Inspection on 28/02/06 for Hadley House Nursing Home

This inspection was carried out on 28th February 2006.

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

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

Other inspections for this house

Hadley House Nursing Home 07/06/07

Hadley House Nursing Home 14/10/05

Hadley House Nursing Home 08/03/05

Hadley House Nursing Home 02/11/04

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

CARE HOMES FOR OLDER PEOPLE Hadley House Nursing Home 24/26 Jersey Avenue Stanmore Middx HA7 2JQ Lead Inspector Clive Heidrich Unannounced Inspection 28th February 2006 9:45 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 Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hadley House Nursing Home Address 24/26 Jersey Avenue Stanmore Middx HA7 2JQ 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) 020 8907 7047 020 8933 2051 Mr Nalin Joshi Mrs Anila Joshi Mrs Anila Joshi Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14), Old age, not falling within any of places other category (14) Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of people accommodated must not exceed 14. Elderly persons with enduring Mental Health, aged 60 years and over. Minimum staffing notice applies Date of last inspection 14th October 2005 Brief Description of the Service: Hadley House is a home providing nursing care for up to 14 older persons. At the time of the inspection there was one vacancy. The owners, Mr and Mrs Joshi, also have a home providing personal care to older persons situated in the same road. Mrs Joshi is registered as the manager of this home. The home is situated in a quiet turning, close to Kenton Lane, on the edge of both Stanmore and Kenton. It is close to local shops and bus routes, with local train and underground links being around thirty minutes’ walk away. Hadley House has off-street parking at the front of the property and there is parking available in the road outside the home. The home consists of two floors and there is a passenger lift to assist movement within the home. There are bedrooms, toilets and bathing facilities on each level of accommodation. Communal space is situated on the ground floor and consists of an open-plan area where there are lounge and dining areas. There is a large attractive garden at the rear of the house. There is one shared bedroom in the home and all other bedrooms are single rooms. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a cool day in late February. It finished at 3:45p.m. Its focus was on inspecting the core standards that were not checked on during the home’s first inspection of the inspection year. All of the service users were present throughout the inspection. The inspector met with five of them individually to discuss the services provided in the home. The inspector also discussed aspects of the service with staff working during of the visit, and with the manager. Additionally, care practices were observed across the day, aspects of the environment were checked on, and a number of records were sampled. Concurrent to the inspection, the manager was requested to send out comment cards to involved people, and to complete an inspection questionnaire. She promptly undertook this, and consequently information from eight service users’, three friend/relatives’, and four health & social care professionals’ comment cards, along with the inspection questionnaire, have been included in this report. Feedback overall has been very positive. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 6 Excellent standards of considerations of, and improvements to, service users’ health were evident at this inspection. Shortfalls in the recruitment checks at a previous inspection were found on this occasion to have been rectified. Service users are now sufficiently protected by these checks. Management have undertaken a detailed quality audit that involved the opinions of many people involved in the home. This has allowed satisfaction to be measured and shortfalls to be addressed. 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. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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 Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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 Service users can be sure that their needs will be assessed in advance of moving into this home, and that these needs will be met in the home. EVIDENCE: The admissions documentation for the two service users most recently admitted to the home were checked. These raised no concerns. Both had assessments in place that were undertaken by the home in advance of the person moving in. There were also external professional assessments in place where appropriate. Key issues from these assessments were in place within the care plans for these service users, and it was apparent from feedback that the home has been able to meet the needs of these service users. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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 and 10. The home provides good standards of personal care, and excellent standards of health care. Minor improvements are needed to ensure that care plans are kept fully up-to-date, and that non-prescribed medications are managed safely, so that service users receive appropriate care. EVIDENCE: The care plans of two service users were checked through and found to be generally suitable. They explained the needs of the service users, what the support should be from staff, and what the aim of the support is. There were monthly updates of each aspect of the care plan. These did not tend to change the plans, despite there being feedback from service users and management about improvements made to each service user’s care. It is necessary for updates to include about the progressions made, to ensure that the guidance to staff is accurate. There were a number of risk assessments on file for each service user. This included standard issues such as for manual handling, falls, and pressure care. There were also specific assessments based on needs, such as for malnutrition, aggression, and diabetes. This is appropriate risk management. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 10 There were ongoing health professional records within service users’ files that reflected their individual health needs and treatments. The home is visited monthly by the consultant psychiatrist. Feedback from health and social care professionals was very positive. They all stated that the home works in partnership with them, that there is always a senior staff member to work with, and that staff demonstrate a clear understanding of service users’ needs. One commented that the care provided is excellent. Weight records of service users are generally taken monthly. No concerns arose from analysis of these. The manager noted that they have worked hard to enable both the better mobilization of a couple of service users, and the weight gain of another. The service users’ needs in these respects were documented within their care plans and daily records. As referred to above, the reviews of these plans did not highlight the improvements made, which must be addressed. Some preventative pressure care equipment was seen to be in place. Recent records showed that the equipment is promptly acquired, which is encouraging. The inspector undertook checks of the medication systems used in the home. There were no concerns found with the provision of prescribed medications to service users. Service users were seen to be offered their medications appropriately, and management spoke appropriately about responses to medication refusals. Medication records were up-to-date and clear. Management gave the inspector examples of where they have worked with health professionals to safely reduce medication levels, which is good practice. The manager said that all nurses and carers completed a distance-learning medication qualification during the summer of 2005. Certificates of this were seen. Whilst nurses retain responsibility for medication administration, the manager expects them to involve care staff within this for personal development and awareness purposes. One issue arose from the medication checks. A service user was recently given a mild laxative medication as a homely remedy. This medication was not part of the homely remedies that a GP had signed off for service users in the home. There was additionally no stock of the designated homely remedy medications. This was discussed with management, as it presents risks to service users of poor medication care. The manager must ensure only those medicines authorised by the GP be used as homely remedies, and that they are then always available to use in the home. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 11 All of the service users were seen to be dressed in appropriate clothing during the visit. Clothing preferences are recorded. Sampled clothing in the laundry room was discreetly marked with the service user’s name, to help ensure that clothing returns to the service user who owns it. One service user was seen to be supported to change their clothing after it had become stained following the morning drinks. One service user noted that staff support her well with manual handling needs. These are evidence of staff treating service users with due respect. Comment cards found 6 of the 8 service users stating that their privacy is respected in the home. All health and social care professional comments about privacy were that it is provided for their visits, whilst none of the friends and relatives’ comment cards disagreed with privacy being provided. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 and 14. Service users are supported to have good standards of daily living and social activities. They are reasonably enabled to have choice and control over their lives in this home. Visitors are made welcome. EVIDENCE: The home has an established activities worker who works during weekdays. Feedback about this arrangement from service users was generally positive. 6 of the 8 comment cards received from service users found them to like the activities provided. Service users were seen to be supported by the activities worker to take part in individual activities such as throwing games during the morning. Staff additionally sat with some service users to play scrabble in the afternoon. There were numerous paintings by service users on display in one area of the lounge, and many facilities such as games and puzzles available. One service user also noted that a mobile library provides books on a regular basis, including in large print, which is appreciated. Many service users undertook the opportunity to have their hair made up by the weekly-visiting hairdresser during the inspection, and it was noted that service users had the choice in this matter. This service is an additional cost (see also standard 35). Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 13 The home has a strong routine of service users being asked to come to the dining tables for tea and snacks. This is to help service users to retain mobility. It was not practiced for all service users, and so was seen to be a flexible routine. The manager noted that service users are supported to make choices. She gave an example of where the choice was not supported by family members but for which the manager felt it was important to the service user’s well-being to nevertheless pursue their choice. 6 of the 8 comment cards received from service users stated that they do not want to be more involved in decisionmaking in the home. It is overall judged that service users are reasonably enabled to make choices within the home. Service users generally fedback that they can have visitors anytime, and that staff make the visitors welcome. Comment cards from friends and relatives all agreed with this. One service user noted that they have agreed to a limited amount of restrictions in this respect, which the manager confirmed in terms of the person’s general well-being. In terms of transparency, this limitation should be recorded about within the care plan. There is a small, enclosable room next to the lounge that can be used if greater privacy for visits is wanted. One service user was able to confirm this as a use of the room. It was also being used by the hairdresser for her service during this inspection, as designated facilities in this respect are within that room. The manager noted that she actively takes out one or two service users for shopping excursions. Records showed that this had recently happened for one service user, to buy a card. This is good practice. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 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 the following standard(s): 16 The home has good standards of complaint investigation processes and adequate systems for complaints to be raised. EVIDENCE: The inspector received a complaint from a couple of service users during the visit, relating to specific care practices. This was discussed with the manager, and then passed onto relevant local authority care management teams for consideration under their adult protection procedures. Management have been co-operative throughout this process. Following investigations, management have taken suitable actions to address the complaint. The last recorded complaint was from a service user to a visitor, who then discussed the issue with the manager. This was from March 2005, and the issue was upheld. Most comment cards from service users stated that they know whom to talk with if they are unhappy with their care, which reflected verbal feedback. 2 of the 3 friends and relatives’ comment cards stated that they are aware of the home’s complaints procedure, and none of them have had to complain in the past. The home’s recent quality audit questionnaire raised no concerns in respect of the auditing of service users’ views. Management also stated that they usually get good feedback from service users if there has been anything wrong. However, as the last two complaints by service users have been made Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 15 indirectly, it is recommended that management consider whether their complaint processes sufficiently enable service users to raise concerns. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Service users benefit from a well-maintained and clean environment. They are provided with good standards of equipment to help meet their needs. EVIDENCE: A brief tour of the premises raised no concerns about the standard of maintenance or décor. A cleaner was cleaning the home from the start of the inspection, and there were no offensive odours noticed at any stage. Temperatures throughout the home were judged as reasonable. One service user showed the inspector how her bed is electronically adjustable, which makes it easier for her to be supported by staff to get up in the morning. This benefits the service user and staff, and so is useful. Staff responded in a matter of seconds to a test of the alarm-call system, which is encouraging. One service user explained that they have to have their bedsides on their bed put up at night. They did not know why. Discussions with the manager about Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 17 this established that there is a risk of this service user falling out of bed. There was however no risk assessment about this scenario in place within the service user’ file, although there was for falls in general. It is recommended that, where a bed-side is used for a service user, a risk assessment justifying this practice and highlighting possible hazards be included within their care file. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Service users are supported by a consistent staff team that provide generally good standards of care and whose qualifications in respect of their jobs is excellent. Recruitment practices are also suitable. EVIDENCE: The expected number of staff were working from the start of the inspection. There was clearly a low turnover of staff. The roster for the week found that staffing levels are being upheld. Comment cards from friends and relatives all stated that there are always enough staff working in the home. The general feedback about staff from service users and visitors was positive, both from discussions and from comment cards. Checks of the recruitment files of two newer staff were undertaken. No concerns were raised from this. There were appropriate Criminal Record Bureau disclosures on file, along with two or more written references, copies of identification, and application forms. Checks found that nursing staff have up-to-date nursing qualifications (PINs). The manager reported that five of the six regular care assistants have qualified at NVQ level 2, with the sixth having started. A couple of these staff have NVQs at level 3, whilst some others are working towards this. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 19 The manager reported that the staff team have recently completed, mostly successfully, a distance-learning course in infection control. Two staff need to do further work to complete the course. The next training for the team will be in dementia care. The manager also noted that a couple of staff have enrolled onto an English improvement course. Standards of training at this home are overall judged as excellent. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The home is well-managed by the experienced manager and co-owner of the home, including in terms of meeting service users’ needs. Minor improvements are needed to ensure that professional checks of safety in the home are fully acquired, to minimise risks of accidents to anyone in the home. EVIDENCE: The manager is a registered general and psychiatric nurse. She has completed the NVQ level 4 award, and is about to undertake a 6-month course in mentoring of other staff. She has also run and co-owned this home for many years. The manager is sensitive to the needs of the service users, and clearly leads the team to ensure that service users’ needs are addressed. The manager noted that members of the management team have recently undertaken unannounced visits at the weekend to ensure that standards of care are Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 21 suitable. Management do not ordinarily work at the weekend, although they will provide cover as needed. The manager supplied their last quality audit report to the CSCI in October 2005. The audit was carried out in July 2005, and involved asking service users, their representatives, and external professionals about their views of the care in the home. 17 questionnaires were returned in total. Feedback was very positive, with only occasional individual issues to improve on. Plans were made where any shortfalls were identified. The home keeps individual amounts of money securely on behalf of most service users. The manager stated that these are generally topped-up by family members, although she is involved in acquiring the income support of a few service users. Checks of the records seen on behalf of the service users raised no concerns. There were receipts available for all items of significance, including for those of the visiting hairdresser. The manager noted that she liaises with social workers where there are difficulties around any individual service users’ finances. One service user showed the inspector that she has a locking drawer in her room within which to store valuables. Another service user reported that she receives bank statements regularly to the home’s address. No concerns were raised by service users in terms of how they are supported with their finances. Arrangements for how a service user’s finances are handled overall were stated within individual care files. A detailed audit was made by the inspector of the professional certificates of safety for various aspects of the home. Suitable certificates were in place for the gas systems and fire systems. Management have identified the need for the legionella prevention testing of water to be updated, whilst it was also found that the electrical wiring test was last undertaken in late 2000 and was hence overdue. The manager agreed to ensure that these issues are addressed, which will help minimise risks associated with the operation of the physical aspects of the home. Accidents were discussed briefly with management. As accident records are distributed into individual service users’ files, it is recommended for there to be a central summary log of all accidents, to help keep track of who has had what accident and to show what monitoring actions have been taken where needed. There are additionally monthly health and safety check records that were seen to highlight issues for addressing where needed. Internal weekly checks of the fire systems are recorded as undertaken. There are monthly fire training sessions for staff. Fire drills, that involve full evacuations, are undertaken every three months. This is appropriate. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2) Requirement It is necessary for updates of service users’ care plans to include about any progressions made, to ensure that the guidance to staff is accurate. The manager must ensure that only those medicines authorised by the GP be used as homely remedies, and that these medicines are then always available to use in the home. The manager must ensure that professional checks of the water systems and of the electrical wiring are updated and valid. Timescale for action 01/06/06 2 OP9 13(2) 01/05/06 3 OP38 13(4), 23(2)(c) 01/06/06 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 Refer to Standard OP13 Good Practice Recommendations In terms of transparency and staff guidance, any agreed limitations on a service user receiving visits should be recorded about within their care plan. DS0000022926.V283996.R01.S.doc Version 5.1 Page 24 Hadley House Nursing Home 2 3 OP16 OP22 4 OP38 It is recommended that management consider whether their complaint processes sufficiently enable service users to raise concerns and complaints. It is recommended that, where a bed-side is used for a service user, a risk assessment justifying this practice and highlighting possible hazards be included within their care file. As accident records are distributed into individual service users’ files, it is recommended for there to be a central summary log of all accidents, for tracking purposes. Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Hadley House Nursing Home DS0000022926.V283996.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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