CARE HOMES FOR OLDER PEOPLE
Nazareth House Liverpool Road Crosby Liverpool Merseyside L23 0QT Lead Inspector
Mrs Trish Thomas Unannounced Inspection 30th September 2005 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 Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Nazareth House Address Liverpool Road Crosby Liverpool Merseyside L23 0QT 0151 928 3254 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) Sisters of Nazareth Sister Joseph Veronica Crowe Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 66 OP. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 16/3/05 Date of last inspection Brief Description of the Service: Nazareth House is a care home for older people owned by the Sisters of Nazareth. The ethos of the home is rooted in Catholicism and there is an integral chapel with daily Mass, which residents may choose to attend. The religious beliefs of service users of all denominations are respected and supported in the home. The manager is Sister Joseph, who has many years experience in health care and service to the community. The home accommodates 66 residents and to ensure a homely and personalised service, the accommodation is divided into three self-contained floors or units. Each unit is individually managed by nominated senior staff, under the supervision of Sister Joseph, who has ultimate responsibility for the day-to-day management of the home. Residents are provided with home cooked meals, accommodation and personal care. The service provides residential care and is supported by visiting general practitioners, community nurses and paramedical services. Nazareth House was built at the beginning of the last century and the general style of the interior reflects this period. Nazareth House is furnished in a homely and comfortable way and there was a relaxed atmosphere during the inspection. Meals are cooked on the premises and served in one of the dining rooms on each unit, or in residents’ bedrooms, if they prefer. The home also provides a laundry service, carried out on the premises. To accommodate the home’s purpose and function, there are two passenger lifts, a nurse call system throughout, a ramp and individual adaptations in accordance with the needs of service users. The home is situated on the main Liverpool to Southport Road with close links by public transport and nearby shops, a cinema, local churches, and a wealth of local community amenities. A number of in-house social events take place, and day-to-day activities. Outings are arranged when Service Users are escorted by staff, or some prefer to go out alone or with family and friends. The home is set in extensive grounds with car park. The gardens are pleasant and well maintained, and views of the garden from the house enhance the general environment and character of the premises. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over a two-day period and inspection methods were, discussion with residents, discussion with staff, reading records and by direct observation. Resident’s comments on the service were positive and they appeared relaxed. They appreciate the in-house chapel, meals and accommodation provided in Nazareth House. They appeared to be satisfied with staff conduct and the care provided in the home. All residents had a care plan. There has been ongoing development of care plans noted over recent inspections and these now follow a standard format throughout the home. Reviews were up to date in all care plans, which were read, and there were risk assessments in place where risks were identified in assessments. Shortfalls were noted with regards to dietary monitoring and terms of reference. Administration of medication procedures observed, were satisfactory other than where an omission was noted regarding the auditing of unwanted medication. The home employs an activities co-ordinator and social events were either observed or described by residents. One lady said she enjoyed the visiting entertainers, and all the conversation and companionship she had experienced during a recent event. Meals were well presented and alternatives are offered, residents were not rushed with their meal. One lady said the meals are “very acceptable.” Residents appeared to be spending time how and where they chose and expressed no concerns regarding undue intrusion into their personal affairs by staff. There was a good level of community contact with regards to visitors and access to health services, religious ministers and advocacy. The home has satisfactory complaints and adult protection procedures. Residents spoken with said they had no complaints, but would approach a member of staff if they had any problems. The building is generally well maintained and was clean and odour free in areas visited. A shortfall was noted in management of infection control in a shower. Staffing levels were being maintained in accordance with residents’ needs at the time of inspection and there is a satisfactory management structure. NVQ and mandatory training was to a good standard. Further training is recommended to meet the changing needs of those in residence. The building is generally well maintained. Home maintenance is ongoing, due to the size, age and function of the building. Hazards were noted during the inspection and requirements are made. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
A requirement is made under regulation 12, that the manager must instruct staff in the correct use of language to be used in residents’ personal records. In meeting this standard the home will ensure that residents’ dignity is maintained not only through care giving and conduct, but also through the written word. A requirement is made under regulation 13 that the manager must arrange for the soiled shower curtain to be removed and replaced. This shower curtain was badly stained with what appeared to be mould spores. In meeting this
Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 7 requirement, the home will ensure that residents and staff are protected from the health risks associated with inhaling mould spores. A requirement is made under regulation 13 that the manager must arrange for water temperatures in baths and showers to be measured and adjusted to 43 degrees where necessary. In meeting this requirement the home will protect residents against the risk of scalds. A requirement is made under regulation 23 that the manager must arrange for the electrical fault on fire doors to be remedied. In meeting this requirement, the home will ensure that fire equipment is in working order and residents’ lives are not put at risk in case of fire. A requirement is made under regulation 23 that the manager must arrange for the replacement of the wash hand basin in room 27a. In meeting this requirement, the home will ensure that residents are not placed at risk of injury from the cracked basin (a) from infection (b) from injury if the basin was to collapse. A recommendation is made under standard 7 that the manager should ensure that food and fluid intake is recorded for residents who are frail and have weight loss, and the G.P. referred to if weight loss continues. In meeting this standard, the home will ensure that residents do not become mal nourished or dehydrated and that their health and welfare is monitored. A recommendation is made under standard 9 that the manager should ensure that a record is maintained of all unwanted medication prior to disposal. In meeting this standard, the home will ensure that an accurate auditing system is in place to avoid the abuse or mal administration of medication. A recommendation is made under standard 30 that the manager should arrange for staff to receive training in dementia care. In meeting this standard, the home will ensure that staff training is accordance with the presenting needs of a number of those in residence. 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. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 The home was meeting standards 2 and 3. The home has an admissions procedure and provides an information pack to all residents as they move into the home. All residents are issued with a contract of residence on admission. All admissions to the home are subject to assessment of need. EVIDENCE: Standards 2. Reference was made to the home’s admission procedure. Individual contracts are issued to residents, on admission and set out the scale of charges and terms and conditions of residence. Standard 3. Reference was made to residents’ care files. All admissions to the home are subject to assessment (either by social workers or home’s staff), and there is a twenty-eight day trial period. Assessment of need is ongoing by home’s staff after admission, and forms the basis of individual care plans. Home’s assessments follow a standard format, which addresses the personal care needs associated with old age. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Standard 7. The home was not meeting standard 7. Care plans were in place for all residents, which include review and risk assessment procedures. Care plans throughout the home follow a standard format. Shortfalls were noted with regards to the content of a minority of care plans. Standard 8. The home was meeting standard 8. All residents are registered with a G.P. and referred to specialist and paramedical services, in accordance with assessment. Standard 9. The home was not meeting standard 9. The home has a satisfactory medication administration procedure and provides training to staff who administer prescribed medication. A shortfall was noted with regards to disposal of unwanted medication. Standard 10. The home was not meeting standard 10. Privacy is upheld and staff were treating residents respectfully, at the time of inspection. A shortfall was noted regarding the language used in a minority of care plans. EVIDENCE: Standard 7. Reference was made to residents’ care plans. These were generally maintained to a good standard having been regularly reviewed with risk assessments in place (including those for moving and handling and pressure care). Shortfalls were noted with regards to frail residents who have
Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 11 recorded weight loss. A recommendation is made that food and fluid intake be recorded in such instances and the G.P. referred to if weight loss continues. Standard 8. Reference was made to residents’ care files, which contained contact details for their G.P. There was evidence on care plans of referrals to district nurses, specialist medical services, clinics and paramedical services. One resident whose care plan was read, was receiving district nursing visits twice a week for treatment of a pressure sore. Standard 9. Reference was made to the home’s medication procedure, which was also discussed with a member of staff who administers prescribed medication. Management of Warfarin was discussed with a senior care assistant who confirmed that the home has a safety system in place when any change in dose is prescribed. Medication is administered from a monitored dose system, individually managed on each floor. All drugs are stored in secure trolleys or locked cupboards in residents’ bedrooms, (for those who selfmedicate). Medication records were satisfactorily maintained. Training is provided for staff who administer prescribed medication. In order that an accurate audit of medication is maintained, a recommendation is made that all unwanted medication is recorded prior to disposal. Standard 10. Seven residents commented and said that staff treat them with respect. Observation of interaction between residents and staff gave no cause for concern during the inspection. In discussion with staff it was evident that they are aware of the need to respect residents’ privacy with regards to personal care giving and confidentiality of information. Shortfalls were noted in a minority of diary records with regards to the choice of language used by staff when completing diary sheets. A requirement is made under regulation 12 (4)(a)(b). Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Standard 12. The home was meeting standard 12 at the time of inspection. Resident’s social and spiritual needs were being addressed by staff through inhouse activities and support of religious needs. Standard 13. The home was meeting standard 13. Visitors are made welcome in the home and residents have access to advocacy services. Standard 14. The home was meeting standard 14. Residents were spending time as they chose, making full use of the building and grounds. Lounges are arranged so as to provide choice of activity and association. Standard 15. The home was meeting standard 15. Meals and alternatives provided were to the satisfaction of residents and meals were well presented. EVIDENCE: Standard 12. Twelve residents expressed satisfaction with their daily life in the home. One resident said there had been a social event that week with entertainers who sang to the residents. She said, “it was wonderful, I really enjoyed it.” On the ground floor I observed a student from a local school, playing classical music on the piano to residents, who were appeared to be enjoying the experience. Residents on one floor were taking part in a game of carpet snakes and ladders supervised by staff. This appeared to provide conversation and fun between residents and staff. There are lounges and quiet areas on all three floors, including a library. The main lounges are spacious
Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 13 and arranged with areas where those not wishing to take part in activities may sit quietly to chat or read. A number of residents are assisted to the chapel each day to attend mass. A resident said, “I like to go to church here as I did before.” The needs of all religions are supported in the home by access to visiting ministers of all denominations as requested. Standard 13. The home was meeting standard 13. Residents confirmed that their visitors are made welcome and that they are left undisturbed with them. Standard 14. The home was meeting standard 14. During the inspection, residents were spending time as they chose, either in the lounges or their bedrooms. Residents who did not wish to take part in activities were not forced to do so. They were served their meals either in the dining room or in their bedrooms, by choice. An example of the availability of alternative meals was observed. I was visiting a resident in her bedroom, she had chosen an alternative to the main meal. Due to her state of health, she could not eat it and a second alternative was served to her on request, without delay. Standard 15. Meals were well presented and were to the satisfaction of residents. There is a dining room on each floor with adjoining serving area. Meals are cooked in the main kitchen and transported to each floor on trolleys in the lift. Several residents commented on their meals and all expressed satisfaction. One resident said, “The food is very good, I cannot fault it.” Residents were not rushed with their meals and two ladies remained in the dining room, one finishing her meal, long after the other residents had left. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 The home was meeting standards 16,17 and 18. Residents are provided with a copy of the home’s complaints procedure on admission and a record of complaints is maintained on each floor. The home does not become involved in residents’ financial affairs and the home has an Adult Protection Procedure and Whistle Blowing Policy. EVIDENCE: Standard 16. The home has a satisfactory complaints procedure, which is made available to residents (and their representatives), being placed in their bedrooms on admission to the home. A record of complaints and remedial action is maintained in the home. Standard 17. Staff confirmed that the home does not become involved in residents’ finances, which remain within their own control or that of their representatives. Residents who do not have representation are provided with details of advocacy services. Standard 17. Reference was made to the home’s Adult Protection and Whistle Blowing policies. The home provides training to staff in protection of vulnerable adults and staff are fully vetted, prior to taking up their posts. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Standard 19. The home was meeting standard 19. The building is vast and was in generally good order in areas visited, at the time of inspection. There is an ongoing maintenance and decoration programme and improvements to furnishing and office space have been carried out since the last inspection. Standard 26. The home was not meeting standard 26. The building in general is maintained to a very good standard, a shortfall was observed in a bathroom on the middle floor. EVIDENCE: Standard 19. The maintenance of this building internally and externally is ongoing and prioritized. Work was being carried out on the roof at the time of inspection. Some areas have been decorated with new carpets fitted and new furniture, since the last inspection in March 05. Office space on all floors, which had previously been confined, has been improved by extending the space into unused areas on two floors, and by transfer to a redundant bedroom on the middle floor.
Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 16 Standard 26. The home employs domestic staff and provides protective clothing and training in control of substances hazardous to health and infection control. The building is maintained to a very good standard of hygiene. A shortfall was noted in the middle floor bathroom where the shower curtain was badly soiled with what appeared to be mould spores, which could carry a risk of infection. Staff said that this shower is in constant use. A requirement is made under Regulation 13 (3) that the shower curtain be removed, replaced. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30 Standard 27. The home was meeting standard 27 at the time of inspection. Staffing levels were being maintained. Standard 28. A high level of commitment to NVQ training was noted. Standard 30. There are very good levels of training in the home, a shortfall was noted with regards to provision of training to meet the presenting needs of residents. EVIDENCE: Standard 27. Staff rosters are maintained on each floor, and these were read and were satisfactory at the time of inspection with regards to care staff numbers. Standard 28. The home was meeting standard 28 with regards to NVQ training. Discussion took place with the training co-ordinator and certification and training schedules were seen. Over 50 of staff have achieved at least Level 2 in Direct Care and a number are at Level 3. The manager and floor managers have Level 4 in management. Standard 30. Discussion took place with floor managers and the training coordinator. The home provides induction training, and mandatory training is ongoing and updated. Training undertaken by staff, in addition to NVQ or Induction into Care, includes, Health and Safety, Basic Food Hygiene, Protection of Vulnerable Adults, Activities, First Aid, Infection Control and Fire Safety. A recommendation is made that staff undertake training in dementia care. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 Standard 31. The home was meeting standard 31. Sister Joseph, is a qualified and experienced manager who has many years experience in health care. There is a management structure in place which best meets the needs and layout of the home. Standard 38. The home was not meeting standard 38. Health and safety certification was in order, however three hazards were observed and requirements are made. EVIDENCE: The management structure consists of the registered manager, and three unit managers supported by senior staff. This structure provides continuity and ensures the availability of responsible staff on each floor, to guide and supervise staff. Managers are trained in accordance with their roles and responsibilities.
Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 19 Standard 38. Reference was made to the home’s health and safety procedures manual and to safety and maintenance certification, which was satisfactory. The home has procedures in place for COSHH, infection control and fire safety. A fire drill had been carried out two weeks previous to the inspection, and the fire officer was due to provide training in fire safety. Shortfalls were noted as follows :Records of water temperatures were measuring over 43 degrees in some instances. A requirement is made under 13 (4) (a) that water temperatures in baths and showers are tested and adjusted to 43 degrees where necessary. There was an electrical fault on automatic fire door closers causing them to be out of commission. A requirement is made under Regulation 23 (4) (c) that the fault be repaired. The wash hand basin in room 27a was cracked and a requirement is made that this be replaced, under Regulation 23(2) (c). Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 21 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 OP10 Regulation 12 Requirement The manager must instruct staff in the correct use of language to be used in residents’ personal records. The manager must arrange for the soiled shower curtain to be removed and replaced. The manager must arrange for water temperatures in baths and showers to be measured and adjusted to 43 degrees where necessary. The manager must arrange for the electrical fault on fire doors to be remedied. The manager must replace the wash hand basin in room 27a. Timescale for action 27/12/05 2. 3. OP26 OP38 13 13 01/11/05 01/11/05 4. 5. OP38 OP38 23 23 01/11/05 10/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager must ensure that food and fluid intake be
DS0000005384.V255895.R01.S.doc Version 5.0 Page 22 Nazareth House 2. 3. OP9 OP30 recorded for residents who have weight loss, and the G.P. referred to if weight loss continues. The manager must ensure that a record is maintained of all unwanted medication prior to disposal. The manager should arrange for staff to receive training in dementia care. Nazareth House DS0000005384.V255895.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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