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Inspection on 09/09/05 for Rowanweald Nursing Home

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

This inspection was carried out on 9th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

The activity co-ordination was consistently praised by service users. Service users reported that they enjoyed the activities and looked forward to them. They also enjoyed working the with activities co-ordinator. The home is making every effort to comply with the requirements set out by CSSI.

What has improved since the last inspection?

The units have changed the format of their care plans. They are endeavouring to be more detailed and prescriptive. The daily records of service user activity were detailed and individualised. Each service user requiring Blood Sugar monitoring had their own Glucometer with a good supply of needles.

What the care home could do better:

The involvement of the service user in the planning of their care should be documented throughout their care plans. The service user`s wishes and their likes and dislikes need to be documented for each area of care. The serviceuser needs to sign their agreement of the care plan. Only when the service user is not able to participate should the next of kin sign agreement. Breakfast needs to be served much earlier. Not everyone needs to be out of bed before the serving of breakfast. Meals, as with all other delivery of care, needs to be tailored to the wishes of the service user, not the service user having to fit with the system.

CARE HOMES FOR OLDER PEOPLE Rowanweald Nursing Home 1 Weald Lane Harrow Weald Middlesex HA3 5EG Lead Inspector Virginia Allen Unannounced 09 September 2005 8.00am 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 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. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rowanweald Nursing Home Address 1 Weald Lane Harrow Weald Middlesex HA3 5EG 020 8424 8811 020 8424 8585 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sanctuary Housing Association trading as Sanctuary Care Mr Hakim Issop Care Home with Nursing 45 Category(ies) of OP 45 registration, with number of places Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Minimum staffing notice applies Date of last inspection 20th April, 2005 Brief Description of the Service: Rowanweald Care Home is a part of Sanctuary Care, a subsidiary of Sactuary Housing Association. First registered in 1998, it is located on one side of the high street in Harrow Weald. Thus, the home is easily accessible by public transport and by car. It is close to shops and amenities. It has a large car park in the front and a well maintained garden area. The home is purpose built and Rowenweald has 45 single rooms with en-suite toilet facilities. The home is on three floors, the ground floor housing two units, Pelena and Rheola, each with 15 beds. On the second floor there is a third unit, Arden with 15 beds also. The laundy, kitchen and maintainence workshop are located in the basement with easy access to the outside in case of emergency. The first floor is leased to Harrow PCT. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a sunny Friday and started at 8.00 am. It lasted for 7 ½ hours. The inspector was able to speak with members of staff, service users, visitors and the deputy manager. The inspection involved looking at records, touring the building and observing care practice. The registered manager was on a training day, however, the deputy manager was able to assist with appropriate records. The inspector would like to thank those who contributed to the inspection. What the service does well: What has improved since the last inspection? What they could do better: The involvement of the service user in the planning of their care should be documented throughout their care plans. The service user’s wishes and their likes and dislikes need to be documented for each area of care. The service Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 6 user needs to sign their agreement of the care plan. Only when the service user is not able to participate should the next of kin sign agreement. Breakfast needs to be served much earlier. Not everyone needs to be out of bed before the serving of breakfast. Meals, as with all other delivery of care, needs to be tailored to the wishes of the service user, not the service user having to fit with the system. 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. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,5 The home provides good information to prospective service users to assist them to make an informed choice about where to live. Each service user has a written contract and statement of terms and conditions. Prospective service users and their relatives and friends are encouraged to visit the home to assess its quality. EVIDENCE: The inspector talked with a new service user and a relative who was visiting the home. The relative explained that they had visited the home because it had a good reputation in the community. They had been reluctant to have their mother placed into a nursing home and had visited many first. Rowanweald had been the only home that had encouraged them to visit at any time without an appointment. They were encouraged to explore all aspects of the home and to make their own judgements. Since their mother had been at the home they had not been disappointed. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 9 The relative reported that prior to her mother being admitted they were also furnished with an admission pack which contained all relevant information pertaining to the home. It detailed the complaints procedure and had a copy of the inspection report. The deputy manager reported that every service user has a written contract and a statement of terms and conditions. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11 Service user’s have a plan of care which sets out personal, social and individual care needs, however, carers must read care plans and amendments regularly as direction for their practice. Service user’s health needs are met. Service users reported that they were treated with respect and their right to privacy is upheld. More detailed information needs to be collected concerning the service users wishes at the time of their death. EVIDENCE: The inspector analysed two service user files from each of the three units. Six files were reviewed overall. Service user care plans set out the detail of action that needs to be taken to ensure a high level of care. The home has improved the level of their documentation and the care plans are now much more detailed. However, several of the carers questioned admitted that they do not look at the care plans before attending to the service user. Hence, their care is not informed by the plan. This needs to be rectified. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 11 Risk assessments are in place for each service user. There was written evidence that these were reviewed monthly. Next of kin were asked to sign risk assessments. However, although with the permission of the service user, involvement of the family is good practice, unless the service user is not able to make that decision, the agreement for all care should be made by the service user themselves. Documentation showed that specialty medical assistance was sought when necessary. This was recorded in the service user file along with recommendations. However, these recommendations should be transferred to the care plan which should contain all recommendations for care, including short term recommendations. There was poor evidence that care plans were reviewed monthly and there was no evidence that care plans were drawn up and reviewed with the assistance of the service user. The service user must be involved in the planning of their own care, and documentation should show the service user’s wishes in each area of care along with their likes and dislikes. This should then be documented and the service user should sign their agreement. The service user should be involved in every review of their care plan each month. If the service user is unable to be involved or to offer their opinion, then the next of kin should be asked to give the details and agree to the plan. Care staff reported that where possible, they encouraged the service user to attend to their own oral hygiene. This is good practice. Since the last inspection the home has endeavoured to improve the documentation relating to pressure areas. If a service user has a pressure area their file now contains photographs of the pressure sores along with a weekly chart for documentation of the progress made with treatment. Service users who have been identified by the registered nurse as being at risk use quarto mattresses. During the inspection the tissue viability nurse visited one of the units. This was to make an assessment and give recommendations for a service user who had recently been in hospital and developed a pressure sore. The home provides a good choice of food on the daily menu. However, although staff ask the service user each day what they wish to eat, food likes and dislikes were not recorded in the care plan. This means that the service user may never receive their choice of preferred food unless it is on the menu. One service user told the inspector that they love ice cream but did not receive this very often. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 12 Medication issues were reviewed at the last inspection. The MARS sheets were reviewed however, and there appeared to be no gaps. Since the last inspection the manager has spoken with the GPs about the home receiving a copy of the blood results when tests have been performed. This has been agreed and the home can now show evidence of these tests. Service users who are taking anti convulsants are tested every four months. During the inspection it was observed that most of the service users sat out of bed and were dressed in their own clothes. The privacy of the service user is respected. The preferred name of the service user is used and recorded in their files. It was noted during the inspection that staff knocked on the service user’s door to request entry. The initial assessment forms in the service user file had space for the entry of details concerning funeral arrangements in the case of the death of a service user. However, this needs to be enlarged to contain any wishes of the service user. Of the six files viewed by the inspector, only two contained the funeral arrangements. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The service users enjoy the lifestyle offered by the home. They are encouraged to maintain contact with family and friends. The meals offered are varied and nutritious. EVIDENCE: All of the service users who the inspector spoke with were very pleased with the activities offered by the home. They looked forward to activity time. They spoke well of the activity co-ordinator. The inspector viewed a weekly programme of activities held on Rheola unit which showed the diversity of activities offered. There was a television room on each of the units and the inspector saw service users watching the TV. Service users said that they were given a choice as to whether or not they participated in daily activities. They were free to spend the day in bed if they wanted to. Service users are given a choice of food each meal time. The home has employed a new chef who is creating new menus. The inspector viewed the menu. The food choices are quite extensive. There has been dissatisfaction with the taste of the food in the past. The home has employed a new chef to rectify this situation. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 14 Several service users complained about the mashed potato which they said was not fresh potato. Meal times need to be reviewed. The inspector noted that breakfast was served at 10 to 10 in the morning and lunch at 2 pm. Those who were awake and out of bed early had a long wait for their breakfast. Several service users complained that lunch was meant to be at 1 pm but was never on time. Breakfast needs to be served much earlier. The nursing routine needs to be fitted around best practice for the service user, not expecting the service user to wait until the nursing routines are completed. One service user’s family reported to the inspector that her mother had an individual request of receiving pre dinner fruit. This request had been met and the family were happy with the service. During the inspection it was observed that some of the service users had visitors. They met them in their rooms. The visitors were observed to move about the home freely and they were treated respectfully by the staff. Service user’s room contain personal belongings brought from home. All service users who were spoken with by the inspector reported that they were happy with their rooms. The inspector viewed the wardrobes and found them to be reasonably tidy and the clothes from the laundry had been put away. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The service users and their relatives and friends are confident that their complaints will be listened to and acted on. The service user is protected from abuse. EVIDENCE: The home has a clear policy concerning complaints. A prospective service user and their family is given documentation setting out the procedure for making a complaint. The complaint procedure is available in the foyer of the home. Since the last inspection there has been three complaints. These were all resolved satisfactorily and through the proper procedures. The home has a policy for the Protection of Vulnerable Adults (POVA). All staff receive training about POVA procedures. All staff receive documentation which sets out the procedures and each unit has a copy of this documentation. The inspector questioned several carers about these procedures. They were well informed but did not know where to locate the documentation if they wished to review the information. Registered nurses should be asked to familiarise the care staff with the location of important documentation. All staff should read policies and procedures of the home and sign to show that they are then familiar with the information documented. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,24,25,26 The service users live in a safe and maintained environment. The service users bedrooms were neat and tidy, light and airy. They were surrounded by their own possessions. EVIDENCE: The inspector viewed the home’s programmes of routine maintenance which are documented regularly. There are weekly checks on emergency lighting, room hot water temperatures, fire alarms, extractor fans, chlorination of shower heads, wheelchair service and various gardening jobs. Documentation was viewed for monthly electrical meter readings, PAT tests on equipment and current certificates for Gas and Electricity. Current certificates were viewed for portable appliance testing and inspection of call bells. The weighing scales had recently been inspected and serviced as had the lift. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 17 There was a chlorination certificate and documentation concerning inspection of the water softener. The kitchen has recently been deep cleaned. The inspector saw that all flammables were stored in a locked cupboard which was located in a locked room. Chemicals were stored in a locked room and the maintenance manager kept the key. PCT emergency equipment was also stored in a locked cupboard in the maintenance area. The maintenance manager reported that he had undergone training in Health and Safety, Fire safety and Moving and Handling. The home has an ongoing re-decoration programme, a copy of which has been sent to CSSI. Some carpets have been replaced and there are plans for the replacement of the grubby carpet in the foyer and main walkway. The home provides a communal sitting area in each unit. This has comfortable chairs and during the inspection service users were seen to use these areas. All bedrooms are of a good size and had en-suite toilet facilities. Each unit had a bath and a shower for general use. However, these were also cluttered with spare wheelchairs. A suitable storage area needs to be made for equipment. The sluice areas on each unit were tidy and free from odour. The passenger lift was clean and hygienic. However, the door grooves in the service lift needs cleaning. The inspector noticed that the bedrooms are kept neat and tidy. Laundry is put in the wardrobes and cupboards. All beds had a call bell and on the day of inspection the call bell was appropriately placed near to the service user. The kitchen and the laundry were viewed by the inspector. These areas were clean and tidy and in keeping with regulations. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The number of staff on the morning shift has improved. The recruitment practice of the home supports the service user and staff are trained to do their jobs. EVIDENCE: Since the last inspection, the home has increased the am staff with the addition of a floating carer. Staff during the inspection did not appear rushed although they were consistently busy. One carer was observed transferring a service user with the use of a lifter. The inspector spoke with the carer about only using a lifting device with the assistance of two carers. The inspector checked the service user care plan and found that the care plan specified that the transfer of the service user should only occur when two carers are present. The inspector spoke with the senior registered nurse who said she would be speaking with the carer and would be recommending further training. The incident was reported to management. The inspector noted that all other carers worked in pairs when using the lifting device. The inspector noted that registered nurses were present on all three of the units during both the morning and the afternoon shifts. The inspector was shown the training schedules for all staff and the lists of staff attending these programmes. Training is given in wound and pressure Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 19 care management, fire procedure, care planning, medication administration, continence management, record keeping and documentation and protection of vulnerable adults. The inspector viewed a staff file. This contained all correspondence and documentation pertaining to one of the staff. It had a transcript of interview, two references, statements of terms and conditions and current CRB check. The file was very organised and everything was in order. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,38 The home is competently managed. The service users financial interests are safeguarded and health and safety regulations heeded in the interest of protecting the service user. EVIDENCE: On the day of the inspection the registered manager had a training day. The inspector was assisted by the deputy manager. The deputy manager was able to access and provide all documentation and files that were requested by the inspector. The deputy manager was informed and aware of all aspects of the home. The inspector checked the arrangements for handling of the service user’s money. This was in order. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 21 The home has taken all precautions to ensure that health and safety regulations are safeguarded. All store rooms containing maintenance equipment, chemicals or hazardous substances are kept securely locked. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x 3 x x 3 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 14 (2) Requirement Care plans must be reviewed monthly or more often if the needs of the service users change. The registered person must ensure that the service user is involved in the drawing up and reviewing of care plans and risk assessments. A representative of the service user may be present (a) with the permission of the service user and (b) if the service user can no longer contribute. Service user involvement must be documented in the care plans. Service users opinions, likes and dislikes need to be recorded. Documentation needs to reflect service user agreement to the care plan e.g. signature. All recommendations and clinical guidelines made by health professionals need to be written in actual care plan. If for any reason a service user does not wish to have a regular appointment with a health specialist, the explanation needs to be documented. This would show the home as robust in Timescale for action Oct 2005 2. 7 14 oct 2005 3. 7 14 0ct 2005 4. 7, 8 13 (1) (b) Oct 2005 Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 24 5. 11 15, 12 (3) 6. 15 16 (2) (i) 7. 8. 19 28 23 12 (1) (a) (b) 13 (4) (c) 9. 7 12 (1) (2) (3) protecting the health status of the service user by offering regular health checks eg optician. The care plan must provide information about the aspirations, about the way the service user sees the future and their wishes and instructions with regard to death taking into consideration their ethnic, religious and cultural background. Meal times need to be reviewed. Breakfast needs to be served early and at a time as may reasonably be required by the service users. Door grooves in passenger lift need cleaning. That any unecessary risks to the health or safety of service users are identified and so far as possible eliminated. Senior staff must ensure that two people are assisting at all times when a lifting device is being used. The service user care plan is to inform the care staff of what actions need to be taken to ensure best practice. Hence, care staff should read the care plans and the ammendments on a regular basis. Oct 2005 Oct 2005 Oct 2005 Oct 2005 Oct 2005 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 18 Good Practice Recommendations The home should ensure that the policy and procedures for the Protection of Vulnerable Adults and whistleblowing should be available in each unit and that staff are aware of the location of the information and have easy access. G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 25 Rowanweald Nursing Home 2. Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 4th Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rowanweald Nursing Home G62-G11 S22941 Rowanweald Nursing Home V248469 090905 Stage 4.doc Version 1.40 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!