Inspection on 15/11/06 for Queen Margaret`s Nursing Home

This inspection was carried out on 15th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Queen Margaret`s Nursing Home 24/10/07

Queen Margaret`s Nursing Home 02/11/05

Queen Margaret`s Nursing Home 17/05/05

Queen Margaret`s Nursing Home 09/12/04

Queen Margaret`s Nursing Home 13/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Queen Margaret`s Nursing Home Queen Margaret`s Nursing Home 19 Filey Road Scarborough North Yorkshire YO11 2SE Lead Inspector Mrs Rosalind Sanderson Key Unannounced Inspection 09:00 15th November 2006 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 Queen Margaret`s Nursing Home DS0000040909.V318948.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. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queen Margaret`s Nursing Home Address Queen Margaret`s Nursing Home 19 Filey Road Scarborough North Yorkshire YO11 2SE 01723 353884 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) www.queenmargarets.co.uk Mrs Ann Christine Davey Mr Michael Davey *** Post Vacant *** Care Home 44 T/A Hawkfish Limited Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (1), Terminally ill (4) of places Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The category of registration PD, relates solely to one identified service user and registration will be amended to remove this category at such time as the identified service user is no longer accommodated in the home. The registered persons must advise the Commission when this occurs. The bathroom currently located in room 25 must be re-located to a more suitable site on the same floor within eighteen months of registration. Room 44 will cease to be used as a bedroom as soon as vacated by the service user currently occupying the room. All service users` bedrooms must be equipped with a lockable facility, and bedroom doors must be fitted with suitable locks within eighteen months. Rooms 30, 31,32,38,39 and 40 must be occupied only by service users whose assessed needs are that they would not be adversely affected by being unable to see out of the window when seated. 2nd November 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Queen Margarets Nursing Home is a care home providing nursing care, personal care and accommodation for up to 44 older people. The home is owned by Hawkfish Limited. The service is located on the south side of Scarborough, close to shops, the post office and a main bus route. Queen Margarets is a large detached Victorian building. It has a basement plus four floors. These are serviced by two passenger lifts. There are 42 rooms in total. All rooms have a wash hand basin. 27 rooms have a full en suite facility. There is a garden area to the front and side of the property and this is accessible to the service users. There is also a large car park. Prospective service users are visited prior to admission when possible. Information about the services available at the home is made available in the form of a service user guide and the most recent Commission for Social Care Inspection report is available in the home. Individual copies are provided on request. The scale of fees charged at 16/11/06 range from the current NYCC rate to £500 per week. Additional charges are made for hairdressing, chiropody, personal newspapers and outings. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager that had been registered in respect of this service has recently left her employment. The deputy manager has also left. This has led to an unsettled period at the home where a number of staff have left or are planning to leave in the near future. The providers have acted to minimise any disruption to the service, however staff and service users have lacked clear and positive management and this has caused a period of unrest and uncertainty for service users, their relatives and staff. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a pre inspection questionnaire; Comment cards returned from 9 service users, 4 relatives, 3 GPs and 2 care managers. A visit to the home carried out by two inspectors. A site visit was carried out and lasted for seven hours. Seven service users, two relatives and seven staff were spoken with. Records relating to service users, staff and the management activities of the home were inspected. During the visit care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspectors to gain an insight of what life is like at Queen Margaret’s Nursing Home for the people that live there. A senior nurse on duty assisted the inspectors during the inspection. Two representatives of the organisation were available to receive feedback. What the service does well: Service users enjoy living at Queen Margaret’s and are satisfied with their lifestyle. The home provides a pleasant, warm and welcoming place to live. Staff have sufficient information about the needs and wishes of service users to enable them to care fully for them. Activities are provided at the home and service users are able to choose whether or not to take part in them. The food provided is of a good quality with a choice of meals available at each mealtime. Service users commented, ‘The food is fine’ and ‘I don’t have a big appetite but the food is very good’. Another stated that they choose to have their meals in their rooms and this wish is respected. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Queen Margaret`s Nursing Home DS0000040909.V318948.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 Queen Margaret`s Nursing Home DS0000040909.V318948.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): 3,6 is not applicable. Quality in this outcome area is good. Service users are assured their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user records showed that information about service user’s care and social needs had been collected before they were admitted to the home. Information had been collected from the service user, their relatives and any healthcare professionals involved in their care. This information is then shared with all staff in order that they are aware of the person’s needs and wishes before they arrive. On the day of the inspection a service user had been admitted. A senior nurse had made a visit to the hospital the previous week to gather the required information. This information had been available for staff to review. The staff were able to talk to the service user about their needs and wishes and a familiar face greeted the service user. Queen Margaret`s Nursing Home DS0000040909.V318948.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): 7,8,9,10 Quality in this outcome area is adequate. Service user’s health care needs are well planned for, however where interventions are indicated these are not always carried out in a timely way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans gave good detail about individual needs and wishes. Service users were aware that written records were kept about them. Risk assessments are in place so that risks were identified at an early stage. However where risks had been identified in some cases the action taken did not reduce the risk or no action had been taken. Two records showed that service users had suffered a weight loss, the plan indicated that a dietician would be involved in this case, however there had been no referral made. Another showed a risk assessment for the use of bed rails. A risk of falling or climbing over the top of the bedrails was identified yet the rails were in place. An accident had been recorded where the service user had fallen over the top of the bedrails. The provider stated that this risk was no longer present yet the assessment had not been updated to reflect this or explain why. Service Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 10 users requiring end of life care are admitted to this home. The staff at the home work closely with the Mc Millan nurses. Basic care plans are in place to address service users needs at this time these are reviewed monthly. One member of staff was due to attend a course to enable her to implement the ‘Liverpool Care Pathway’ in the home. This will ensure that service users and their carers will have their holistic needs addressed and planned for at the end of their lives. Currently families wishing to stay overnight with relatives at this stage of their lives are able to do so but are not provided with facilities to do this. The provider is arranging for foldaway beds for this purpose. Due to recent staff changes there are no trained staff at the home that have undergone training in palliative care. Call bells were answered promptly and service users generally had access to them. In one case a service user that was in bed had considerable difficulty reaching his bell. Two members of staff were seen to transfer service users using an underarm lift where the service user was unable to weight bear. This has the potential to cause injury to the service user or member of staff. The nurse in charge addressed this with the staff members during the inspection, however the staff involved did not have a good grasp of the English language and the nurse questioned whether they understood. They had received video training for moving and handling. Service users are appreciative of the assistance they receive. A new shower room has been provided that enables service users to enjoy a shower if they wish. Staff demonstrated a caring approach towards service users. Assistance and support was provided with respect and dignity, and the atmosphere was calm. Comments included, ‘They (the staff) are smashing they are always available to help’, ‘The staff are very good and help me all they can’. Another said, ‘They don’t rush us and are always polite, there are a number of foreign workers but they are lovely girls’. A relative commented that although they were very concerned about the number of staff leaving, their relative’s care had not been affected. They explained that their relative has difficulty in communication but the staff have developed ways of understanding them. A recent pharmacy inspection had advised that the dates of opening were recorded on items such as eye drops and creams. However there was some eye drops in use that did not have an open date on them. The controlled drug register showed a balance of zero for MST 60mg however there were four tablets in the cupboard. The register stated that these had been returned to the pharmacy. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Quality in this outcome area is good. Service users are satisfied with their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said they were satisfied with their daily lives. They are able to join in arranged activities if they wish. If they do not then their wishes are respected. Relatives confirmed that they are able to visit at anytime and are always made to feel welcome. Religious preferences are recorded on individual care plans and service users are given the opportunity to continue with their preferred. An activities co-ordinator is employed to attend the home twice a week. Staff explained that they have time to spend with service users. The activities coordinator was present in the afternoon and there were a number of service users taking part in the activities. There is a choice of menu at each mealtime, and the mealtime itself was unhurried. There were staff available to help service users who needed assistance, and the cook is present whilst the meals are being served, so he is able to judge where amendments to the menu are needed. He receives Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 12 information from the staff about service users who have additional nutritional needs. Special diets are catered for including diabetic, gluten free and diets where there are restrictions due to religious beliefs. The food provided on the day was well presented and looked appetising. Comments received from service users include, ‘The food is fine’ and ‘I don’t have a big appetite but the food is very good’. Another stated that they choose to have their meals in their rooms and this wish is respected. The cook stated that there is no budget restriction on food and on the day of the site visit there was plenty of fresh produce available. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 13 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): 16,18 Quality in this outcome area is adequate. Service users are listened to but are not fully protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure that is displayed at the home and contained in the home’s information pack. Relatives indicated on comment cards returned that they were aware of the procedure. Those spoken with on the day of the site visit were able to confirm that they knew what to do if they were unhappy about anything. They confirmed that they would be able to speak with the nurse in charge and felt happy to do so. One commented, ‘I have complained in the past and it was dealt with promptly and professionally’. They indicated that they were aware they could speak to an inspector if they were unhappy about any aspect of their relatives care. There have been two complaints received by the Commission for Social Care Inspection since the last inspection. One was referred back to the provider to investigate. This related to concerns over a service users care and the attitude of the manager at that time. This complaint was partially upheld and as a result the manager reviewed the policies and procedures at the home. The other complaint related to the handling of the discharge of a service user to another home. As North Yorkshire County Council Adult and Community Services were responsible for the service users care, the complaint was referred to them for investigation. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 14 The organisation’s adult protection policy is clear about how to refer cases and who will investigate. The previous manager had referred an incident to the Adult Protection Team. There was no further action required in this instance. Staff have received video training in this area. Staff have been recruited to the home without the necessary checks in place and this means that service users could be cared for by staff that are not suitable or are unsafe. Queen Margaret`s Nursing Home DS0000040909.V318948.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): 19,26 Quality in this outcome area is good. Service users live in a clean, safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is warm, welcoming and free from offensive odours. Private accommodation is clean and pleasantly decorated. Some areas need re decoration and the dining room carpet needs replacing. There is a plan in place to address these issues. Hand washing facilities are sited around the home and personal protective equipment is provided for all staff and service users. There is a garden area on a level access with seating available. Service users said they enjoy using this area, weather permitting. One said, ‘This isn’t home but it’s the next best thing’ Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 16 Laundry facilities are sited away from communal areas and food preparation areas. Service users were dressed in well-laundered clothes and there were no problems reported with the laundry. The kitchen has been refurbished and the new wall coverings make the area easier to keep clean. Queen Margaret`s Nursing Home DS0000040909.V318948.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): 27,28,29,30 Quality in this outcome area is adequate. Service users are not protected by the home’s recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a big turnover of staff in recent months that has led to an unsettled period for service users, their relatives and the staff. The registered manager, her deputy and a number of carers have left their employment. One relative said, ‘Alarm bells are sounding, we do not know what is happening’. The providers acknowledged that there have been problems in recent weeks. A display in the entrance hall has been put in place to keep relatives and visitors up to date with any developments around staffing. Staff recruitment records showed that some staff had been deployed at the home before pre employment checks had been obtained. This places service users at potential risk of being cared for by unsuitable staff. The providers are in the process of checking all records and making sure that all staff have the required checks in place. Some staff have been recruited from abroad and there was a language barrier. One of the inspectors attempted to discuss their work with them but it was obvious that they had little understanding. The registered person confirmed that they were receiving English speaking lessons but acknowledged there was a slight problem. Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 18 Staff receive in house training with the use of training videos. The provider stated that after staff have watched the videos they are tested formally to check knowledge and understanding. There were no training records completed to verify that the training had been undertaken although records are available awaiting completion. All staff receive an induction to the home and 62 of care staff have achieved an NVQ at level 2 or above in care. Queen Margaret`s Nursing Home DS0000040909.V318948.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): 31,33,35,38 Quality in this outcome area is adequate. Service users and staff have lacked clear and positive management support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no registered manager in post at the time of this site visit. The providers state that they have inherited problems from the previous manager. They are working hard to rectify the problems. A new general manager and a matron have been recruited to start employment in early December. They have worked together previously and have given references for each other. No reference has been sought from the previous employer for either candidate. The information received on the pre inspection questionnaire stated that the home does not handle any monies for service users. However the providers Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 20 have discovered that the previous manager had in her safe keeping some personal allowances from service users. One of these service users was no longer at the home. The provider stated that it is the policy of the home that they do not handle any personal monies for service users. If the service user wanted the service to provide hairdressing, chiropody or personal toiletries an additional set charge was added onto the monthly account and this was agreed within the contract. However a recent complaint made to NYCC Adult and Community Services has led the provider to withdraw this service. Relatives now have to arrange payment direct to the people providing the additional services. Quality assurance within the service had not been formalised and was in the process of being developed further. All health and safety certificates were current and showed that equipment used in the home was safe. A fire risk assessment was seen, however fire training records for staff were not kept up to date and the records for testing of the emergency lighting had not been maintained. Queen Margaret`s Nursing Home DS0000040909.V318948.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 3 8 1 9 2 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 13(4) Requirement Where a risk assessment identifies a risk to service users, then the necessary steps must be taken to reduce these risks. This includes: • Making referrals to healthcare professionals promptly. • Reviewing the use of bedrails for service users. The registered person must ensure that: • Where eye drops are used the date of opening is recorded and they are discarded within the timescale stated. • All controlled drug balances are recorded correctly. The registered person must ensure that all staff deployed at the home have in place: • Two written references • A CRB check for this employment. The registered person must make arrangements to return to the service users in question or DS0000040909.V318948.R01.S.doc Timescale for action 29/11/06 2. OP9 13(2) 29/11/06 3. OP18 OP29 13(6) 19(1) 22/12/06 4. OP35 17(2) sch 4 para 9b 29/11/06 Queen Margaret`s Nursing Home Version 5.2 Page 23 5. OP38 23(4(c&d) 6. OP38 13(6) their representative, the personal monies that have been retained by the previous manager. Records must be kept to confirm and acknowledge that these monies have been returned. The registered person must ensure that: • All staff receive fire training and a record of this training is kept. • Records of tests to the emergency lighting must be maintained. The registered person must ensure that all staff receive training in safe moving and handling of service users. This training must include a practical session. 29/11/06 29/11/06 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. Refer to Standard OP30 OP31 OP33 Good Practice Recommendations It is recommended that full records are kept of all training that staff have completed. The registered person should seek a written reference from the former employers of the new general manager and matron. It is recommended that the registered person meet with service users, relatives and staff in order that they can keep them up to date with developments at the home and keep them fully informed. It is recommended that the quality assurance system is further developed to enable the views of all stakeholders to be taken into account. Results of any surveys or consultation should be used to inform the annual development plan. 4. OP33 Queen Margaret`s Nursing Home DS0000040909.V318948.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Queen Margaret`s Nursing Home DS0000040909.V318948.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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