Inspection on 15/06/05 for St George`s Nursing Home

This inspection was carried out on 15th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St George`s Nursing Home 05/02/08

St George`s Nursing Home 04/12/06

St George`s Nursing Home 26/01/06

St George`s Nursing Home 17/11/04

St George`s Nursing Home 26/05/04

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Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

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Langrigg House

Parkside

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

CARE HOMES FOR OLDER PEOPLE St Georges Nursing Home Northgate Lane Moorside Oldham OL4 4RU Lead Inspector Tracey Rasmussen Announced 15 June 2005 th 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. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Georges Nursing Home Address Northgate Lane Moorside Oldham OL4 4RU 0161 626 4433 0161 678 2473 mm@chipchase.demon.co.uk St Georges Nursing Limited 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) Anthony Pinnington Care Home 55 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (30), Old Age, not falling within any other of places category (20), Physical Disability (15), Physical Disability over 65 years of age (25) St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 No Service User to be admitted into the home who is under 30 years of age. 2 The Manager must be supernumerary at all times. 3 A minimum of 2 Registered Mental Nurses and a minimum of 2 Registered Nurses must be on dutybetween the hours of 8 a.m. and 3 p.m. 4 A minimum of 1 Registered Mental Nurses and 2 Registered Nurses must be on duty between 3 p.m. and 8 a.m. 5 Service users to include up to 20 OP, up to 20 DE, up to 30 DE(E), up to 15 PD and up to 25 PD(E). Date of last inspection 17 November 2004 Brief Description of the Service: St George’s Nursing Home is a purpose built nursing home, which was first registered in October 2002. The home is owned by St George’s Nursing Home Limited. The home is registered to provide nursing care to 55 people, primarily to older people with dementia type illnesses. The home also offers general nursing care unit and an early onset dementia facility in a separate suite. St. Georges is situated in Moorside, approximately three miles away from Oldham Town Centre. Access to the Pennine Moors is literally minutes away. Local amenities and access to local bus services is readily available. Close to the home a new housing estate has been developed. Outside the home, some borders have been planted, patio areas developed and other areas around the building have been grassed. Car parking facilities are available. Accommodation is provided over two floors. Each floor is split into two separate suites and each suite provides a lounge, dining room and bathroom facilities. Each suite provides a keypad security lock. All bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. Each suite also provides a small servery where service users and visitors can make a drink. The home is a no-smoking home. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over ten hours on the 15th June 2005 by a inspector. A tour of the two floors in the home took place and care and records were seen. Five of the 55 residents, three visitors (close relatives) and a significant number of staff were spoken to. Seven GP questionnaires were returned to the CSCI and these contain positive responses. Four resident and seven visitors questionnaires were returned to the CSCI and all but one contained written comments detailing concerns about staffing in the home. Two relatives also sent detailed letters listing areas of concern. At this inspection there was a strong feeling of dissatisfaction expressed by residents, relatives and staff about the management approach used in the home. The manager had reduced staffing levels on both floors in the home and this had resulted in a number of experienced staff members leaving the home. Since the last visit to the home little progress has been made in improving the areas of concern identified previously. Verbal feedback of the findings from the inspection was given to the manager and the proprietor of the home. As a direct staff to the concerns identified at this inspection the proprietor of the home took immediate action to address the management issues in the home. At the time of writing this report the proprietor had changed the management structure in the home, spent time with residents, relatives and staff and had commissioned an independent expert to interview the residents, relatives and staff to identify what went wrong and how to move forward to improve the service provided at St. Georges Nursing Home. What the service does well: The home employs an activity therapist who was enthusiastic and motivated. Residents with dementia are encouraged and supported to participate in the activities. The home environment is pleasant and spacious and garden areas are maintained to a high standard. The home has a committed core group of staff who are very loyal to the home and who want to give a high standard of care. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 6 The proprietor of the home listens to concerns and will attempt to find solutions to resident, relative and staff issues. What has improved since the last inspection? What they could do better: The management approach and attitude of the manager was repeatedly reported to be dismissive. Communication with residents and relatives about the changes in the home had not been managed particularly well which has led to relatives becoming worried and staff demoralised. Relatives said they received no response to their concerns and staff said the manager wouldn’t listen to them, “he just walked away.” One resident said the manager ‘was unprofessional’. The main areas of concern expressed both in writing and verbally by residents, relatives and staff were; the reduction in staffing levels, the use of agency staff and the employment of ‘young and inexperienced’ care staff, which had all led to a reduction in the quality of care provided in the home. A number of the requirements issued to the home following this inspection are a result of the staffing in the home. Many of the relatives stated very clearly that “ the regular staff are lovely” The home’s pre-admission assessment needs developing so that residents can be confident that the home is aware of the prospective resident needs. Staff training in the protection of vulnerable adults has not been provided and the home’s policies and procedures for abuse did not contain enough information. Some limited statutory health and safety training has been provided but a training programme for dementia care had not. Induction training had not been implemented properly as a new staff member commenced work without training. This staff member left after three days. Residents and staff were unhappy with the meals provided, the main area of concerns being the sandwiches or alternative at lunchtime- one resident said the sandwiches were boring and the alternative unappetising. Kitchen staff stated that the manager had planned the menu. They said that they had tried to discuss the nutritional value and variety of the menus but the manager had been unwilling to listen. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 7 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. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 Residents are not assessed to a consistent standard by the home and so, cannot confirm they can meet the needs of the resident on admission. EVIDENCE: A selection of care plans were viewed on all four units in the home. All the files looked at had Community Care Assessments and or Nursing Assessments. It was reported that the home did have their own pre-admission assessment, however one recent admission had only a few handwritten bullet points on a piece of notepaper. The manager did say he had ‘a proper pre-admission assessment available’ but he could not provide this for inspection. A poorly recorded pre-admission assessment could result in the resident not receiving the right care on admission to the home. Some training has been provided in the home but care staff training in dementia care and managing challenging behaviours had not been planned. The manager did say he was developing a package of training in dementia care but further detail of this was not provided. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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, 9, 10 Residents are protected by the care planning documentation, which details health, personal and social care needs. Medication practices are safe. The home does not always promote the privacy and dignity of the residents. EVIDENCE: All care plans viewed were very detailed listing resident’s need which was linked to the relevant risk assessments. Evaluation of the care plans were undertaken regularly and on two units these were very detailed. Daily written records were informative and contact records with family, GP and other professional visits kept. Medication storage and practices were looked at on two units as part of a case tracking. The issues identified at the last inspection had been addressed. Residents were well presented and attention had been paid to clothing coordination, nails and hair. Residents, relatives and staff all voiced concerns around the high number of new young and inexperienced care staff and agency care staff that had been working in the home in recent months. (At this visit regular long term staff were on duty). Resident’s relatives and staff all said this had resulted in a lower standard of care because the new staff were St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 11 frequently ‘left to get on with it’ without the necessary training and experience to care for people with dementia. One relative said that some of the agency staff ‘couldn’t even speak English’ resulting in poor understanding of the resident’s needs. The relative gave examples where residents were not assisted to the toilet resulting in ‘accidents’. The manager agreed that there had been a problem with staffing and that one agency supplied some care staff who could not speak clear English. The manager said this had been addressed and another agency was now used. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Resident’s maintain contact with family and friends, and the social aspect of the service meet all resident’s needs. Residents are not afforded choice and control in their daily lives. Menus do not provided a balanced diet for residents. EVIDENCE: Since the last visit the home has recruited an activity therapist who was very motivated and enthusiastic. During the morning of the visit, Prize Bingo was played on Medlock suite and residents from Haven also joined in. Residents and relatives were very complimentary about this service. The activity therapist reported that records of activities and resident participation were available. These were not seen. Social care plans were available on all the files examined. Residents said they could have visitors at ant time and relatives confirmed this. Residents, relatives and staff said that choices had been reduced in the home due to a reduction in the staffing, the employment of inexperienced care staff and the use of agency staff. One resident said that agency staff couldn’t put compression stockings on, another resident said he had been told that he could no longer walk down the corridor because staff didn’t have time to walk with him. This resident did say that this had improved and he was walking. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 13 One family member and staff on the suite for residents under the age of 65 said that staffing had been reduced at weekend ‘because it was quieter’ but the feeling was that this had reduced opportunities for residents and staff to go out of the home. The home provides a cooked breakfast, lighter lunch and a main evening meal. The menus were viewed and these did not appear to offer a nutritionally balanced selection of meals. The lighter lunch time meal consisted of soup and sandwiches or an alternative. The alternatives were reported to be unpopular. The kitchen staff said that the manager had written the menus and he was unwilling to discuss or listen to them about the variety and content. One resident said they had had “chips on Monday tea, Tuesday lunch, roast potatoes Tuesday tea and chips Wednesday lunch” The manager did say he had written the menus following discussion with the residents. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Residents are not confident that complaints will be responded to. Residents are not protected fully from abuse. EVIDENCE: A copy of the complaints procedure was available in the home’s service guide. The manager reported that he had received two complaints since the last inspection visit. Residents, relatives and staff all said that the manager did not respond to issues and concerns and nothing was done to improve the situation. One staff member said he was aware that a number of written complaints had been left for the manager recently. In contrast residents, relatives and some staff said that when they took their concerns to the proprietor he addressed them immediately. Staff said they had not had training in the protection of vulnerable adults. Requirements to address this were made at the previous inspection. The home’s policy and procedure for abuse was not linked to the local authorities policy on the protection of vulnerable adults and a separate policy on Whistle blowing was not available. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Residents live in a clean, safe, well-maintained and comfortable home which has aids and adaptations to meet their needs. EVIDENCE: The home is a purpose built care home that has been open for nearly three years. The home is furnished to a high standard. It was reported that some redecoration work had been undertaken and the manager said he was developing a redecoration plan for the home. Communal lounges and dining areas are provided on each floor. Residents were complimentary about the quality of the furnishings and fittings and two residents were proud to show off their bedrooms. Some residents had personalised their room to their individual preference. Toileting and bathing facilities are accessible. Outdoors the home has enclosed garden areas with patio furniture. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 16 Equipment including hoists was available on all floors in the home, The home employs two domestic cleaning staff who were struggling to keep on top of the cleaning in the home. The home was reasonably clean. The manager stated that he was struggling to recruit sufficient domestics for the home. Residents did say that cleaning at weekend had not been provided for several weeks until very recently. One care staff member also said that the care team cleaned the toilets one weekend because they were dirty. The laundry staff team were organised and the laundry room was clean and tidy. The home’s health and safety representative also provides routine daily maintenance. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 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, 30 Staffing levels and staff training was insufficient to meet resident’s needs. EVIDENCE: There has been a reduction in staffing levels in recent months on all three nursing units and this has caused a high number of experienced staff to leave, which in turn has resulted in recruitment problems and an increase in the use of agency staff, consequently staff moral was low and realtives were worried about standards in the home. Staff comments included that “I want to be proud to work here and of the care I give but I’m not” A relative said she had visited several dementia care homes in Oldham, Ashton and Stockport and she said she, “..had picked St. Georges” for her relative, ..“because it was the best in the area but now feared that the standards were dropping to the level of these other homes”. Six of the seven relative questionnaires that were returned to the CSCI contained written comments (two contained detailed letters) expressing concern about the staffing levels and the drop in the standard of care in the home. Similar themes were identified and these included: “agency staff – don’t know the home or the residents they provide no consistency for the residents and newly employed care staff lack understanding and experience of working with people with dementia”. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 18 Staff rotas viewed showed that new care staff were started as part of the staff team without an opportunity for induction training and this resulted in a least one new member leaving after three days employment. Staff also said that the staff rota wasn’t properly maintained and they never knew if they were working with enough staff or if agency staff were rotaed to work. One care staff member was working 19 consecutive days without a day off and 5 of these shifts were double shifts which meant the staff member was occasionally working 14½ hours each day. Other staff regularly worked 14½ hour shifts because they preferred it. Excessive long shift and working without a break could result in residents not receiving the best care because staff are tired. The manager did say he was using agency staff while waiting for CRB disclosures to be returned and these were taking a long time. He had not used the PovaFirst service which would have speeded up the employment process. There had been limited staff training in the home. The manager and the proprietor of the home was informed of the above concerns. The proprietor was very concerned and commenced addressing the problems within a day of the visit. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 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, 32, 33 The management of the home does not promote health and wellbeing of the residents. EVIDENCE: Many of the concerns about the management of the home are recorded in all areas of this report. Every resident spoken to who could respond, every visitor and every staff member spoken too regardless of role (care assistant, nurse, kitchen and laundry staff) were negative about the managers role the home. Relatives said the manager didn’t listen to concerns. Staff said they felt unsupported and many said they were seeking other employment. In contrast the same people were positive about the proprietor of the home stating that he listened and acted on the identified concerns. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 20 Following this visit the proprietor has reviewed the management of the home and incorporated some changes which has resulted in an ‘up lift of staff spirits’. The proprietor has also commissioned an independent assessor to talk with residents, relatives and staff to identify what went wrong in the home and how to build and improve the service provided at St. Georges. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 1 1 1 x x x x x St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 22 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 3 Regulation 14 15 Requirement The regsitered person must ensure that the homes preadmission assessment comprehensively details all the needs of each resident. The registered person must ensure that staff have the skills and experience to care for the needs of residents living in the home and this includes promoting privacy and dignity. The registered must ensure that there is sufficient staff on duty to meet the assessed needs of residents. The registered person must ensure that menus offer a nutritionally balanced meal that provides choices and variety. The registered person must ensure that all issues, concerns and complaints are responded to in accordance with the homes policy and procedures. The registered person must ensure that policies and procedures for the protection of vulnerable adults are available in the home and this includes a whistle blowing policy. (Timescale of the 15/12/05 was F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Timescale for action 30/06/05 2. 4 10 12 15 18 15/09/05 3. 14 27 15 12 30/06/05 4. 12 16 22 15/07/05 5. 16 30/06/05 6. 18 13 15/07/05 St Georges Nursing Home Version 1.30 Page 23 not met). 7. 18 13 18 The registered person must ensure that all staff receive training in the different forms of abuse and the home’s policies and procedures on the protection of vulnerable adults. (Timescale of the 15/12/04 was met). The registered person must ensure all staff receive induction training within the first six weeks of employment and this is recorded and available within the care home.(Timescale of the 15/12/04 was met). The registered person must ensure that training records are available in the home.(Timescale of the 15/12/04 not met). The registered person should ensure that the management approach in the home is responsive, open and transparent. The registered person must ensure quality assurance monitoring is undertaken in the home. 15/07/05 8. 30 18 30/06/05 9. 30 18 15/07/05 10. 31,32 10 12 30/09/05 11. 33 24 26 30/09/05 12. 13. 14. 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. Refer to Standard 7 27 Good Practice Recommendations The registered person should ensure that all care plan evalutions recorded are detailed. The registered person should review the homes practice of allowing staff to work shifts of 14 plus hours. St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne OL7 0QD 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 St Georges Nursing Home F54-04 St Georges NH S31914 V224911 150605 Stage 4.doc Version 1.30 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. 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. 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