Inspection on 14/08/06 for Nethercrest Nursing Home

This inspection was carried out on 14th August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nethercrest Nursing Home 16/07/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nethercrest Nursing Home Brewster Street Netherton Dudley West Midlands DY2 OPH Lead Inspector Mr Richard Eaves Key Unannounced Inspection 14th August 2006 09:00 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 Nethercrest Nursing Home DS0000066287.V300148.R02.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. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nethercrest Nursing Home Address Brewster Street Netherton Dudley West Midlands DY2 OPH 0115 922 4333 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) Mimosa Healthcare Group Limited Care Home 41 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (41), of places Physical disability (22) Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 41 OP, 6 DE(E) and 22 PD The category of PD applies only to intermediate care places and the 2 permanent placements already approved. 3rd October 2005 Date of last inspection Brief Description of the Service: Nethercrest Care Home is privately owned by Mimosa Healthcare Group Ltd, it provides nursing care and accommodation, on a shared site with its sister home Nethercrest Residential Home. First registered in 1991 up to forty-one older persons can be accommodated, six of which may require dementia care and up to twenty receiving intermediate care which is for patients discharged from hospital but not sufficiently recovered to go home. The home is situated on the outskirts of Netherton within the local community and is near to local shops and amenities. It is on an accessible public transport route to local areas and there are adequate car parking facilities available. The premises consist of a two-storey purpose built building with access to the first floor by a passenger lift. The accommodation consists of 33 en-suite single bedrooms and 4 double rooms. Currently the 2 double rooms are furnished as single rooms, making the homes capacity 39. A large lounge/dining room with a conservatory and a further linked small sitting area with a second conservatory provide communal space. The communal areas are serviced with a 4 suite assisted toilet room. Three bathrooms and two showers are located around the Home. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was undertaken by a single Inspector from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the unannounced inspection during February 2006, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire, survey responses and records held at the home. The inspection involved a full tour of the home including, bedrooms, communal rooms, service areas and provided an opportunity to speak with many service users, visitors and staff. What the service does well: What has improved since the last inspection? What they could do better: The manager should audit the recording of medication to ensure a good standard of completion is maintained consistently. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 6 The supper that is provided during the evening should be shown on the menu allowing service users the opportunity to choose what and when to eat knowing the choices available, it will also demonstrate that the period between evening supper and breakfast does not exceed twelve hours. The cleaning schedule should be reviewed to ensure no areas of the home are left out such as the fire escape lobby from the lounge and cleaning of the conservatory blinds. A contingency arrangement must be found for cleaning carpets while the current cleaner is either repaired or replaced. The regular monitoring of services such as hot water supply and fire detection testing must be maintained during the absence of a maintenance person and during the replacements induction. The manager while newly in post must make application for registration at this home. The manager must ensure that arrangements for staffing are sufficiently flexible to respond to unexpected shortfalls due to absences or increased activity. 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. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 The overall outcome for this group of standards was judged to be good. Service users and prospective clients including intermediate care users and their supporters are provide with good sources of information about the home. The staff group are stable well established and collectively have the knowledge and skills to assess needs and to meet these assessed needs of the current service users. Confirmation that assessed needs can be met further enables service users to make informed decision about entering the home. Designated staff provide skilled intermediate care in a clearly defined area maximising the opportunities for rehabilitation. EVIDENCE: The statement of purpose and service user guides were reviewed at the start of the year and an intermediate care specific section added to the guide, a further amendment has been made to provide details of the new manager. The assessment processes in use are comprehensive and include a collaborative assessment undertaken by the stepdown/discharge co-ordinators of the hospital home staff expand on this with a range of risk assessments. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 9 Senior staff of the nursing home undertake assessments for prospective permanent clients and include activities of daily living and a range of clinical risk assessments such as pressure areas, nutrition and falls. The case files show that a previous omission to assess the topic of preparation and wishes in respect of death and dying has been fully addressed. It is recommended that intermediate care service users be reassessed on arrival for falls, nutrition and pressure area care using the home comprehensive documentation. Regular reviews of the assessments are undertaken but these would benefit from a more detailed approach. In all cases the home confirms that the identified agreed needs can be met by the home in writing and a contract is issued at admission, copies are kept on file. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions which are right for them, but it is acknowledged that currently most service users are admitted from hospital. The home has 20 beds dedicated for intermediate care and these are fully utilised by the hospital. A rehabilitation room has been developed for the Physio and Occupational therapists to work with service users. A senior carer has recently been designated to lead the intermediate carer team to assist in co-ordination and communications to maximise the rehabilitation process. The home recognises a training need for care staff in this area of work. Nethercrest Nursing Home DS0000066287.V300148.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10 The overall outcome for this group of standards was judged to be good. Health care needs of service users are fully met. Care plans are derived from a comprehensive range of assessments and provide the basis for the delivery of care and detail the actions required of staff to meet the identified needs. There remains scope to further develop the direction to staff and be more informative. Medications are well managed all facilitating the promotion of service users health. Service users are treated with respect and their privacy upheld. EVIDENCE: The case files of 4 service users were case tracked in depth and showed that they comprehensively identified problems requiring nursing and personal care interventions. A current bedside chart is recommended to be further developed to record all interventions and attendances including times and type of intervention. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 11 The home administers two systems for the administration of medication with a monitored dosage system for long term residents, and bottled system hospital supply for the step-down residents. Administration and record keeping are generally good with booking in and returns out and retention of medications following death this previous requirement is now included in the policy document, however on this occasion a number of examples were noted of omissions on the MAR charts. Arrangements for the storage administration and recording of controlled drugs are satisfactory. The public telephone is situated in the lobby, which offers little privacy although the area is little frequented other than passing through. The manager advises that incoming calls are usually taken in the office, these can be taken in their own rooms using the cordless phones. Service users wear their own clothes at all times and on the day of inspection everyone appeared neatly attired, although one lady had spilled tea on her sleeve and this had not been seen and the stain was almost dry. The manager advised that there were few problems with personal laundry and the policy was to reimburse if losses are not found quickly. Service users rights dignity and respect are given prominence during the induction of new staff and the interaction between staff and service users was observed to be easy, thoughtful and considerate meeting this element of the standard. Currently no rooms are shared and should medical examinations be required service users are returned to their room. Nethercrest Nursing Home DS0000066287.V300148.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 The overall outcome for this group of standards was judged to be good. The home provides limited but well-organised and varied social and recreational activities that provide interest and pleasure for the residents. Many aspects of care evidences that service users exercise choice and control over their lives. The meals at Nethercrest nursing home are good, offering both choice and variety and catering well for special dietary needs. EVIDENCE: A senior care staff member is responsible for organising and co-ordinating entertainments, leisure and social activities at the home and has attended a training course. The range includes sing-a-longs, exercises, games, relaxation and memory lane. Hairdressing, manicures and facials are provided on a regular basis. A number of other events have taken place or are planned such as a BBQ, a show by the staff and trips to the Black Country Museum and the Botanical Gardens. The home has an open visiting policy and visitors were seen to be arriving from around 10am onwards. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 13 The case files include a section that identifies personal likes and wishes and in conversation with service users some were able to confirm that staff assist them to make their own choices. The home are not responsible for service user personal finances but do hold small amounts of cash for safe keeping and full records are maintained. A number of permanent service users rooms were visited and show that they have been furnished and decorated with personal possessions. The assessment process clearly identifies to service users that they may access their case file at any time and this is reiterated during reviews. The home provides a 4-week rotating menu that includes choice and a cooked option at all three main meals, supper and snacks are also available. The lunch served during the visit looked appetising and a number of residents spoke well of the meals. The menus have been assessed as nutritionally sound and are put together using a high proportion of fresh produce and full fat milk. The home recently achieved the Gold Award for Healthy Eating. The previously identified need to show the provision of supper on the menu has not been met. This is required to demonstrate that the interval between evening snack and breakfast does not exceed 12 hours. It also enables service users to make choices in their diet in the knowledge of what will be served at the next meal. Nethercrest Nursing Home DS0000066287.V300148.R02.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The overall outcome for this group of standards was judged to be good. The home complaints and protection policies are robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. Staff demonstrate knowledge and understanding of adult protection issues which contributes in providing an environment safe from abuse. EVIDENCE: The Homes complaints policy is readily available by way of the service user guide and notices displayed around the Home. The home has received a complaint since the previous inspection in respect of staff deficiencies due to staff sickness, which was not responded to. Subsequent to this the manager is authorized to book agency staff to maintain minimum staff numbers. The Home has a robust policy and approach to the protection of adults from abuse, with staff training in adult protection given a high level of priority. An allegation of neglect is currently the subject of adult protection procedures, this being the second to be raised since the previous inspection. Nethercrest Nursing Home DS0000066287.V300148.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The overall outcome for this group of standards was judged to be adequate. The home provides a good standard of décor and furnishings. Managed services have not been monitored potentially placing service users at risk. The home is overall clean, free from odours and hygienic. EVIDENCE: The home is well presented with a programme of decoration recently completed but the reception area already requires further attention. The home is furnished comfortably, is clean and hygienic with no unpleasant smells. Over the summer the conservatory blinds have been in use and these were generally found to be in poor condition, stained and at a high level very dusty. The all en-suite bedrooms and communal areas are comfortable with a domestic appearance making each of the areas pleasant and homely. The home is well provided with additional toilets and bathrooms in sufficient numbers disbursed about the home all adapted to accommodate the disabled. Tablet soap was observed to have been left in the shower in breach of infection Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 16 control good practice. The ground floor bathroom was observed to be used as a wheelchair store preventing its proper use. The lounge was noted to have a curtain pulled away from its hooks, a radiator cover required painting and the fire escape hall requires to be included in the cleaning schedule. The garden area adjacent to the rear conservatory requires to be secured to allow free access by service users. The laundry while small is fitted with modern equipment that meets sluice and disinfection requirements. Each floor has a sluice fitted with a sluicing disinfector. Each staff hand wash has controlled safe hot water supply to promote good hand washing. The first floor has a room set aside as an occupational therapy kitchen. There are 21 bedrooms 3 of which are designated as doubles. Most rooms visited were pleasantly personalised, a room seen that is used as part of the step down programme was in need of attention and decorating to make it more inviting with pictures and ornaments. Nethercrest Nursing Home DS0000066287.V300148.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 The overall outcome for this group of standards was judged to be good. The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home has been proactive in developing a skilled staff group with understanding of service users needs. Recruitment and selection processes are to a good standard protecting vulnerable people. EVIDENCE: The home is consistently staffed with adequate numbers and skill mix of Nurses and carers over the 24 hour period, being 2 nurses and 6 carers in the morning, 2 nurses and 4 carers afternoon and 1 nurse and 3 carers at night. It is of concern that these numbers while meeting minimum numbers appear inflexible and not responsive to activity and dependency levels. Staff met and spoken with were enthusiastic and those who were recently employed received formal induction that meets TOPPS standard. The number of care staff having achieved NVQ level 2 now stands at 70 well in excess of the standard of 50 . All staff have an individual training record and a training matrix of statutory and other regular training required. These records show mandatory training to be up to date and nursing staff undertake professional updating courses currently being undertaken include ENB941 Elderly Care and N11 Dementia Care. Over the past year training has included tissue viability, venepuncture and intravenous injections, diabetes care and care delivery. The Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 18 home has 3 manual handling trainers and the manager has attended the West Midlands Fire Safety training. A sample of 4 staff files were inspected including recent starters and found that recruitment and selection processes are completed to a good standard. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 The overall outcome for this group of standards was judged to be adequate. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities and service users benefit from this consistency. The home regularly reviews its performance but has not sought the views of service users and their families since the change of ownership. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users interests personal and financial. Staff receive supervision and direction to ensure that the service users receive consistent quality care but this has been disrupted during the change over of managers which potentially could undermine this. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. EVIDENCE: Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 20 On the day of the inspection it was apparent that there was a very good atmosphere amongst the staff. The manager holds frequent staff meetings and maintains a record and actions taken in response to staff inputs. In conversation with staff it was apparent that they consider themselves to be valued and respected for their input into the team as a whole. The company quality assurance systems are extensive and completed on weekly, monthly and quarterly basis. The area manager also undertakes Regulation 26 visits on behalf of the company with copies of reports shared with the Commission. Since the change of ownership no surveys have been undertaken of service users and relatives views of the service. The home does not act as appointee for service users but assists some service users with their personal allowances the records of which are completed thoroughly. The staff supervision programme has been disrupted over the period of manager change and requires to be re-established. The home has an up to date health and safety policy for safe working practice with a range of risk assessments of workplace activities, these require to be kept under review and expanded to cover all areas of work for the safety of staff. Staff receive training and regular updates in health and safety and fire safety. A fire risk assessment was available and this is subject to review as changes occur. Certification of a range of servicing and annual inspections undertaken of all utilities and equipment in the home are maintained and up to date. The weekly and monthly monitoring has been disrupted since the maintenance person left but is being addressed as a priority by the new appointment. Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The registered person must ensure that staff comply with the medication policy in respect of recording by the thorough completion of the MAR chart The registered person must demonstrate that the interval from pm to breakfast does not exceed 12 hours by including the provided supper on the menu. The registered person must ensure that all parts of the home are kept clean, namely the fire escape lobby from the lounge and carpets in the main entrance. The conservatory blinds should be kept clean and in good condition. The registered person must ensure that monitoring of hot water temperatures is undertaken in accordance with the company direction. The registered person must ensure that at all time suitably qualified competent and experienced persons are working in such numbers to meet the needs of service users and that DS0000066287.V300148.R02.S.doc Timescale for action 31/10/06 2 OP15 16(2)(i) 31/10/06 3 OP19 23(2)(b) (d) 31/10/06 4 OP25 23(2)(j) 31/10/06 5 OP27 18(1)(a) 31/10/06 Nethercrest Nursing Home Version 5.2 Page 23 6 7 OP31 9(1) 18(1)(c) OP36 systems are adequate to respond to unexpected shortfalls. The manager must make 31/10/06 application for registration without delay. The manager must restart 31/10/06 regular supervision sessions for care staff to meet the minimum 6 sessions for each year. 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 OP3 Good Practice Recommendations It is recommended that the single assessment used for intermediate care service users be supplemented with the homes own assessment process for falls, nutrition and pressure areas. It is recommended that assessment and care plan reviews are completed to be more informative. It is recommended that the current bedside chart is developed to show times and type of intervention provided. It is recommended that a service user and relatives survey of views be undertaken. 2 3 4 OP7 OP7 OP33 Nethercrest Nursing Home DS0000066287.V300148.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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