Inspection on 20/04/05 for Harley Grange Nursing Home

This inspection was carried out on 20th April 2005.

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 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

Harley Grange Nursing Home 14/08/08

Harley Grange Nursing Home 17/08/06

Harley Grange Nursing Home 13/09/05

Harley Grange Nursing Home 21/02/05

Harley Grange Nursing Home 15/09/04

Harley Grange Nursing Home 23/03/04

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

CARE HOMES FOR OLDER PEOPLE Harley Grange Nursing Home 25 Elms Road Leicester Leicestershire LE2 3JD Lead Inspector Gillian Adkin Unannounced 20 April 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Harley Grange Nursing Home Address 25 Elms Road Leicester Leicestershire LE2 3JD 0116 2709946 0116 2700409 harleygrange@schealthcare.co.uk Southern Cross Healthcare Services Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Jeanne Moitt Care home with nursing 34 Category(ies) of PD(E) Physical disability - over 65 (34) registration, with number OP Old age (34) of places Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.To admit the named person of Category PD as identified in Correspondence in Application number V10761 dated 02/08/04. 2.To admit the named person of Category DE(E) as identified in Correspondence in Application number V13892 dated 09/11/04 Date of last inspection .21.February 2005 # Brief Description of the Service: Harley Grange is a care home owned by Southern Cross Healthcare and is registered to care for thirty-four service users under categories OP (older persons) and PD (physical disabilities). The premises are purpose built and are situated in Stoneygate, a quiet residential area two miles from the city centre of Leicester. The premise is easily accessible by private and public transport.The premises consist of two floors and service users can access both floors with the use of the passenger lift or stairs. A choice of facilities are available namely an adequate number of toilets, washing and bathing facilities. These include a dining and lounge area.The home has eighteen single bedrooms and eight double bedrooms all with ensuite facilities. A wellmaintained garden is located to the rear of the building which is accessible to all service users with physical disability. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected for the seventh time against the Regulations as in the Care Standards Act 2000. This was an unannounced inspection, which took place over one day and commenced at 9.00 am on 20/04/05.The registered manager facilitated the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they received through review of their records, discussion with them, and their relatives, care staff and observation of care practices. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. This inspection took place over one day and whilst being a statutory unannounced inspection was also prompted by previous concerns with the home relating to care practises (resulting in Protection of Vulnerable Adults investigations) and recording of care delivered. The allegations concerning the home were serious enough to warrant a further unannounced inspection by the Commission for Social Care Inspection. During this inspection a tour of the home took place and the inspector viewed internal records, and care plans. She also spoke to care and ancillary staff, residents and relatives. Residents and their relatives gave the inspector their impressions of the home. What the service does well: The home is clean and well maintained and has a happy, calm atmosphere. The registered manager is approachable and has the ability to communicate well with service users. Residents receive well-planned and nutritious meals to suit their individual needs. The registered manager has worked hard to improve standards and manage a number of recent difficult staff issues. The Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 6 registered manager conducts a thorough assessment of residents prior to admission. This includes the involvement of relatives and friends. All fire records are kept up to date and regular fire training is provided for staff. What has improved since the last inspection? What they could do better: Several residents accommodated in the home are not able to independently access call bells or call for assistance from staff whilst seated in the lounge. The registered manager should consider where call bells are situated and their appropriateness in order to ensure that resident’s needs are attended to in an timely manner. Care plans could be improved significantly to reflect outcomes of care delivered and must involve residents and families to ensure an open transparent approach is achieved. The current system of obtaining additional prescriptions could be improved to ensure that no discrepancies occur and dialogue between the GP is improved. The current method of auditing medication could be improved to demonstrate that the system is safe, well managed and that staff are working according to the organisations policies and procedures and their own professional code of conduct. The registered provider could be more proactive in improving relationships with professionals including GP’s, community nurses, social workers and other stakeholders by including them in their quality assurance programme. The outcomes for residents could be improved by including additional training specific to the categories and conditions of registration, for example palliative care, behaviour management, culturally specific training, Diversity and equality Pressure area care etc. Please contact the provider for advice of actions taken in response to this Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) #2.3.4.5.6.# Corporate documentation provided and assessment of individuals prior to admission ensures that residents and their families are confident that the home will meet their individual needs. EVIDENCE: A statement of Terms and Conditions is issued to all residents on admission. This document along with the service users guide and Statement of Purpose are concise and reflect the requirements of the Care Homes Regulations. One of the residents case tracked was able to confirm receipt of this information. Three care plans were case tracked and all contained evidence of a pre admission assessment and community care assessment (where appropriate). One resident was funded by Health and records included a full assessment from the hospital, which the home was following. Care plans tracked in the main were reflective of the assessed needs of the residents concerned however serious concerns were raised over the management of a specific person in relation to meeting cultural and communication needs, also with regard to management of behaviour which had been identified in the initial assessment. Concerns were highlighted to the reviewing officer(regarding weight loss) who was present in the home during this inspection. The residents care plan Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 10 indicated that a significant amount of weight had been lost in a specific period of time due to difficulties in meeting cultural/ nutritional needs. Kitchen staff informed the inspector that they had experienced significant difficulties in establishing a suitable diet. Concerns were considered significant enough to warrant the Commission for Social Care Inspection leaving an immediate requirement notice with the registered manager. The registered manager stated that the home do not provide Intermediate Care currently. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9 Inadequate care planning and inappropriate management of medication. Has the potential to cause significant risk of discomfort or harm to residents. EVIDENCE: Three care plans were case tracked on this occasion. Two of the residents tracked were identified by assessment as at significant risk of developing pressure sores. Both service users tracked had appropriate pressure relieving equipment on their bed however one service user did not have a cushion on the lounge chair in which he was seated. The resident had been admitted to hospital in January 2005 and no evidence was found to suggest that a skin assessment had been undertaken on his return to the home despite evidence of refusal by the resident to take food and /or fluids. No further entries were found in care plans to demonstrate action taken by the home after and entry was made on 4th February stating the resident had excoriated buttocks. Evidence was seen in records of the resident receiving food supplements however no evidence was found of a GP actually prescribing them. A second care plan tracked identified that the resident had leg ulcers no evidence was found of wound measurement or mapping which would reflect wound management and positive outcomes. The registered manager stated that the individual had been referred to a vascular consultant however. Two Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 12 care plans tracked contained no evidence of pressure mattresses used or correct pressure and one plan contained no pressure sore risk assessment (Waterlow) or nutritional risk assessment. Thus placing residents at additional risk of developing pressure sores. A trained nurse spoken with informed the inspectors that due to lack of time on the shift care plans were not kept up to date. One registered general nurse made comments reflecting dissatisfaction with current care practises and lack of time to complete essential paperwork. Medication was inspected in relation to residents tracked and two instances were found where essential medication had not been signed for these included diabetic tablets and insulin. A medication (paracetamol) prescribed as to be given four times a day was not being given as prescribed and a registered general nurse stated that it was “PRN” and given as required. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 Without appropriate monitoring and staff intervention residents are unable to exercise choice and maintain control over their lives EVIDENCE: Observation of staff throughout the day indicated that residents were given choices regarding routines in the home. It was evident however through observation and by discussion with residents, that on occasions their requests for assistance are not met in a timely manner thus reducing their level of control, which is disempowering. A residents who was confined to bed informed the inspector that staff are ok but stated “ I am kept waiting for along time, especially for a bedpan or to change my position in bed” Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.17.18 Lack of appropriate supervision and training of staff has the potential to place Residents at an increased risk of harm and/or abuse. EVIDENCE: The registered provider has a sound complaints system, which is fully, detailed in corporate documentation. It was not possible to clarify with two residents tracked if they understood the process due to communication difficulties. One resident tracked informed the inspector that he would write to the manager or get his family involved. The registered manager had, prior to this inspection suspended a member of staff following a complaint made by a family member. The registered manager was in the process of obtaining postal votes for those residents wanting one and had contacted a resident’s social worker to advise on another person’s civil rights. Some concerns have been identified with care practises in the home since the last inspection, which have resulted in Protection of Vulnerable Adults procedure being instigated. This related to allegations regarding night staff. Both instances have been investigated by the Social Services Department and have involved the police but had not been formally concluded at the time of this inspection. Since the last inspection the registered provider has provided adult abuse training for a large number of staff from all departments. It was noted by observation of records that a high percentage of those who had not attended were night staff however and it is considered vital in light of recent allegations that this is completed immediately. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 15 The registered manager stated that it was very difficult to facilitate supervision of night staff which would be considered an appropriate time to address poor performance issues. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 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 standard(s) 22.23.24.25.26 A comfortable and safe standard of accommodation is provided for the residents, however without consideration of resident’s individual and cultural needs and the provision of essential equipment residents are at risk of harm or disempowerment. EVIDENCE: Observations during this inspection confirmed that several residents’ require adaptations and equipment to meet their assessed needs, including pressure relieving mattresses and cushions, nursing beds, hoists, turntables etc. Discussion with one resident case tracked indicated that staff were possibly using unsafe and potentially illegal moving and handling procedures despite equipment being readily available. Observations of two care plans and associated risk assessments detailed any specialist equipment required by these individuals including wheelchairs, bedrails, hoists, nursing beds, pressure relieving mattresses and cushions. One care plan regarding a resident who was assessed as at high risk of developing pressure sores did not contain any information about reduction of pressure whist seated I.e. cushion required. Rooms of residents tracked were found to clean and well maintained and to meet their individual needs, however one Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 17 service user tracked was noted to be in a shared room whereas the initial assessment had identified that a single room was necessary due to cultural requirements and associated issues. The registered manager informed the inspector that this was the only room available on admission and that the family had accepted this room in the interim. The inspector discussed with the review officer and the registered manager the potential issues that may arise out of this situation and in view of other residents who may be accommodated in the room. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.28.29.30 The procedures for recruitment of staff are not sufficiently robust therefore may not provide the safeguards to offer individuals an environment in which they would feel safe and well cared for. Insufficient training of staff has the potential that residents needs may not be fully met. EVIDENCE: Staffing rosters were inspected on this occasion and a calculation of staffing hours indicated that the home was meeting the minimum staffing levels according to the Department of Health’s Residential Forum guidelines A total of 651 care hours were being provided including trained staff. This calculation does not include manager supernumerary hours or ancillary staff, which are additional hours. Discussions with the registered manager indicated that staff are currently undertaking National Vocational qualification level two/three. The registered manager who is a registered general nurse is undertaking the National Vocational qualification level four programme. All other staff employed in the home are registered general nurses. Three staff files inspected contained essential information including application forms and references, pin numbers etc however one file contained a minimal work history and a second file contained no evidence of identification. Since the last inspection all staff have received updated food hygiene and moving and handling training. Twenty day staff have attended training entitled” Abuse in the Care Home”. Discussions with staff and the registered manager identified that although no link nurses were currently in post in the home two members of staff have been identified to take on the responsibilities Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 19 of tissue viability and have applied to attend Community training, this includes the registered manager. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32.33.34.35.36.37.38. Appropriate management of the home along with sound policies and procedures ensures that residents rights and best interests are considered and that the health, safety and well being of residents is protected. EVIDENCE: The registered manager is a Registered General Nurse with a current active PIN number. She was registered with the Commission for Social Care Inspection in July 2004 She has approximately eight years experience in a managerial role and was employed as acting manager at Harley Grange Nursing Home from 2002 until registered with the Commission. Staff, residents and relatives speak highly of the manager and her approach to ensuring residents needs are met. Although the home is supported by a large national organisation the manager’s style is described by staff as democratic and supportive. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 21 Sound accounting procedures and policies are in place in the home and residents financial interests are protected by minimising risks associated with personal money held on their behalf. This is achieved by the registered provider by issuing a personal allowances and valuables policy to residents on admission. A fully audited system and provision of regular statements to residents. Only two persons, which include the administrator and the registered manager to be involved in the actual cash handling procedure. Accounts were examined by the inspector and found to be fully in order. The registered manager was able to supply evidence of recent supervision sessions, but informed the inspector that she experienced difficulties in supervising night staff. Records of supervision were seen and recommendations have been made to improve them. Safe working practises was explored at the last inspection all evidence found demonstrated that the home was safe and that the health, welfare and safety of residents was given high priority. Observation of records identified that individual risk for example: 1. Moving and Handling (use of equipment) 2. Risk of wandering outside. Had not been addressed within the care plans of two resident’s tracked. Significant risks were associated with both residents in terms of person safety. Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION x x x 2 2 3 3 x STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 3 3 3 3 2 3 2 Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The manager must ensure that the administration of medication is carried out in a safe manner which is routinely audited. The manager must take appropriate action to address the matters raised with regard to the cultural, communication, nutritional and accomodation needs of a resident identified at inspection. This must include consultation with the resident /family and social worker... The manager and staff must improve the quality and content of care plans to be reflectice of all assessed needs. The manager and staff must improve care planning in relation to pressure area care and all aspects of pressure area management including risk assessments,weight monitoring and nutritional assessments, equipment usage. Care plans as identified at inspection must be brought up to date and must be reflective of outcomes and must include residents family input. The manager must ensure that Timescale for action Immediate 2. OP4 12.14.18 Immediate 3. OP7 15 By 31st May 2005 By 31st May 2005 4. OP7 15 5. OP7 15 By 31st May 2005 6. OP14 12 By 31st Page 24 Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 7. 8. OP18 OP18 13 13 9. OP38 13 10. OP38 13 11. OP23 14 12. OP29 19 13. OP30 18 14. OP36 18 appropriate measures are taken to ensure that residents care needs are attended to in a timely manner this must include monitoring of call bell response times. The manager must provide evidence of when remaining staff will receive adult abuse training. The manager must make appropriate arrangements to deliver supervision to staff permanently working on night duty. The manager must make appropriate arrangements to ensure that where identified as required in care plans/assessments that slings and slide sheets are used appropriately and that unsafe handling techniques cease. The manager must randomly audit the methods/ equipment that staff use to transfer residents The manager must make appropriate arrangements to address the matter of the specific resident identified in their assessment as requiring a single room who was accomodated in a double room. The manager must ensure that staff files include a full employment history,and photographic proof of identity. Training appropriate to meeting the assessed needs of the residents accomodated must be put in place including pressure area care and continence care. The manager must facilitate regular supervision of staff including night staff and must keep adequate records to demonstrate that supervision has taken place. C51 S1908 Harley Grange V223067 200405.doc May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 By 31st May 2005 Harley Grange Nursing Home Version 1.30 Page 25 15. OP38 13 The manager must put in place and make staff aware of risk assessments in relation to all risks associated with individuals accomodated,including moving and handling and risk of wandering outside the building. Immediate 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 OP27 Good Practice Recommendations It is recommended that the manager audits time given to completion and updating of care plans by trained staff on each shift.Where it is identified that insufficient time is available to complete care plans regularly on a shift consideration should be given to increasing nurse hours/numbers. It is recommended that the employer seeks to obtain at least a ten year work history on application forms. It is recommended that the manager considers the introduction of internal rotation in order to effect adequate supervision and monitoring of night staff. 2. 3. OP29 OP36 Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 26 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park, Enderby Leicester LE19 1SX 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 Harley Grange Nursing Home C51 S1908 Harley Grange V223067 200405.doc Version 1.30 Page 27 - 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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