Inspection on 28/04/08 for Meadbank Nursing Home

This inspection was carried out on 28th April 2008.

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

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

Meadbank Nursing Home 23/10/08

Meadbank Nursing Home 23/07/07

Meadbank Nursing Home 19/05/06

Meadbank Nursing Home 25/01/06

Meadbank Nursing Home 14/09/05

Meadbank Nursing Home 24/02/05

Meadbank Nursing Home 26/07/04

Meadbank Nursing Home 24/02/04

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Meadbank Nursing Home 12 Parkgate Road Battersea London SW11 4NN Lead Inspector Simon Smith Key Unannounced Inspection 28th April 2008 10:30 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 Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadbank Nursing Home Address 12 Parkgate Road Battersea London SW11 4NN 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) 020 7801 6000 020 7978 5726 rayners@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Care Home 176 Category(ies) of Dementia (176), Mental disorder, excluding registration, with number learning disability or dementia (10), Old age, of places not falling within any other category (176), Physical disability (176), Terminally ill (176) Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd July 2007 Brief Description of the Service: Meadbank Care Centre provides accommodation for a maximum of 176 residents. The home is situated in Battersea, close to local shops and services. Battersea Park and the River Thames are nearby. Weekly fees range from £900 to £1175 for permanent care and £1275 for respite care. The home is well decorated and there is a small but well-maintained garden. Each resident has a single room. Communal lounges and dining areas are provided on each floor. The home is divided into units, each of which has an allocated manager. There is a dedicated dementia unit on the third floor. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. We used evidence from a wide range of sources to inform our judgements about the home. These included visiting the home and talking to residents, relatives, the manager and staff. One inspector joined residents and relatives for a meal. We checked a sample of records, including staff and residents’ files. We spoke to some relatives and staff by telephone. Sources of evidence for this report are as follows: • • • • • • The lead CSCI inspector spent two days at the home, arriving unannounced each time. Two other CSCI inspectors spent a day at the home, also arriving unannounced. One CSCI inspector used an observation tool to assess the experience of people living on the dementia unit. This is called a Short Observational Framework for Inspection (SOFI). A CSCI Pharmacy inspector examined the home’s arrangements for medication. Her findings are included in the Health and Personal Care section of this report. The Lead Nurse from the local Health Protection Unit carried out an audit of infection control practices and procedures. A summary of her findings is included in the Environment section of this report. We received 23 surveys from residents, 15 from residents’ friends and families and 12 from staff who work at the home. Feedback and comments from these surveys are included in the relevant sections of this report. We received surveys and comments from healthcare professionals who have an involvement in the home. These included hospital staff, adult protection co-ordinators, care managers and healthcare specialists. Feedback and comments from these surveys are included in the relevant sections of this report. The BUPA Regional Support Manager filled in a Quality Assurance assessment (AQAA), which gave us information about the home and the people who live and work there. • • The home met nine of 31 National Minimum Standards assessed at this visit. Fourteen standards were almost met and eight standards were not met. Three of the Requirements made at this inspection had also been made at the last visit. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Provide sufficient staff, with appropriate skills, to meet residents’ needs at all times. Ensure that residents have access to appropriate healthcare services when they need them. Ensure that staff have the skills and knowledge to take prompt and effective action when residents became unwell. Promote and maintain residents’ dignity, privacy and respect. Promote residents’ choice in their daily lives. Implement recommendations from Safeguarding Vulnerable Adults investigations and take all other measures necessary to keep residents safe from abuse. Investigate any discrepancies between information supplied by staff and Criminal Records Bureau Disclosures. Ensure that improvements are made where these are identified through the complaints process. Improve the management support provided to staff. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 7 Address the tensions within the staff group to ensure that this does not affect the care provided to residents. Improve the assessment of residents at the time of admission and the information provided to staff about the people they care for. Ensure that staff communicate effectively with one another, especially when sharing information about residents’ needs. Provide adequate information about residents’ needs when they are admitted to hospital, including residents’ choices concerning end of life care. Carry out a review of the dementia unit that addresses management, staffing, environment and the skills and experience of staff. Record the outcomes of healthcare professionals’ visits. Ensure that daily notes provide an accurate picture of the care residents receive and what they do during the day. Provide a range of activities, which reflects residents’ choice and includes outings into the community. Support residents to maintain contact with their families where necessary. Respond to maintenance issues promptly and effectively. Ensure that all areas of the home are free from offensive odours. Improve the laundry system to ensure that residents’ clothes are returned to them. Improve the food ordering system so that residents always receive the food they request. Improve records of fire drills so that information is clear. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1, 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a range of information available about the home. The assessment of residents at the time of admission must improve. Staff must be provided with up to date information about the people they care for. There are concerns about the quality of care available on the dementia unit. EVIDENCE: BUPA has produced a range of information about the home and there is a Statement of Purpose. This information is available in brochure form or via the Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 10 BUPA website. The Complaints procedure is accessible and the latest CSCI inspection report is available in the home. The Annual Quality Assurance Assessment (AQAA) told us that there were 113 people living at the home at the time of inspection and that 58 of these had been admitted in the last year. A high proportion of recent admissions have been for residents on short term or respite stays. The AQAA told us that 85 people have been admitted on a short term basis in the last year. Some healthcare professionals said that the home managed short term admissions poorly and failed to carry out full needs assessments. One healthcare professional identified as a concern “poor management of respite care placements/pre-admission planning which has led to inaccurate care and medical records/treatment”. Another professional said that, following a multi agency meeting in 2007, the home had agreed to appoint a respite coordinator, although this had not happened. Some staff said that they do not receive sufficient information about new residents to enable them to provide good care. One member of staff said, “Many times we don’t get adequate handovers on new admissions”. The CSCI survey asked staff whether they are given up to date information about the people they care for. Four staff said ‘always’, one said ‘usually’ and five said ‘sometimes’. The home must ensure that adequate assessments are carried out on all residents admitted and that staff know their needs and provide appropriate care. See Requirement 1. The inspection identified concerns about the quality of care available on the dementia unit, which is situated on the third floor. The unit manager has left since the last inspection and the new manager does not have previous experience in managing dementia services. A high proportion of the home’s referrals to the local Safeguarding team have concerned residents on this unit. Relatives, staff and healthcare professionals say that there are often not enough staff on duty to meet residents’ needs. One member of staff who contacted the CSCI by telephone said that staffing levels on the third floor are often very low. A healthcare professional identified concerns including “a lack of staff cover and poor management on the 3rd floor”. Observation of the dementia unit indicated that the experience of residents who have dementia is variable. Some staff were seen to engage well with residents and to demonstrate knowledge of their individual preferences. Other staff demonstrated a lack of awareness of residents’ needs and of the importance of maintaining an appropriate environment. For example the television, radio and vacuum cleaner were on simultaneously at one point, Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 11 resulting in observable confusion for several residents. The home must carry out a review of the dementia unit, which addresses management, staffing, environment and the skills and experience of staff. See Requirement 2. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of information on care plans has improved since the last inspection but some areas of recording need further improvement. Residents do not always receive adequate healthcare. Care staff do not consistently take prompt and effective action when residents become unwell. The home does not provide adequate information about residents’ needs when they are admitted to hospital. Care staff and general practitioners do not communicate effectively about residents’ care needs. Medication recording was generally satisfactory and there was some evidence of good practice. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 13 Medication was stored securely but the controlled drugs cupboard should be used solely for this purpose. The lancets used for testing blood glucose were unsuitable for the purpose despite previous guidance on this issue from the Medicines and Health Regulatory Authority. Residents’ dignity, privacy and respect are sometimes compromised by the actions of staff. Staff do not always communicate appropriately with residents when delivering care. EVIDENCE: The home uses the Quest care planning system to record residents’ needs across a range of areas, including communication, lifestyle and preferences about the care they receive. There are useful tools to record important information about residents’ personal history, identifying important events, relationships, hobbies and interests. Care plans also contained a nutritional screening tool and moving and handling assessment, which had evidence of regular review. Where a high risk of pressure ulcers was identified on a Waterlow assessment, there was evidence that appropriate pressure relieving equipment had been obtained. The Quest system had just been introduced at the last inspection in July 2007 and the inspection report noted, “the quality of information…is variable. Some care plans contained good, individualised information about residents…. others contained significant gaps or insufficient detail”. This visit found that the quality of information on residents’ care plans had improved. Whilst this is encouraging, there are still some areas where written information needs to improve. For example the recording of healthcare professionals’ visits lacked sufficient detail. One resident had been reviewed eleven times by the home’s general practitioners but the outcomes of these visits were not recorded, staff simply recording the entry “Seen by Dr” on each occasion. See Requirement 3. The quality of recording in daily notes also needs to improve to provide an accurate picture of the care residents receive and what they do during the day. See Requirement 4. The inspection produced evidence that in many cases residents do not receive adequate healthcare and this is a major concern. One healthcare professional said, “I have been involved in several patients who have arrived in the emergency department significantly unwell. From the presentation/condition of Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 14 the patients who have arrived by ambulance in this way it has not been evident that their healthcare needs had been met during the days immediately prior to their attendance to hospital”. Safeguarding Vulnerable Adults investigations found that care records failed to evidence that residents received good care. One healthcare professional expressed concern that a resident’s care notes demonstrated “no close monitoring of fluid input” despite the resident having a high risk of dehydration. See Requirement 5. Some healthcare professionals said that the home does not provide adequate information about residents’ needs when they are admitted to hospital. For example an Emergency Department doctor telephoned a resident’s relative for information when she was admitted to hospital, as “basic medical information was not available to him, including the fact that [the resident] is diagnosed with diabetes”. See Requirement 6. Healthcare professionals also raised concerns about the skills and knowledge of care staff. One healthcare professional said, “When patients have arrived unwell in the Emergency Department the accompanying staff or those that we have phoned for details have been unclear and unaware of healthcare needs that should have been met or how to care for an acutely unwell patient”. Another healthcare professional said that she had observed a “failure to recognise the ill patient” and a “failure to commence basic life support measures when required”. There was evidence that staff do not consistently take prompt and effective action when residents became unwell. One healthcare professional said that staff do not always react appropriately to “signals of ill health” and noted, “it has seemed that it has taken a major crisis to trigger an intervention”. Another healthcare professional expressed concern that there was “no clear guidance with regularity of observations and liaison with GP” and “Staff need to be able to recognise the unwell patient and be able to respond effectively in an emergency”. See Requirement 7. One relative said that staff on duty failed to call the on-call doctor when his mother became ill, telling him that it was against the home’s policy to do this on a weekend. The relative reported that staff asked him whether he wanted his mother admitted to hospital but said “I don’t want to be asked this – I want a medical professional to be available to make this decision”. Another relative also said that staff had asked her whether she wanted her mother admitted to hospital when she became unwell and felt this decision should not have been hers to make. Healthcare professionals and relatives expressed concern about the support available to residents from the home’s general practitioners and communication between them and care staff. A healthcare professional said Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 15 that some residents received “poor medical care resulting from the lack of advice and support provided to registered nurses by resident GP’s”. Another healthcare professional said there needs to be more clarity “around clinical indicators for contacting GP and when an emergency transfer is required”. The home notified the CSCI in March 2008 that there had been a complaint from a relative about a visiting general practitioner. The Regional Support Manager said that senior managers from the home were to meet with the general practitioner in the week after inspection to address this issue. Another relative said of the general practitioner “He’s not at all sympathetic”. The home must demonstrate that residents have access to appropriate medical support when they need it. See Requirement 8. A number of relatives said that their family members had received poor care, which in their opinion had contributed to a deterioration in health and well being. One relative said, “I have seen a decline in my aunt’s condition since she was admitted to Meadbank. She does not receive any physiotherapy or stimulation which has led to her being depressed and unhappy” and “My aunt was perfectly capable of using the toilet before entering Meadbank – now I am told she is ‘doubly incontinent’ which is totally unacceptable”. Several relatives said that they noticed that basic care issues were not attended to when they visited. One relative said, “The need for some things to be in reach is sometimes overlooked e.g. water, paper, tissues. The ‘alarm’ is sometimes not within my husband’s reach. Change of incontinence pads are sometimes delayed”. The following is a report of the CSCI pharmacist’s inspection of medication arrangements. The recording of receipts, administration and disposal of medication was inspected in each of the four units of the home. Stock held was audited against the Medication Administration Records (MAR) and storage including Controlled drugs was inspected. Overall the recording was considered to be satisfactory. Medicines were checked when received into the home and with the exception of a few received mid cycle, records were accurate. Records of administration showed few omissions. One exception was on the second floor when Warfarin was not signed for on 14.5.08. Another omission on the third floor was Quetiapine on 4.5.08 at 18:00. Audits or counts of several medicines including antibiotics indicated that they were being administered and recorded as prescribed. If a laxative is prescribed as 2-6 spoonfuls then the actual dose given must be documented so that the effectiveness of the laxative can be reviewed. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 16 If the code ‘O’ is used then the reason must be given. If a resident refuses a medication every day (e.g. Amilofruse) then it must be recorded as refused so that the GP can review appropriately. Several residents were able to keep their independence by self-medicating and in each one inspected there were risk assessments in place, which had been regularly updated. One resident was pleased to show us where she kept her medicines under lock and key. There was good practice of keeping pain assessment charts for residents with chronic pain. There was also evidence of liquid preparations being prescribed where possible if a resident was unable to swallow. Storage of medication was secure in the home. Fridge temperatures should indicate both the minimum and maximum temperature. The labels of medication must be read and the storage instructions followed so that potency is maintained. E.g. Fludrocortisone, which needs to be kept in the fridge. Dates of opening were written on liquid medicines and all but one eye drops so that they were not used past their expiry date. Some attention is needed to the management of diabetes in the home. The care plan should indicate acceptable low and high levels of blood glucose and management if it falls out of this range. If continually out of the target range then a diabetic review should be sought. The lancets used for testing blood glucose must be professional lancets, as recommended by the Medicines and Health Regulatory Authority. This is to prevent the transmission of blood borne infections. Insulin pens should be stored as indicated by the manufacturers. Usually this is at room temperature when open. Controlled drugs in the home were checked. The controlled drugs cupboard should be a designated cupboard and not used to store money etc. All balances were correct. Several residents were prescribed complex doses of Warfarin. There was evidence that these were being given correctly but to prevent the risk of error the evidence of the current dose and blood test (INR) should be kept with the MAR so that there is an immediate reference for checking. If the dose changes mid-cycle then it is considered good practice to re-write the dose. The prescribed dose must be documented on the MAR. It is not good enough to write as directed against just the name Warfarin and then sign with no indication of what has been actually given. The care plan of residents prescribed enteral feeding and Oxygen were also reviewed. Appropriate notices were in place to warn of the hazards of oxygen and protocols were in place in the care plans for enteral feeding. The latter were regularly reviewed by the dietician. Both enteral feeds and oxygen are Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 17 prescription products and their use should also be listed on the MAR. This concludes the pharmacist’s report. See Requirement 9. Observations of practice during the inspection identified a number of examples of residents’ dignity being compromised by the actions of staff. One inspector sat in the lounge on the first floor from 10.20 to 10.50am. Six residents were in the room in this period but no staff came into the room. At 10.50am a resident became distressed and vomited over herself. The inspector immediately informed a member of staff in the corridor about the incident. The member of staff walked towards the lounge, stopping to collect a towel on the way. On entering the lounge, the member of staff saw the resident and dropped the towel on her lap. The member of staff then left the resident in the lounge without assisting her and returned to the nurses’ station at the far end of the corridor. After five minutes the member of staff had not returned. The inspector went to the nurses’ station and asked the member of staff to assist the resident. The member of staff left the nurses’ station and walked towards the lounge but walked past it and went elsewhere for several more minutes before returning to the lounge to assist the resident. Shortly after this incident the member of staff was observed to be washing the resident, who was semi-clothed, in a communal bathroom on the main corridor with the door open. An inspector overheard two members of staff on the first floor inside a resident’s bedroom talking very loudly to each other. The conversation continued for approximately five minutes and consisted mainly of one member of staff complaining to her colleague about other members of staff on the unit. When the staff left the room, they told the inspector that they had “just changed [resident]”. It was apparent that the staff had not interacted with or spoken to the resident whilst providing intimate care. One resident spoken to during the inspection said, “Staff are very aggressive and “They don’t have the spirit or the skills for nursing”. A student nurse on placement at the home in 2007 reported that a member of care staff said to her, “You’re wasting your time with this one, she can’t talk”. A resident described an incident where he had fallen to the floor in his bedroom and used the call bell to alert staff. He said a member of staff arrived but told him she could do nothing to help him as she had a problem with her back. The resident said the member of staff then called a second member of staff to the room. The resident said that the second member of staff also failed to assist him but was “crazy laughing, although this was not in any way a comic situation”. Relatives’ comments supported the view that residents’ dignity is not maintained. One relative said, “In the time my aunt has been at Meadbank I Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 18 have seen a massive decline in her health, physically and mentally. I believe that nursing elderly people is a vocation and should be undertaken by people who genuinely care about a resident’s dignity and needs – I have not seen this at all so far!” The relative continued, “From what I have seen and heard everyone is treated the same with very little compassion or respect. I feel very strongly that my aunt’s identity has been taken away”. See Requirement 10. Healthcare professionals who work with the home in delivering palliative care said, “Initial assessment and ongoing documentation demonstrates individual’s needs are taken into consideration and active support is provided” and “Suggestions made by the palliative care team are usually acted upon very quickly”. Residents’ choices concerning end of life care were recorded in the sample of care plans examined but hospital staff raised concerns that this information was not available to them when residents are admitted to hospital. Healthcare professionals said that this had caused problems when patients had deteriorated and they were unable to provide this information themselves. See Requirement 6. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range of activities available to residents is limited and residents have few opportunities to go out. Relatives say the home keeps them informed about important events but that they sometimes have difficulty contacting residents when they want to. Staff must ensure that they promote residents’ choice in their daily lives. Some of the interaction observed between staff and residents was poor. Opinions about the food provided by the home were mixed. EVIDENCE: The last inspection report concluded that “The activities programme is over reliant on a small number of activities” and found “no evidence that residents are encouraged to maintain interests that they had before entering the home”. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 20 The report also said, “Residents have few opportunities to go out, either individually with staff or as part of organised outings”. This visit found little evidence of improvement in the range of activities available to residents or opportunities to go out. There is an activities programme but the range of activities is limited. Residents are able to attend regular religious services held in the home. Residents’ care plans record the activities in which they take part. These records did not demonstrate that residents participate in a range of activities. ‘Life Maps’ in care plans list residents’ hobbies but there was no evidence that residents are supported to pursue these interests. Relatives’ surveys highlighted trips and activities as an area that the home should improve. One relative said the home should provide “more activities, trips out of the home environment” whilst another said that staff should take “more interest in encouraging the patients to do things”. Even in cases where residents’ reviews specifically identified developing participation in activities as a goal there was no evidence that this was achieved. For example, one resident’s review notes stated that care staff should “liaise with activity lady to involve her in activities she likes” but there was no evidence that this liaison took place or that the resident’s opportunities to take part in activities had improved. See Requirement 11. The lack of suitable activities is partly a resource issue. The home employs 2.5 staff to arrange activities in the home, which is insufficient given the number of residents. One relative said there are “too few activities staff”, whilst another said “there are not enough staff to take her out”. The activities co-ordinators spoken to during the inspection said they spend much of their time working on a one-to-one basis with residents, which limits the time they have to plan group activities. It is recommended that the home employ more staff to coordinate activities and events for residents. The majority of relatives’ said that the home keeps them informed about important events affecting their family member. One relative said, “I am always telephoned and kept in contact” and others commented, “They always ring me if she has fallen or is ill”, and “If my cousin has a medical problem…I am telephoned by the nursing staff”. However some relatives said they have difficulty in contacting residents when they want to. One relative said, “When we phone in there can be problems being put through to anyone and at night its impossible”. One relative said of a member of staff “she often does not answer the phone [on the unit] when people call in”. See Requirement 12. Observations of practice during the inspection identified a number of examples where staff did not promote residents choice during their interactions with them. For example some staff on the third floor were observed giving residents Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 21 tea without asking how they would like them or indeed whether they wanted them at all. Cups of tea were then removed without the resident being asked whether they had finished. This also occurred with some residents’ meals during mealtimes, despite residents having eaten only a small proportion of their meal. All the residents in the third floor dining room at lunchtime were given blackcurrant juice without being asked what they would like to drink. A bowl of soup was placed in front of each resident. Some said that they did not want this and staff took the bowls away, although did not offer an alternative. Staff must ensure that they promote residents’ choice in their daily lives. See Requirement 13. The interaction between staff and residents at lunchtime on the first floor was observed to be poor. There were six staff were on duty during this period in the dining room. Staff served residents’ food but often did not speak to or acknowledge them as they did so. When not serving food, staff clustered around the dining room’s serving hatch and spoke to one another whilst residents ate in silence. Comments about the food provided by the home were mixed. One resident said, “The menu often doesn’t reflect my tastes and choices are unsuitable for someone with a delicate stomach. Presentation often bad and doesn’t tempt one to eat”. Other residents said, “I am a vegetarian and initially there were problems but efforts since then have provided a variety of vegetarian dishes” and “I don’t like the food given here”. One relative said, “Food is very good”, whilst another commented, “Food is a big disappointment”. Another said, “My aunt and other residents feel that the standard of nutrition has declined in recent months”. Other relatives said, “Menu requests are not followed. It is not unusual for the ticked menu to be lost”. The home should address this area to ensure that residents always receive the food they require. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some complainants are dissatisfied with the home’s response to their complaint. There was no evidence that complaints lead to improvements in practice. Residents are not adequately protected from abuse. There was no evidence that Safeguarding Vulnerable Adults investigations and subsequent recommendations lead to improvements in practice. EVIDENCE: The volume of complaints was identified as a concern at the last inspection and this visit found little improvement in this area. The Annual Quality Assurance Assessment (AQAA) told us that the home had received 64 complaints in the last year, half of which had been upheld. A number of people who had complained were not satisfied with the home’s response to their complaint. One relative said, “I had a meeting recently with a manager but nothing has significantly changed”. A healthcare professional said, “Despite the complaints, practice still isn’t improving, as some issues Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 23 from last year are still evident”. Another healthcare professional said, “In some instances withdrawal from the care home has been instigated as it was felt that concerns hadn’t been adequately addressed”. There was no evidence that complaints had led to improvements in practice. For example there were numerous complaints about residents’ clothing being lost in the laundering process but no evidence that the system has improved. The home must ensure that complaints receive an appropriate response and that improvements in practice are made where these are identified through the complaints process. See Requirement 14. The last inspection report also identified the number of Safeguarding Vulnerable Adults referrals as a concern. The 2008 Annual Quality Assurance Assessment (AQAA) told us that there have been 29 referrals to the local Safeguarding Vulnerable Adults Team in the last year. Some safeguarding investigations found that allegations of psychological and physical abuse were substantiated. The Annual Quality Assurance Assessment (AQAA) told us that one member of staff has been referred to the Protection of Vulnerable Adults List in the last year. There was no evidence that Safeguarding Vulnerable Adults investigations and recommendations had led to improvements in practice. One healthcare professional said, “In spite of a number of [Safeguarding Vulnerable Adults] alerts I do not see an active improvement as a result of recommendations”. See Requirement 15. Healthcare professionals identified some common themes emerging from Safeguarding Vulnerable Adults investigations. These included: “Poor quality of care Poor management of residents’ personal property (such as laundry, money) Staff not taking appropriate action when residents display signs of becoming unwell Poor record keeping/lack of appropriate care documentation about residents’ needs (e.g. inaccurate recording of medical information) Residents being sent to hospital without sufficient information about their health needs Poor attitude of staff, including speaking to residents inappropriately and not maintaining dignity Staff having little knowledge of residents’ individual needs Poor monitoring and supervision of staff Poor communication with family members about residents’ medical and care needs”. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is attractively decorated and communal rooms are well furnished. Residents’ bedrooms reflect their individual tastes and interests. Residents have access to specialist equipment if they need it. Residents’ and relatives’ opinions about cleanliness were divided. Maintenance issues are not always dealt with effectively. The home must demonstrate that the water supply is safe. There were unpleasant odours in one area of the home. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home is situated close to local shops and services and Battersea Park and the River Thames are nearby. A good standard of decoration has been achieved throughout the home and there is a small but well-maintained garden. Communal lounges and dining areas are provided on each floor. The home is divided into units, each of which has an allocated manager. Residents’ bedrooms have en suite bathroom facilities and reflect the tastes and preferences of their occupants. Residents are able to bring personal items with them when they move in and to install a private telephone line should they wish. The home provides specialist equipment and adaptations where necessary to meet residents’ needs. Adapted bath and shower facilities are available and hoists are available to assist transfer. One relative said that maintenance issues are not always dealt with efficiently. The relative said that the heating system on his family member’s floor was out of action for seven days over the Easter period. Another relative said, “The radiator in my husband’s room heats to an uncomfortable temperature and has no thermostatic control”. See Requirement 16. The Health Protection Unit’s Lead Nurse carried out an Infection Control audit and found that “Standards in the home appeared quite good overall but there are some issues identified that require action”. These issues were outlined in detail in a report provided by the Lead Nurse to the home. The home must demonstrate that all actions outlined in the report have been taken by the next inspection. See Requirement 17. Residents’ opinions about cleanliness were divided. When asked whether the home is fresh and clean, one resident said, “As clean as it should be”, whilst others said, “Could be much better”, and “Spring clean needed and carpet could be washed more frequently”. Relatives’ opinions about cleanliness were also mixed. One relative said, “The home is always clean and well presented”, whilst another said, “Room often dusty/untidy”. Standards of hygiene at the time of inspection were generally good but, as at previous visits, there was a strong smell of urine on one floor of the home. This must be addressed by the home. See Requirement 18. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not always enough staff on duty to meet residents’ needs, especially on the dementia unit. Relatives said that some staff provide very good care but expressed serious concerns about the attitude of others. The home carries out appropriate pre-employment checks on staff but must follow up any discrepancies between application forms and Criminal Records Bureau Disclosures. Staff say that the home provides good training and that new staff have a thorough induction. EVIDENCE: Relatives, staff and healthcare professionals expressed concerns that there are not always enough staff on duty to meet residents’ needs. Relatives’ comments included: “Staff are kind but there are too few care workers”. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 27 “On some occasions there appears to be a shortage of staff”. “Still occasions when no carer is seen when residents are in the lounge area” “The manager on our first meeting advised there was a staff shortage on the dementia floor including no matron. She reassured me that this staff shortage would be resolved the following week, beginning 17 March. The staff shortage appeared to continue to be a problem until these last 10 days when it seems more staff are on duty”. “My husband fell and was discovered by the private carer of the patient in the room opposite. There was no staff response when the alarm bell was pushed”. “There are too few staff to give the clients the care/time they should get. E.g. a newly admitted lady was wandering up the corridor, old hospital gown open at the back, displaying pants, and plastic bag of clothes unopened in her room. No-one was talking to her, getting her into a nightie, giving her a cup of tea etc”. The CSCI survey asked staff whether there are enough staff to meet the needs of the people who live at the home. Of the 12 staff that returned surveys, one said ‘always’, two said ‘usually’, nine said ‘sometimes’ and one said ‘never’. Several staff also made additional comments about staffing. One said, “Sometimes we are short staffed and a lot of pressure is put on the staff on duty”. Another member of staff said, “Employ more staff on bank duty or to hire agency when there are sickness and absence. If the home is always short of staff the standard of care given to client will not meet required standard”. One member of staff who contacted the CSCI by telephone said that some managers exert pressure on contracted staff to work extra hours due to a reluctance to employ agency staff. Comments made by other staff included, “Not enough staff” and “3rd floor needs attention because this floor is a special floor we need enough staff”. A healthcare professional said “levels of staffing could be increased and use of agency staff cover if planned staffing levels are short e.g. by sickness. Some reports by staff when covering absences means they are working long stretches without a break”. Comments about the skills and approach of staff were mixed. Staff on some units were singled out for providing good care. For example one relative said, “My mother has been in Meadbank for over 3 yrs and has been excellently looked after by Sister and her team on the second floor. I cannot praise her care and devotion highly enough” and another said, “I’ve been very happy with my mother’s care”. Other relatives’ comments included, “The nurses are kind, attentive and humorous, creating a happy atmosphere” and “They are kind and caring”. However relatives’ expressed concerns about the attitude of some staff. One relative said, “Some carers are very good, some excellent when attention to detail is needed. Some are not: this can be an attitude problem. Asking a question or collaboration to assist seems to be unwelcome with some carers”. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 28 Another relative said, “some staff are very casual and laissez faire” and “I have to wait around just to make sure things are done properly”. One relative described the new unit manager on the ground floor as “very good indeed” but said that the quality of staff is “variable”. The relative said of one member of staff “I have no confidence in her” and “I’m always nervous when she’s on duty”. The home must ensure that there are sufficient staff, with appropriate skills, on duty to meet residents’ needs at all times. See Requirement 19. The AQAA told us that 28 full-time and seven part-time staff have left the home in the past year and there were a number of vacancies at the time of inspection. Staff files checked contained evidence of appropriate pre-employment checks, including application form, two references and proof of identity. Staff files also contained evidence of Criminal Records Bureau Disclosure with reference number and date of issue. All staff said that the home had carried out checks, including Criminal Records Bureau Disclosure and references, before they started work. One member of staff’s application form but the individual’s Criminal Records other convictions not mentioned in evidence that this had been noted Requirement 20. disclosed a previous criminal conviction Bureau Disclosure listed a number of the application form. There was no or followed up by the home. See Staff said that the training provided by the home is good and that they had a formal induction when they started work. The Regional Support Manager told us that over 50 of the staff team has achieved a minimum of NVQ level 2. One healthcare professional involved in delivering palliative care said that “Meadbank has always welcomed further training offered by [name of organisation] and endeavours to organise staffing to ensure the training is attended by as many staff as possible”. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a new manager, who is committed to improving the service. There was evidence of tension between groups of staff and between individual staff. The level of management support provided to staff is variable. Information about residents is not always shared effectively amongst staff. Some of the home’s systems need to be improved, especially the laundry service. Records of fire drills should be improved. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 30 EVIDENCE: A new manager started work on the 7th May 2008, who has relevant experience for the post. The Regional support manager plans to work at the home three days a week initially to support the new manager into the role. The manager must apply for registration with the CSCI. See Requirement 21. Discussion with the manager demonstrated that she has a commitment to improving the service and, in particular, to addressing the issue of staff attitude and practice. There was evidence of tension between groups of staff and between individual staff. One member of staff said, “Most times the environment is too tense and it’s very difficult to work under such conditions”. Another member of staff said, “There’s always an argument between carers and sister in charge, specially when it comes to answering the call bell”. One staff member’s file contained evidence of disciplinary action for swearing at a colleague in front of a resident. A member of Housekeeping staff said that care staff often do not speak to Housekeeping staff with respect and gave examples of care staff not being willing to talk to her when she had a query about her work. When asked what the home could do better, one member of staff said, “Reduce office gossip and rumour mongering”. The home must address the issue of tensions within the staff group to ensure that this does not affect the care provided to residents. See Requirement 22. There was evidence of a lack of effective management or leadership on some units. One relative said there had been a lack of effective management on the ground floor between October 2007 and January 2008, partly because the unit manager left and was not replaced for this period. The relative said that the new manager has made “a big difference” but that he still observes examples of “poor practice and a laissez faire attitude”. The management support provided to staff appeared to vary from one unit to another. One member of staff said, “Support depends a great deal on the management staff. Some management staff are really supportive and some are not”. Another member of staff said, “Manager hardly has time to meet with staff. Maybe she’s too busy”. Several staff said they do not get enough opportunities to discuss issues that concern them in one-to-one supervision. The CSCI survey asked staff whether they meet with their manager to discuss how they were working. Four said ‘regularly’, two said ‘often’, six said ‘sometimes’ and one said ‘never’. The home must ensure that staff receive individual supervision at least six times a year. See Requirement 23. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 31 There was evidence that information, especially about residents, is not always shared effectively amongst staff. When asked to identity what the home could do better, one member of staff stated, “Effective communication”. Another member of staff responded, “The service do better if the staffs work as a team”. One member of staff’s survey provided an example of how poor communication amongst staff can affect residents. The member of staff said, “I pass information to the sister in charge regarding my clients and the following days I’m off for 2 days. When I come back to work the work wasn’t done its still there, like dressing their wounds”. The home must ensure that staff communicate effectively with one another, especially when sharing information relating to residents’ needs. See Requirement 24. Information received from a healthcare professional said of one incident, “There was no evidence of an inventory when the resident entered the home and some of the resident’s clothes were lost. Staff on duty did not know the resident’s needs in terms of medication or mobility aids or make sure all his clothes were packed. He was sent home without these”. Several relatives raised concerns about the home’s laundry system. One relative said, “Laundry – this is very disorganised. Not all items are returned. Slow and careless. We have had to purchase replacement garments”. Another relative said, “Shirts, T-shirts, sarongs etc lost. I now supply photos of clothing”. See Requirement 25. Where the home holds residents’ money, there are secure computerised records of all transactions and balances. Statements are produced regularly and provided to residents and their next of kin. The home was free of obvious health and safety hazards on the day of inspection. All COSHH products were stored appropriately and COSHH data sheets were available. Maintenance staff carry out health and safety checks around the home regularly. The specialist equipment used by residents is checked and serviced on a regular basis. The gas safety record was issued in February 2008. The home has an appropriate fire detection system, which is serviced on a regular basis. Records of fire drills should be improved, as those checked were unclear. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 32 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 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 3 3 3 X 3 2 2 STAFFING Standard No Score 27 1 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 2 X 3 Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 33 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 OP3 Regulation 14 Timescale for action The Registered Person must 30/06/08 ensure that assessments are carried out on all residents admitted to ensure that staff know their needs and provide appropriate care. The Registered Person must carry out a review of the dementia unit, which addresses management, staffing, environment and the skills and experience of staff. The Registered Person must ensure that the outcomes of healthcare professionals’ visits are recorded in sufficient detail. The Registered Person must ensure that daily notes provide an accurate picture of the care residents receive and what they do during the day. This Requirement has been made in previous inspection reports. 30/06/08 Requirement 2 OP4 12, 18 3 OP7 17 30/06/08 4 OP7 17 30/06/08 Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 34 5 OP8 13(1) The Registered Person must ensure that residents have access to appropriate healthcare when they need it. The Registered Person must ensure that the home provides adequate information about residents’ needs when they are admitted to hospital, including choices concerning end of life care. The Registered Person must ensure that staff have the skills and knowledge to take prompt and effective action when residents became unwell. The Registered Person must demonstrate that adequate medical support is available to residents from the home’s general practitioners. The Registered ensure that: Person must 30/06/08 6 OP8 12 30/06/08 7 OP8 18(1) 30/06/08 8 OP8 13(1) 30/06/08 9 OP9 13(2) 30/06/08 1. Further attention is paid to the accurate recording of medication when received into the home and administered. If not administered the correct endorsement must be used. 2. The management of diabetes in the home is reviewed, paying particular attention to target levels for blood glucose and safe monitoring to prevent the risk of infection. Insulin must be stored as indicated by the manufacturer. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 35 3. Attention is paid to the safe management and recording of Warfarin in the home to prevent the risk of error. 4. Controlled drugs cupboards are designated cupboards and not used to store other items. 5. The minimum and maximum temperature of fridges are recorded in addition to the actual temperature. 10 OP10 12(4) The Registered Person must ensure that residents’ dignity, privacy and respect are maintained. The Registered Person must ensure that residents have access to a suitable activities programme, which reflects residents’ choice and includes outings into the community. This Requirement has been made in previous inspection reports. 12 OP13 16(2)(m) The Registered Person must ensure that staff support residents to maintain contact with their families. The Registered Person must ensure that staff promote residents’ choice in their daily lives. The Registered Person must ensure that complaints receive an appropriate response and that improvements in practice are made where these are identified DS0000019107.V361449.R01.S.doc 30/06/08 11 OP12 16 30/07/08 30/06/08 13 OP14 12 30/06/08 14 OP16 22 30/07/08 Meadbank Nursing Home Version 5.2 Page 36 through the complaints process. 15 OP18 13(6) The Registered Person must implement recommendations from Safeguarding Vulnerable Adults investigations and take all other measures necessary to keep residents safe from abuse. The Registered Person must ensure that maintenance issues are dealt with effectively and that residents are able to regulate the temperature in their bedrooms. The Registered Person must demonstrate that all improvements outlined in the Health Protection Unit’s Infection Control report have been actioned. The Registered Person must ensure that all areas of the home are free from offensive odours. This Requirement has been made in previous inspection reports. 19 OP27 18(1) The Registered Person must ensure that there are sufficient staff, with appropriate skills, on duty to meet residents’ needs at all times. The Registered Person must ensure that discrepancies between application forms and Criminal Records Bureau Disclosures are investigated. The Registered Person must ensure that the manager applies for registration with the CSCI. The Registered Person must 30/06/08 30/06/08 16 OP19 23(2) 30/07/08 17 OP26 13(3) 30/07/08 18 OP26 16(2) 30/07/08 20 OP29 19 30/07/08 21 OP31 8(2) 30/07/08 22 OP32 12(5) 30/07/08 Page 37 Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 address the issue of tensions within the staff group to ensure that this does not affect the care provided to residents. 23 OP36 12(5) 18(2) The Registered Person must ensure that all staff receive individual supervision at least six times a year. The Registered Person must ensure that staff communicate effectively with one another, especially when sharing information relating to residents’ needs. The Registered Person must ensure that the laundry system is effective and that residents’ clothing is returned to them. 30/07/08 24 OP33 12 30/06/08 25 OP33 16 30/06/08 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 3 Refer to Standard OP12 OP15 OP38 Good Practice Recommendations Employ more staff to co-ordinate activities and events for residents. Improve the food ordering system so that residents always receive the food they request. Improve records of fire drills so that information is clear. Meadbank Nursing Home DS0000019107.V361449.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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