Inspection on 15/11/05 for Manton House

This inspection was carried out on 15th 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 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

Manton House 02/03/09

Manton House 12/02/08

Manton House 30/04/07

Manton House 03/05/06

Manton House 14/04/05

Manton House 18/11/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Manton House Nursing Home 5 Tennyson Avenue Kings Lynn Norfolk PE30 2QG Lead Inspector Mr Christopher Handley Unannounced Inspection 15th November 2005 09:30 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 Manton House Nursing Home DS0000061111.V265688.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. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manton House Nursing Home Address 5 Tennyson Avenue Kings Lynn Norfolk PE30 2QG 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) 01553 766135 Mrs Lai-Wah Collin Mr Raju Ramasamy, Mr Inayet Patel Mrs Catherine Florence French Care Home 22 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (22) of places Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Twenty-two (22) Older People, not falling into any other category, may be accommodated. Two (2) Service Users, over the age of 65 years, who have dementia may be accommodated. Total number accommodated not to exceed twenty-two (22). Date of last inspection 14th April 2005 Brief Description of the Service: Manton House is a registered care home, providing both nursing and residential care. The home is a large end of terrace building of traditional design. The accommodation is on the ground and first floor. There is a small garden at the front of the home, and a lawn and car park at the rear of the home. Nursing care is provided by the nursing staff of the home. If medical or other nursing expertise is required this is provided via the local GP service. The home is situated on Tennyson Road, which is near to the centre of Kings Lynn. There are shops and facilities adjacent to the home. The home was purchased by Mr Inayet Patel, Mrs Lai-Wah Collin & Mr Raju Ramasamy in October 2004. Manton House Nursing Home DS0000061111.V265688.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, which forms part of the annual inspection programme. The Inspector interviewed five residents, three visitors, and five members of staff and the manager of the home. A wide range of records and documents were inspected. A tour of the home was undertaken. The Inspection commenced at 9.30 and took 6 hours to complete. What the service does well: What has improved since the last inspection? 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. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 6 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 Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 7 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 & 5 The home provides good information for residents. The health care needs of residents are met. Privacy forms an integral part of the care provided. EVIDENCE: The home provides all residents with a Statement of Purpose and Service User Guide, the Manager said. The documents are comprehensive and complete. In the inspection dated 14/4/05 a recommendation was made that all residents are provided with this information and this now happens. Residents and relatives interviewed were aware of these documents. One said that they were provided with information about the home when their relative was admitted. Some members of staff interviewed were also aware that residents/relatives are provided with information when they come to the home. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 8 All residents are provided with a Contract, the Manager said and visitors interviewed confirmed this. The Manager said that it was mostly relatives who dealt with contracts. The home keeps a signed copy. Staff interviewed were aware that residents had contracts, but that they were not involved with them. Pre-admission visits to the home by prospective residents and their relatives, are welcomed, the Manager said. She is aware of the importance of these visits which is to ensure, as far as is possible, that the home not only meets the needs of the residents, but that the potential resident also like the home, as it may become their permanent home. The Manager said such visitors are taken round the home; they meet and talk to other residents and staff. One relative interviewed, told the Inspector that he had toured the home prior to the family placing their relative in the home. Another relative told the Inspector that he had visited a number of homes before deciding on Manton House. Manton House Nursing Home DS0000061111.V265688.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 & 10 All residents have an individual care plan. The health care needs of residents are met. The medicine system is safe and effective. Privacy forms part of the care provided. EVIDENCE: All residents have an individual care plan, three of which were read carefully by the Inspector. Each plan is contained in an individual A4 ring binder folder, which has the name and a photograph of the resident on the front, and these are stored appropriately. The file is made up of a pre-admission assessment, a care plan, a selection of risk assessments, the daily record, records of visits by health providers and letters regarding health provided by various persons and organisations. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 10 It is recommended that some of the photographs on the outside of the folders be changed and updated and that “Confidential” is written on the outside of the folder to ensure that all are aware that the entire contents are confidential information. In the documents seen there was no evidence of the resident or relative being involved in the care planning process despite there being a space for this. This is not acceptable. The structure of the documentation is good, with an assessment, plan, implementation, and review. Many of the spaces in the documents, which are of significant importance to the residents, have been left blank. Again this is not acceptable. The daily record tends to record “physical” aspects of the resident’s care, and little mention is made of the mood/general welfare or social wellbeing of the resident in the documents seen. A more holistic record of the resident’s day needs to be made. The Manager is advised to set out some simple guidelines for staff when completing this record, so as to ensure that there is a holistic record of the resident’s day/night. The Manager needs to monitor these records on a weekly basis to ensure that there are no blank spaces left. Trained nursing staff provide any nursing care. The Manager said that at present there are three residents who have pressure sores and they are receiving appropriate treatment for this, which is recorded. The home has a good range of equipment to enable care to be provided, including airflow mattresses, air cushions, a hoist and other equipment, which might be required for the care of a resident. The Continence Advisor, Tissue Viability Nurse, the Falls Prevention Co-ordinator, and Physiotherapist attend if required. If nutritional advice was required then the Manager would seek the advise of the Dietician. All residents are registered with a GP. The Manager arranges hearing and sight tests if required. If required the GP. would refer residents to consultants for further tests and treatment. The residents interviewed spoke highly of the personal care provided, as did their relatives, who also said that they were aware that, if needed, the GP would be called. Some of the staff interviewed briefly outlined some of the training they had received for tasks that they were carrying out. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 11 The medicine system was inspected. The medicines are kept in a designated room, which is kept locked, and the trained nurse on duty holds the key. The home has a Monitored Dosage System of medicines. The medicine trolley which was locked, and in turn locked to the wall was neat, clean, and tidy, there were no loose or uncounted medicines. The records of administration are neatly and fully recorded. There are no residents who self medicate. The Inspector read the homes medicine policy which appears full and comprehensive. In the last inspection a requirement was made that the home purchase a larger Controlled Drug Cupboard, this has been done, and the requirement is fulfilled. Records of one of the controlled drugs were inspected and found to be in order. The home has a very good working relationship with the supplying chemist, the Manager said. If staff had any concerns about the effect of medicines on residents they would contact the prescribing G.P. Privacy forms part of the care provided in the home, and privacy forms part of the induction programme. Knocking on doors is a normal practice in the home and the Inspector observed this on a number of occasions during the process of the inspection. Residents wear their own clothes. Discussions with solicitors and doctors would be carried out in private. Residents are called by their preferred names, the Manager said. Residents interviewed told the inspector that the staff always provided privacy for them, and this was confirmed by relatives. Staff interviewed said that privacy was important to residents, and that they provided it. Manton House Nursing Home DS0000061111.V265688.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, 14 & 15 Residents’ lifestyle match their expectations and preferences. Residents enjoy a wide range of choice in their lives. The home provides a good catering service. EVIDENCE: The residents choose what they do during the day; they choose when they get up, and when they go to bed, the Manager said. They choose their meals, their dress, hair style, and many other aspects of the life and pattern of their day, the Manager added. Representatives of religious organisations call to the home and a religious service is held in the home on a monthly basis. The home appointed a person to be responsible for activities, and this fulfils a recommendation made in the inspection dated 14/4/05. However the Inspector was informed that this person has been off sick for some time. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 13 Activities provided include bingo and quizzes, and they are very popular the Manager said. Many residents enjoy watching the soaps on television the Manager added. A musician attends the home and will be coming at Christmas. Relatives interviewed said that their relatives always have something to do. Staff interviewed were aware of the importance of the residents leading a full life if possible and one resident said that they have chosen what they want to do, based on their past interests. Residents, mainly with help from their relatives, deal with their finances, and one relative confirmed this, in discussion with the Inspector. The Manager would facilitate external contact, e.g. advocates if legal or financial advice were needed. Residents have brought in a wide range of photographs, ornaments etc with them to personalise their rooms. Residents do have access to their records, the Manager said but none had asked to seem them. Staff are aware of the importance of residents having personal possessions with them, and told the Inspector that they thought that this was important to the residents. The Inspector saw the menus; they appeared varied, nutritious, and interesting. Special diets are provided and they are also recorded. The Manager said that she would contact the Dietician at the local hospital if she required any nutritional advice. The staff interviewed spoke highly of the meals provided, they said that they are “very nice and the residents always like them”. Residents and relatives interviewed spoke very well of the meals, one told the Inspector that his relative always enjoyed the meals and that was always enough. Another visitor said that there were always fresh vegetables and fresh fruit in the home. The Inspector observed residents taking their midday meal with obvious delight. The Inspector spoke to the cook and she told him that she thought it was very important that residents enjoyed the meals she cooked for them. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 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 the following standard(s): 16, 17 & 18 The home has an effective complaints procedure. The home ensures that the legal rights of residents are protected. Staff are aware of the procedures which protect residents from abuse. EVIDENCE: The home has an effective complaints procedure, which is normally posted up in the entrance to the home, but due to decoration taking place this has been moved nearer the office. This procedure is in large print size. Any concerns are dealt with quickly, the Manager said, and by doing this she finds it prevents concerns developing into complaints. Residents and especially their relatives told the Inspector that they know how to make a complaint if they needed to, and felt able to approach any member of staff or the manager. Residents’ legal rights are protected and the Manager would facilitate legal advice if required and if needed would involve the Social Worker. The Manager is very conscious of the importance of residents’ legal rights. Some of the staff interviewed were aware that they needed to refer these issues to the Manager. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 15 The home has an Adult Abuse Awareness policy, which was seen by the Inspector. Staff interviewed were aware of this. Staff who have undertaken their NVQ II have taken training in Adult Abuse Awareness as part of that course. The Manager informed the Inspector that it was intended to provided training for all staff in this important matter in the New Year and the Inspector requires that this training be provided, because of the possible serious consequences of abuse to the residents of the home. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 16 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, 24 & 25 The location of the home is suitable for its stated purpose. Residents have personalised their rooms. Residents live in a safe, comfortable, environment. EVIDENCE: There is a small garden at the front of the home, and a small lawned area at the back of the home, both of which are well maintained. There is a small car park at the rear of the home The home complies with the requirements of the local fire service and the environmental health department, and there is documentation to this effect. Since the last inspection the safe access of one external fire door has been improved and the Manager showed this to the Inspector. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 17 At the last inspection it was recommended that the Manager develop a programme of routine maintenance, as yet this has not been done and because of the importance of this the Inspector makes this a requirement. In the inspection dated 14 April 2005 a recommendation was made that the carpet on the ground floor corridor should be replaced. This has since been done and it improves the look of the area. The Proprietors are commended for this. The carpet on the top floor corridor was clean but in some areas there were stains on the carpet, and this should be cleaned before it gets worse. On the day of the inspection the entrance hall was being painted. This area has already been wall papered, and whilst the painting was not complete, it looked much brighter and very much improves the appearance of this area. The Proprietors are commended for this. The Inspector made a tour of the home and visited most of the residents’ rooms. The residents’ rooms seen were well decorated and there were lots of personal items which have been brought in by the occupants. These include pictures, photographs and ornaments. The residents and relatives interviewed told the Inspector that they thought very highly of the rooms. They are in a good state of decoration, they were neat, clean and tidy. There were call bells and smoke alarms in place. These rooms have good natural light. The residents prefer to leave the doors of their rooms slightly ajar the Manager told the Inspector. There are mobile screens in double rooms to provide privacy. The Inspector recommends that these be replaced with curtains which are suspended from the ceiling. In this way privacy will be preserved, and the potential of residents stumbling over the screens would be removed. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 18 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 & 30 The needs of residents are met by the numbers of staff on duty. The home has an NVQ training programme, but this needs to improve. Some staff are trained to do their job. EVIDENCE: On the morning of the inspection there were 8 staff on duty plus the Manager who listed the staff on duty. This consisted of 1 trained nurse, 1 Senior Care Assistant, 3 Care Assistants, 2 Domestic staff, 1 Kitchen staff and the Manager. This agreed with the rota. This level of staffing appeared to be sufficient to meet the present needs of residents at their present dependency. The Manager said that she was allowed to bring in additional staff if required. The Manager is advised to monitor the level of resident dependency which will rise as their needs increase with age and infirmity. The home has an NVQ training programme in place. The Manager informed the Inspector that there are only 7 staff who have completed or are taking an NVQ in care. This is not a very large percentage of the staff. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 19 The Inspector spoke to staff some of whom had undertaken their NVQ, and they told the Inspector that they had learnt a lot from it and they now had the theory to back their practice. The staff who have taken their NVQ are commended for this as the Inspector appreciates that it is difficult for people who lead busy lives. The Company and the Manager need to increase the level of this training programme. The Manager said that other training provided includes Fire Prevention, Food Hygiene, First Aid, Training in Understanding Dementia and Dementia Awareness. Health and Safety training is planned to take place early next year. It is recommended that the Manager undertakes a training audit of the skills required by trained nursing staff and care staff. Once the audit has been completed, a training plan for the home needs to be developed and implemented. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 20 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 & 37 The Manager is of good character and manages the home effectively. The home does not have a Quality Assurance system in place. The home maintains the records required, and these are held safe. EVIDENCE: The Manager is an RGN and has been in post for just over a year. She has previously held senior positions in the local Health Authority. She is responsible for this home only. The Manager and senior staff are familiar with the conditions/disease associated with old age. The Manager has a job description which was seen by the Inspector. There are clear lines of accountability within the home, and also with external management. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 21 The Manager informed the Inspector that it was her intention to commence the management training early in the new year. Based on discussions with staff and residents it was clear that they respect the Manager and see her not only as the Manager but a source of advice and help. Visitors told the Inspector that if they needed to know about any matters concerning their relatives, they would contact her. At present the home does not have a Quality Assurance system. The Manager monitors services on a daily basis and the General Manager monitors the services on a monthly basis. The Manager informed the Inspector that the Company intends to implement a quality assurance system early in the new year, and is in the final stages of preparing this system at present. The Inspector recommends that the company implement a Quality Assurance System by April 2006. A wide range of records were seen during the process of this inspection. Residents can see their records if they wish the Manager said but none had chosen to do so. The records are held secure, and are kept in accordance with the Data Protection Act. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 22 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 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 X X X X 3 3 X STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X 3 X Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23 Requirement That the home has a programme of routine maintenance and renewal of the fabric and decoration of the premise is produces and implemented with records kept. It is required that training in Adult Abuse Protection is provided. It is required that the level of NVQ training be improved. It is required that the Manager undertakes recognised management training. It is recommended that the home implement a Quality Assurance System. Timescale for action 01/03/06 2. 3. 4. 5. OP18 OP28 OP31 OP33 18(1)(c) 18(1)c) 92(6)(i) 24 01/03/06 01/03/06 01/03/06 01/03/06 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that the photographs on the front of DS0000061111.V265688.R01.S.doc Version 5.0 Page 24 Manton House Nursing Home 2. 3. OP25 OP30 folders be replaced, and that Confidentiality is written on the outside of the folder. The all spaces for information be completed. That residents and relatives are involved in reviews, and that this is recorded. The Daily Record needs to be more “Holistic”. It is recommended that the mobile screens in double rooms be replaced with curtains. It is recommended that the Manager undertake an Audit of the training needs for trained nursing staff in order to enhance the clinical nursing skills needed. Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Manton House Nursing Home DS0000061111.V265688.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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