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Inspection on 02/11/06 for Mill House Nursing Home

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

This inspection was carried out on 2nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable homely environment for the residents. All areas of the home are clean and maintained to a high standard. Residents and relatives spoke highly of the kindness and respect shown by the staff. The programme of activities is very welcome and much appreciated by both residents and relatives. It is still in the process of being developed. Meals and mealtimes are much appreciated by the residents, and the cook enjoys making birthday cakes as well as providing for each of the resident`s food choices. A relative commented that the laundry service was very good and that her relative always looked smart.

What has improved since the last inspection?

Residents` meetings have been planned to take place shortly. The complaints procedure is now readily accessible to residents, staff and visitors. The activities have improved greatly since the appointment of the activities co-ordinator. The central heating system has been addressed and is to be replaced. Those staff of foreign nationality whose English language skills are limited are being given the opportunity to attend tutorials on a regular basis. Plans are in place to draw up a training matrix for all staff to ensure that they receive the appropriate training to equip them for the job. The induction programme meets the skills for care recommendations. The nutritional assessment tool is evidence based and only one is in place. The service users` guide has been made available to all the residents.

What the care home could do better:

Pre-admission assessments must be thorough and the individual must be informed in writing that the home is able to meet their care needs before they are admitted to the home. Every resident must have a care plan in which their assessed care needs are identified and the action required to meet those needs. Communication between the care staff and nursing staff about changes in a resident`s condition need to be improved. Any resident who has a wound of any description must have a specific care plan in which the wound is scientifically identified, and the specific treatment that is being used described in detail. The staff require updates on the use of the nutritional assessment tool and ongoing monitoring.Information with regard to the residents` wishes about the time of their death needs to be accessed and included in the assessment and care plan. Waste bins in bathrooms should have lids on them, and light pull chords need to be replaced on a regular basis. Sound activated door holders need to be placed on residents` doors when they require them to be left open. The staff team need to be more aware of their roles and responsibilities.

CARE HOMES FOR OLDER PEOPLE Mill House Nursing Home 32 Bridge Street Witney Oxfordshire OX28 1HY Lead Inspector Philippa MacMahon Unannounced Inspection 02 November 2006 10:00 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 Mill House Nursing Home DS0000027165.V319596.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. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill House Nursing Home Address 32 Bridge Street Witney Oxfordshire OX28 1HY 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) 01993 775907 01993 776388 millhouse@schealthcare.co.uk Chiltern Care Homes Limited (part of the Southern Cross Healthcare Group) Karen Rouse Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission persons should be aged 60 years and over. Date of last inspection 23rd June 2006 Brief Description of the Service: Mill House is an old house in the market town of Witney, Oxfordshire, owned by the Southern Cross Healthcare Group since 2005. It was totally renovated and extended in 1996 and has accommodation for 43 residents. The rooms are single or double, all with en-suite facilities. It is situated close to the town centre and within easy reach of all local amenities. There are three dining rooms and two sitting rooms, together with a garden room overlooking a landscaped courtyard. The home is furnished to a high standard and provides a comfortable home for the residents. The registered manager runs the home, with a team of nurses, housekeeping and care staff. The weekly fees range from £567 to £900.48. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was the second key inspection to be carried out unannounced in the inspection year. The inspector arrived at the service at 10:00 and was in the service for a total of seven.hours over two days. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has, in this report, made judgements about the standard of the service. The registered manager was not present on the first day of this inspeciton and one of the registered nurses was in charge of the home. The inspector looked at care plans and followed this by visiting the individual resident to assess if the identified care needs were appropriate and being met. The medication system was examined. Staff files and current rosters were examined and discussion took place with the registered manager on the second day around areas of training and development of staff. The inspector also had conversations with the company’s regional operations director and operations manager. Lunch was observed and the inspector also sampled the meal by joining the residents in the dining room. The opportunity to have discussion with the residents, relatives and visitors was taken, as was meeting with various members of the staff. Records required by regulation were examined. The inspector would like to thank all the staff for their assistance and co-operation during this inspection. What the service does well: The home provides a comfortable homely environment for the residents. All areas of the home are clean and maintained to a high standard. Residents and relatives spoke highly of the kindness and respect shown by the staff. The programme of activities is very welcome and much appreciated by both residents and relatives. It is still in the process of being developed. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 6 Meals and mealtimes are much appreciated by the residents, and the cook enjoys making birthday cakes as well as providing for each of the resident’s food choices. A relative commented that the laundry service was very good and that her relative always looked smart. What has improved since the last inspection? What they could do better: Pre-admission assessments must be thorough and the individual must be informed in writing that the home is able to meet their care needs before they are admitted to the home. Every resident must have a care plan in which their assessed care needs are identified and the action required to meet those needs. Communication between the care staff and nursing staff about changes in a resident’s condition need to be improved. Any resident who has a wound of any description must have a specific care plan in which the wound is scientifically identified, and the specific treatment that is being used described in detail. The staff require updates on the use of the nutritional assessment tool and ongoing monitoring. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 7 Information with regard to the residents’ wishes about the time of their death needs to be accessed and included in the assessment and care plan. Waste bins in bathrooms should have lids on them, and light pull chords need to be replaced on a regular basis. Sound activated door holders need to be placed on residents’ doors when they require them to be left open. The staff team need to be more aware of their roles and responsibilities. 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. Mill House Nursing Home DS0000027165.V319596.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 Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 6. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The pre admission assessments carried out are not robust and could lead to residents with high care needs being inappropriately placed. The home does not provide an intermediate care service. EVIDENCE: The home’s statement of purpose has recently been updated and a copy was sent to the Commission. A sample of care plans was examined, including the most recent person to be admitted to the home. The pre-admission assessments in each case were incomplete and did not give an accurate “picture” of the person’s care needs. The home does not confirm in writing to the individual that the home can meet their care needs. It is a requirement that all pre-admission assessments must be completed in full and a letter confirming that the home can meet their care needs be sent prior to admission to the home. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome group is poor. This judgement has been made using available evidence, including a visit to this service. There appears to be a poor understanding or consistency in ongoing care planning to meet residents’ care needs, leading to unmet needs. This is an area that has not shown any improvement since the last key inspection. No attempt is made to find out person’s wishes for the arrangements at the time of their death. Overall, residents feel that they are treated with dignity and respect EVIDENCE: The inspector examined a sample of care plans. In each of the care plans examined there were significant care needs mentioned but no action plan to meet them. Wound care in particular had no measurements or photographs of the wounds and no prescription of how to dress the wounds. In one instance a care assistant had identified a pressure ulcer on a wound map, but this was not mentioned in the daily record, nor was there a care plan for how this was being treated. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 11 One of the residents readmitted for a short stay recently did not have an up to date care plan in place. An immediate requirement was made as follows – ‘It is a requirement that all residents in the home, whether for short or long stay, must have an up to date care plan in place that takes into account all of their care needs’. This was a requirement at the last key inspection on 23rd June, and there is still no improvement. Nutritional assessments are not being carried out adequately. The weight is recorded but not the BMI (body mass index) that needs to be calculated in order to assess an individual’s nutritional status. It is a good practice recommendation that all staff involved in carrying out nutritional assessments should have further training on how to use the tool in place. The inspector also noted that there was no information in the care plans about how to meet a person’s wish at the time of their death. It is recommended that staff should endeavour to ascertain what the resident’s wishes are in respect of the arrangements at the time of their death. Residents spoken to said that the staff were very kind and that they always treated them with dignity and respect by knocking on doors before entering their private room, and calling them by their preferred term of address. One relative spoken to said that the care was very good and that the laundry service is excellent. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Great strides have been taken in providing an interesting programme of activities, that is well publicised for residents and their visitors. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religions, race, and culture. EVIDENCE: The inspector met with the activities co-ordinator who is relatively new in post and thoroughly enjoying her role. The programme of planned activities is varied to meet the individual needs of the residents. An individual record is being kept of participation and enjoyment of the activities. A monthly newsletter is being produced that is informative and enjoyably newsworthy. The co-ordinator works 20 hours a week and this is flexible time to suit the programme of events, and to provide 1-1 time with the residents. Some visiting relatives often take part in games such as bingo and card games. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 13 The inspector met with a visitor from the local Catholic Church who is one of a team of visitors who come into the home on a regular basis. The local churches in Witney provide services of Holy Communion on a regular basis. The home is very much a part of the local community and many of the residents are local, which means that visitors often know the residents and each other. The home is in walking distance of the local shops and town centre and those residents who are able to go into town. Meals and mealtimes are regarded by a group of residents spoken to as being an important part of their day. The inspector joined the residents for lunch and enjoyed a delicious well-presented meal, and the residents spoken to said that the meals were always very tasty and that there is always a choice. The inspector spoke to the cook and observed a lovely birthday cake being prepared for one of the residents whose birthday it was. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has an accessible complaints procedure in place and all complaints are taken seriously and handled appropriately. EVIDENCE: A copy of the complaints procedure is posted in the main entrance hall for all visitors to access. It is also included in the home’s statement of purpose and service users’ guide. The Commission did receive a complaint from a relative in September 2006. The registered manager and the operations manager, in conjunction with the Social Services Department, investigated this and the complaint was found to be unsubstantiated. Examination of a sample of staff training records show that training in the protection of vulnerable adults is given to staff during the induction period and on further occasions. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Overall the premises are clean and well maintained. However, a number of health and safety issues need to be addressed and requirements and recommendations are being issued in this report. EVIDENCE: The inspector toured the building and overall found all areas to be clean and well maintained. The furnishings and fittings are of a good standard and offer a comfortable homely environment for the residents. The décor is in need of redecoration and a plan is in place and progress commenced in the redecorating of the home. Those areas that have been completed are most attractive and tastefully laid out. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 16 The office is in a room with no outside windows and is poorly ventilated. The room temperature was recorded by the inspector to be 30°C. It is the area in which medication is stored, the staff write care plans and the registered manager carries out administrative work and meets with relatives, residents, visiting professionals and staff. It is a requirement that the suitability of the present office as a working environment and medication storage place must be addressed and appropriate changes made to ensure that medication is stored in an area where temperatures do not exceed 25°C, and the office is suitably ventilated and appropriate lighting is installed. A number of waste bins in the bathrooms were found to contain used incontinence pads and no lids were provided on the bins. This, in the inspector’s view, could pose a risk to the health and safety of the residents. It is a recommendation that lids should be provided for all waste bins in the bathrooms. The pull cord for the lights in the bathrooms are in need of replacing as they are grubby and no longer have a weight on the bottom. It is a recommendation that the pull chords in communal bathrooms and toilets should be changed on a regular basis. The inspector noted that oxygen cylinders were free standing in one of the resident’s private rooms and in one of the sitting rooms. This, in the inspector’s view, could pose a risk to residents, staff and visitors as they could easily fall over and cause damage to individuals and the property. An immediate requirement was made that any oxygen cylinder stored in the home must be either in a stand or suitably secured to prevent them falling over. One oxygen cylinder was being used to prop open the door to the resident’s room. It is recommended that a suitable sound activated door closure should be fitted to the door of Room 10. The problems identified at the last key inspection around the central heating system have been identified and a new system is to replace the existing one and the work is being scheduled. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The recruitment processes have improved and are in good order. Training and development is being provided but will need to be sustained, and improvements in the keeping of care records need to be evidenced to support the care provided. EVIDENCE: At the time of this inspection the staff on duty were as identified on the duty roster. The roster showed that sufficient numbers and skill mix of staff are on duty at all times. A sample of staff files was examined and found to be up to date and complete and confirming that the home’s recruitment procedures are in good order. Discussion with the company’s operations manager about training provision revealed that since the last key inspection there has been an improvement in the training provision for staff, and mandatory training in fire safety, moving and handling and food hygiene has been undertaken. Training in other areas such as handling of abuse and the use of bedrails has also been provided. The company has appointed a trainer for the region who will be helping with the development of a training matrix and plan for the service. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There is little evidence of good teamwork and staff taking on the accountability and responsibility of their positions. Quality systems are in place and being further developed. The residents’ finances are safeguarded. EVIDENCE: The registered manager was not available on the first day of this inspection as she was attending a course about the implementation of health and safety in the home. The registered manager is qualified to manage the home and is very well supported by the company’s regional operations manager. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 19 Comments from residents and relatives spoken to are that all of the staff are lovely but they are not working well as a team - “Issues raised with staff are accepted and assurance is given that they will be acted upon but nothing seems to materialise”. It appears to the residents and relatives that staff do not accept responsibility for seeing something through, it is always somebody else’s job. It is recommended that the company address issues of staff roles and responsibilities and accountability in order to develop good team practices. The company has a comprehensive quality assurance programme that requires monthly audits being completed - monthly monitoring visits by the operations manager and residents’ satisfaction surveys. The registered manager has an “open door” style of management and meets regularly with residents and relatives. The residents’ spending money is kept safely in the home’s safe and appropriate records are kept of all transactions made. Mandatory training in fire safety, moving and handling and food hygiene has recently taken place for all staff, and first aid training is programmed. Records required by regulation are in place and up to date. Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X 2 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 X 3 2 Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement It is a requirement that all pre-admission assessments must be completed in full and a letter confirming that the home can meet their care needs is sent prior to admission to the home. It is a requirement that all residents in the home, whether for short or long stay, must have an up to date care plan in place that takes into account all of their care needs It is a requirement that the suitability of the present office as a working environment and medication storage place must be addressed and appropriate changes made to ensure that medication is stored in an area where temperatures do not exceed 25°C, and the office is suitably ventilated and appropriate lighting is installed. An immediate requirement was made that any oxygen cylinders stored in the home must be either in a stand or suitably secured to prevent them falling over. DS0000027165.V319596.R01.S.doc Timescale for action 23/11/06 2. OP7 15 02/11/06 3 OP25 23(2)(p) 13/12/06 4 OP38 13(4)(c) 02/11/06 Mill House Nursing Home Version 5.2 Page 22 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 OP8 Good Practice Recommendations It is a good practice recommendation that all staff involved in carrying out nutritional assessments should have further training on how to use the tool in place. It is recommended that staff should endeavour to ascertain what the residents’ wishes are in respect of the arrangements at the time of their death. It is a recommended that lids should be provided for all waste bins in the bathrooms and it is further recommended that the pull chords in communal bathrooms and toilets should be changed on a regular basis. It is recommended that a suitable sound activated door closure should be fitted to the door of Room 10. It is recommended that the company address issues of staff roles and responsibilities and accountability in order to develop good team practices. 2. OP11 3 OP21 4 5 OP38 OP32 Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mill House Nursing Home DS0000027165.V319596.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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