Inspection on 24/06/05 for Harnham Croft Nursing Home

This inspection was carried out on 24th June 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

Harnham Croft Nursing Home 14/09/07

Harnham Croft Nursing Home 09/12/05

Harnham Croft Nursing Home 10/01/05

Harnham Croft Nursing Home 13/07/04

Harnham Croft Nursing Home 12/03/04

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

CARE HOMES FOR OLDER PEOPLE Harnham Croft Nursing Home 76 Harnham Road Salisbury Wiltshire SP2 8JN Lead Inspector Susie Stratton Unannounced 24th June 2005 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. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Harnham Croft Nursing Home Address 76 Harnham Road Salisbury Wiltshire SP2 8JN 01722 327623 01722 334983 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) BUPA Care Homes (CFC Homes) Limited Mrs Nicola Maguire Care Home with Nursing 44 Category(ies) of OP Old Age (44) registration, with number PD Physical Disability (4) of places TI Terminally Ill (4) TI(E) Terminally Ill - over 65 (4) Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 44. 2. No more than 4 service users between the ages of 18-65 years with a physical disability may be accommodated at any one time. 3. No more than 4 service users with a terminal illness may be accommodated at any one time. 4. The staffing levels set of in the Notice of Decision dated 31 March 2005 must be met at all times. Date of last inspection 10th January 2005 Brief Description of the Service: Harnham Croft Nursing Home was first registered as a nursing home in 1947; it was renovated and extended in 1978, 1989, 1993 and a further extensive renovation was completed in 2003. The original building was built in 1898. Accommodation is provided over 3 floors and the grounds extend down to the River Nadder, with views looking towards Salisbury Cathedral. The home is registered to care for 44 persons. At the time of the inspection, there 34 persons resident in the home and four empty beds. The home is owned by BUPA, a national provider of care homes. The manager of Harnham Croft is Mrs Nicky Maguire, she leads a team of registered nursing and care staff. A team of ancillary and administrative staff are also employed. The home is situated on the main road in Harnham, which is on the outskirts of the city of Salisbury, about a mile from the city centre and three quarters of a mile from Salisbury District Hospital. There is a bus stop immediately outside the entrance and ample parking is available on site. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of Harnham Croft took place between 9.40am and 2.15pm on a Friday, in the presence of Mrs Nicky Maguire, registered manager. The Inspector was accompanied by three professionals from the Czech Republic and their interpreter, who were reviewing systems for care in England, until 12 midday. This was with the permission of Mrs Maguire. During the inspection, the Inspector met with the registered nurse with responsibility for management of medicines in the home, another registered nurse, four care assistants, the chef, the activities co-ordinator, the administrator, the laundress, the maintenance man and one of the domestic staff. The Inspector met with nine of the residents and observed care provision for six residents who were not able to communicate. Records relating to five residents were reviewed in detail. The Inspector toured the building, including the kitchen and the laundry, observed a lunch-time meal and an activities session. Records examined included medicines records, residents personal finance records and the fire log book. What the service does well: What has improved since the last inspection? Much work has been put in to improving consistency in care planning. All care plans had been completed to the same standard and reflected the resident’s care needs. Care plans were all in place and available for staff to follow. All residents had manual handling and falls risk assessments and where risk is identified, a care plan is in place to direct staff on how risk is to be reduced. All care plans had been evaluated regularly and up-dated as care needs changed. Residents with wounds had care plans in place to direct staff on how the wound was to be managed, responses to treatment had been regularly Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 6 evaluated. The home are extending the role of care assistants, supporting them in completing residents’ documentation. Records of residents and their relatives wishes in the event of sudden illness are being maintained. Improvements have been made to the management and storage of medicines. The temperature of the medicines refrigerator was now monitored on a regular basis and written records maintained. Where residents wished to selfmedicate, risk assessments had been completed and the relevant code used on the resident’s medicines administration record. Improvements have been made to the prevention of the spread of infection by ensuring that all clinical waste is placed in foot pedal operated bins and that linen is always placed in an appropriate linen skip. Of the seven requirements identified, six had been addressed in full. Both recommendations had been 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. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 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 standard(s) 1, 3, 4 & 5. Harnham Croft does not provide intermediate care, so this standard is not applicable. Information about the service offered at Harnham Croft is made available to all residents. Pre-admission visits are encouraged and full assessments of nursing and care needs are made prior to admission, to ensure that the home can meet the needs of residents admitted to the home. EVIDENCE: A comprehensive service users’ guide is provided in all residents’ rooms. Residents are assessed by Mrs Maguire or her deputy prior to admission, to ensure that the home can meet the resident’s needs. Where residents are admitted from a distance, Mrs Maguire obtains full and detailed assessments from the current care provider. Residents spoken with said that they had been too unwell to visit the home prior to admission but that one of their family had visited on their behalf. Discussions with residents, staff, observations of care and reviews of documentation showed that the home were able to meet the needs of residents admitted to the home. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11 Care plans are maintained in full and regularly evaluated and up-dated when residents’ conditions change, so that changed needs can be met. Staff at all levels showed an awareness of the importance of ensuring service users’ dignity and treating them with respect, this included frail persons who could not communicate. Residents are protected by Harnham Croft’s effective system for management of medicines. EVIDENCE: Significant improvements in the standards of assessment and care plans were noted at this inspection. However, of the assessments which were reviewed, one resident did not have any written assessments, although they did have care plans in place, which reflected the resident’s needs so informal assessment will have taken place. For another resident, their assessments had not been dated and signed; all other residents assessment had been dated and signed. All nursing and care documents should be dated, to identify who had drawn them up, and dated to assist in identifying when review is next needed. All residents have full and detailed care plans in place, plans have been evaluated regularly and most had been signed by the resident or their representative. Residents are assessed for risk of falls and where risk is identified, a care plan is put in place to reduce risk. Footwear can be a factor Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 10 in increasing risk of falls, so it is advisable to include this in risk assessments. Residents with wounds have clear assessments and care plans in place. One care plan relating to a wound reflected in full what the resident told the Inspector. All medicines and drugs were stored in accordance with current guidelines. All records relating to medicines were fully completed. Where a resident wished to self-medicate, risk assessments were drawn up, these were regularly reviewed. Records provided evidence of regular consultation with residents’ GPs and external professionals. The home had ensured that one recently admitted person had been referred to the optician and the chiropodist. The daily records of one resident who had had a sudden collapse, were clear, detailing all relevant matters about the collapse, to inform staff and the resident’s GP. Records also clearly stated when relatives had been contacted about a resident’s condition and details of conversations, to ensure that staff on different shifts were fully aware of what had been discussed. Staff were observed to knock on resident’s room doors prior to entering. Staff also informed the resident of who was coming into the room and told the resident when they were leaving. As many of the residents were frail and some spent all their time in bed, this supports such residents, as they will not be sure of who is coming into their room and when staff are leaving. All personal care was performed behind closed doors. Harnham Croft cares for some very frail persons. All such residents looked comfortable, with brushed hair, clean nightclothes and fingernails. All residents looked well hydrated at this hot time of year. Where residents needed frequent care, relevant records were in place, to ensure that they were turned and offered fluids regularly. Where residents needed assisted feeding regimes clear records were completed and there was evidence of consultation with the Speech and Language therapist. Some residents and their representatives had expressed wishes on actions to be taken in the event of sudden illness or collapse and full records relating to these wishes were retained on file. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 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 standard(s) 12, 13, 14 & 15 A range of recreational activities are offered to residents and clear records are maintained. Visitors are encouraged. Residents can choose how they spend their days. A varied menu is offered and residents can choose where they ate their meals. EVIDENCE: The home’s activities coordinator performs individual assessments of residents’ social and recreational needs, this includes their religious needs. A comprehensive activities programme is offered, this includes large group, small group and individual activities. The activities coordinator reports that she tries to see each resident every day. Trips out are provided, some are to larger attractions, others are smaller, such as to local garden centres. Relatives are encouraged to come on trips out if they wish to. Relatives may also book to have a meal in the home. Several residents said that they went out regularly with their relatives and visitors. Links have been made with two local schools. The home is to have its annual fete shortly, people living in the local area have been invited and it was reported that it is usually well supported by the local community. Residents said that they could choose how they spent their days. If they wanted to stay in their room and eat their meals there, this was respected. They said that they could get up and go to bed when they wanted. For frail persons and persons with communication difficulties, care plans detailed what Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 12 the resident preferred to wear. Many of the residents had brought some of their own possessions into their rooms, giving the rooms an individual appearance. The chef has been in post for many years and knows long-term residents personally. He reports that he visits all newly admitted resident shortly after admission and if a resident has any particular needs, he continues visit them regularly to discuss their preferences individually. He reported that he was providing nine liquidised meals. It was observed that liquidised meals were attractively presented, with the different parts of the meals placed separately on the plate. The menu is rotated every six weeks. The days menu is made available in the entrance hall and residents can ask for something different if they wish. On the day of the inspection, some residents were having breaded fish, while others had fish poached in a sauce. One resident said that their favourite meal in the home was fish and chips. A resident who was visited at lunchtime said “I’m enjoying this” about their meal, another said how “well presented” the meals were, another described portions as “generous” and another that they liked the “nice” puddings. A care assistant was observed assisting two different residents to eat their lunch, it was noted that she sat with them, chatting in a friendly manner, describing the meal to them and supporting them in swallowing. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 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 standard(s) 16 & 18 The home has a complaints procedure, which residents reported works in practice. Staff showed an awareness of ensuring that vulnerable adults are protected. EVIDENCE: The complaints procedure is displayed and provided individually to residents in their service users’ guide. A review of records showed that any complaints were investigated in accordance with the home’s procedure. Residents spoken with said that they knew who to raise issues with. One resident said that they would tell their family and they would then talk to staff, another said that they talked to Matron if they had any problems and another said that they could talk to any member of staff if they had concerns. The home has a vulnerable adults procedure in place and staff spoken with knew how to raise issues of concern with management. Mrs Maguire has experience of working within local vulnerable adults procedures. There was evidence that further training in abuse awareness for staff is to take place shortly. Where residents need restraints such as safety rails, these are documented and care plans are regularly reviewed. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 14 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) 19, 20, 21, 22, 23 & 24 Harnham Croft is well maintained. There are spacious communal rooms and bedrooms. A range of sanitary facilities are provided on each floor. Equipment to support disabled persons is provided. All rooms are clean, attractive and fully furnished. EVIDENCE: Harnham Croft gives the appearance of being well-maintained. The maintenance man is on site during the day and able to respond quickly when issues are identified. There is a large lounge on the ground floor, this offers access onto a terrace, with views over the river Nadder and Salisbury Cathedral. The dining room is also spacious. The front entrance is provided with seating and some residents and visitors like to sit there too. The grounds are well maintained and a sensory garden has been developed on the terrace. A range of wcs and bathrooms are provided for residents, all have relevant equipment to support disabled persons. Most rooms are large and all have ensuite facilities. Some rooms have views looking towards the water meadows and Salisbury Cathedral, the rooms which look towards the main road are Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 15 screened by trees. One resident described the views from their room as “beautiful”. All relevant equipment for disabled persons is in place. A range of hoists to support staff in moving disabled persons are provided. All residents had been left with access to the call bell system. Staff response times when call balls are activated are monitored, to ensure that staff attend in a timely manner. One resident said “I’ve only to press my bell, night or day and they come”, another said that they had fallen recently and that staff had got to them “so quickly” to assist them and another said that if they used their bell, staff would come and tell them if they were with another resident and would then make sure that they returned to attend to them “as soon as they can”. Residents who are assessed as being at risk of pressure damage have pressure relieving equipment which is consistent with their assessed degree of risk in place. The maintenance man has full records of all equipment, detailing where each item was in the building. All of the home was clean. A member of the domestic staff was observed performing his duties; he was noted to be thorough, cleaning under surfaces as well as upper surfaces. The laundry was well-organised, with safe systems for management of infected or potentially infected laundry. The laundress also had effective systems to ensure that residents’ own clothes were returned to them. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 Harnham Croft are staffing the home as required by the Commission and continuity of care to residents has been improved by a reduction in use of agency staff. EVIDENCE: Harnham Croft is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. On occasions since the last inspection, where the home have had problems with complying with their minimum staffing levels, due to sudden sickness, the home always informs the Commission and outlines how residents have been protected. A range of nursing, care and ancillary staff are in post. Some staff have been in post for a considerable period of time and form a core of staff who know the home and its systems well, this supports newer staff. The home has succeeded in reducing its use of agency staff. Mrs Maguire reported that they still had some staff vacancies but these were fewer than at the last inspection and the home’s own staff tended to volunteer to pick up the additional shifts. Mrs Maguire also said that they had recently had a positive response to recruitment advertisements and she was hopeful of being fully up to establishment in due course. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 17 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, 33, 35, 36, 37 & 38 Harnham Croft is managed by a qualified, experienced manager. BUPA regularly reviews quality of care and makes findings known to residents. Safe procedures are in place to ensure that residents’ moneys and valuables are kept secure. Staff are supervised to support them in their roles. Records, polices and procedures are in place, to safeguard residents interests. There are systems to ensure promotion of health and safety, however residents and staff may be put at risk by lack of appropriate warning signage and securing of oxygen cylinders. EVIDENCE: Mrs Maguire is an experienced registered nurse and manager. She has completed the Managers’ award and I.O.S.H. Mrs Maguire is supported by a deputy manager. BUPA perform regular quality audits and findings are made available to resident in the service users’ guide. The home is visited regularly by representatives from the proprietors and reports completed. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 18 A clear system is in place for management of residents’ moneys. The administrator keeps a copy of all receipts on file. Residents moneys are held in individual accounts, to which interest is applied. The administrator can provide all residents and their relatives with copies of their personal account on request. There is a clear audit trail for valuables handed in for safekeeping. All staff are regularly supervised, at present the home are developing staff in line with BUPA’s “Personal Best” programme, to support staff in developing their own areas for improvement in service provision to residents. All required documentation and polices and procedures are in place. The home has policies relating to cross-gender care and are advised that they should develop a procedure to ensure that residents’ preferences are protected. The home should obtain the up-dated local Health Protection Guidelines on prevention of infection, to support their practice. The home has been visited during the past six months by the Environmental Health Department and their recommendations actioned. The home’s fire log book is fully maintained as advised by the local fire brigade. Where oxygen is prescribed, in one case, there was no required British Standard warning notice on the door of the resident’s room this is needed to advise residents and staff in event of a fire. The cylinder was also not secured as required to ensure resident, visitor and staff safety. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 19 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 3 3 3 2 Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 20 NO 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 38 Regulation 13(4) (a)(c) 23(4)(a)( b) Requirement Where a service user is prescribed oxygen, appropriate British Standard warning signs must always be placed on their door and the cylinder must always be fully secured. (Parts of this requirement relate to a requrement which was indentified at the previous inspection.) Timescale for action 31 July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 7 37 37 Good Practice Recommendations All nursing and care assesments should always be in writing and be dated and signed by the person drawing up the assessment. Risk assessments for falls should include an assessment of the service users footwear. A procedure on cross-gender care should be drawn up. A copy of the up-dated Health Protection Agency guidelines on infection control should be obtained. Harnham Croft Nursing Home D51_D01_S15915_HARNHAMCROFT_V183271_200605_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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