meat in the casserole, while nicely seasoned and well presented was quite tough. This resulted in the service user in question choosing not to eat any of it. This was discussed with the chef, who agreed that on occasion the cut of meat provided could be more tender. This is an area that should be an integral part of the home’s quality assurance systems – however these are systems that still need to be put into place (see Standard 33). It was also noted that meals were served to the majority of service users in the lounge, but that as a number of them needed assistance several had to wait some considerable time before staff became available. During this time their meal was just left to get cold on their table. Given that so many residents need help, it is necessary to ensure that staffing levels at lunchtime are sufficient (see Standard 27). Two good practice recommendations have been made in relation to the aforementioned comments. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, which is accessible to service users. The adult protection procedure requires revision. Once this is done it should, if followed by staff, offer sufficient protection to service users. EVIDENCE: The complaints procedure has been revised and the up to date version can be found in the Service User Guide. It is recommended that the outdated version be removed from the staff policy and procedure manual and replaced by the new one. The complaints book did not contain any new complaints. A relative commented that they had not had to make any complaints but that they felt sure that they could approach staff if they had any issues – even though they had never seen the complaints procedure itself. The Registered Provider should ensure that this procedure is on clear display in the home. There was a policy/procedure re adult protection in the aforementioned staff manual. It did not, however, make any reference to the Local Authority multi agency procedure or the fact that in any instance where abuse is suspected or alleged, the aforementioned Authority must be contacted and they will take the lead from that point on. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 14 The home received an additional visit in March of this year in response to concerns that service users were being neglected. The concerns could not be substantiated. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 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 the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises were found to be clean and generally well maintained. Unfortunately the number of emergency call bell cords that were found to be tied up out of the way means that the home is not providing as safe an environment as it easily could and, indeed, should. EVIDENCE: A tour was made of all of the home. As mentioned above, it was found to be very clean however in almost all of the bathrooms/WC’s and en-suite toilets the emergency call bells were tied up out of reach. A considerable number of lamps were also without shades – a small issue but one that adds towards creating a homely atmosphere. A number of other relatively minor issues were also identified. These are listed in the requirements section of this report, and number thirteen in all, with four requirements. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. From the rota provided it did not appear that the number of qualified staff on duty was always adequate to meet service user needs. Furthermore it was not evident that staff had been enabled to attend training specific to the client group in this home. This means that residents may not always receive the specific care that they require, or may not receive it promptly. EVIDENCE: In the last inspection report it was stated that following a number of complaints the qualified staffing levels were increased so that there would always be two nurses on duty until 6pm. The rota provided at this inspection did not show that this level was always being maintained. Furthermore, as commented in Standard 15, there appeared to be an insufficient number of staff at lunchtimes. As the manager was not on duty at the time of this inspection it was not possible to determine if the staff recruitment procedures were satisfactory. An additional visit will be made to examine staff files. Without access to staff files it was not possible to determine how many care staff had obtained NVQ awards, or what other training courses had been attended. At the previous inspection it was required that staff attend training Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 17 specific to caring for residents with dementia. From talking to staff on this visit it was not evident that such training had been made available. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of concerns regarding quality assurance, staff supervision and the lack of a registered manager means that the health, safety and welfare of both service users and staff is neither promoted or protected to the extent expected. EVIDENCE: While the proprietors have now appointed their acting manager to the permanent manager’s post, until that individual has actually been registered it is not possible to determine how suitable they are for the position. From the available records it seemed evident that staff meetings were held on a very infrequent basis. It would be good practice for the manager to ensure that these take place regularly. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 19 The new manager needs to work on quality assurance systems as a matter of urgency, and they must include periodically seeking the views of service users, relatives, friends and other visitors, staff and stakeholders. The results of these surveys should be made public. It appeared from the manuals that the policies and procedures had not been reviewed for a number of years. It is good practice to review these annually. The home does not look after the money of any of the service users. They may keep a simple record of any minor purchases made on behalf of a resident, and then this would be reimbursed via family members or the placing Authority. While some staff supervision was taking place and being recorded, it was not evident that this was being done as previously required, and carried out with care staff at least six times annually. The vast majority of the maintenance contracts for the home were up to date, however current contacts could not be found for the lift, for portable electrical appliances or to evidence that regular checks were being made (and recorded) re hot water temperature in the baths. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 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 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 1 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 2 Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 21 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 OP30 Regulation 18 Requirement The Registered Provider must put into place an action plan detailing how staff will receive ongoing training in caring for people with dementia. The previous timescale has not been met. The Registered Provider must ensure that a suitable person is put forward for registration as the manager of the home. The previous timescale has not been met. The Registered Provider must ensure that all care staff receive supervision at least six times a year. The previous timescale has not been met. The Registered Provider must ensure that certificates of worthiness for all equipment and services in the home are available for inspection. The previous timescale has not been met. The service user plan must included assessment of social care needs. A risk assessment and a manual DS0000044083.V297555.R01.S.doc Timescale for action 15/07/06 2. OP31 8(1)(a) 15/07/06 3. OP36 18 15/07/06 4. OP38 13(3) 15/07/06 5. 6. OP7 OP8 15 13 15/07/06 15/07/06 Page 22 Grantley Court Nursing Home Version 5.2 7. 8. OP9 OP11 13 12 9. OP18 13 10. 11. OP19 OP19 16 13 12. OP19 23 13. 14. 15. 16. OP19 OP19 OP19 OP19 13 23 23 13 17. OP19 13 18. 19. OP19 OP19 23 16 handling assessment must be carried out and recorded for each service user. Medication charts must be accurately completed at all times. Staff must ascertain and record the wishes of each service user in the event of their serious illness/death. A resuscitation policy & procedure also need to be established. The in-house adult protection procedure must include reference to the Local Authority multi agency procedures. Staff must ensure that all privacy curtains in shared bedrooms are properly hung. All call bell points in bedrooms must have leads attached that are within reach of each service user. The redundant shower pieces and other discarded toilet fittings should be removed from the top floor shower room. There must be a call bell within easy reach of the WC in the top floor bathroom/WC. A suitable lock must be fitted to the top floor bathroom/WC door. All bedrooms must be supplied with an item of lockable furniture. A thermometer should be supplied to each bathroom so that staff can measure the hot water temperature. Staff must ensure that all emergency bell cord pulls are untied and within reach at all times. The hole in the wall behind the door in bedroom 18 needs to be repaired. All lights must be fitted with DS0000044083.V297555.R01.S.doc 01/06/06 15/07/06 15/07/06 15/07/06 01/06/06 30/06/06 30/07/06 30/07/06 30/08/06 30/06/06 01/06/06 30/06/06 30/07/06 Page 23 Grantley Court Nursing Home Version 5.2 20. 21. 22. 23. OP19 OP19 OP19 OP27 13 23 23 18 24. OP33 24 suitable shades. A risk assessment must be put into place for the electric standalone heater in bed 19. The chest of drawers in bedroom 11 and the wardrobe drawer in bedroom 10 must be repaired. All extractor fans must be cleaned on a regular basis. The Registered Provider must ensure that previously agreed staffing levels are maintained at all times. The registered person must ensure that there are satisfactory quality assurance systems in the home. 30/06/06 30/06/06 01/06/06 01/06/06 30/07/06 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 OP8 OP8 OP12 OP15 OP16 Good Practice Recommendations It is recommended that a method to monitor the healing process of wounds be introduced. It is recommended that processes be introduced to facilitate the transfer of residents into hospital. It would be good practice to review the activities on offer so as to ensure that they were based on individual service users needs. Quality assurance checks should be periodically made of the food provided, so as to ensure that it is compatible for service users who may have difficulties eating. It is recommended that the out of date complaints procedure contained in the staff policy & procedure manual is replaced by the revised version that is in the DS0000044083.V297555.R01.S.doc Version 5.2 Page 24 Grantley Court Nursing Home 6. 7. 8. 9. OP19 OP19 OP19 OP26 10. 11. OP31 OP33 Service User Guide. The (new) procedure should also be on clear display in the home. It is strongly recommended that a lock be fitted to the cupboard housing the hot water tank. It is recommended that the cause of the water staining of the ceiling tiles in bedroom 10 is investigated and any remedial action that is necessary is taken. It is recommended that the ground floor WC (adjacent to bedroom 4) is re-painted. If staff need to wear disposable gloves when giving personal care to service users they should always remove them before attending to other service users or moving into communal areas. It would be good practice to hold staff meetings on a regular basis. It would be good practice to ensure that all policies and procedures are reviewed on an annual basis. Grantley Court Nursing Home DS0000044083.V297555.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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