Inspection on 20/06/06 for Pax Hill Nursing Home

This inspection was carried out on 20th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Pax Hill Nursing Home 24/08/07

Pax Hill Nursing Home 13/09/05

Pax Hill Nursing Home 13/04/05

Pax Hill Nursing Home 14/10/04

Pax Hill Nursing Home 05/04/04

Pax Hill Nursing Home 11/02/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Pax Hill Nursing Home Pax Hill Bentley Nr Farnham Surrey GU10 5NG Lead Inspector John Vaughan Unannounced Inspection 20th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pax Hill Nursing Home DS0000012225.V292246.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. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pax Hill Nursing Home Address Pax Hill Bentley Nr Farnham Surrey GU10 5NG 01420 23786 01420 22690 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) Dr M Zaki Dr N Zaki Care Home 61 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (26), Mental disorder, excluding learning of places disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (61), Physical disability (21), Physical disability over 65 years of age (21), Terminally ill (10), Terminally ill over 65 years of age (26) Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. A maximum of 26 service users may be accommodated who are in need of nursing care. All service users must be at least 55 years of age. A maximum of 10 service users may be accommodated at any one time between the ages of 55 and 65. A total of 6 service users in the PD and PD(E) categories may be accommodated on the residential side. Service users in the categories PD and PD(E) are not to be accommodated in the area known as The Annex. A total of 15 service users in the PD and PD(E) categories may be accommodated on the nursing side. A total of 10 service users may be accommodated in the MD and MD(E) categories. Service users in the DE and DE(E), MD and MD(E) and TI and TI(E) categories must also be in need of nursing care. 13th September 2005 Date of last inspection Brief Description of the Service: Paxhill Nursing Home is a 61 bedded home offering both nursing and personal care. It is situated in the village of Bentley at the end of a private road amidst farmland. The home has large grounds available to service users and many rooms overlook the countryside. The home offers accommodation in 37 single rooms and 12 double rooms. There is an activity programme available for service user participation and a quarterly newsletter, informing service users of events within the home. The home scale of fees for this home range from £300 to £760 per week. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two visits to the home. The inspector met with service users, family members and their representatives. The deputy managers of the home met with the inspector during the visits as did the provider Dr Zaki. Staff were interviewed and observed and records held in the home were sampled. The inspector also toured the home. What the service does well: What has improved since the last inspection? Assessments of service user’s needs and care plans have improved with more detailed information on how to support each person. Activities have improved and are documented. The home was free from unpleasant smells during this visit and equipment for helping service users move around the home and relieve pressure areas was found to be working. The controlled book was in place and the lock to the medication room door has been fixed. Staff training has improved and the home could demonstrate that staff have had updates in moving and handling, fire training and first aid. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 6 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. Pax Hill Nursing Home DS0000012225.V292246.R01.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 Pax Hill Nursing Home DS0000012225.V292246.R01.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The home can demonstrate that service users needs will be correctly identified and acknowledged. This home does not provide intermediate care. EVIDENCE: The inspector looked at six service user’s records during the two days that he spent in the home. Concerns had been raised at the last key inspection that service users were not having an assessment of their needs prior to moving into the service. On this occasion more detailed assessments were seen on service user’s files with details of their healthcare, social, mobility and personal care needs documented in the assessment. The inspector was also able to see care plans linked to the assessed needs in most cases. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 9 The inspector also had the opportunity to talk to service users and their family members who said that the home provided opportunities for them to visit the service and an information pack was also provided to help them to know what would be provided in the home. Pax Hill Nursing Home DS0000012225.V292246.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to this service. Improvements have been made to services user’s plans however further work is needed to fully demonstrate that service users needs and wishes are acknowledged and responded to. The medication administration procedures are satisfactory and demonstrate that safe practice exists in the home. The home provides support for service users to access Health Care professionals to meet their needs and the practices of the home mean that service users are treated with respect and their dignity is maintained. EVIDENCE: The records examined had care plans for main areas of personal care and nursing support. The inspector noted that these are being reviewed regularly with a documented record of these reviews. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 11 Areas in the care planning strategies for the home were highlighted during the inspection that still need to be addressed. Some service users require nursing intervention for pressure ulcers. There is a plan in place but the prescribed method of managing these wounds are not evident until you read the daily account of the nurse providing treatment. The deputy manager was advised to ensure clear strategies are recorded with more specific treatment regimes to ensure the effectiveness of this approach can be monitored and reviewed. A plan for one service user provides information to indicate that a service user has mobility problems and they are generally independent in this area however they can require staff support with moving at times and this was confirmed when talking to staff members and the service user. The deputy manager was advised to develop a clear moving and handling assessment and guidelines for this person to ensure staff are consistent in their approach and the safety of the service user and staff is maintained. Another service user can become very anxious and as a result they are potentially aggressive towards others. The care plan has some information on how to deal with these situations however clearer guidelines need to be put in place to address the needs of this individual. This includes the actions taken to minimise the risk of falling and assaulting other people. Bedrails are in use for a number of service users and these are mentioned in the care plan however a risk assessment is not in place to fully explore the possible risks involved in the use of this equipment and the reasons for their use. Visiting professionals such a physiotherapists and members of the district nursing team were observed during the inspection. The inspector received positive feedback from those people he spoke to about communication and support within the home. The inspector examined the records for both the residential and nursing wings of the home and found accurate records and correctly stored medication. The medication room door on the residential side has been appropriately secured. The inspector was told that none of the service users self-administer their medication. The General Practitioner has provided homely remedy agreements and a controlled drug book was in place on each wing. Staff receive training on medication administration before they can carry out this practice on the residential side and only trained nurses dispense medication in the nursing wing. The inspector met with a number of service users and family members during the visits to the home and talked to them about their experiences in the home. Service users confirmed that they are always treated with respect and their Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 12 dignity and privacy is maintained. Examples given included staff always knocking on doors and waiting for permission to enter a service user’s room, staff recognising that a service user was embarrassed about receiving intimate personal care for the first time that they treated the situation sensitively and respected the service user’s wishes. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Service users receive a service that meets their social and leisure needs and this is enhanced by a service that welcomes and encourages family contact. The practices in the home support service users to make decisions about their lives. Service users receive a well-balanced and varied diet reflecting their likes and dislikes. EVIDENCE: Service users and their families had positive things to say about the level of support and activity in the home. Some service users choose not to take part in activities and they said that they were aware of sessions going on but preferred to read a book. A relative told the inspector that the home has an activity worker who comes in to spend time with their family member and they commented that the Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 14 opportunity to reminisce about their life and important events has been welcomed. Concerns have been raised at a previous inspection about the potential isolation of service users upstairs in the nursing wing. A document has been introduced to demonstrate that staff will check on this small group of service users every half hour. The records examined by the inspector show that the activity worker is also spending time with these service users and a monthly record is maintained. The inspector recommends that the individual sessions are recorded to assist with developing a picture of times these sessions take place. This will help demonstrate how effective and consistent the contact is and therefore help with the review of the persons needs. Family members stated that they are made welcome in the home and there are no restrictions on visiting. Contact details for families, friends and representatives are recorded in the service user’s plan. During the visits to the home the inspector noted family members coming and going and the home was very relaxed. The menu was provided for the inspector and this had a wide variety of meals are offered to service users. Service users told the inspector that they are very happy with the meals provided and if they do not want what is offered they can have an alternative. A mealtime was observed and this was relaxed and unhurried, the meal was presented well and looked and smelt appetising. Some service users require help and support with eating and staff attended this to in a sensitive way. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Service users can be confident that the home has systems in place to acknowledge and respond to their concerns and procedures to protect service users from abuse are in place EVIDENCE: The homes complaints record was examined to confirm that complaints received have been responded to promptly and appropriately. A complaints policy and procedure are in place and available to all service users and visitors to the home. Service users and family members said that they knew how to raise a concern if the needed to and would talk to staff or the manager if they were unhappy. They were confident that the staff team and the manager would listen them to. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 16 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, 20, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to this service. The decoration, layout and cleanliness of the home has improved since the last visit however further work is needed to demonstrate that the nursing wing is meeting service user’s needs. EVIDENCE: The inspector toured the home with the assistance of staff members. The home was generally clean and tidy during the visit. Large lounges and smaller rooms were seen and these are individual and in a generally good state of repair. Service users commented on these spaces being comfortable. Outdoor spaces are very attractive and extensive and service users commented that they enjoyed sitting outdoors in the warmer weather. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 17 The residential wing of the home is large with attractive rooms and spaces that look and feel homely, bedrooms are larger and have en-suite facilities. The nursing wing has been decorated in part but does need more work to achieve the same homely feel. One service user’s bedroom on the nursing wing had a worn and frayed carpet both in the room and across the threshold. This not only gives a poor image of the home but is a potential hazard to service users. The carpet in the corridor by the dining room of the residential side of the home looks is dirty and stained and this had been cleaned on the day of the visit. This was discussed with the provider who stated that it would be replaced in the future but there are no immediate plans to replace this. The inspector advised that this area should to be kept under review and replaced if it cannot be kept clean. The nursing wing has a sluice room and a second room for cleaning items and equipment. On the first day of the inspection these rooms were full of boxes, mattresses and other items that meant the areas could not be used. Staff could not explain where they cleaned soiled bedpans and stated that they did not have anyone using them at present. This facility was seen in a number of rooms and a care plan seen by the inspector stated that the service user could make use of the commode in their room. When the inspector returned the provider had these areas cleared and cleaned. The provider also provided an invoice and brochure for a new bedpan sanitizer that is due for delivery next month. The provider was advised that these areas must be kept free from clutter at all times to demonstrate that staff have access top facilities to maintain the cleanliness of the home and prevent cross infection. The inspector noted flaking and chipped paintwork in the shower room of the nursing wing and brought this to the attention of the provider to take action to improve the décor in this part of the home. The threshold of this room was also very wet and presented a possible slip hazard although the floor in the bathroom was dry. This was discussed with the provider who was advised to investigate the cause of the wetness. The equipment in the home was examined during the tour of the home this included electric beds, chair lift and pressure relieving equipment. These were all found to be operating and the home provided service information confirming repairs and maintenance is carried out. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including visits to this service. The training of staff has improved however the home cannot demonstrate that service users are being supported by staff members who are supervised and fully trained to meet their needs. The recruitment practices in the home are unsatisfactory and do not demonstrate that service users are protected. EVIDENCE: The staff records provided evidence that mandatory training in areas such as first aid, health and safety and fire safety have been updated and a training record is in place to support this. The manager of Pax Hill EMF unit which is on the same grounds as this home has provided moving and handling training and the provider stated that this person is competent to deliver this training. Inductions take place in the home and staff are also obtaining National Vocational Qualification (NVQ) awards. The inspector interviewed a number of staff and they confirmed that this training has taken place. It remains difficult to communicate with some staff as English is not their first language and again questions had to be rephrased a Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 19 number of times to help the staff member understand. Service users also commented that at times it is difficult to communicate with staff members due to their limited comprehension of English. Service users emphasised that this did not take away from the caring and supportive nature of the individuals Staff are attending English classes at a local language college and in the home to improve this situation. The inspector noted that due to the lack of management input in the home there are no supervision and support sessions for staff members to ensure they understand and develop their role. The home provided support to service users who can be confused and at time aggressive. Staff reported a lack of training in this areas and a great deal of apprehension in managing challenging behaviour. The inspector advised the deputy manager and provider of this concern and advised that appropriate training is provided to ensure staff have the necessary skills to manage this behaviour. The inspector examined the records of all new staff who have been recruited to the home since the last key inspection. All files contained information on the individual. Two written references and proof of identity was also in place. The records of two staff concerned the inspector. One member of staff had a Criminal record Bureau (CRB) check dated over three months after they took up their post. The provider stated that they did not have the facility to carry out a Povafirst check and this meant the member if staff worked in the home without these completed checks. A second person was working in the home at present and although they had applied for a CRB check this had not returned yet. The provider was required to take immediate action to demonstrate that the safety of service users is being maintained. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including visits to this service. The provider cannot demonstrate that the home is being effectively managed. Systems are in place to obtain the views of service users however further work is needed to demonstrate that these have any impact on the service. EVIDENCE: The home is without a registered manager and this has had a detrimental effect on the home. The deputy managers have worked on developing care planning and responding to day-to-day management issues. Staff members are not receiving supervision and trained nurses are not receiving clinical supervision and support. Team meetings do not take place regularly. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 21 The provider told the inspector that a new manager is due to start next month and they hope that this appointment will address the management concerns in the home. The and this any inspector was told that service user satisfaction questionnaire is completed the administrator oversees this process. The inspector was unable to see information as the administrator had gone home. Staff were unaware of formal quality assurance programme or development plan in the home. The provider carries out regular regulation 26 visits and a report is sent to the commission. Service users leave money for safe keeping with the home and this is held in the office. A record is maintained for each person with receipts for transactions. The provider does not act as an appointee for any service users. Areas identified during a tour of the premises need to be addressed by the manager include the use of bedrails, the potential risks to service users due to wet and frayed carpets. All windows are appropriately restricted to prevent falls. The home provided records to demonstrate that fire checks and tests are carried out regularly. A fire drill and practice was carried out on the day of the inspection. Certificated and records are in place to demonstrate that heating and alarms systems are serviced appropriately and moving and handling equipment is also serviced. Portable appliance check was carried out in November 2005. Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP7 Regulation 15 Sch 3(1)(b) Requirement The registered person must ensure that care plans fully reflect the needs of the service users with clear guidelines to demonstrate how needs will be met. This is a repeated requirement and the previous timescale of 30/11/05 partly met. 2. OP7 13 The registered person must ensure a safe system of moving and handling is documented for each person who may require support with this need. 3. OP20 13 The registered person must ensure that the frayed carpet identified at the inspection is repaired or replaced. 4. OP26 23 The registered person must ensure that facilities in the home remain free from clutter and are able to be used properly. 23/07/06 23/08/06 23/08/06 Timescale for action 23/08/06 Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 24 5. OP27 18 5. OP29 19 schedule 2 The registered person must ensure that staff have the necessary communication skills to enable them to support service users effectively at all times. The registered person must immediate action to ensure that all staff recruited to work in the home do not start without a full CRB or a POVAfirst check. 23/09/06 23/06/06 6. OP30 18(1)(2) 7. OP36 18 (2) 8. OP38 13 The registered person must 23/08/06 ensure that staff receive training to support service users who challenge the services provided for them. The registered person must 23/08/06 ensure that staff receive formal supervision at least six times in a year and a record is maintained of the practice. The registered person must 23/07/06 ensure that service users are kept safe by the completion a full risk assessment for each service user that includes use of bedrails, risk of falls due to wet floor or frayed carpets . RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Pax Hill Nursing Home DS0000012225.V292246.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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