CARE HOMES FOR OLDER PEOPLE
Palace House Nursing Home 460 Padiham Road Burnley Lancashire BB12 6TD Lead Inspector
Mrs Marie Matthews Unannounced Inspection 09:30 6 March 2007
th 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 Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Palace House Nursing Home Address 460 Padiham Road Burnley Lancashire BB12 6TD 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) 01282 428635 01282 416165 Alliance Care (Dales Homes) Limited (wholly owned subsidiary of Four Seasons Healthcare Limited) Mrs Julie Elizabeth Johnson Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (33) of places Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 22 October 1999 The service must, at all times, employ a suitably qualified manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 33 service users to include: Up to 33 service users who fall into the category OP Up to 33 service users who fall into the category of PD Up to 25 service users who require personal care 19th December 2005 Date of last inspection Brief Description of the Service: Palace House is a care home that provides personal and nursing care for up to thirty-three people and is situated within extensive grounds on the main road between Burnley and Padiham. The home is converted from a Georgian building and still has some of the features of the original house. There has been an extension built to provide extra accommodation. There is a lift to access the first floor. The attractive gardens are visible from many of the bedrooms and the lounge and dining room. There is a level path through the garden and it is possible to push a wheelchair around this. A raised patio area, which overlooks the gardens, is easily accessible from the dining area. The home is near to local amenities including shops, bus stops and pubs and the town centre of Burnley is accessible by a bus ride. At the time of the inspection all rooms except one were used as single occupancy rooms. Some of the rooms are particularly spacious. Six of the single rooms and one of the double rooms have en-suite facilities all others have hand washbasins. Many of the people who live in the home have personalised their room with their own belongings and this enhances the comfortable appearance of the home. The communal areas of the home are homely and nicely decorated. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees range from £313.00 to £533.00 per week. Additional charges are made for newspapers, toiletries and hairdressing. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Palace House was conducted on 6th March 2007. The inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. The inspection involved looking at records, talking to the registered manager, three staff, three visitors and five residents, a tour of the home and generally looking at what was happening in the home. Information was also obtained from survey forms received from four visitors and five residents. There were thirty-one residents living in the home on the day of the inspection. Residents and relatives made positive comments about the staff; comments included ‘its like being in a big family, I couldn’t be in a better place’ and ‘the efforts of the staff are heroic’. What the service does well:
Residents had their needs assessed and were assured they would be met prior to moving into the home. Staff had the skills and experience to meet resident’s needs. The policies and procedures for the management of medication provided staff with safe guidance and ensured resident’s medication needs were safely met. There was evidence residents had access to a range of health care services and specialised equipment was provided to meet residents needs. One relative said ‘medical care has been second to none’. Residents said they were able to exercise choice in various aspects of their lives, were treated with respect and their rights to privacy were respected. The home employed a person who was responsible for organising activities and entertainments. Records showed that a range of activities had been provided that met resident’s diverse needs and expectations. Visitors said they were always made to feel welcome and one said staff would always make her a drink when she arrived. The menus showed residents were offered a varied and nutritious diet and drinks and snacks were available at all times. Records showed that residents had been offered a choice and that at times alternatives to the menu had been provided to ensure residents dietary needs were met. Residents said there was always sufficient to eat and comments included ‘its good home cooked food’ and another said ‘it always tastes good’.
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 6 Residents and relatives had access to clear information regarding raising concerns and complaints. Most people were aware of how to make a complaint and thought they would be responded to appropriately although a number of residents said they would leave this to their families. The home had clear adult protection procedures and staff had received training to ensure they were aware of how to respond if abuse was suspected. A tour of the home was conducted. All areas were comfortable, clean and tidy and there was evidence that areas of the home had been redecorated and refurbished to improve the environment for people who lived in the home. Grounds were attractive, safe and accessible to residents and their visitors. The staffing rotas showed there were sufficient staff to meet resident’s needs. The majority of residents and relatives thought there were ‘always’ or ‘usually’ sufficient staff although one resident said they ‘sometimes’ had to wait for attention. Another resident said ‘I’m looked after very well and there are enough staff to make sure of that’. Three staff employment files were looked at and showed the home had followed a safe procedure that had protected residents from the risk of abuse. The home provided staff with appropriate training that would improve outcomes for residents. More than half of care staff had a recognised qualification that would give them the skills and knowledge to help them to meet resident’s needs. Regular meetings were held for residents and their visitors to allow them to air their views and opinions and to give them a chance to be involved in decisions about the running of the home. Resident’s finances were managed appropriately and clear and accurate records were maintained. Records showed that systems were serviced regularly and staff received regular training to keep them and others safe from harm. What has improved since the last inspection?
The service user guide had been updated and made available to residents and their relatives who said they had been given enough information about the home prior to admission. Individual care plans had improved and generally included all information to ensure staff had a good understanding of how to meet the resident’s health needs; the plans had been reviewed and updated regularly to reflect any changes in care needs and there was evidence that residents or their relatives had been involved in decisions about care. Relatives said they were kept up to date and informed about any changes to care. The home had introduced a number of new records that would show that resident’s needs were being met. The home had installed sluicing facilities to reduce the risk of cross infection. The home had a new registered manager. Mrs Johnson is a registered nurse with experience in management and care. She had recently completed a
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 7 recognised management certificate to enhance her skills and knowledge. Residents, visitors and staff made positive comments regarding her contribution to the home. Comments included ‘ she is very supportive’ and ‘she is very kind, caring and helpful’. There were a number of systems in place to check that staff were following safe policies and procedures and that all aspects of resident’s needs were being met. 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. The summary of this inspection report can be made available in other formats on request. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were given up date the information about services offered by the home to enable current and future residents to make an informed choice about admission to the home. Residents had their needs assessed and were assured they would be met prior to moving into the home. Staff had the skills and experience to meet resident’s needs. EVIDENCE: The service user guide had been updated and made available to residents and their relatives who said they had been given enough information about the home prior to admission. The records of two recent admissions were looked at. Detailed information about residents needs was obtained before they were admitted to the home to make sure they could be looked after properly. Training records showed that the staff had a range of appropriate skills and experience to meet the needs of the people in the home.
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans generally included all information to ensure staff had a good understanding of how to meet the resident’s health needs. The policies and procedures for the management of medication provided staff with safe guidance and ensured resident’s medication needs were safely met. Residents were treated with respect and their rights to privacy were respected. EVIDENCE: Three residents records were looked at. The care plans had been developed from the assessment information and generally detailed the action to be taken by staff to meet resident’s health, personal, and social needs. The plans had been reviewed and updated regularly to reflect any changes in care needs and there was evidence that residents or their relatives had been involved in decisions about care. Relatives said they were kept up to date and informed about any changes to care.
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 11 A range of risk assessments were in place although falls risk assessments had not been completed for two of the residents who were at risk of falling; the care plan did not detail action to be taken by staff to protect them from harm. Assessments were in place to determine whether bed rails would be appropriate and safe and consent from relatives had been sought. Residents were assessed to identify whether they would be at risk of developing pressure sores and interventions to reduce or eliminate the risks had been included in the care plan. However one care plan did not show that the condition of a residents skin needed to be monitored and to prevent further deterioration. These issues were discussed with the registered manager who had introduced regular care plan audits that would identify areas requiring improvement and ensure resident’s needs were met. There had been a recent complaint regarding failure to complete residents care records. A number of records were checked during the inspection; individual records were detailed and supported that residents were receiving appropriate care to meet their needs. There was evidence residents had access to a range of health care services and specialised equipment was provided to meet residents needs. One relative said ‘medical care has been second to none’. There were clear policies and procedures to support staff with the management of medicines. Records were found to be accurate although staff needed to ensure that any handwritten medication charts are consistently witnessed and that PRN (when needed) medication should always be supported by protocols that provide clear guidance for staff. Medications were stored safely and appropriately. Monthly audits had been introduced to make sure staff were following procedures and medications had been managed safely. Residents said they were ‘looked after’ and treated well. Staff were observed knocking on doors prior to entering, responding to residents and relatives in a positive and friendly manner and ensuring residents were visited by their GP in the privacy of their own rooms. Staff were aware of privacy and dignity issues and had covered the subject on induction training. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offered a range of suitable activities to meet the social needs, expectations and interests of the residents. Residents were offered a varied, wholesome and nutritious diet that was suited to their dietary needs and preferences. EVIDENCE: Residents said they were able to exercise choice in various aspects of their lives including meals, activities and routines. The home completed detailed social histories that would help staff to provide a range of activities that were suitable for all residents. There had been a number of comments from residents and relatives that the home did not provide suitable activities or provide enough stimulation; two residents said suitable activities were not provided and two said they had enjoyed activities. The home employed a person who was responsible for organising activities and entertainments. Records showed that a range of activities had been provided including massage, aromatherapy, musical afternoons, ballgames, bingo, skittles and pat a dog. The activity co-ordinator had maintained separate records for each
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 13 resident and had identified what activities they were interested in, when they had participated in any activity and whether group or one to one activities were appropriate for them. Two residents had received one to one sessions with the activity co-ordinator and had not recognised this as providing activities. Information about activities was usually displayed each day in the entrance hall although the activity co-ordinator was currently on leave. Visitors said they were always made to feel welcome and one said staff would always make her a drink when she arrived. The menus showed residents were offered a varied and nutritious diet and drinks and snacks were available at all times. Records showed that residents had been offered a choice and that at times alternatives to the menu had been provided to ensure residents dietary needs were met. There had been comments from residents and relatives that ‘the food was sometimes cold’ when it was served to them. This was discussed with the registered manager and the cook and they confirmed that action would be taken to resolve this problem. Residents said there was always sufficient to eat and comments included ‘ its good home cooked food’ and another said ‘it always tastes good’. Residents were able to dine in their rooms if they preferred some privacy or in the dining room, which was bright and pleasant. Staff were observed giving discreet assistance where needed. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure was clear and accessible and people felt their concerns would be taken seriously and responded to appropriately. People were protected from harm by the home’s clear procedures and by staff awareness. EVIDENCE: Residents and relatives had access to clear information regarding raising concerns and complaints. Most people were aware of how to make a complaint and thought they would be responded to appropriately although a number of residents said they would leave this to their families. The complaints record showed only one recent complaint and this had been responded to according to procedure. The home had clear adult protection procedures and staff had received training to ensure they were aware of how to respond if abuse was suspected. Policies and procedures supported staff with the protection of resident’s finances and with how to respond to physical and verbal aggression to keep them and others safe. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents were provided with a clean, safe and well-maintained environment that met their individual needs in a comfortable and homely way and records showed that ongoing improvements to the home were planned. EVIDENCE: A tour of the home was conducted. All areas were comfortable, clean and tidy and there was evidence that areas of the home had been redecorated and refurbished to improve the environment for people who lived in the home. Bedrooms and communal areas were pleasantly decorated, comfortable, clean and odour free. Furniture and fittings were generally of a high standard and a wide range of aids and adaptations were available to meet the individual needs of the residents. Residents were happy with their rooms and had brought in
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 16 personal items to enhance the homely feel. One resident said she had been able to move to a larger room with a better view and was happy with this. Not all rooms had en suite facilities but rooms were provided with washbasins and commodes as required and were close to bathroom and toilets. Call bells were available in all rooms for residents to call for assistance from staff; one resident said staff always came promptly. Bedroom doors had locks on them and secure lockable storage was provided for personal items. Grounds were attractive, safe and accessible to residents and their visitors. The home had installed sluicing facilities to reduce the risk of cross infection. Four residents had commented that the home was always clean and fresh although one felt that some areas could have been improved. All areas of the home were clean on the day of the inspection and domestic staff were on duty in sufficient numbers. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient staff to meet the needs of the residents. The home had followed a safe and robust recruitment procedure, based on equal opportunities, and had protected residents from the risk of abuse and harm. Staff were competent and skilled and had received relevant training that would improve outcomes for residents. EVIDENCE: The staffing rotas were clear and showed that there were sufficient staff to meet resident’s needs. The majority of residents and relatives thought there were ‘always’ or ‘usually’ sufficient staff although one resident said they ‘sometimes’ had to wait for attention. Another resident said ‘I’m looked after very well and there are enough staff to make sure of that’. Residents and relatives made positive comments about the staff; comments included ‘its like being in a big family, I couldn’t be in a better place’ and ‘the efforts of the staff are heroic’. The recruitment procedures were clear and provided safe guidance for staff. Three staff employment files were looked at and showed the home had followed a safe procedure that had protected residents from the risk of abuse
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 18 from unsuitable people. Residents were not involved in the interview and selection of new staff and this should be considered to allow residents to be involved in running of the home. Records and discussions with staff confirmed that new and existing staff received relevant training that would improve outcomes for residents. More than half of care staff had a recognised qualification that would give them the skills and knowledge to help them to meet resident’s needs. Palace House Nursing Home DS0000022466.V326549.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensured that people’s health, safety and welfare were promoted and protected. Staff were supported and supervised to ensure they had the skills and knowledge to meet resident’s needs. EVIDENCE: The registered manager was Mrs Julie Johnson. Mrs Johnson is a registered nurse with experience in management and care. She has recently completed a recognised management certificate to enhance her skills and knowledge. Residents, visitors and staff made positive comments regarding her contribution to the home. Comments included ‘ she is very supportive’ and ‘she very kind, caring and helpful’.
Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 20 Regular meetings were held for residents and their visitors to allow them to air their views and opinions and to give them a chance to be involved in decisions about the running of the home. The home had not yet introduced service users surveys which would allow people to air their views anonymously and to help the home to determine whether it was meeting people’s needs and expectations. The registered manager said the company was reviewing this. Meetings were held with staff on a regular basis and staff said they were confident they could raise issues. The home had achieved the Investors In People award that was an external quality monitoring system that would help the home to maintain and improve standards. There was a plan for the ongoing development of the home. Policies and procedures were continuously reviewed and updated to provide staff with current and safe guidance. The registered manager had responded promptly to any issues identified at the last inspection to ensure resident’s safety was not compromised. There were a number of efficient systems in place to check that staff were following safe policies and procedures. Resident’s finances were managed appropriately and clear and accurate records were maintained. Head office conducted regular audits of the records to ensure they were being managed safely. Staff confirmed they had received regular one to one supervision with the registered manager and had received feedback about the standard of their work. Records showed that systems were serviced regularly and staff received regular training to keep them and others safe from harm. Palace House Nursing Home DS0000022466.V326549.R01.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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 4 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. OP8 13 Interventions must be 30/04/07 documented in the care plan once a risk has been identified. 2. OP33 24 The views of residents, their 30/04/07 representatives and stakeholders in the community about the services offered must be sought. The results of the survey must be published and made available to interested parties. Timescale 13/02/07 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP9 OP9 OP15 Good Practice Recommendations There should be falls risk assessments in place for all residents. Transcribing should be witnessed on medication administration records. PRN administration of medication should be supported by protocols. Alternative measures should be considered to ensure meals were served hot at all times. Palace House Nursing Home DS0000022466.V326549.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston Lancashire PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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