CARE HOMES FOR OLDER PEOPLE
Peel Gardens Nursing Home Off Vivary Way Colne Lancashire BB8 9PR Lead Inspector
Mrs Marie Matthews Key Unannounced Inspection 10:00 23rd April 2007 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 Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Peel Gardens Nursing Home Address Off Vivary Way Colne Lancashire BB8 9PR 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 871243 01282 871344 peelgardens@tiscali.co.uk European Care (UK) Limited Mrs Patricia Joan Cairns Care Home 45 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered to provide personal care to a maximum of 45 service users, 29 of whom may be in the category of DE (Dementia). 14th November 2005 Date of last inspection Brief Description of the Service: Peel Gardens has recently made changes to the registration and is now registered to provide personal care for a maximum of forty-five people; twenty-nine of who may be suffering from a dementia. The first floor will eventually offer a secure specialised unit to accommodate people with dementia. The home is situated in a quiet residential area and there is adequate parking. Attractive lawned areas surround the home and there is a patio area that is accessible from the main lounge. All rooms were single occupancy and offered en suite toilets and hand basins. There is a passenger lift to access the first floor. There are a variety of communal areas in the home including two adjoining lounges and a separate dining room on the ground floor and a dining room and two lounges on the first floor. Information about the services offered by the home 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. On the day of the inspection the fees ranged from £315.00 to £515.00. Items not included in the fee include newspapers, toiletries, hairdressing and private chiropody. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced key inspection, including a visit to the home, was conducted on 23rd April 2007. The inspection process included looking at records, a tour of the home, discussions with the registered manager, three staff, five people who lived in the home and one visitor. Information was also included from survey forms filled in by four residents and two visitors. The inspection also looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were forty-three people living in the home on the day of the inspection. What the service does well:
Detailed information was collected about people before they were admitted to the home to determine whether they could be looked after properly. Records showed that staff had a range of experience and skills to meet the needs of the people in their care. People who lived in the home said there were enough staff to give them the help and support they needed although two visitors commented there were insufficient staff. People were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence. Staff treated people with respect and kindness and people said their wishes, choices and preferences were respected. People said they were happy with the care they received. Social, cultural and recreational activities met people’s diverse needs and expectations; records showed the different activities that had been provided in groups and on a one to one basis. People said they were able to join in with the activities or stay in their rooms and enjoy reading or watching TV. People said they were given choices in many aspects of their lives; some of these choices were detailed in their care plan and one person said ‘you can please yourself what you do’. Staff had access to important information about the different faiths, beliefs and religions and how they could support people with their spiritual needs. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 6 The menu was displayed in the dining room and showed that people were given a varied and nutritious diet; comments about the food included ‘the food is fine’, ‘the food is alright, there is always plenty but no choice’ and ‘mum enjoys the food there is always plenty’. People knew how to make a complaint and were happy that their concerns would be resolved. One lady said ‘If things are not done properly I have said so and the proper action has been taken’. Staff confirmed they had received adult protection training and would know how to respond to ensure people were safe. People said they were looked after and one visitor said she was confident her mother was safe. Grounds were tidy, safe and accessible; people said they enjoyed the gardens. Bedrooms were bright and airy and some people had brought in some personal items to make their rooms more homely. There were locks on doors and everyone had access to lockable storage; the rooms were equipped with accessible alarm facilities to enable people to call for assistance from staff. People said they were happy with their rooms and that the home was always ‘fresh and clean’. Staff in the home were skilled, competent and sufficient in numbers to meet people’s changing needs. The recruitment process provided clear evidence to show that staff were suitable to care for vulnerable people. The home had consulted people and encouraged them to air their views and opinions about whether the home was meeting their needs and expectations What has improved since the last inspection?
The care plans were clearer, developed from information obtained prior to admission and generally included information that would help staff to meet people’s choices, needs and preferences. The home had assessed risks that would affect people’s safety and had recorded the action to be taken by staff to keep people safe. Medication policies and procedures were in place to support staff with safe management of medicines. During a tour of the home it was clear that some areas had been decorated and refurnished and this included the changes made to the first floor to accommodate the new dementia unit. Rooms were bright and well equipped, Systems had been introduced to monitor whether staff were following policies and procedures and meeting people’s needs. The records supported that the home was safe and that people’s health, safety and welfare were protected.
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 7 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. Peel Gardens Nursing Home DS0000022494.V333039.R02.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 Peel Gardens Nursing Home DS0000022494.V333039.R02.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): 3 and 4. Standard 6 was not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service People were generally provided with enough information about the services offered by the home to help people to make an informed choice about whether the home would meet their needs. Detailed information about people’s needs was obtained prior to admission to ensure the staff had the appropriate skills to look after them properly. EVIDENCE: People had access to a range of information about the home and available services however the service user guide and statement of purpose needed further detail regarding the provision of a specialised dementia unit. The registered manager said a separate service user guide would be available for the dementia unit once it was fully operational.
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 10 The records, or care plans, of two people who had recently been admitted to the home were looked at in detail. Detailed information was collected about people before they were admitted to the home to determine they could be looked after properly and then the home confirmed they were able to meet people’s needs. Records showed that staff had a range of experience and skills to meet the needs of the people in their care. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. The information in the care plans did not include enough detail to ensure staff could meet people’s needs and maintain their safety Some aspects of recording of medication still needed improving to ensure people’s medicines were managed safely. EVIDENCE: Three care plans were looked at in detail; the plans were clearer, developed from information obtained prior to admission and included information that would help staff to meet people’s choices, needs and preferences. The home had assessed any risks that would affect people’s safety and had recorded the action to be taken by staff to reduce or eliminate the risks. There were assessments to identify whether people were at risk of injury from falling but once a risk had been identified there was no information to guide staff in what action to take to reduce or remove the risk. Bed rails and assessments of risks were in place to protect people from the risk of falling; however there was no
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 12 evidence to support this had been agreed or discussed with people prior to use. Also people who had enteral ‘PEG’ feeds in place did not have a plan that contained enough information about the care they needed. It was clear from the care plans and from discussion with people who lived in the home that their needs were met although staff had not always recorded care needs in detail; the care plans needed to include all details regarding care needs to ensure they received the correct care and attention from all staff. People were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence but details about the type of equipment in use was not always recorded. The care plans did not show that people had been involved in decisions about care; care plans had been reviewed and updated to reflect current care needs but people had not been involved with this. Two visitors commented that they were consulted and kept informed regarding care of their relative. The home had introduced a system to monitor a number of care plans each month to ensure staff were following procedures and that people’s needs were being met; this should gradually improve the standard of the care plans. Medication policies and procedures were in place to support staff with safe management of medicines. Records were generally accurate and clear although the recording of medicines awaiting disposal should be improved to ensure no mishandling occurs and the records to support administration of creams and lotions had not been signed and needed to show that people were receiving prescribed treatment. Some people were given medicines only when they needed them (PRN), there should be clear guidance in place for staff to help them to make appropriate decisions. All medicines were stored safely and securely, storage areas were clean and spacious and the temperatures of storage areas had been monitored to ensure medicines were stored at the right temperature. One person had an oxygen cylinder in her room and this was not stored safely; there was a risk that it could fall and cause injury and the correct signage was not displayed on her door to notify people in the event of a fire. Some people had clear means of identification attached to their medication record to help prevent medication errors but this was not the case for everyone. Staff treated people with respect and kindness and people said their wishes, choices and preferences were respected. Privacy, respect and dignity were covered during the induction period. Staff were seen responding to people in a positive and friendly way and people said they were happy with the care they received. Peel Gardens Nursing Home DS0000022494.V333039.R02.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. 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. Social, cultural and recreational activities met people’s diverse needs and expectations. Although the diet was healthy and nutritious diet a choice of meals was not always offered that would be suited to individual preferences. EVIDENCE: The home employed a person responsible for arranging activities and entertainments and making sure that people’s social needs were met. Records showed the activities that had been provided in groups and on a one to one although the individual records did not reflect the varied activities and entertainments on offer and this was discussed with the registered manager and activity person. People spoke very highly about the activity person and were able to discuss the different ways in which he had helped them. People said they were able to join in with the activities or stay in their rooms and enjoy reading or watching TV. People said they were given choices in many aspects of their lives; some of these choices were detailed in their care plan and one person said ‘you can please yourself what you do’. Staff had access to important information about the different faiths, beliefs and religions and how they could support people with their spiritual needs.
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 14 Residents and their relatives said that staff were friendly and visitors were always made to feel welcome and could visit at any time and in any area of the home. The menu was displayed in the dining room and showed that people were given a varied and nutritious diet; however the menu did not show that a choice of meals was available. People said they were not offered a choice at lunchtime and there were no records that would support that alternatives were offered. Comments about the food included ‘the food is fine’, ‘the food is alright, there is always plenty but no choice’ and ‘mum enjoys the food there is always plenty’. The most recent customer satisfaction survey had indicated that people would like ‘more variety of menu’. The registered manager said the head chef had been on leave for some time and this had caused some difficulties in the kitchen. Both dining rooms were clean and pleasant and the tables were attractively set. The dining area on the ground floor had recently had work completed to the floor and new tables and chairs had been provided. Meals were served at separate sittings to ensure staff had sufficient time to give support to people when needed. Peel Gardens Nursing Home DS0000022494.V333039.R02.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. 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. People had access to a robust and effective complaints procedure and were protected from abuse by staff awareness and policies and procedures. EVIDENCE: The complaints procedure was clear and people knew how to make a complaint and were happy that their concerns would be resolved. One lady said ‘If things are not done properly I have said so and the proper action has been taken’. There had been no complaints. The adult protection procedures, provided by European Care were very detailed but did not reflect local guidance or include contact information to guide staff in the event of any suspicion of abuse; however the registered manager had developed a separate procedure and training pack that provided safe and appropriate guidance to ensure the right action was taken to protect people. Staff confirmed they had received adult protection training and would know how to respond to ensure people were safe. Policies for managing aggression and abuse towards staff were in place and this would ensure people were protected from harm. People said they were looked after and one visitor said she was confident her mother was safe. Peel Gardens Nursing Home DS0000022494.V333039.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally met people’s individual needs in a safe, homely and comfortable environment. EVIDENCE: During a tour of the home it was clear that some areas had been decorated and refurnished and this included the changes made to the first floor to accommodate the new dementia unit. Rooms were bright and well equipped, some armchairs and dining room tables and chairs had been replaced, the dining room floor had been attended to and there were a number of new specialised beds available. However there were areas of the home that still needed attention to improve the environment for those people who lived in the home. This included the external paintwork, replacement or repair of the
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 17 entrance carpet which was frayed in places, replacement or cleaning of a number of carpets around the home, attention to ‘scuffed’ bedroom furniture and doorways and replacement of a number of faulty double glazed windows. The faulty double glazed windows had been raised as a concern at previous inspections as the views from lounge and bedroom areas affected people’s outlook into the gardens; the company had previously advised the Commission for Social Care Inspection that the faulty windows would be replaced to improve the home although it was clear that this work had not been completed. There were no records to support there were any planned improvements to be made to the home although the registered manager said a new estates manager had recently visited the home and would ensure that a number of improvements would be made. Grounds were tidy, safe and accessible and people said they enjoyed the gardens. People were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. There were no storage areas but wheelchairs were seen to be stored safely and did not present any risks to people. Bedrooms were bright and airy and some people had brought in some personal items to make their rooms more homely. There were locks on doors and everyone had access to lockable storage; the rooms were equipped with accessible alarm facilities to enable people to call for assistance from staff. People said they were happy with their rooms and that the home was always ‘fresh and clean’. The laundry was organised and clean and people said their clothes were looked after and always returned promptly to their rooms. Peel Gardens Nursing Home DS0000022494.V333039.R02.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. 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. Staff in the home were skilled, competent and sufficient in numbers to meet people’s changing needs. The recruitment process provided clear evidence to show that staff were suitable to care for vulnerable people. EVIDENCE: The staffing rotas showed the home was staffed with sufficient numbers of staff to meet people’s needs. People who lived in the home said there were enough staff to give them the help and support they needed although two visitors commented there were insufficient staff. One person said there was enough staff to make sure she is looked after and that staff always came when she pressed the buzzer; another said ‘there is always someone nearby’. Records and discussions with staff showed they had received appropriate training to help them to understand the needs of people in their care. The recruitment procedure was clear. Three staff recruitment files were looked at to help decide whether a safe procedure had been followed. The files were organised and contained the required information to ensure that staff were suitable to care for vulnerable people. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 was safe and well managed by a qualified and competent manager. Quality assurance systems monitored whether the home met people’s needs and expectations. EVIDENCE: The registered manager is Mrs Patricia Cairns. Mrs Cairns is a registered nurse with a range of experience in management and care. She has obtained a qualification in management to support her in her role. The home had consulted people and encouraged them to air their views and opinions about whether the home was meeting their needs and expectations.
Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 20 Systems had been introduced to monitor whether staff were following policies and procedures and meeting people’s needs. Resident’s finances were safe guarded by the systems and record keeping. Staff confirmed they received one to one support to help them to identify whether they were meeting people’s needs and whether they required any further support or training. They confirmed that they received regular update of safety training to ensure they and others were safe from harm. The records supported that the home was safe and that people’s health, safety and welfare were protected. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 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 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 3 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 3 Peel Gardens Nursing Home DS0000022494.V333039.R02.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. OP7 15 The care plan must set out in 04/06/07 detail the action to be taken by staff to ensure all aspects of people’s needs are met and where possible people must be involved in decisions about their care. 2. OP8 13 Appropriate interventions must 04/06/07 be recorded for people identified as being at risk of falling. 3. OP19 23 The registered person must 04/06/07 ensure that all parts of the home are safe and well maintained and there is a programme of maintenance and renewal to support ongoing and planned improvements to the home. Timescale of 02/01/06 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. Refer to Standard OP1 Good Practice Recommendations The service user guide should be revised to include information to reflect the facilities and services available on the dementia unit.
DS0000022494.V333039.R02.S.doc Version 5.2 Page 23 Peel Gardens Nursing Home 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. OP8 OP8 OP9 OP9 OP9 OP9 OP9 OP15 OP15 OP25 OP29 The registered person should ensure that the type of health care/medical equipment in use should be documented in the care plan. The use of bed rails should be discussed and agreed with people prior to use. A record should be made of the agreement. All medicines prescribed as “when required” or, as “variable dose” should have a clear written protocol to ensure they are given correctly. The administration of creams and lotions needs to be recorded to ensure people are receiving prescribed treatments. Oxygen cylinders should be stored safely and appropriate signage should be in place when used in people’s rooms. Photographs as a means of identification should be included with the MAR charts. The recording of medicines awaiting disposal should be improved to ensure no mishandling occurs. Records of food served should be maintained. There should be a choice of meal available at all times. There should be a programme to replace failed doubleglazed windows. Staff files should include a photograph as a means of identification to prevent any errors. Peel Gardens Nursing Home DS0000022494.V333039.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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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