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Inspection on 24/04/07 for Portland Nursing Home

Also see our care home review for Portland Nursing Home for more information

This inspection was carried out on 24th April 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and relatives spoken with, and those responding to the surveys, were generally pleased with the care provided at the home. Residents commented that staff were "very good" and it was observed that there was a good rapport between residents and staff. The home provided a comfortable, clean and homely environment for residents. Residents spoken with and those responding to the surveys were pleased with the meals provided at the home.

What has improved since the last inspection?

Some of the requirements made at the inspection in April 2006 had been met. This had resulted in improvements to information provided for residents, staff induction training, and to the environment of the home. The manager had successfully completed the registration process with CSCI.

What the care home could do better:

Care plans were lacking in detail so it was not clear that residents` needs and preferences were fully met. The range of activities in the home was limited and did not meet the needs of all residents, particularly those with dementia. As at the last inspection, the bathrooms on the first and second floors had not been refurbished and remained stark and uninviting. No progress had been made on converting two other bathrooms, currently used for storage, into shower rooms. Recruitment practices at the home did not protect residents as new staff were found to be working without a satisfactory Criminal Record Bureau disclosure and other required information in place.

CARE HOMES FOR OLDER PEOPLE Portland Nursing Home 8 Park Road Buxton Derbyshire SK17 6SG Lead Inspector Rose Veale Key Unannounced Inspection 24th April 2007 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 Portland Nursing Home DS0000002071.V335226.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. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Portland Nursing Home Address 8 Park Road Buxton Derbyshire SK17 6SG 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) 01298 23040 01298 23040 Mr Joginder Singh Rai Catherine Mary Fogarty Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No one falling within category OP to be admitted into Portland Nursing Home when there are 40 persons of category OP already accommodated within the home The maximum number of persons to be accommodated within Portland Nursing Home is 40 26th April 2006 Date of last inspection Brief Description of the Service: Portland Nursing Home is situated near to the centre of Buxton where there is a wide range of amenities. This Victorian building has been extended to provide accommodation on three floors, accessed via a lift or staircases. The home is registered to provide personal care with nursing for up to 40 older people. There are a large number of shared bedrooms. None of the bedrooms have en-suite facilities. Three lounges, including dining facilities, are provided on the ground floor. A patio area is provided to the rear of the building, which can be accessed by residents from the larger lounge room. Information about the service, including CSCI reports, is available in the main entrance area of the home and on request from the manager or provider. Fees at the home range from £510 - £530 per week. This information was provided in the pre-inspection questionnaire completed by the manager and received on 13/04/07. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 5½ hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 31 residents accommodated in the home on the day of the inspection, including 28 residents assessed as needing nursing care. 4 residents, 2 visitors and 4 staff were spoken with during the visit. The manager and deputy manager were available and helpful throughout the inspection visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including the care records of 4 residents, 4 staff records, maintenance, and health and safety records. A tour of the building was carried out. A questionnaire and 21 surveys had been completed and returned prior to the inspection and information from these has been included in the body of this report. There was a random, unannounced inspection of the home in November 2006. The random inspection focused on compliance to requirements made at the inspection in April 2006. Information from the random inspection has been included in the body of this report. What the service does well: What has improved since the last inspection? Some of the requirements made at the inspection in April 2006 had been met. This had resulted in improvements to information provided for residents, staff induction training, and to the environment of the home. The manager had successfully completed the registration process with CSCI. Portland Nursing Home DS0000002071.V335226.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. The summary of this inspection report can be made available in other formats on request. Portland Nursing Home DS0000002071.V335226.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 Portland Nursing Home DS0000002071.V335226.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. 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 a visit to this service. The needs assessment process was sufficient to ensure residents were confident the home could meet their needs. EVIDENCE: The care records of 4 residents were examined and each included assessment information obtained prior to the admission of the resident. In addition to the homes own assessment, there was information from Social Services and / or hospital staff. There was also assessment information obtained on or soon after admission. The surveys received indicated that most residents felt they received the care and support they needed at the home. Standards 6 did not apply to this service. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 9 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 care plans were lacking in detail, there were gaps in medication records and dignity was not always promoted by staff so that residents care needs were not always met. EVIDENCE: The 4 care records seen each included a care plan produced from the assessment information. The care plans covered all the assessed needs of the residents. Information was included about the personal preferences of residents regarding personal care and daily routines. The care plans seen had all been reviewed monthly up to date. Some care plans were signed by the resident or their representative to indicate their involvement in devising the care plan. The care plans lacked details of the action staff should take to meet the needs of residents. For example, one care plan stated that “mental health needs to be monitored”, but did not specify how staff should do this. Another care plan Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 10 noted that the resident needed assistance with getting washed and dressed but did not specify what help was required and how staff should provide assistance. There was an assessment that a resident was at risk of developing pressure sores but no mention of this in the care plan. The manager said that she and the deputy manager were to attend training about care planning in May 2007. Staff spoken with were knowledgeable about the care needs and personal preferences of residents. There were records of the input of other healthcare professionals, such as GP, District Nurse and chiropodist. It was clear from the records seen that residents were referred appropriately to other healthcare professionals. The survey responses indicated that most residents felt they received healthcare to meet their needs. The records included assessment of the resident’s nutritional needs, risk of falling, risk of developing pressure sores, and continence needs. The assessments had all been reviewed monthly to date. There was evidence that residents were appropriately referred following assessments, for example, for assessment for pressure relieving equipment. Medication in the home was stored securely. All medication was administered by registered nurses working at the home. There were satisfactory records of the receipt and disposal of medication. The Medication Administration Records (MARs) were examined for 4 residents. 3 of the MARs had some gaps instead of the initials of the person giving the medication or a code letter indicating why it had not been given. Handwritten entries on MARs were not signed by the person writing them and countersigned by another person who had checked the entry as correct – despite a prominent notice asking staff to do this. One handwritten entry was only of the name and strength of the drug with no other directions. For one resident prescribed medication “as required” there was no detail in the care plan about when this medication should be given. Residents and visitors spoken with, and those responding to the surveys, said that residents’ dignity and privacy were maintained at the home. It was observed that staff knocked on doors before entering and gave explanations to residents before assisting them with mobility. Residents commented that staff were “very good” and it was observed that there was a good rapport between residents and staff. However, there were some examples of lack of staff awareness of promoting dignity. At lunchtime, it was observed that 1 resident was ‘fed’ their meal by a care assistant who remained standing up throughout. It was also observed that a resident requiring pureed food had the whole meal mixed together in a dish, rather than keeping the flavours and colours separate. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 11 Portland Nursing Home DS0000002071.V335226.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 adequate. This judgement has been made using available evidence including a visit to this service. The limited range of activities provided did not meet the needs of all residents. EVIDENCE: The care records seen included some details of residents preferences regarding their daily routines, and also included a ‘life story’. Residents were encouraged to bring in their own belongings and it was seen that bedrooms were well personalised. Most of the bedrooms did not have lockable doors. The manager said that if a resident wanted to be able to lock their own door, a suitable lock could be fitted. There was no evidence in the records seen that residents / their representatives had been asked if they wanted to be able to lock their bedroom door. There was a range of activities offered, such as walks into the town centre, beauty treatments, and visiting entertainers. There was a member of staff and a volunteer helper who worked for a total of approximately 7 hours per week to provide activities. Care staff also helped to provide activities for residents. As at previous inspections, it was observed that residents with dementia or limited communication abilities were not engaged in meaningful activities. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 13 The survey responses received indicated that most residents were not satisfied with the activities provided or were not able to take part in the type of activities offered. Visitors spoken with said they were always made welcome at the home and were able to visit at any reasonable time. The responses to the surveys indicated that most residents were satisfied with the meals provided at the home. Residents and visitors spoken with said the meals were good and that choices were offered. It was observed that most residents preferred to stay in the lounge chairs to eat their meal on a small table in front of them. As noted in the Health and Personal Care section of this report, it was observed that 1 resident was ‘fed’ their meal by a care assistant who remained standing up throughout. It was also observed that a resident requiring pureed food had the whole meal mixed together in a dish, rather than keeping the flavours and colours separate. Portland Nursing Home DS0000002071.V335226.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 adequate. This judgement has been made using available evidence including a visit to this service. There was a satisfactory system in place so that residents’ complaints were taken seriously and dealt with appropriately. Although there was good staff awareness of safeguarding vulnerable adults, residents were put at risk by poor recruitment practices at the home. EVIDENCE: Records were kept of complaints with details of the action taken and the outcome. No complaints about the home had been received by CSCI since the last inspection. Most of the residents spoken with and those responding to the surveys said they knew how to make a complaint. Staff had received training in safeguarding vulnerable adults. Staff spoken with were aware of abuse issues and of the correct procedures to follow if abuse was suspected. It was found that recruitment practices at the home did not protect residents. (See Staffing section of this report). Portland Nursing Home DS0000002071.V335226.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some improvements had been made so that the environment was more safe and pleasant for residents, there was a lack of progress in providing a choice of bathing and shower facilities. EVIDENCE: A tour of the building was carried out, including some of the bedrooms, the bathrooms, lounges, sluice rooms and the laundry. There was a continuing programme of upgrading and refurbishing. It was found at the random inspection in November 2006 that several bedrooms had been redecorated, a new sluicing disinfector had been installed and new hoists provided. At this inspection it was seen that more bedrooms had been redecorated and several new ‘rise and fall’ beds had been provided. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 16 The bathrooms on the first and second floors had not been refurbished and remained stark and uninviting. No progress had been made on converting two other bathrooms, currently used for storage, into shower rooms. The carpet in one bedroom was ripped, causing a potential trip hazard. There was a sluice room on each floor, the first floor having the mechanical sluicing disinfector. All the sluice equipment was in working order, (it had not been at previous inspections). The laundry was suitably equipped. The patio area accessed from the large lounge had been renovated to provide a safe area for residents to use. Further work was planned to provide plants and garden furniture and to screen off the outlet pipe from the laundry so that the area would be more pleasant and welcoming. On the day of the inspection visit, the home was clean and free from offensive odours. Residents and visitors spoken with, and those responding to the surveys said the home was usually clean and fresh. Residents, visitors and staff spoken with were generally satisfied with the décor, maintenance, and the equipment provided. Portland Nursing Home DS0000002071.V335226.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 adequate. This judgement has been made using available evidence including a visit to this service. There were staff in sufficient numbers and with training to meet the needs of residents. Residents were put at risk by poor recruitment practices. EVIDENCE: The staff rota showed that there were usually 2 registered nurses plus 6 care assistants for the morning shift, 1 registered nurse plus 4 care assistants for the afternoon shift, and 1 registered nurse plus 2 care assistants for the night shift. The manager was usually supernumerary and the deputy manager was allowed 6 hours per week supernumerary time for administrative work. Care staff were supported by kitchen, laundry and domestic staff. Residents and visitors spoken with and those responding to the surveys said that there were usually staff available when needed. It was observed that there appeared to be sufficient staff on duty on the day of the inspection visit. For instance, at lunchtime, there were enough staff available to assist residents with eating their meals. Staff spoken with said the staffing levels were sufficient to meet the needs of residents. It was commented that staffing levels had improved over the last few years and consequently that staff “don’t feel rushed” when assisting residents. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 18 It was found at the random inspection in November 2006 that the induction programme for new staff had been improved. At this inspection it was seen that further improvements had been made and that the induction programme was based on Skills for Care standards. Staff records seen showed that staff had received training in the required areas, such as safeguarding vulnerable adults, manual handling and fire safety. Some staff had received other training to meet the specific needs of residents, including training about Parkinson’s disease, dementia, and diabetes. Staff spoken with were pleased with the training offered at the home. Out of 25 care staff, 4 had already achieved a National Vocational Qualification (NVQ) and another 5 were working towards the qualification. It was found that there were 5 staff working at the home who did not have all the required information and documents in place. 2 of these staff had started work before a Criminal Records Bureau (CRB) disclosure had been applied for and without a completed application form or full employment history. The other 3 staff had made an application for a CRB disclosure, but did not have other required information in place. There was no evidence of a formal system in place at the home for new staff to work under the supervision of a suitably qualified and experienced member of staff. When the situation was discussed with the manager, immediate action was taken to remove the staff from duty. An Immediate Requirement was made that staff must not work unsupervised with residents until a satisfactory CRB disclosure and the other required information was in place. Following the inspection visit, it was confirmed that the CRB disclosures had been applied for, other information was being put in place, and that none of the 5 staff identified were working until everything required was in place. A week after the inspection visit, it was confirmed in writing that a system had been put into place to ensure proper supervision arrangements for new staff who were allowed to start work before the CRB disclosure had been received. Portland Nursing Home DS0000002071.V335226.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 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was generally well organised, however, there were poor recruitment practices that put residents at risk. EVIDENCE: The manager had successfully completed registration with CSCI since the last inspection. The manager was supported by a deputy manager and it was clear that they worked well together. Since the inspections in April and November 2006 the manager and deputy manager had worked to comply with requirements made and to make improvements to the service. Staff spoken with felt well supported by the manager and said she was “approachable”. The manager and deputy manager were responsible for all the administration tasks at the home. Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 20 The manager said that a new quality assurance system was in the process of being set up. Surveys had recently been sent out to residents / their representatives. The provider had carried out visits under Regulation 26 and reported on their findings. Records were seen of residents’ personal money kept at the home. Access to the money was restricted to the manager and deputy manager. Records were kept of all transactions and most entries had two signatures. The fire log book was seen and weekly checks of the fire equipment were up to date. Regular fire drills for staff were recorded. Records were kept of accidents to residents and staff. Staff had received training in fire safety, manual handling, and first aid. As detailed in the Staffing section of this report, there were poor recruitment practices at the home that did not protect residents. Portland Nursing Home DS0000002071.V335226.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Portland Nursing Home DS0000002071.V335226.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. 1. Standard OP7 Regulation 15(1) Requirement All residents must have a detailed care plan covering all of their assessed needs. This will ensure that they receive person centred support that meets their needs. Where instructions are hand written on Medication Administration Records, (MARs), the details on the original prescription must be reproduced. This will ensure that residents receive the correct levels of medication. When medication is administered to residents it must be clearly recorded. This will ensure that residents received the correct levels of medication. The damaged carpet in the identified room must be made safe so that it does not cause a tripping hazard for residents or staff. The upgrading programme must be implemented for the bathrooms including redecoration and provision of appropriate aids. DS0000002071.V335226.R01.S.doc Timescale for action 31/05/07 2. OP9 13(2) 11/05/07 3. OP9 13(2) 11/05/07 4. OP19 13(4) 31/05/07 5. OP21 23(2)(b) (d) 30/11/07 Portland Nursing Home Version 5.2 Page 23 6. OP29 19(1)(4) 7. OP29 19(4)(4a) (9)(10) (11) (From inspection report 31/01/06) Before commencing employment at the home, new staff must have all the required information and documents, as specified in Schedule 2. This will protect residents. Where a new member of staff is allowed to start work before a CRB disclosure has been obtained, the other required information must be in place and there must be a suitable system of supervision. This will protect residents. 11/05/07 11/05/07 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 OP9 OP12 OP15 OP24 Good Practice Recommendations Handwritten entries in MARs should be signed by the person making the entry and countersigned by another person who has checked the entry is correct. The activities programme should be further developed to meet the needs and preferences of all residents. The flavours and colours of food in a pureed diet should be kept separate to present a more appealing meal for residents. Following risk assessment, residents who wish to should be able to lock their bedroom door. It should be recorded in the care records that residents/their representatives have been consulted about this. The manager should have more administrative support to enable her time to be used more effectively. 5. OP31 Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 © 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 Portland Nursing Home DS0000002071.V335226.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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