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Inspection on 05/08/05 for Lauriston House Nursing Home

Also see our care home review for Lauriston House Nursing Home for more information

This inspection was carried out on 5th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 is a large facility of 100 beds. This home is an enormous management task, however, the home addresses this well with a good standard of care provided. Several members of the senior staff team have been in post for many years offering a continuity and consistency which is essential to the effective running of a home.

What has improved since the last inspection?

The activities and leisure provision had improved in the home. Two activities staff share the full time post offering a variety of group and individual activities. The home provides several communal areas which can accommodate large groups of residents. Any items needed for leisure and group activities would be purchased and it was evident that the home already has a lot of equipment for residents` use.

What the care home could do better:

The home has two lifts. However, for some time, these have needed repair and have been out of action; fortunately not at the same time. This impacts on the running of the home throughout all departments particularly as the laundry and kitchen are located on the lower ground floor. The CSCI have requested that the lift provision be reviewed and staffing levels increased as needed to deal with this situation. In some parts of the home it was malodorous; this was particularly evident in the corridors.

CARE HOMES FOR OLDER PEOPLE Lauriston Nursing Home Bickley Park Road Bickley Kent BR1 2AZ Lead Inspector Rosemary Blenkinsopp Unannounced 5 August 2005 08:50 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. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lauriston Nursing Home Address Bickley Park Road, Bickley, Kent, BR1 2AZ 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 8295 3000 020 8295 3674 Ashbourne Life Ltd Ms Penny Hammond Care Home with Nursing 100 Category(ies) of Old age, not falling within any other category registration, with number (100) of places Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 10 January 1995 2. 12 Beds designated for intermediate care 3. 1 Place registered for service user category PD for named service user only Date of last inspection 14/12/04 Brief Description of the Service: Lauriston House is a purpose-built care home for the nursing care of older people. Twelve beds are designated for intermediate care. The accommodation for service users is on three floors, with access by passenger lifts. There is a large garden at the back of the home and parking at the front. The home is two miles from Bromley town centre and within walking distance of Bickley rail station for those with full mobility. The home is on a bus route. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors conducted the inspection over a period of approximately six hours. Only two floors were inspected - the ground floor for frail elderly residents and the twelve-bedded rehabilitation unit. A selection of records were inspected including care plans from each unit, staff personnel files and health and safety records. Staff members were interviewed individually on the different units. Residents were spoken to individually and generally feedback was positive. A tour of the environment was undertaken on both floors with a brief visit to the garden suite on the lower ground floor. The kitchen and laundry were also inspected. Under some sections the findings may vary as the inspectors identified different issues on the two units. What the service does well: What has improved since the last inspection? What they could do better: The home has two lifts. However, for some time, these have needed repair and have been out of action; fortunately not at the same time. This impacts on the running of the home throughout all departments particularly as the laundry and kitchen are located on the lower ground floor. The CSCI have requested that the lift provision be reviewed and staffing levels increased as needed to deal with this situation. In some parts of the home it was malodorous; this was particularly evident in the corridors. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 6 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. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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 Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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) 1,3,4,5,6. Systems are in place to provide information and opportunities to inform the residents in respect of their placement prior to admission. EVIDENCE: All prospective residents are assessed prior to admission by a member of the management team. Standard company assessment formats are used covering physical needs and mental heath issues. The residents and families are invited to visit the home although in reality residents are sometimes too frail to undertake a visit. Residents, to whom the inspector spoke, said they or a relative had viewed the home before they were admitted. Supporting information from the placing authority care manager is also generally received prior to admission. In the Intermediate Care Unit many residents are transferred directly from hospital and do not have the opportunity to visit prior to admission. Preadmission assessments and care manager assessments are obtained prior to admission. The information on the home’s assessment forms was quite limited. However a further assessment was done following admission. Staff said the documentation used on the unit was prepared with the involvement of social services and it was not the same as that used in the rest of the home. Please see requirement 1. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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 The provision for addressing health care is well provided for although in some cases poorly incorporated into care plans. EVIDENCE: During the inspection staff were attending to residents needs using appropriate equipment and aids. Staff with whom the inspector met were aware of residents needs .The residents with whom the inspector met felt they were well cared for and “ had no complaints”. On the ground floor the standard care plan documentation used was an Ashbourne company format. Care plans are developed only if there is something specific outside of the everyday care provided. Risk assessments, including those for falls, skin integrity, and manual handling were all included. Some of the detail recorded in the section headed “Normal care needs” was limited and not reflective of the residents’ wishes. In one file there was no photograph of the pressure sore identified in the care plan. The inspector was advised this had healed and was no longer an ongoing problem. Some clinical notices were in bedrooms e.g. “Size 6 pads during the day”. This is not in keeping with a home-like environment and information of this nature should be retained confidentially. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 10 The lunchtime medication was observed administered by the two RGNs on duty on the ground floor. The unit is divided into two sections and subsequently staff are allocated to their individual sections. There is an RGN for each side. They address the medications using individual trolleys which is an improvement and frees up valuable qualified staff time. The procedure was conducted correctly checking names and seeing the medication swallowed, then signing for those medications. The medication records were to a satisfactory standard with photographs, allergies and medication received all documented. On the intermediate care unit three care plans were viewed. These included full assessment of needs but not all needs identified had a care plan prepared to show how the need would be met. For example, the following identified needs did not have care plans prepared: risk of falls, poor mobility, continence issues, risk of developing pressure sores, details on catheter care, details on wound care and dressing renewal and managing confusion. One resident assessed as being at risk of developing pressure sores did not have a special mattress provided. The care plans that were prepared had very limited details as to how the identified need would be met. Daily evaluation records did not reflect the implementation of the prepared care plans. Many of the residents received physiotherapy and a small gym was provided. Residents said that staff encouraged and supported them to continue with the exercises and activities planned by the physiotherapist and occupational therapist. However details of these were not included in the care plans seen. Accident records were kept. One resident sustained an injury which should have received medical attention, but this was not done for about 4 days following the GP visit. From the injury sustained, a fractured thumb, staff should have taken earlier action and referred the resident to the A&E department sooner. There was no evidence of resident or relative involvement in care planning. Care plans on this unit were being reviewed. Relatives seen were generally satisfied with the care provided. A GP visits the home almost every day and the NHS provided physiotherapy and occupational therapy services. On the Intermediate Care Unit medicines were stored properly, a medicine trolley was used to administer medicines, records of administration were well completed and policies and procedures were available on the neighbouring nursing unit. Additional medicine supplies, controlled drugs and those requiring refrigeration were stored in the neighbouring nursing unit. Medicines returned to pharmacy were recorded in the same book as the neighbouring nursing unit. Homely remedy medicines were shared with the neighbouring nursing unit. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 11 The recording of medicines brought into the unit was poor and made it impossible to do an audit trail. Medicine administration charts were mainly handwritten, some entries had been signed by the GP and others signed by one member of staff. None of the residents managed their own medicines. This practice should be reviewed as the residents in the unit were being rehabilitated to return home where they most likely would have to do this themselves. Staff had access to information on medicines and said they had received training on medicine management in the last year. Residents said staff treated them with respect and respected their privacy. The comments made about the staff team were positive and complimentary with residents saying ‘they are very nice’, ‘they are kind’ and ‘I am very pleased with the service’. Please see requirements 2 and 3 and 4. Please see recommendations 1 and 2. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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) 12,13,14,15 The daily life and activities provided in the home are, as far as possible, individual to the residents. EVIDENCE: As the inspectors toured, the hairdresser was in. She visits the home three times a week. The female residents seemed to enjoy this activity and the interaction between the hairdresser and the residents was warm and positive. On the ground floor breakfast and lunch were observed. Choice and variation were evident at both meals. Special diets including soft foods and pureed were provided. Staff were assisting and supervising residents during the lunch, in an unhurried manner. The menu cycle is operated on a four-week basis. Residents were seen to spend time either in communal areas or their individual bedrooms. Rising and retiring times are residents’ choice as far as possible within the confines of communal living. TV and radios were the main activity in the morning with a bingo session in the afternoon. It was noted that several residents were sitting in their wheelchairs for long periods. This may have been their choice, however, this looked quite uncomfortable to the individual residents and quite institutionalised. This practice must only be at the residents’ choice. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 13 On the Intermediate Care Unit residents said staff treated them with respect and respected their privacy. The comments made about the staff team were positive and complimentary with residents saying ‘they are very nice’, ‘they are kind’ and ‘I am very pleased with the service’. On the ground floor, a group of ladies, and later, two gentleman individually, all met with the inspector. The comments from residents were favourable and all felt “some staff were better than others”. Visiting is open. Residents are encouraged to personalise their bedrooms and evidence of individual items were seen. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18. Avenues and information by which to address complaints is made available for residents, staff and visitors to the home. Training is provided to staff to enable them to action abuse/complaints through the appropriate channels. EVIDENCE: The CSCI has received no complaints regarding this service for over twelve months. Copies of the service user guide were seen in bedrooms and this included information on complaint management. Information received from two members of staff indicated that they were unsure as to how to handle suspicions or allegations of abuse. Both displayed a good understanding of what constituted abuse but gave the impression they would not report such incidents without delay. Also both were unsure who they could report such an incident to outside the organisation. Some staff said that if they witnessed anything untoward that they would take the staff aside and speak to them. This matter was discussed with the person in charge of the home. She confirmed, and evidence was seen of training on this matter. She was the training coordinator for the home. In view of the inspectors comments she would revisit the training in respect of abuse. Staff, other than care staff, were also questioned about abuse and poor practice, and all felt that they could, and have in the past raised it with members of the management team and action had been taken. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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) 19,20,21,22,23,24,25,26. The home is purpose built and therefore is suitable for residents with disabilities. The home is maintained as domestic as possible within a nursing home environment. EVIDENCE: The home was purpose built some twelve years ago. It is located over three floors accessed by two lifts. The garden is located to the back of the building with car parking to the front. The garden area was pleasant and well maintained. The home has two lifts. However for some time these have broken down and needed repair rendering them out of action; fortunately not at the same time. This impacts on the running of the home throughout all departments particularly as the laundry and kitchen are located on the lower ground floor. The CSCI have requested that the lift provision be reviewed and staffing levels increased as needed to deal with this situation. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 16 Bedroom accommodation is all en-suite with a mix of double and single bedrooms. On the ground floor, in the corridors, and in some of the bedrooms, there was an odour although the areas were generally clean and tidy. Patio doors are provided in some bedrooms. Staff must risk assess these to ensure that these are safe for residents use. The dining area on the ground floor was nicely presented with serviettes tablecloths etc. The kitchenette area has a hot water dispenser, this was freely accessible to staff and residents. Measures must be put in place to ensure that this does not cause risk or injury to residents. In addition the use of portable fans must be risk assessed for safety. The laundry was tidy and items of clothing organised, although staff stated labelling of clothing could be problematic. The intermediate care unit was clean and tidy although there was a malodour noted in one room, which affected the corridor area. A relative had complained about this and was told the carpet would be cleaned but to date this had not been addressed. Residents were satisfied with their individual and the communal space provided. As residents were in for rehabilitation they did not wish to bring in too many personal items and tended to bring in only photographs. Three bedrooms were inspected and found to be generally satisfactory. Some issues brought to the attention of the person in charge were the need to keep bedrooms free of offensive odours, one call bell was out of order and was replaced during the inspection and vinyl gloves were seen in the waste paper bin in one bedroom. Furniture and fittings were domestic in character and suitable equipment provided to meet the needs of the current residents. All bedrooms had en-suites with shower, WC and washbasin. Residents who needed a bath had this on the neighbouring nursing unit. The communal toilet had no liquid soap and the inspector was told this had been the case for about 2 weeks. Please see requirement 6,7 and 8. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 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) 28,29. Staff receive training appropriate to the work they do. Senior staff are available for support and advice on any issue that arises. EVIDENCE: The home works to the staffing notice dated 1994, and the subsequent amendments made January 2000, issued by the previous regulatory authority. There seemed to be sufficient staff to supervise residents and attend to their needs on the ground floor. The laundry and kitchen seemed less well staffed. The kitchen operated on one chef and two catering assistants, the laundry has two staff and one staff working through the night period. Four personnel files were inspected. These were well maintained with the information required by regulation obtained. A system was in place to check nurses were registered with the NMC. However there was no evidence to show this had been done for one nurse at the time of employment, one employee had a one-year gap in her employment history; it was not evident that this had been explored. Some files did not have a recent photograph but did have copies of passports. Staff who spoke to the inspector said they received training and support to enable them to fulfil their roles. They said they did not receive regular formal supervision. The records for supervision were not inspected although the inspectors were informed that supervision systems were in place. Please see requirement 9. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 18 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) 31,32,37,38. Health and safety issues are taken seriously in this home monitored by the management team and supported with ongoing training and regular audits. EVIDENCE: Penny Hammond is the registered manager and has been in post since January 2001. The manager is well experienced in this area of care and within a nursing home setting. In addition there are a senior head of care, catering manager, domestic supervisor and senior maintenance man in the home. The manager was not on duty for this inspection, however, the senior staff that assisted the inspectors were knowledgeable, helpful and responsive to comments and feedback. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 19 The health and safety certificates were inspected and the maintenance man attended for this part of the inspection. Stickers were applied to hoists confirming servicing and inspection under the LOLER regulations. First aid boxes were in several areas throughout the home and appropriately stocked. Staff receive annual updates in relation to health and safety and manual handling. The fire records detailed staff fire drills. The inspector was advised all day staff have two fire drill training sessions and night staff four. All training is prompted through the computer to remind managers that up dating is due. Emergency lighting, fire extinguishers and all fire equipment are on a service contract. Weekly fire alarm testing is conducted. Certificates for gas and electrical checks were in place. In addition the maintenance team conduct ongoing regular tests on hot water, window restrictors and a number of other health and safety related items. The laundry staff confirmed training on manual handling and COSHH. On the garden suite it was observed that a domestic was using a can of air freshener spray beside and above the tea trolley where there were uncovered biscuits. This was related to the domestic supervisor for action. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 20 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 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 x 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x x 3 3 Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 21 yes 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 3 Regulation 14 Requirement The Registered Manager must ensure full and comprehensive assessment information is received prior to admission. The Registered Manager must ensure care plans incorporate and fully reflect residents needs, including specific care plans for specialist input from O/Ts etc. Care plans must have supporting risk asessments, be kept under review with daily events reflecting those identified needs. Previous time frame for action 31/1/05. The Registered Manager must ensure that robust medication systems are in place and comprehensive information retained, including all supporting records. Previous time frame for action 31/1/05. The Registered Manager must ensure all health care interventions are made in a timely manner with appropriate intervention from the multidisciplinary team, including the GP, made as required. Timescale for action 30/10/05 2. 7 15 30/12/05 3. 9 13 30/9/05 4. 10 12 30/9/05 Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 22 5. 26 23 6. 19 23 7. 26 13 8. 25 13 9. 29 19 The Registered Manager must ensure that the home is maintained free of offensive odours. The Registered Provider must ensure that the lift provision is appropriate to service the home and well maintained. The Registered Manager must ensure infection control measures are addresssed including correct disposal of items and access to liquid soap. The Registered Manager must ensure that all items in the home are safe for residents to use this includes fixed e.g. hot water boilers, patio doors and portable fans. The Registered Manager must retain evidence of staff qualifications including those for registered nursing staff. 30/9/05 30/9/05 30/9/05 30/9/05 30/9/05 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. 2. Refer to Standard 7 9 Good Practice Recommendations The Registered Manager should avoid use of clinical type signs in residents bedrooms. The Registered Manager should promote self medication of those residents who are able. Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH 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 Lauriston Nursing Home G51-G01 s10139 Lauriston UI v240580 050805 Stage 4.doc Version 1.40 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!