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Inspection on 11/08/05 for Hawthorn Green Nursing Home

Also see our care home review for Hawthorn Green Nursing Home for more information

This inspection was carried out on 11th August 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides small living units compared to other nursing homes of a similar style, which promotes a more homely environment and a more cohesive approach to the recognition and meeting of individualised needs. The care plans are well written, although concerns have been expressed in this report in relation to the lack of on-going documentation in a care plan for a day-care service user. Activities and community involvement were not assessed at this inspection; however, this service has traditionally met and exceeded the National Minimum Standard in this area. Generally, the home is well managed and maintained and offers a good quality of care.

What has improved since the last inspection?

The last inspection report was very positive and contained only one requirement; therefore, specific improvements were not observed at this inspection report. The lead inspector did not regard this finding negatively.

What the care home could do better:

Ten requirements and four recommendations have been issued in this report. Some of these requirements and recommendations are related to standards that have been met and are therefore related to continuous improvement and development of the service. One of the requirements is for the purpose of `information` in the event of the home considering an expansion of the provision of a day-care service. The areas that specifically need to be improved upon are (1) accurate record keeping during the administration of medications (2) choice and food service at mealtimes and (3) training for staff and delivery of service on the units for people with dementia.

CARE HOMES FOR OLDER PEOPLE Hawthorn Green Care Home 82 Redmans Road Stepney Green London E1 3XX Lead Inspector Sarah Greaves Unannounced Inspection 11th August 2005 10:00am 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. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hawthorn Green Care Home Address 82 Redmans Road, Stepney Green, London, E1 3XX 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) 020 7702 7788 020 7702 8045 eileenharland@sanctuary-housing.co.uk Sanctuary Care Limited Ms Jemma Craig Dressekie Care Home 90 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2005 Brief Description of the Service: Hawthorn Green Care Home is a ninety bedded nursing home situated in Stepney Green, close to Stepney Green and Whitechapel underground stations and accessible by local bus routes. This purpose built care home has a ground and first floor, with lifts. The home is divided into six separate units, each with up to fifteen service users. Three of the units provide nursing care for people with dementia and the other three units provide general nursing care. Six of the beds have been purchased by the Tower Hamlets Primary Care Trust for the provision of Continuing Care. The home offers respite care and at the time of the inspection,daytime only care was being provided for two people. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted in one afternoon and evening. The inspector spoke to service users, one visitor, the registered manager, the deputy manager and staff. Two care plans were looked at as well as other relevant documents. The inspector observed a medication round and the serving of supper on one of the units. Twenty of the applicable thirty-seven standards were assessed at this inspection; all of the applicable standards will be assessed at least once per year. What the service does well: What has improved since the last inspection? The last inspection report was very positive and contained only one requirement; therefore, specific improvements were not observed at this inspection report. The lead inspector did not regard this finding negatively. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 and 5 The Service Users Guides need to be provided to prospective service users to assist them to make an informed choice about the home. Prospective service users and their representatives can visit the home for a pre-arranged or impromptu visit. EVIDENCE: A requirement was issued in the previous inspection report for the home to supply all current service users and prospective service users with a Service User Guide that is written in accordance to the National Minimum Standards for Care Homes for Older People. The inspector viewed the Service User Guide, which was found to be satisfactory apart from the absence of information regarding the qualifications and experience of the registered manager and staff. The inspector noted that this information had been collated for the home’s Statement of Purpose and should therefore be transferred into the Service User Guide. At the time of this inspection the home were awaiting for the Service User Guide to be published into copies which could then be appropriately distributed. This requirement has been deleted; however, the inspector will be monitoring whether the Service User Guide is widely available at the next inspection visit. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 9 The inspector noted at a previous inspection visit that the home complied well with promoting the entitlement of prospective service users to visit prior to making a decision as to whether they wished to move into the home. The inspector had received information prior to this inspection, which indicated that the family of a prospective service user were not permitted to view the home unless they made an appointment. The registered manager stated that prospective service users and their families were advised of the benefits of prearranging a tour of the home so that a member of staff could be allocated to provide information and answer any queries; however, ‘ad hoc’ visits are also encouraged. The inspector acknowledged the rational for pre-arranged visits, taking into account the complex nature of information people may need related to clinical/nursing care needs. The registered manager stated that they would ensure that administrative staff were made aware of the need to clearly explain to enquirers that either type of pre-visit can be undertaken. Standard 6 was not applicable for assessment, as the home does not provide intermediate care. Standards 2,3 and 4 will be assessed at the next inspection visit. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 10 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 and 9 The care plans were well –written and applicable to the needs of the service users; however, the home needs to ensure that the ‘day-time only’ service users possess a care plan that demonstrates the home’s accountability for their health and welfare during the times that these individuals are at the home. Staff must ensure that medication administration records are correctly completed in order to safeguard service users. EVIDENCE: The inspector read two randomly selected care plans. The first care plan was very well written, clearly presented and up-to-date. Monthly evaluations of identified care needs and risk assessments (for care needs such as the prevention of pressure sores, falls and nutritional problems) had been undertaken on 10/08/05, the day prior to this unannounced inspection. The first care plan demonstrated that care needs and risk assessments were appropriately linked to the actual multiple diagnosis of the individual and the recognised associated potential risks. The second randomly selected care plan was for a service user who came into the home four days a week for ‘day-time only’ respite care. The inspector observed that the staff had discontinued undertaking the same rigorous level of documented monitoring as noted in the first care plan. The inspector Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 11 acknowledged that the individual’s circumstances were different as they do not live at the home; however, it is recommended that the service clearly documents the boundaries of its responsibilities for care planning in conjunction with the relevant parties (for example, the service user, their representatives, General Practitioner and social worker). The inspector observed the administration of medications on one of the units. The medications were administered safely in accordance to national guidelines. The inspector observed that a medication administration chart had gaps where staff had not signed whether a nighttime medication had been given or not. All nursing staff had been provided with medication training. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 Service users and their representatives benefited from the home’s flexible visiting approach. Staff must ensure that service users are served their meals in a pleasant, hospitable and relaxed fashion. EVIDENCE: The home offered flexible visiting hours for the friends and family of service users. The inspector spoke to one visitor during this inspection that emphasised he was extremely pleased with the standard of care provided at the home. The visitor stated that he often turned up at different times of the day or evening and was always made to feel very welcome. The inspector observed service users receiving their evening meal. It was noted that two choices of savoury food were available for this meal, followed by desserts. The inspector noted that condiments were not offered for the savoury dishes and a dessert was placed in front of a service user whilst they were still eating their main course. The inspector discussed these practices with staff in the presence of the deputy manager and was disappointed by the responses received, which failed to promote the rights of people to be served their meals in a manner that promoted their dignity and choice. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 and 18 The home’s complaints procedure and the management of complaints demonstrated that complaints are taken seriously. The home provided satisfactory systems to protect vulnerable adults from abuse. EVIDENCE: Complaint 1: The complaints received by the home since the last inspection was discussed with the registered manager. A complaint was received by the Commission from the representative of respite service user. The registered manager was investigating this complaint and their response was due soon after this inspection. This complaint will be commented upon in the next inspection report. Complaints 2 and 3: Tower Hamlets Social Services convened an Adult Protection meeting in response to a complaint from London Ambulance Services and a complaint from the representative of a respite service user. The inspector was informed that complaints 2 and 3 have now been investigated by Tower Hamlets Social Services and did not demonstrate any circumstances of neglect by the home. The registered manager reported that a member of staff was still suspended following an allegation of abuse in December 2004. The registered manager had stated that Sanctuary Care had written to Social Services for a report on the outcome of their investigation. The inspector has made a recommendation in this report for the resuscitation status of all service users to be recorded in their care plans, following discussion with the service user (if possible), their family, General Practitioner and any other relevant medical/health professionals. Although this was not a specific element of any of the complaints, this information would assist the Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 14 home to maintain a professional working relationship with London Ambulance Service. This recommendation has been issued in conjunction with a recommendation for the home to ensure that registered nurses have up-todate cardio-pulmonary resuscitation training. The home used the Tower Hamlets Social Services Adult Protection procedures and provided staff with training regarding the protection of vulnerable adults. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 standard(s) 20,21 and 26. The needs of people with dementia must be addressed through the provision of calming environments. Although the home had a sufficient number of en-suite and communal toilets, redecoration of the communal facilities is required. EVIDENCE: The inspector’s observations were limited to one of the units on this inspection visit. It was noted that a television and music system were being simultaneously broadcast on a unit for people with dementia, which did not meet their identified needs for a calming environment with limited noise stimuli. The bedrooms contained en-suite toilets; however, some of the communal toilets needed to be redecorated. It is recommended that the toilet doors should have additional pictorial signs to enable people with dementia to identify the room as a toilet facility. The general bathrooms were suitably equipped with adapted equipment suitable for service users who are immobile or have restricted mobility. It was noted that the last maintenance date recorded on this equipment was May 2004. A requirement has been issued in this report for the home to demonstrate that annual maintenance is conducted. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 16 The premises were found to be generally clean, comfortable and hygienic. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 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 and 30 The staffing numbers appeared appropriate at the time of this inspection; however, the home must submit a written application to the Commission if it wishes to increase the provision of day-time services in order to evidence that enough staff are available to meet the demands of this service. Staff training is generally satisfactory although the home needs to demonstrate that all trained nurses caring for people with dementia possess suitable training. A more rigorous approach must be evidenced of the verification of previous employer references. EVIDENCE: At the time of this inspection visit, the home was providing day care for two individuals who live in the community. The Commission agreed to a request for one person to receive this service but was unaware that this service had now expanded to two people. A requirement has been issued in this report for the home to suspend any further development of this service until the Commission issues formal agreement. The inspector was informed that less than 50 of the care staff (not inclusive of registered nurses) possessed a National Vocational Qualification (NVQ) level 2 in Care. The service was aware of its responsibility to ensure that a minimum of 50 of care staff attains this qualification by December 2005. The registered manager had offered this training to a sufficient number of staff via a rolling programme of NVQ courses in order to meet this target. The home provided mandatory training for staff, including health and safety, manual handling, fire training, protection of vulnerable adults, first aid and medication training (for registered nurses). The registered nurses were either trained in general or mental health nursing. The Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 18 inspector noted that not all of the general trained nurses working in the dementia units possessed post qualification training in caring for people with dementia; a recommendation has been issued in this report for this level of training to be provided. The inspector looked at the personal files for four members of staff. These files were maintained in accordance to the stipulations of the Care Homes Regulations. The inspector observed that some staff had references from employers that did not clearly evidence their status (for example, an ink stamp bearing the name of the company or written notes to demonstrate that the authenticity of the referee was checked upon by Sanctuary Care). Staff files demonstrated that appropriate induction and foundation training. The home is recommended to establish individual training profiles for staff, listing their current qualifications and training, proposed future training and highlighting when ‘refresher’ training is needed. All nursing and care staff should be offered the equivalent of at least three days training per annum; individual training profiles will be looked at during the next inspection in order to ascertain if this level of training is being provided. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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 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) 31,32,33,36 and 38. The home is well –managed and appropriately focused on the needs of the service users. The organisation and delivery of staff supervision must ensure that all staff receive regular supervision. EVIDENCE: The registered manager is experienced and qualified for their position. The general management of the home demonstrated that effective systems were in place for auditing the quality of the service. The inspector noted that the home had produced its own quality assurance report within the past twelve months and the ‘person-in-charge’ visits by the registered provider (a senior person employed by Sanctuary Care) were up-to-date since the last inspection. The inspector looked at four staff files to monitor the frequency and quality of formal one-to-one supervision sessions. Three of the files demonstrated that staff had received sufficient supervision at regular intervals in order to meet Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 20 the National Minimum Standards of six per year; however, one staff nurse had not received supervision since January 2005. The health and safety checks (maintenance of fire equipment, maintenance of pressure relieving equipment and hot water temperature) were found to be satisfactory. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION x 2 2 x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 2 x 3 Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 22 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 7 Regulation 15 Requirement The Registered Manager must ensure that all service users (inclusive of people who use the service for day-time care only) have a care plan which is regularly monitored and reviewed. The Registered Manager must ensure that medication administration records are correctly completed in order to accurately document whether medication has been given or not. The Registered Manager must ensure that service users are not given the next course of their meal until they are ready and condiments should be offered at mealtimes. The Registered Manager must ensure that the television and music system are not simultaneously broadcast in communal areas. The Registered Manager must ensure that the communal toilets are maintained in good decorative order. The Registered Manager must ensure that the bathing Timescale for action 30/09/05 2. 9 13 01/09/05 3. 15 12(4)(a) 01/09/05 4. 20 12(1) 01/09/05 5. 21 23(2)(d) 31/06/05 6. 21 23(2) (c ) 30/09/05 Page 23 Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 7. 27 12(3) and 18(1)(a) 8. 28 18(1) (c ) 9. 29 19(4) (c ) 10. 36 18(2) equipment is professionally maintained at least annually. The Registered Manager must inform the Commission of any proposal to increase upon the current provision of two daycare places for people living in the community. Any proposal to expand this service must include comprehensive information including staffing numbers and evidence of consultation with existing service users and their representatives. The Registered Manager must ensure that all registered nursing staff working with people who have dementia possess appropriate post-qualification training. This would be expected to include training at a standard equivalent to the former English National Board for Nursing Dementia Course for RGN/EN(G) staff and refresher training for RMN/EN(M) staff. The Registered Manager must ensure that references are checked to ascertain their validity, as necessary. The Registered Manager must ensure that all staff receive a minimum of six formal one-toone supervision sessions per year. As necessary Training plan to be in place by 31/10/05 Henceforth 30/09/05 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 1 Good Practice Recommendations The home should ensure that staff are aware of the services philosophy of encouraging either formally arranged or informal visits for prospective service users G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 24 Hawthorn Green Care Home 2. 3. 4. 8 21 30 and their representatives. This should extend to offering individuals the choice of undertaking both types of visits if they wish to. The home should ensure that the resuscitation status of service users is recorded in their care plans and registered nursing staff have up-to-date resuscitation training. The home should ensure that the toilet facilities are as recognisable as possible for service users with dementia and/or impaired vision. The home should ensure that all staff have individual training profiles. Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ 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 Hawthorn Green Care Home G57 G06 S7357 Hawthorn Green Care Home V224183 110805 Stage 4.doc Version 1.20 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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