Inspection on 21/11/05 for Manor Court Nursing Home

This inspection was carried out on 21st November 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.

Other inspections for this house

Manor Court Nursing Home 06/11/06

Manor Court Nursing Home 07/12/04

Manor Court Nursing Home 21/07/04

Manor Court Nursing Home 23/04/04

Manor Court Nursing Home 17/11/03

Manor Court Nursing Home 29/07/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Manor Court Nursing Home Britten Drive North Road Southall Middlesex UB1 2SH Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 21st November 2005 10:05 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 Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor Court Nursing Home Address Britten Drive North Road Southall Middlesex UB1 2SH 020 8571 5505 020 8574 9243 jacksonpe@bupa.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) BUPA Care Homes Limited Mrs Patsy Mary Jackson Care Home 120 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0), Terminally ill (0) Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of 30 service users over the age of 60 years with Dementia. A maximum of 60 service users with a Physical Disability of which 20 may be under 65 years. Three may require palliative care. A maximum of 30 service users over the age of 60 with Mental Disorder. Two named service users with Learning Disability as agreed on the 20th April 2004 and 18th May 2005, may be accommodated at the home. This condition applies to the two specific service users and is not transferable. The home must advise CSCI when either of the service users no longer resides at the home. 3rd May 2005 Date of last inspection Brief Description of the Service: Manor Court is a 120-bedded purpose built care home, divided into four separate buildings, each of which is self contained having its own communal facilities. Each unit has a television, a sensory room and each offers aromatherapy. Two units are for service users with Mental Health needs and two are for the Elderly Frail service users; of these one unit can provide care for service users, over the age of 20, who suffer from physical disabilities. The home has 90 Continuing Care beds. Included in this number are 30 beds for the Elderly Frail, 15 beds for those with Mental Health needs and 45 are for Dementia Care. The other 30 beds are funded by Ealing Primary Care Trust, Social Services and privately. All bedrooms are single rooms. There are no ensuite facilities. Service users access GP services via the homes own doctors, an allocated GP or through signing up with a GP of their choice. A consultant psychiatrist visits the home for service users who have mental health needs. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. Clare Henderson Roe accompanied Rekha Bhardwa on this inspection. A total of 19 hours was spent on the inspection process. The Inspectors carried out a tour of each house, and inspected service user plans, medication records, staff records, financial records, servicing, maintenance and fire safety records. 14 service users, 8 visitors, 16 staff and 4 visiting healthcare professionals were spoken with as part of the inspection process. It must be noted that it is sometimes difficult to ascertain the views of service users with dementia care needs. The purpose of this inspection was to follow up the requirements and recommendations from the last inspection, and to view some additional standards. All the key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. What the service does well: What has improved since the last inspection? The management of the service user plans had improved, with evidence of monthly updates and comprehensive information about the service users needs. Risk assessments for falls and for the use of bedrails had improved. Staff training and supervision programmes have both shown an improvement since the last inspection. Social and leisure care plans have improved and the activities provision is appropriate to meet service users needs. The lounge areas have been redecorated. Further work is still required in addressing the replacement of furnishings within the units. Overall there was an improvement in the team working amongst the staff. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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 the following standard(s): 1, 2 and 3 Service users and their representatives are provided with information about the home. Written agreements are available for privately funded service users, thus providing clear information about the services provided. This is being reviewed for Social Services placements. Service users are assessed prior to admission to ensure the home can meet their needs. EVIDENCE: The Statement of Purpose had been updated to include the details of the Registered Manager. This document, along with the Service User Guide, was available in each bedroom viewed. For all service users that are funded privately a contract is available. Where service users are funded by Social Services the main contract is held with the Responsible Individual. Discussions are in progress with the Performance Relationship Manager for the CSCI and BUPA regarding individual contracts for each service user. In the service users records viewed pre-admission assessments, admission assessments and Social Services needs led assessments were available. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 11 The service user plans are well formulated and updates take place, thus ensuring that the information required by staff to meet the service users needs is clear and up to date. Medications are generally well managed in the home and safeguard service users. Service users needs in respect of death and dying are being met, thus ensuring that the service users final days are comfortable and appropriately managed. EVIDENCE: A sample of service user plans were viewed on each unit. Overall these were comprehensive, up to date and gave a clear picture of the service users needs. There was evidence of monthly review, plus updates whenever a service users condition changed. Falls risk assessments were in place, with one being completed at the time of inspection. For one service user who had a fall the documentation had been appropriately completed and updated. Risk assessments had been completed for other areas of identified risk. There was evidence in most cases that the service user or their next of kin had been involved in the formulation of the service user plan. For one service user in Beech House a registered nurse had signed the service user plan agreement document, due to the lack of next of kin visits. It was recommended that for Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 10 this service user, advocacy services be contacted and involved. In Larch House for one service user there was no involvement evident from the next of kin. Some duplication of documentation was noted on Larch and, to a lesser degree, Beech houses, and this needs to be sorted and the excess documentation archived. All these areas were discussed with the Registered Manager at the time of inspection. Pressure sore risk assessments were in place. The wound care documentation was clear and up to date, and the dressings and pressure relieving equipment in use had been clearly recorded. There was evidence of input from the Tissue Viability Nurse Specialist. For one service user who required pain control prior to dressings being carried out, this had not been identified in the service user plan. Whilst it is acknowledged that the pain control was being given, reference to this should be included in the service user plan. Continence assessments were available and care plans to address service users continence needs were in place. Moving and handling assessments generally had been completed, with the exception of one for a service user in Larch House. Bedrail assessments were available and consents for the use of bedrails had been obtained in most instances. In Larch House this had not been obtained for one service user, and in Willow House a registered nurse no longer working at the home had signed the consent. These points were discussed and appropriate action to address them needs to be taken. Nutritional assessments were in place and monthly weights had been carried out. Care plans to address nutritional needs, to include those service users on percutaneous endoscopic gastrostomy (PEG) tube feeding and any other special dietary needs. There was evidence of input from the Dietician, and changes in PEG feeds had been recorded. Both Inspectors spoke with one of the GPs for the home, who commented positively regarding the care provided in respect of service users medical needs. The Physiotherapist was also visiting at the time of inspection and service users were seen to be enjoying this therapy. An Aromatherapist had recently started at the home and the service users were observed to be relaxed and peaceful during and following their treatment. Medications were generally being well managed. There was a full audit being undertaken by a Pharmacist on behalf of BUPA at the time of the inspection. Medication systems and records in all 4 houses were viewed. In two instances medication had run out and had therefore been omitted prior to new stock being obtained. This is a repeat finding. Two items for one service user had not been recorded when received, and all other receipts viewed had been recorded. The administration on the medication administration record (MAR) charts viewed had all been signed for, with appropriate coding instructions being used when medication was omitted for any reason. Dates of opening had been recorded on liquid medications with the exception of Calogen on Willow House. Prescriptions were being photocopied and checked against the monthly repeat prescription orders. Variable medication doses were being recorded. Instructions for the use of ‘as required’ medication such as rectal diazepam are now in place. Fridge temperatures were being recorded on a daily basis and Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 11 were within the required safe range. Each medication room has an air conditioning unit in place, and the room temperatures were maintained at satisfactory levels. The system for the disposal of medications had been reviewed in line with new legislation. The policy and procedure had been updated to reflect this. Records of medications for disposal were available. One registered nurse records medications for disposal and for good practice two registered nurses should check and record medications for disposal. Controlled drugs were in use in Willow House and these were being securely stored and correct administration records maintained. PEG feeds were being signed for on the MAR charts and also recorded on the service users fluid balance charts. Any changes were clearly recorded and endorsed by two registered nurses. For one service user on Warfarin therapy the home was not receiving a copy of the results of each blood test. The importance of this to ensure the correct dose is given at all times was discussed and needs to be discussed with the service users GP. The service users plans are updated whenever there is a change in the service users condition and the home aims to ensure that the wishes of the service users and their representatives concerning their care in their final days are recorded and respected. Information in respect of service users religious needs is available throughout the home. The home is registered for 3 palliative care beds. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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 the following standard(s): 12 and aspects of 15 The home has 2 activities co-ordinators who provide both communal and individual activities for service users, to meet their needs. Documentation in respect of each service users social interests is comprehensive, thus providing staff with information in order to meet each service users needs. Dietary needs of service users are well catered for with food choices provided and food available that meets service users preferences. EVIDENCE: In each service user plan viewed a ‘Map of Life’ document had been formulated with many of the significant social history events in the individuals’ life being recorded. Care plans for social activities had also been formulated, plus a record of activities participated in is maintained. The activities programme is displayed in each house and is now in print that is easily readable. Information regarding different religions is on display in each house. Activities were taking place in all the houses at different points of the inspection. The Inspectors sampled the lunchtime meals on the first day of inspection. These were well presented, well cooked and tasty. Staff were observed to be offering service users assistance at mealtimes in a courteous and respectful manner. Service users and visitors spoken with said that there is a choice at mealtimes and expressed satisfaction with the food provision. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a clear complaints procedure in place to address any concerns raised by service users and their visitors. Systems are in place for the protection of vulnerable adults so as to protect them from possible risk of harm or abuse. EVIDENCE: Since the last inspection in May 2005, the home had received 9 complaints. There was evidence of responses to the complainants and any outcomes were recorded. A complaints summary record for each house is maintained. No complaints have been reported directly to the CSCI. Staff have received training in the protection of vulnerable adults (POVA), and further training is planned. Since the last inspection there had been one POVA investigation, which has not yet been resolved. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Some improvements in the environmental standard of the home have been made, but more financial investment and ongoing work needs to be done to provide a homely environment for service users. Systems were in place for the management of infection control, thus safeguarding service users. EVIDENCE: A tour of each house was undertaken. The houses were found to be clean and, with the exception of Beech lounge, odour free. The Registered Manager reported that some bedrooms on 3 houses had been redecorated and that she was awaiting the supply of new curtains. The quality of furnishings in all bedrooms and communal areas in all houses, except Sycamore, requires review and where necessary, replacement. In particular the chairs and carpet in Beech House lounge are in need of urgent attention. The grounds are well maintained, and on Beech and Larch houses, are safe for the service users to access. Although the radiators are reported to be ‘low surface temperature’, some appeared very hot to touch, and this needs to be reviewed and addressed. Protective clothing to include gloves and aprons were available. Liquid soap and paper towels were also available in areas where service users, Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 15 staff and visitors may wish to wash their hands. There were no issues with infection control noted at the time of inspection. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The home is appropriately staffed to meet the needs of service users. Staff recruitment procedures are robust and safeguard service users. Staff undergo training to provide them with the skills to meet the needs of the service users. EVIDENCE: At the time of inspection, each house was appropriately staffed to meet the needs of the service users. The Registered Manager said that she had been carrying out some reviews of staffing and was looking to make adjustments where shortfalls had been identified. Overall the home has a fairly static staff group, and several of the staff spoken with had worked at the home for some years. A programme for NVQ training is available. 33 of the care staff have completed NVQ in care level 2 or 3. The induction and foundation training programmes for BUPA meet the Skills for Care core standards. A sample of staff employment records were viewed. These were up to date and contained the required information. Evidence of ongoing training for staff was available. Staff spoken with said that they receive regular training sessions to include the mandatory training updates. Each house has a moving and training assessor and a fire safety trainer. Training records were available along with certificates. A central record is maintained. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The Registered Manager has a clear plan and vision for the home, which she has effectively communicated to service users, staff and visitors. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Service users monies are well managed and secure procedures are in place. Staff receive supervision, thus promoting communication and review of practice. Systems for the management of health and safety throughout the home are good, thus safeguarding service users, staff and visitors. EVIDENCE: The Registered Manager is a first level registered nurse and has completed the Registered Managers Award. In addition she is undertaking a qualification in dementia care. The Registered Manager was able to clearly describe her role and style of management. This included an open approach and giving staff Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 18 some autonomy within their roles and responsibilities, to which staff had reacted well. BUPA undertake regular customer satisfaction surveys. At the time of the inspection the survey for 2005 was in progress. Results from the last questionnaires had been collated. It was recommended that these are available to service users and visitors, plus a copy sent to the CSCI. Monthly Regulation 26 unannounced visits by or on behalf of the Responsible Individual take place, with reports being formulated and copied to the CSCI. The Deputy Manager carries out audits of areas of care and where shortfalls have been identified, works hard with the staff involved, to include identifying additional training needs, to address these findings. One Inspector viewed some of the records for service users personal monies. These were up to date and the income and expenditure was clearly recorded and receipts were available. The BUPA financial department undertakes an annual audit of service users monies. A system for staff supervision had been implemented since the last inspection. In each house records of supervision are available and had been signed by the supervisee and supervisor. Servicing and maintenance records were viewed at random and those viewed were up to date. This included fire records and fire drill training records. Each house has a health & safety representative and there were no obvious health & safety issues noted at the time of inspection. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 There must be evidence that the service user and/or their representative has been involved in the formulation and review of the service user plan. Where a service user has been fully assessed for the use of bedrails and this is assessed as appropriate, a written consent must be obtained from the service user, their representative or relevant healthcare professional prior to use. Instructions for pain control in relation to any procedure must be recorded in the service user plan. Moving & handling assessments must be in place for all service users. To ensure that continuous supplies of medication are maintained. (timescale of 01/06/05 not met) Dates of opening must be written on liquid medicines. (timescale of 01/06/05 not met) Receipts for all medications must DS0000010951.V265732.R01.S.doc Timescale for action 01/01/06 2. OP8 13(7) 01/01/06 3. OP8 12 01/01/06 4. 5. OP8 OP9 13(5) 13(2) 01/01/06 22/11/05 6. OP9 13(2) 22/11/05 7. OP9 13(2) 09/12/05 Page 21 Manor Court Nursing Home Version 5.0 8. OP9 13(2) 9. OP19 23(2)(b) & (d) 23(2)(b) & (d) 10. OP19 11. OP26 16(k) be recorded. There must be written evidence in the home of the results of blood tests for service users on warfarin therapy. Arrangements to receive this information as a priority must be made with the GP. Action must be taken to replace the carpet in Beech & Larch Houses lounge and to replace the chairs in poor condition. The redecoration and refurbishment of each house must be progressed and financial investment provided to facilitate this. The home must be kept free from malodours (Beech House) 09/12/05 01/03/06 01/04/06 01/01/06 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 OP7 OP9 Good Practice Recommendations It is strongly recommended that where service users do not have a next of kin or representative, arrangements for the provision of an advocate for the service user be made. It is strongly recommended that disposal of medications is witnessed and signed by two registered nurses. Manor Court Nursing Home DS0000010951.V265732.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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