Inspection on 05/02/08 for High Trees Nursing Home

This inspection was carried out on 5th February 2008.

CSCI found this care home to be providing an Adequate service.

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

High Trees Nursing Home 15/09/07

High Trees Nursing Home 26/01/07

High Trees Nursing Home 07/06/06

High Trees Nursing Home 01/03/06

High Trees Nursing Home 19/12/05

High Trees Nursing Home 04/01/05

High Trees Nursing Home 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Trees Nursing Home 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB Lead Inspector Jo Pasker Unannounced Inspection 10:00 5 February 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Nursing Home Address 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB 01202 761380 01202 761189 office@3glenfernavenue.bt.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 3 Glenferness Avenue Ltd ** Post Vacant *** Care Home 13 Category(ies) of Dementia (13), Dementia - over 65 years of age registration, with number (13), Mental disorder, excluding learning of places disability or dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Physical disability (13), Physical disability over 65 years of age (13) High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Conditions concerning minimum staffing levels remain in force. Schedule of requirements, set out in a separate letter to the provider, to be complied with by 31.12.06. 15th September 2007 Date of last inspection Brief Description of the Service: High Trees is registered with the Commission for Social Care Inspection to provide nursing care for a total of thirteen people with dementia, mental disorder and/or physical disability. The home is situated in Talbot Woods, a residential area of Bournemouth and is close to the shopping area of Westbourne. A public transport bus stop, for buses to the nearby town centre, is opposite the home. There is parking space for visitors available at the front of the home. The building is on two floors, with a passenger lift, which enables easy access. Five of the rooms are single rooms and the other four are shared. There is a small comfortable lounge on the ground floor, which is also used as a dining area. Meals are prepared on the premises. There is also an attractive garden and conservatory for residents and visitors use. A nurse is available on the premises at all times and a nurse call system is installed in all rooms. A hairdresser visits the home each week; there is an additional charge for this service. During each Thursday a reflexologist visits to provide individual private therapy to particular residents; there is an additional charge for this service. The home is owned by Three Glenferness Avenue Ltd; there is no manager currently in post as of the date of this inspection. They are in the process of recruiting a manager. The fee prices in February 2008 range from £430 to £1025 per week. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. The purpose of this visit was to review the requirements and recommendations made at the last key inspection and another inspector, Mandy Porter, assisted with the visit. Information for this report was obtained from discussion with the Registered Provider, discussions with 2 residents and 5 members of staff on duty, a review of a variety of documentation including records provided to the Commission, care records, staff records, maintenance records, policies and procedures and a tour of the home. One of the directors and registered providers, Mr Phillip Bamborough, was available throughout the inspection and received the feedback. The inspection team would like to thank all the staff and Mr Bamborough for their positive and helpful approach during the inspection. What the service does well: The home’s pre admission procedure is good and prospective residents and their representatives are provided with sufficient information about High Trees to enable them to make a decision about living there. Relatives and key people are actively encouraged to be involved in the life of the home and in the planning and meeting of residents’ needs. Residents are treated with respect, their history and life style informing care practice. A balanced diet is provided and residents are supported to make choices and enjoy their meals. High Trees provides a comfortable clean environment that has been improved to support residents with dementia and mental health needs, where a smaller calm environment makes High Trees feel like home. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service needs to ensure that all care and health plans are up to date, relevant and signed to ensure that the specific health and social care needs of residents are fully met. To ensure that residents health care needs are fully addressed further detail on the management of diabetes should be included in the care plan of the resident with this condition and any future residents to support positive care practice. The service currently uses a basic nutritional guidance tool however to enable them to have more detailed information and meet the specific health care needs of residents, it is recommended that they start to use a clinical nutritional risk assessment tool. Some improvements have been made in the storage of medication but this needs to continue to ensure that medicines are safely administered, recorded, stored and disposed, protecting residents from the risk of harm. An audit system must be established to ensure medicines are regularly checked from receipt to disposal and throughout administration, ensuring that amounts of medication held are correct and support the health care needs of residents. Staff members must complete all mandatory training and the service needs to establish clear processes of ensuring that staff members are trained to meet the identified needs of residents. (A written response received from the provider dated 28 March 2008, indicated that all of the above areas for improvement were being addressed and changes had been made. However, these have not yet been verified by the inspector and will be checked at the next inspection.) High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not assessed as this home does not provide intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are completed before people move into the home so that residents can be assured that their needs will be met by the service. EVIDENCE: The care documentation for a new resident was reviewed and this showed that the home continues to have a good pre admission assessment procedure in place. Peoples’ needs are assessed before moving to the home and sufficient information is obtained so that a suitable plan of care can be written based on this. The provider showed that letters are sent out to all residents and their representatives prior to them moving into High Trees, to confirm that the home can meet their assessed needs. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 10 High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally adequate systems are in place to provide staff with the information they need to meet the health and personal care needs of residents but more improvements must be made regarding aspects of recording and medication handling by staff. Individuals continue to be treated with respect and dignity. EVIDENCE: The care records of 2 residents were reviewed and found to be generally informative and able to provide staff with sufficient information to care for the resident. Completed assessments were in place for falls, continence, pressure areas, mental health, nutrition and physical health needs and regular weights were recorded. Specific interventions given in the care plans, such as ‘Ensure X has 2 baths a week’ and ‘Ensure Y has at least 8 beakers of hot drinks or juice a day’, were cross referenced with the daily entries and fluid charts and evidenced that this care was given. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 12 Another file showed that a resident had been admitted to the home with pressure sores and an appropriate wound care chart had been put in place. Some shortfalls in assessment and recording were evident though, with 1 file not having an appropriate pressure risk or nutritional assessment tool completed. Also, the care plan for diabetes indicated that random blood monitoring (BM) should be taken and recorded. This was happening and there was no indication in the care plan of what was an acceptable range for the BM for this particular resident. However, the appropriate equipment and care were being delivered to this resident, who also looked well nourished and hydrated. (A written response received from the provider dated 28 March 2008, indicated that these areas for improvement were being addressed and changes have been made. However, these have not yet been verified by the inspector and will be checked at the next inspection.) Residents continue to receive appropriate contact with various healthcare professionals and evidence was seen of GP, chiropodist and social worker visits. During the last inspection an immediate requirement was issued regarding the drug trolley being left unsecured and medicines being left out. On arrival at the home this time, the trolley was secured to the wall and no medications left unlocked although a single loose tablet was found on the floor under the trolley. Other shortfalls included: • • • • • Incomplete medication policy available. No clear audit trail as to what stock of medication was kept. Allergies not recorded on the MAR’s. A number of hand written instructions on the MAR’s were not signed or counter signed. Fridge temperatures were not recorded daily. Although there have been some improvements in medication processes, with medications being held securely and Medicine Administration Records (MAR’s) completed fully, further improvements are needed. (Again, a written response received from the provider dated 28 March 2008, indicated that these areas for improvement were being addressed and changes have been made. However, these have not yet been verified by the inspector and will be checked at the next inspection.) Residents and relatives spoken with were happy with the care they received and confirmed that staff treated them with respect and were supportive and kind. Comments included: High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 13 • • • “Everyone is very caring” “ They do their best” And a visitor commented that their relative was “very happy living here and gets good care”. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of activities and social events planned by the home, which meet the residents’ social, recreational and religious needs. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. A good choice of food is available, which provides a balanced diet and the individual needs of the residents are well catered for. EVIDENCE: The home continues to provide a good standard of daily life and activities for the residents, as documented in the last report. An activities co ordinator is employed and peoples’ preferences regarding activities and daily choices are well recorded. Residents during the afternoon appeared to be appropriately occupied and there were sufficient staff on duty to engage them with various activities. Everyone looked happy and residents spoken with, confirmed they were doing what suited them, whether that be listening to music or resting. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 15 Several visitors were seen coming and going during the course of the day and were seen to be welcomed into the home and made to feel comfortable. 2 visitors spoken with said they were very happy with the care and facilities provided at High Trees. The menu provides a well balanced diet, with individuals’ likes/dislikes and dietary needs accommodated, which staff spoken with, demonstrated a good knowledge of. The kitchen area was seen to be clean and tidy, with ample amounts of food and fresh produce stored. Several residents require a pureed diet; thickeners or supplements and these were seen to provided or available where needed. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are procedures in place to ensure that complaints are fully investigated and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection policies are in place, in order to safeguard residents from potential abuse and harm but not all staff have received training in this area or are familiar with the local protocol. EVIDENCE: An adequate complaints system is in place, which residents and visitors appear familiar with and in discussion, felt happy to approach staff with any concerns they may have. There has been 1 complaint to the home recently and this had been appropriately managed and resolved. The home has an adequate policy and procedure to respond to suspicion or evidence of abuse or neglect and some staff have received adult protection training, with certificates seen. Another session is planned to ensure that all staff are up to date in this area. The home’s director has already attended a 3day course on adult protection and it was recommended that more senior staff also attend this course. In discussion, staff are able to identify different types of abuse but appeared unfamiliar with local safeguarding procedures. (The registered provider has since provided a copy of a planned comprehensive staff training programme to the Commission, including safeguarding and it will be checked that this has been implemented, at the next inspection). High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 17 There has been 1 Safeguarding referral made since the last inspection and a thorough action plan was implemented by the providers following it, to address the issues raised. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. High Trees provides residents with a comfortable and safe place to live, which is clean and free from any offensive odours. Some areas require further improvement and these are being addressed by the provider. EVIDENCE: The home continues to provide a good standard of environment for the residents, as documented in the last report. A tour of the premises found the home remained generally clean, tidy and well maintained. Some storage areas in the downstairs bathroom and linen cupboard appeared untidy and insufficient, the assisted bath needs replacing due to rust and the ceiling here requires some work. The provider confirmed that there is an on going refurbishment programme underway and planned to convert this area into a wet room. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 19 The laundry appears to be well managed with a new tumble dryer in operation. The area continues to be used as a storeroom for items that need disposal and the floor as yet has not been resurfaced. However, the provider has plans to address both of these issues and the work is currently on going, stating that planning permission has been granted to extend this room. Evidence of good infection control procedures were seen, with staff observed appropriately using gloves and aprons and washing their hands. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident that there are sufficient staff members on duty at all times. Significant improvements have been made in the appropriate recruitment and training of staff, ensuring that residents will be competently cared for and protected. EVIDENCE: Staffing levels within the home continue to be sufficient, with the home working towards all care staff achieving a National Vocational Qualification (NVQ) in care, as documented in the last report. The files of 4 staff members (2 recently recruited) were viewed and a significant improvement was seen in the recruitment procedure and relevant documentation filed. All Registered nurses’ files contained evidence of their current nursing PIN numbers and expiry dates. However, there were still some shortfalls with 1 file containing no references and 2 files not recording that gaps in employment had been explored. This was discussed with the registered provider, who has worked hard to ensure that all staff recruitment requirements are met and it was evident that the 2 new staff files contained all the relevant documentation. It was advised that character references could possibly be sought for long standing members of staff whose files do not have references and a note made that this shortfall had been noticed during an inspection already. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 21 Improvements are also being made in training provision to staff, with the home having arranged for an external company to provide all the mandatory training needed during 2008. 1 staff member has been given specific responsibility for devising a programme for the carers’ annual training needs and the home’s director has already attended a 3-day course on adult protection. Other recent training undertaken by staff includes dementia care; fire safety and phlebotomy training and training certificates were seen in staff files. 3 staff are also booked to attend a 2-day manual-handling course, facilitated by Bournemouth Borough Council, following recommendations made from a recent safeguarding referral. (The registered provider has since provided a copy of a comprehensive staff training programme to the Commission and it will be checked that this has been implemented, at the next inspection). The improvement plan submitted prior to inspection, also states that the home has paid for 2 members of staff to have driving lessons. This will increase the opportunities for residents to be able to be taken out in the home’s own vehicle. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no registered manager in place to ensure that the home is safely managed, well organised and run in the best interests of residents. However, the registered provider is making active attempts to appoint a new person in the management role. Some improvements have been made in providing an adequate quality assurance system, which is based on the views of residents. Generally, practices in the home ensure that the health, safety and welfare of all are promoted and protected. EVIDENCE: The home continues to be without a registered manager, as documented in the last report however following this, both directors have attended the home on a daily basis, ensuring that improvements have been made and continue. They High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 23 have actively sought to recruit a suitable full time manager, who could be considered to be registered with the Commission and have recently interviewed for this position. As documented in the last report, great time and commitment has been put into implementing a quality assurance system on the part of the providers and this is reflected in the positive improvements seen in the home’s environment. The providers are clearly concerned about the day-to-day running of the service and improving the service in the best interests of residents. Some evidence of auditing was seen but the providers are still looking for an appropriate tool to implement. The home does not currently manage the finances of any resident and these are undertaken by relatives or appointed representatives. Following the last inspection an immediate requirement was issued regarding the unsafe storage of hazardous substances. During the course of this visit, all hazardous substances were seen to be stored away securely and sharps bins appropriately stored. As already discussed in the Staffing and Complaints and Protection sections of this report, poor manual handling practice was highlighted by a recent Safeguarding referral. This has been addressed by the home and staff members will receive updates in manual handling training, to ensure that all residents are safely moved. High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X X X 3 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 1 X 2 X 3 X X 2 High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement All care plans and health records must be kept up to date and be easily accessed to ensure that the health and social care needs of residents are always fully met. The previous timescale for action was 30/11/07. 2. OP9 13 The registered person must ensure that medicines are safely administered, recorded, stored and disposed of, protecting the health and well being of residents. There must be an audit system in place so that medicines are regularly checked from receipt to disposal / administration, ensuring that amounts of medication held correspond with Medication Administration Records. The previous timescale for action was 31/10/07. 4. OP30 18 Staff members need to be 30/06/08 trained sufficiently to ensure that DS0000059925.V358517.R01.S.doc Version 5.2 Page 26 Timescale for action 30/05/08 31/03/08 High Trees Nursing Home residents are in safe hands. The previous timescale for action was 10/12/07. 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 OP7 Good Practice Recommendations It is recommended that specific information on the management of diabetes is included in the care plan of the resident with this condition. It is recommended that a clinical nutritional risk assessment tool be used to assess the dietary and nutritional needs of residents at the home. 2. OP8 High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 High Trees Nursing Home DS0000059925.V358517.R01.S.doc Version 5.2 Page 28 - 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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