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Inspection on 21/06/05 for Oakhurst Court Nursing Home

Also see our care home review for Oakhurst Court Nursing Home for more information

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

Residents stated that they were happy in the home, that staff are kind, caring and professional. Feedback from the comment cards received indicated that relatives are consulted about changes in the resident`s health and that the level of care provided in the home was satisfactory. Other comments stated that choice and privacy is respected. The paperwork viewed was generally in place and well maintained, especially the personal care plans and bath care charts. The home has a good training programme in place and staff receive support to achieve their National Vocational Qualifications (NVQ).

What has improved since the last inspection?

There is a supervision programme in place and all staff have received their appraisal. The supervision programme will now commence with staff allocated to a supervisor who plans to complete up to six sessions of formal supervision in the next twelve months. Staff stated that they have seen some changes implemented by the new manager and in the way the service is run and they felt that these were having a positive effect. The manager commented that there are a number of small changes she plans to implement, one of these being a proposal to hold a relative`s meeting. Other areas where work is being done is in the review of policies and procedures and ensuring that all staff files contain all the information as required by legislation. No fire doors were seen to be propped open and those that were open, were held open by proper door opening devices such as magnetic holders that release when the fire alarm sounds.

What the care home could do better:

An immediate requirement was made in respect of there being two (2) trained staff on duty for each shift, including the night shift. This was followed up with a serious concerns letter. It was noted during the course of the inspection that a number of windows on the first floor were opened off their restrictors. It is acknowledged that there have been a number of very hot days, however no risk assessments had been put in place for the residents in those bedrooms or others that could be at risk. Staff complete risk assessments on each individual resident however there were no action plans or follow-ups to any risks that were identified during the assessment process to keep residents safe. It was recommended that the information written in the daily notes could be expanded to include the resident`s mood, appetite, activities etc. Staff files were sampled and not all contained the information as required by legislation. It is acknowledged that the manager and administrator are aware of this issue and have been working towards rectifying the situation. This will ensure there is evidence of appropriate recruitment practices and that suitable and competent staff are employed.

CARE HOMES FOR OLDER PEOPLE Oakhurst Court Nursing Home Tilburstow Hill Road South Godstone Surrey RH9 8JH Lead Inspector Mrs M McHugh Announced Inspection 21 June 2005 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 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. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oakhurst Court Nursing Home Address Tilburstow Hill Road, South Godstone, Surrey. RH9 8JY 01342 893043 01342 892690 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Oakhurst Court Ltd Mrs Pamela Elizabeth Milne CRH (N) 57 Category(ies) of Dementia - over 65 years of age (DE(E)) 57. registration, with number of places Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Total number of beds not to exceed 57. Date of last inspection 21 September 2004 Brief Description of the Service: Oakhurst Court Nursing home is a substantial detached property that has been converted to provide accommodation for fifty-seven service users. The home is located in a rural part of South Godstone. Access to shops, church, public transport and other local amenities are a distance away, however, transport is provided for service users when required. Part of the accommodation is provided in the original building, with the rest in a number of annexes surrounding the main building. These have been added during a continuous upgrading program. Accommodation is provided on the ground and first floors and most bedrooms have en-suite facilities. There are two passenger lifts accessing the first floor.The home has a number of sitting areas including a large main lounge area. There is a large homely dining area that is used for other activities as well as serving meals. The home is located in substantial grounds with some of the gardens landscaped and a river that runs close to the main entrance. All areas have wheelchair access.There is plenty of parking areas to the front of the home. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over seven and a half hours. Since the last inspection there is a new manager in post and a new administrator for the home, since January 2005. It is acknowledged that this is a significant change in the home and it has taken the manager time to settle into her post, get to know the staff and residents and to become familiar with the way the home operates. A tour of the premises was undertaken and staff and care records were sampled during the day. Staff were spoken with during the course of their duties and five of the fifty residents were spoken to in depth. A number of other residents were spoken with in passing or during the lunchtime meal. The inspector received comment cards back from two residents and eight relatives/visitors. The inspector spoke to three visitors during the day and received one letter about the service. What the service does well: What has improved since the last inspection? There is a supervision programme in place and all staff have received their appraisal. The supervision programme will now commence with staff allocated to a supervisor who plans to complete up to six sessions of formal supervision in the next twelve months. Staff stated that they have seen some changes implemented by the new manager and in the way the service is run and they felt that these were having a positive effect. The manager commented that there are a number of small changes she plans to implement, one of these being a proposal to hold a relative’s meeting. Other areas where work is being done is in the review of policies and procedures and ensuring that all staff files contain all the information as required by legislation. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 6 No fire doors were seen to be propped open and those that were open, were held open by proper door opening devices such as magnetic holders that release when the fire alarm sounds. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 standard(s) 1, 2, 3 and 5 Residents have access to information about the home to enable them to make an informed choice about the service. This includes information about the level of needs the home can cater for and any specialist equipment available. Contracts were in place for all residents. People are invited to visit the home prior to making a decision about admission to the home. EVIDENCE: The home’s brochure, statement of purpose and residents guide were available and contained information about the home, activities, meals, staff and more. These documents are in the process of being updated to include information about the new manager and administrator. The inspector saw examples of contracts between the home and the resident and/or the funding authority. These contracts included the room that the person was to occupy and information about any additional costs that are not covered in weekly fees. There was also terms and conditions of residence included in the contract. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 9 All residents are assessed by the home or by the social services care team prior to admission. The resident then has a comprehensive admission assessment completed which looks at physical, emotional, social, health and nutritional needs. These are reviewed as part of the care planning process each month. Any needs that are identified as requiring specialist equipment are provided through the home or the occupational therapist. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 standard(s) 7, 8, 10 and 11 The resident’s health, personal and social needs were documented in the care plan and their health care needs were being met. Some work is needed in respect of risk assessments and action plans. Overall, issues of privacy or dignity were promoted, however the home needs to consider some feedback from a resident following a survey of views. EVIDENCE: Care plans were sampled and were generally well written and were reviewed on a monthly basis. There were general risk assessment forms completed for falls, pressure sores, nutrition and manual handling. However when a risk was identified there was no follow-up noted or action plan put in place to protect that resident from the identified risk. The daily notes were completed during the day, however these could be more informative about the individual’s care needs met during the day, what activities they participated in, meals taken and emotional needs assessed. The tick boxes for care needs were completed by the care staff ensuring that information was documented. Records of external professional’s visits were viewed and showed that the GP, optician and chiropodist make regular contact in the home. Residents stated that they see the GP as required. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 11 No issues of privacy or dignity were brought to the inspector’s attention during the inspection process and staff were observed to be knocking on bedroom doors and calling residents by their preferred form of address. Although a comment card received back from a resident, stated that their privacy was sometimes respected. None of the residents spoken to on the day of the inspection made any comments about this matter. It was noted that resident’s wishes in the event of death were generally noted on the care plans, however this was not always done. Staff have received training in bereavement and handling death and dying. The home has clear policies in place detailing the steps staff are to take in this event. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 standard(s) 13, 14 and 15 Mealtimes were well managed and provided a choice, daily variation and social contact for residents. Residents had a right to make choices and exercised some control over all aspects of daily living, as long as the choices they made did not put them at risk. EVIDENCE: Although activities were not looked into in detail during this inspection, it must be noted that during the inspection two comments were received that the activities provided were not satisfactory. The residents in the home have varying degrees of dementia and it was stated that those who are unable to verbalise are not included in the activities. It was also stated that if residents remain in their bedrooms, they are not included in any activities and did not receive much contact from the staff, except for the set duties that must be performed. These comments and the activities provided in the home will be looked into in detail at the next inspection. Visitors were seen in the home throughout the day and many stated that they were welcomed into the home at any time and were always treated with respect. Meals are taken in the large dining room or in resident’s bedrooms if they prefer. Comments received back following the meal were positive and many Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 13 residents appeared to have enjoyed their meal. Those residents who require special meals, were provided for and staff were on hand to provide assistance where required. A resident commented that their meal was not hot enough and that there was only a choice of sandwiches in the evening. The menus viewed showed a choice of sandwiches and a hot meal in the evenings. The manager stated that all meals are served hot in the kitchen and taken directly to the resident. No further information was obtained and no other comments were received about the temperature of the meals provided. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 standard(s) 16 and 18 Residents and relatives are aware of the complaints procedures. Procedures were in place in respect of the protection of vulnerable adults and training and induction was available for staff. EVIDENCE: The complaints procedure also contains contact information about the Commission and the local Ombudsman. The manager stated that the home had received one complaint in the last six months. Residents stated that they would talk to a member of staff or the manager if they had a complaint. Two comment cards out of ten received back from residents and relatives/visitors stated that they were unaware of the home’s complaints procedure. Staff receive training in their induction and full abuse training that teaches them how to recognise signs of abuse and what to do if they witness or suspect that a resident is being abused. Residents spoken to stated that staff were caring, kind and polite at all times. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home is safe, well maintained, provides comfortable communal areas and residents have bedrooms to suit their needs. The home has sufficient heating, ventilation, lighting and is clean and free from malodours. Various specialist equipment was available in the home. EVIDENCE: The home has a rolling refurbishment programme in place and the health & safety officer stated that any area noted to require refurbishment especially if it affects the safety of service users is attended to as a matter of priority. The home is well decorated and they have used colours specific to their service user group. For example: the hand rails are painted bright yellow as this is a colour that people with dementia respond well to and it is the last colour that is seen by people who are losing their sight. A relatives/visitors comment card stated that the communal areas of the home could benefit from some attention. The home provides a number of seating areas throughout. There is the large main lounge, a smaller but still large quiet lounge alongside, a seating area near the nurses office and another seating area on the other side Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 16 of the house for service users whose bedrooms are around that part of the home. There is also a very large dining room area where there is space for all service users to have their meals together. The home also has a number of courtyard areas, a gardening area around the back of the property. Those bedrooms that were viewed on the day of the visit, were large in size, many exceeding the National Minimum Standard’s size requirements, and were decorated with residents’ furniture, photos, pictures and ornaments. Specialist equipment in the form of handrails, safety rails in bathrooms, specialist baths, hoists, wheelchairs, Zimmer frames and specialist pressure relieving equipment was found throughout the home. The hot water, lighting and ventilation in the home were seen to be satisfactory and the maintenance person carried out regular checks on all equipment. The home employs a dedicated housekeeping staff and they showed a good awareness of COSHH (Control of Substances Hazardous to Health) and infection control issues. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The staffing levels in the home were satisfactory to meet the needs of the current residents. However there is one issue about the number of trained staff to be on duty at night time. Not all staff files checked contained the information required as set out in the Care Homes Regulations 2001, as amended. Staff are trained to do their jobs and National Vocation Qualification (NVQ) training is in progress. EVIDENCE: Information taken from the resident’s questionnaires stated that residents felt they were well cared for. Six of the eight comment cards received back from relatives/visitors stated that in their opinion, the home was sufficiently staffed and two felt it was not. A further comment received on the day of the inspection was that there were not enough staff on duty on the weekends. However, the duty rota showed that the same amount of staff are due on to work at the weekend as during the week. A resident stated that they sometimes felt rushed by staff and two residents stated that sometimes staff take a while to answer the nurse call bell. On the day of the inspection staff were seen around the home at all times and residents were not seen to be unattended at any stage. It was concluded that the staffing levels were satisfactory to meet the current residents needs during the day. However, at night time the home has recently reduced the number of trained staff on duty from two to one. This has not been agreed with the Commission and an immediate requirement was issued for the number to be increased again to two trained staff on duty at all times. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 18 Mandatory staff training is in place and up to date with fire training, food hygiene, manual handling, health & safety and protection from abuse plus many more training courses are offered in the home. Twelve of the thirty care staff have obtained their NVQ level 2 award and five more are working towards this qualification. The manager stated that the home has one NVQ assessor and two staff working towards becoming NVQ assessors so that they can continue to assist staff to gain these qualifications. Not all of the staff files sampled on the day of the inspection contained the information as required by legislation. Staff files must include information on proof of identity, details of any criminal offences, two written references and CRB checks. For those staff who require visas to work in the UK, the service should check that these are within the dates specified on the visa. It is acknowledged that the manager is aware of this shortfall and has already begun working towards meeting this Regulation. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36, 37 and 38 Residents benefit from the ethos and management approach of the home, which is run in the residents best interests. The health, safety and welfare of all in the home is promoted EVIDENCE: The home’s manager is new to post from January 2005. There has been a ‘settling in’ period as staff and residents ‘get to know’ the new manager and adjust to a different management style. The home is generally well run and staff and residents were observed to respond positively towards the registered manager. Staff stated that they like the new manager and have seen some positive changes that she has made in the home. The manager stated that due to the differing levels of dementia the residents of the home have, it is difficult to complete quality audit questionnaires and hold resident’s meetings. The manager stated that there were plans to hold a Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 20 relatives meeting and it was suggested that she develop a relative’s questionnaire too. Many relatives pop in and see the manager or staff if there are any issues they wish to discuss and this was confirmed by a relative spoken to on the day of the inspection. The administrator informed the inspector that the home’s finances were in a satisfactory state. A copy of the home’s financial statements were seen and satisfactory. The home has a five year business plan in place and is currently in year three of this plan. The home does not take any responsibility for the financial affairs of any service users. The administrator stated that the home pays for any additional services for the service user and their representative is invoiced at the end of each month. A supervision programme is now in place and all staff have received their yearly appraisals. The manager stated that she is in the process of reviewing and updating all the policies and procedures in the home. Fire testing, maintenance, health and safety checks records were up to date and well maintained. The home promotes the health, welfare and safety of its staff and residents and this was evident through the records viewed on the day of the inspection. However, it was noted that some windows on the first floor were open wide off their restrictors. It is acknowledged that it was a hot day, however, no risk assessments were in place for the residents in those bedrooms or any other residents that could be at risk. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x 3 3 3 3 2 Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 22 NO 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 OP 8 Regulation 13(4)(c) Requirement Timescale for action 05/07/05 2. 3. OP 27 OP 29 18(1)(a) 19(4)(b) Schedule 2 13(4)(a) 4. OP 38 An action plan must be put in place for any resident where a risk has been identified during the assessment process. The home must have two trained 22/06/05 staff on duty at all times, including night time. Staff files must contain all the 21/07/05 relevant information, including two written references and proof of identity. The home must put the windows 24/06/05 back on the restrictors or put risk assessments in place for any resident who has their bedroom windows open off the restrictors. These risk assessments must include any other resident in the home who could be at risk of this action. 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 OP 7 Good Practice Recommendations Daily notes should be expanded to include information H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 23 Oakhurst Court Nursing Home 2. OP 33 about what the resident has done during the day. The home should consider developing a relatives quality audit survey. Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakhurst Court Nursing Home H58 H09 s13343 Oakhurst Court v223884 210605 Stage 4 ann.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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