Inspection on 22/09/05 for Hamilton Nursing Home

This inspection was carried out on 22nd September 2005.

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

The inspector 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

Hamilton Nursing Home 15/05/06

Hamilton Nursing Home 04/05/05

Hamilton Nursing Home 03/11/04

Hamilton Nursing Home 02/06/04

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

CARE HOMES FOR OLDER PEOPLE Hamilton Nursing Home 24 Langley Avenue Surbiton Surrey KT6 6QW Lead Inspector Diane Thackrah Unannounced Inspection 28th September 2005 11:30 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 Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hamilton Nursing Home Address 24 Langley Avenue Surbiton Surrey KT6 6QW 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) 0208 399 9666 0208 390 9394 London Residential Healthcare Limited Mrs Gnanawathie Jamanetti Care Home 28 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Physical disability (0) of places Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of three service users in the categories of Dementia and Physical Disability aged between 55 and 65 years. 4th May 2005 Date of last inspection Brief Description of the Service: Hamilton Nursing Home provides personal and nursing care and accommodation for up to twenty-eight people who have dementia. London Residential Health Care Ltd owns and manages the home. The home is a large detached property that is situated in a residential area of Surbiton. Public transport, local shops and leisure facilities are all within a short distance from the home. The home is comprised of a large communal lounge, a communal dining area, twenty-six single bedrooms and one double bedroom. Passenger lifts are available in the home. There is a large garden to the rear of the home and parking is available. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 11.30 and 16.00 A partial tour of the premises took place and care records were examined. The Registered Manager, care and nursing staff and service users were available for discussion. Two visitors were also spoken with. A number of service users were unable to express their views about the home due to the nature of their dementia. However, all service users and visitors spoken with during the inspection expressed their satisfaction with the service. What the service does well: What has improved since the last inspection? Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 6 A Requirement set at the last inspection of the home, regarding the need to ensure that staff members are aware of service users rights in relation to respect and dignity, has been addressed. All staff members were observed to engage in respectful interactions with service users at the time of this inspection. One staff member confirmed that they had received training in ‘Dignity and Respect’ 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. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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 Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. There are good arrangements for ensuring that the needs of service users are assessed prior to them moving into the home, this ensures that staff are aware of, and can meet needs. EVIDENCE: All prospective service users have their needs assessed prior to moving into the home. Needs are assessed by a senior nurse, in the service user’s home, or in hospital. The home uses the ‘Standex’ tool for assessing service users and this covers all areas of health, personal and social care need. Care Management assessments are obtained for those service users who are admitted through Care Management arrangements. There was a Local Authority Care Management initial needs assessment in place for the most recent service user to be admitted to the home. The home had also completed a needs assessment in relation to this service user. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. Past failures by the home to record care effectively have left it unclear whether the needs of a service user were fully met. However, there have been some improvements in the recording of care. This enables staff members to be clear about how needs should be addressed, and how to meet changing needs. Medication is handled safety and therefore the wellbeing of service users is protected. EVIDENCE: Shortfalls were identified during a recent investigation into a complaint, regarding the recording of care issues. It is therefore unclear whether the home had fully met the health, personal and social care needs of the service user. A Requirement has been made regarding the need for the home to fully record any changes service user’s health and physical condition, and treatment requested by the GP. A further Requirement has been made regarding the need for wound charts to detail the size, type and condition of service user’s pressure sores, along with the colour and whether there is any excrement. Additionally, all service users’ wounds must be reviewed regularly and a documented record of the review and treatment made, along with the type of Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 10 specialist mattress and cushion that is being used. There must be training for staff members regarding Types 1 and 2 diabetes, and advise sought from the diabetic specialist nurse regarding the recording of blood glucose levels, the calibration of the monitor and when there are indications that medical intervention is required. It was noted that improvements had been made regarding the recording of care during this inspection. Care plans examined detailed the health, personal and social care needs of the service user, and how staff members should provide care. These provided good detail about individual needs. Plans had been reviewed on a monthly basis, and changes in need had been recorded. The Registered Manager said that service users and their relatives have opportunities for being involved in the drawing up, and reviewing of care plans. Service user’s relatives had signed care plans examined. Risk assessments were in place in relation to moving and handling, falls and developing a pressure sore. Each service user is registered with a local GP during the admissions process and contact details for GP’s were detailed in service user’s personal records. An accident and incident book is maintained. Records were available of recent accidents, and the action taken by the home to reduce risks to service users following an accident. Care plans detail how personal and oral hygiene are to be maintained. Staff members providing personal care receive training how to do so appropriately and there were records which detailed that junior staff members are closely supervised when providing such care. Records detail that the home works with a variety of local health care professionals in addressing the needs of service users. One service user has been seen by a GP on a regular basis, a psycho geriatrician, chiropodist, optician and dental hygienist since moving into the home. Medication Administration Records examined were accurate and up to date. There were records detailing that in-house audits of medication handling occur on a regular basis. One staff member confirmed that they had received training in the safe handling of medication. All medication was noted to be stored securely at the time of this inspection. Good practice occurs for the safe handling of controlled medication. An incident was observed at the last inspection of the home were some service users were not consulted with appropriately about being involved in an activity. There were minutes of a recent staff meeting that detailed that this issue had been addressed with staff members, and the importance of respecting dignity and being respectful was stressed. No such issues were noted during this inspection. Staff members consulted with, and interacted respectfully with service users. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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 and 15. Varied activities and wholesome and enjoyable meals are provided therefore differing expectations and lifestyles are well catered for. EVIDENCE: There continues to be a varied programme of activities in the home. An activities programme was displayed in the main entrance of the home and this detailed activities including a discussion group, gentle exercise and music session. The activities coordinator was holding a discussion group with a small number of service users, in the main lounge at the time of this inspection. One care staff member said that part of their job involved talking with service users, providing newspapers and going for walks with service users. Another staff member said that some service users have been on outings recently with the home to Kew Gardens, and shopping. Some service users were spending time in their bedrooms during this inspection. These service users had a television or radio in their bedroom and a number had newspapers. One service user said, “I prefer listening to the radio in my bedroom” Two visitors reported that they were always made to feel welcome when visiting the home, and were provided with a quite and comfortable area to meet with their friend. One said, “We always get a tray of tea and biscuits” A visitor also said that they had been pleased that a staff member from the Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 12 home had been available to escort a service user on a visit to see their family. Care records indicate that one service user had recently received Holy Communion in the home. There have been no major changes in respect of meals and mealtimes and service users spoken with confirmed that meals remain enjoyable. The kitchen was clean and well organised and there was a planned menu, and a good supply of food, including fresh fruit and vegetables. The lunchtime meal appeared wholesome and was well presented. There was a choice between curry and fish pie, and banoffee pie and yogurt. The cook said that there would soon be a change from a summer, to winter menu. Staff members provided good support to service users at lunchtime. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. Complaints are not handled effectively, therefore service users and their representative’s may feel that they are not listened to, taken seriously, or that their concerns will be acted upon. Vulnerable adults procedures in the home are in place and serve to ensure that service users are protected from abuse. EVIDENCE: There are policies and procedures in place for dealing with complaints. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. This information also includes details about how a complaint may be made to the Commission for Social Care Inspection. One complaint has been made since the last inspection of the home. Records indicate that policies and procedures were followed in relation investigating, and responding to the complainants in a timely fashion. However, the complainants were not satisfied with the home’s outcome and subsequently a Commission for Social Care Inspection investigation into the complaint occurred. Of the six elements of the complaint, the Commission for Social Care Inspection found one to be upheld, two to be unresolved, two to be not upheld and one to be partially upheld. Six Requirements were made as a result of the investigation and these are detailed in the Requirement section of this report. The home’s own investigation into the complaint did not identify a number of important issues, and therefore a Requirement has been made that there should be a review of the complaints policies and procedures. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 14 There are policies and procedures in place for dealing with suspected or alleged abuse and the home has a copy of the Royal Borough of Kingston Upon Thames adult abuse procedures. Examination of staff training records detail that training in abuse forms part of indication training, and refresher training in identifying elder abuse has been undertaken by some staff members. A recommendation made at the last inspection of the home, that all family members are given opportunities to sign consent forms in relation to the use of cot sides, has been addressed. All staff members have signed to indicate that they have read and understood the homes whistle blowing policy. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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, 22, 24 and 26. The home is maintained, decorated and furnished to a good standard and in general facilities are clean and safe. This ensures that service users live in a pleasant, homely environment. However, shortfalls in hygiene maintenance do not ensure the comfort and well being of all service users. EVIDENCE: The home is a large attractive building on a quite street in Surbiton. Communal areas are decorated and furnished to a good standard and in general, well maintained. There is parking space at the front of the building and a large well maintained garden to the rear. Part of the pathway in the garden has been laid with tarmac since the last inspection, allowing easier access for wheelchair users. There is a maintenance worker who can be contacted for routine maintenance and records indicate that staff members are expected to report any problems with maintenance without delay. Some of the ceiling tiles are missing in the Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 16 hallway. The Registered Manager said that this was due to a recent leak, and that they will be replaced soon. The home has been assessed by an Occupational Therapist and there are a number of specialist environmental adaptations. There are ramps and a passenger lift, and grab rails are provided throughout. All bedrooms are fitted with a call bell, and call bells tested were in working order. There are three hoists. One staff member was clear about how hoists are used safely. Specialist baths are provided. Bedrooms viewed provided all furniture and fittings required by Regulation. Some adjustable beds are provided. In general, bedrooms were comfortable and furniture was of good quality. Bedroom fourteen had a broken wardrobe. The Registered Manager said that plans are in place for this to be fixed and this will be examined at the next inspection. Window restrictors are in place for the protection of service users, but there was a window restrictor in bedroom fourteen that was not attached to the window. The Registered Manager explained that this was because the room was being aired. Were windows, were there is a risk of falling, do not have a restrictor attached; there must be a risk assessment in place. A Requirement has been made following a recent Commission for Social Care Inspection complaint investigation regarding the need for automatic closing devices to be fitted to all service users’ bedroom doors, in order that they can choose to have their doors left open. Service users are provided with a lockable storage space in their rooms. A repeat recommendation is made regarding the need for the arrangements for having a bedroom door key, to be recorded. Rotas indicate that cleaning staff members are employed in the home. In general, the home was clean, pleasant and hygienic. However, bedrooms three and four had dirty walls and the carpet in bedroom fourteen required cleaning. Requirements have been made in relation to these issues. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 29 and 30. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. There is a staff training and development programme that provides staff members with skills necessary for meeting the needs of service users. EVIDENCE: Staff recruitment files were examined for a random sample of three staff members. Each file contained identification documentation, an up to date photograph, two written references, visa information, a statement of terms and conditions and completed application form. Documentation was not available detailing that a satisfactory Criminal Records Bureau or Protection of vulnerable adults check had been carried out for one of these staff members. A representative from the home advised that police checks are obtained in the country of origin for staff members coming to work in the home directly from overseas. The home must apply for, and be in receipt of a new Criminal Records Bureau and Protection of vulnerable adults check for each new staff member prior to them commencing work. When staff members are employed directly from overseas, and there is evidence that they have not previously worked in the UK, the home must apply for directly, and be in receipt of a police clearance check, from the county of origin of the worker. Staff members who do not currently have thorough safety checks, must not work unsupervised with service users. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 18 There is a training and development coordinator in place. All new staff members undergo induction training. There were training records for the most recent staff member. These detailed that they had undergone induction training, which covered Moving and Handling, Elder Abuse, Food Hygiene, Infection Control, Fire Safety, and Introduction to Dementia. The staff member said that they had watched a video, and received a lecture regarding these topics, then been required to complete a written test. Records of these tests were available and discussions with the staff member highlighted that they were knowledgeable about these subjects. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 19 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): 35 and 38. Service user’s money is handled appropriately, ensuring that their financial interests are safeguarded. Arrangements for health and safety practices are generally good, ensuring that service users remain safe. EVIDENCE: Small amounts of money are retained in a safe for service users who request this service. Written records were available of transactions, including the signatures of staff members who handle the money and receipts. There are good arrangements for ensuring safe working practices in the home. All staff members undergo training in safe working practices and safety procedures are posted throughout the home. Risk assessments of the premises and individuals are in place. All accidents and incidents are recorded. There were records detailing that the gas system and boiler had been serviced recently. Testing for legionella occurs and there are regular checks made of Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 20 hot water temperatures. There is a contract for the collection of hazardous waste and the hoist and lift is serviced regularly. There are good systems in place for fire safety including regular testing of the fire alarm and emergency lighting and regular fire drills. Three Requirements have been made in relation to health and safety issues (Refer to Standards 24 and 26) Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 21 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 3 X 2 X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 Page 22 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 17 (1)(a) 3 (3)(k) Requirement Timescale for action 01/11/05 2 OP8 17 (1)(a) 3 (3)(m) 3 OP8 18 (1)(c)(i) 4 OP8 18 The Registered Provider must ensure that any changes in service user’s health or physical conditions are documented in their care plans. (Requirement made following complaint investigation on 16/08/05) 01/11/05 The Registered Provider must ensure that any treatment or intervention undertaken by the nursing and care staff must be recorded. This must include any treatment/intervention requested by the General Practitioner and other medical professionals. (Requirement made following complaint investigation on 16/08/05) 01/12/05 The Registered Provider must ensure that all staff members are trained in the care of service users with Type 1 and Type 2 diabetes. A record of this training must be kept. (Requirement made following complaint investigation on 16/08/05) The Registered Provider must 01/12/05 DS0000026247.V251338.R01.S.doc Version 5.0 Hamilton Nursing Home Page 23 (1)(c)(i) 5 OP8 17 (1)(a) 3 (3)(n) 6 OP16 22 (3) 7 OP24 23 (2)(a) 8 OP24 23 (4)(c)(i) 9 OP26 23 (2)(d) ensure that advice and training is sort from the diabetic specialist nurse regarding the recording of service user’s blood glucose levels, the calibration of the monitor and when there are indications that medical intervention is required. (Requirement made following complaint investigation on 16/08/05) The Registered Provider must ensure that a wound chart is devised to ensure that the size, type, and condition of service user’s pressure sores are recorded along with the colour and whether there is any excrement. All service users’ wounds must be regularly reviewed and a documented record of the review and treatment made, along with the type of specialist mattress and cushion that is being used. (Requirement made following complaint investigation on 16/08/05) The Registered Provider must review the current arrangements for investigating complaints to ensure that all elements of a complaint are investigated fully. The Registered Provider must ensure that were windows, were there is a risk of falling, do not have a restrictor attached; there is a risk assessment in place. The Registered Provider must allow all service users to have their bedroom doors open and must fit automatic closing devices to all bedroom doors. (Requirement made following complaint investigation on 16/08/05) The Registered Provider must ensure that the walls in DS0000026247.V251338.R01.S.doc 01/12/05 01/12/05 01/11/05 01/01/06 01/11/05 Page 24 Hamilton Nursing Home Version 5.0 10 OP29 Schedule 2 (7)(a) bedrooms three and four, and the carpet in bedroom fourteen are cleaned. The Registered Provider must ensure that no staff member is employed to work in the home unlesss there is a satisfactory Criminal Records Bureau, Protection of Vulnerable Adults, or Police check in place. These documents must be made available for inspection. 01/11/05 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 OP24 Good Practice Recommendations The Registered Provider should ensure that a risk assessment is in place were a service user is not provided with a bedroom door key. Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. Extracts may not be used or reproduced without the express permission of CSCI Hamilton Nursing Home DS0000026247.V251338.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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