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Inspection on 06/12/05 for Stocks Hall Nursing Home

Also see our care home review for Stocks Hall Nursing Home for more information

This inspection was carried out on 6th December 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

Systems were in place to protect the privacy and dignity of those living at the home and any complaints received were seen to be well managed. The routines of daily living were flexible, providing those living at the home with choices and control over their lives. The premises were maintained to a high standard to ensure that a safe and comfortable environment was provided for those living at the home. Training provided for staff demonstrated that those working at the home were competent to do the job expected of them and that there was an acceptable percentage of staff employed to ensure adequate supervision of more junior staff. The home was being well managed and was being operated in the best interest of those living at the home. Comprehensive systems were in place to ensure that the quality of service being provided was being regularly monitored. The policies and procedures of the home demonstrated that service users` finances were adequately protected.

What has improved since the last inspection?

Copies of all assessments conducted prior to admission had been obtained so that the home could determine if the staff team could adequately meet the individual`s needs. The plans of care had been developed with the service user or their representative to demonstrate that people living at the home were encouraged to be involved in decision making about the care they received and were given the opportunity to discuss any concerns, which they may have. The safety of those living in the home had been improved by the replacement of more suitable locking devices on bedroom doors.

What the care home could do better:

The home`s written policies and procedures in relation the safe handling of medications must be improved to ensure that the potential for drug error is minimised. Although some activities were seen to be provided, the provision of activities was not ideal, as care staff were responsible for providing this aspect of service, due to the long-term absence of the activities co-ordinator. The menu should show a choice of meals available and should be presented in a more suitable format to ensure that those living at the home are aware of meals available. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept to ensure that the home has an ongoing maintenance programme. The registered manager should be calculating the ratio of care staff to service users in accordance with the dependency levels of those living at the home. The registered manager should up date her training to demonstrate that she has maintained her personal professional development and kept up to date with current practices.

CARE HOMES FOR OLDER PEOPLE Stocks Hall Nursing Home Stocks Hall 249-251 Liverpool Road South Burscough Ormskirk Lancashire L40 7TD Lead Inspector Vivienne Morris Announced Inspection 6th December 2005 09:30 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 Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Stocks Hall Nursing Home Address Stocks Hall 249-251 Liverpool Road South Burscough Ormskirk Lancashire L40 7TD 01704 895667 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) Stocks Hall Care Homes Limited Mrs Janet Molyneux Care Home 52 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (52), of places Physical disability (4) Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Up to 52 service users in the category of OP who need nursing care. Up to 8 service users in the category of OP who need personal care only. Up to 4 service users in the category of PD. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. Up to 7 service users in the category of DE(E) who need nursing care. Date of last inspection 16th June 2005 Brief Description of the Service: Stocks Hall Care Home is located in a residential area of Burscough, within walking distance of the village centre. The home is registered to accommodate up to 52 elderly service users requiring personal or nursing care. There are also a number of places available for those service users who have care needs associated with a diagnosis of Dementia. Accommodation is situated on two floors, serviced by a passenger lift, enabling access to all areas of the home for those who are less mobile. A 4-bedded rehabilitation unit is located on the first floor. Lounge areas and dining facilities are provided on both floors of the home. Service users’ private accommodation is provided mainly in single rooms. However, two shared rooms are available for married couples, companions or those who prefer to share facilities. Although en-suite facilities are not provided at Stocks Hall, toilets and bathing facilities are located at convenient intervals throughout the home. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day during December 2005. The inspection process focused on the outcomes for people living at the home. During the course of the inspection service users, relatives and staff were spoken to, relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas and service areas were seen. As part of the inspection process the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus on a small group of people living at the home. All records relating to these people were inspected along with the rooms they occupied in the home. However this was not to the exclusion of other people living at the home. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. What the service does well: Systems were in place to protect the privacy and dignity of those living at the home and any complaints received were seen to be well managed. The routines of daily living were flexible, providing those living at the home with choices and control over their lives. The premises were maintained to a high standard to ensure that a safe and comfortable environment was provided for those living at the home. Training provided for staff demonstrated that those working at the home were competent to do the job expected of them and that there was an acceptable percentage of staff employed to ensure adequate supervision of more junior staff. The home was being well managed and was being operated in the best interest of those living at the home. Comprehensive systems were in place to ensure that the quality of service being provided was being regularly monitored. The policies and procedures of the home demonstrated that service users’ finances were adequately protected. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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 Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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 the following standard(s): No standards from this section were assessed on this occasion. EVIDENCE: Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 Systems were in place to facilitate the safe handling of medicines but these were not supported by the implementation of written policies and procedures. The right to privacy and dignity of those living at the home was upheld. EVIDENCE: There was an assessment of safe self-administration for service users in the rehabilitation unit. None of the nursing residents currently self-administer their medicines. Trained carers (rehabilitation unit only) or qualified nurses administer all other medicines. Nurses explained that it was necessary to crush medicines for three residents. This was not documented for two residents. If the medicines are disguised the Nursing and Midwifery Council (NMC) guidance should be followed and advice sought from the community pharmacist regarding the suitability of crushing medicines. On the nursing floors medicines are, where possible packed into a monitored dosage system (MDS), and supplied with pre-printed medication administration records (MARs). Handwritten MARs are used on the rehabilitation unit. The MARs were generally up-to-date throughout the home but handwritten entries were not signed, checked and countersigned. One handwritten entry (nursing) Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 10 had been incorrectly copied from the pharmacy label resulting in a medication administration error. This was addressed on the inspection day. It is strongly recommended that entire MAR’s are checked and signed, to reduce the likelihood of medication errors. Medication was securely stored throughout the home. The temperature of the basement medicines room, but not the first floor medicines room was recorded. Temperatures recorded in the summer months were sometimes above the maximum of 25oC. The storage was generally orderly but there was some unwanted medication in the first floor trolley and in the medicines refrigerator. The manger had recently received updated medication policies and procedures, and was beginning to implement them on the nursing floors. It was advised that separate procedures were under development and would be implemented in the rehabilitation unit. The service users’ guide and systems in place at the home demonstrated that the privacy and dignity of those living there was respected and those spoken to confirmed that the staff were always very courteous and caring. The inspector observed staff treating service users in a respectful manner, which confirmed that the privacy and dignity of those living at the home was protected. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. The routines of daily living were flexible, although the provision of activities could be improved. Service users were able to exercise choice and control over their lives. Meals, in general were well managed, although the menu could be presented in a more suitable format to ensure that those living at the home were aware of meals available . EVIDENCE: An informative social history profile had been conducted in respect of each service user shortly after admission so that those working at the home were aware of individual preferences and interests. The plans of care were very detailed in relation to service user’s individual social care needs, hobbies, interests, preferences and religious observance, demonstrating that staff were aware of individual preferences and interests. The activities co-coordinator, who had developed the provision of activities, was on long term leave, so the care staff were responsible for providing a variety of activities. This situation was not ideal and comments received indicated that the provision of activities could be improved, taking into consideration the preferences of those living at the home. A suggestion made by one relative was that the advisory forum be reactivated. At the time of the inspection a movement to music session was seen to be taking place and age Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 12 appropriate music was playing, which seemed to be enjoyed by those taking place. However, comments received included, “They could do with more activities like bingo” and “There are not enough activities”. Service users informed the inspector that the routines of daily living were as flexible as possible and that the staff were very understanding, demonstrating that people felt that they were able to exercise choice and take some control over their lives. However, one service user commented, “At night I am lonely. No-one comes to see me”. The service user’s guide demonstrated that service users and their relatives and friends were supported to contact external agents, such as advocates, who would act in their interests and the process of accessing the local advocacy service was discussed on admission to ensure that those concerned were aware of their right to have someone acting on their behalf, should they so wish. The policies of the home supported this information and demonstrated that access to personal records, in accordance with the Data Protection Act 1998, was facilitated for service users so that they were aware of information written about them. The inspector observed that service users were entitled to bring personal possessions into the home with them. A property audit was conducted for each service user on admission to ensure that personal property and belongings were protected as far as possible. Meals, in general were well managed, with food being presented in an appetizing manner to maintain adequate nutrition. However, the menu was hand written and was not seen to be displayed within the home so that service users were made aware of meals available. The hand-written menu did not show a choice of meals available to demonstrate that those living at the home were offered an alternative to the set menu. However, meals served records showed that a variety of dishes were provided, showing that those living at the home were able to have different meals than those shown on the menu. Comments received included, “The food is not always that good” and “The food is sometimes better than others. It isn’t too good sometimes”. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints were seen to be well managed. EVIDENCE: A written complaints procedure was in place at the home, which was incorporated within the statement of purpose and the service users’ guide and which informed readers of their right to contact the Commission for Social Care Inspection at any time should they so wish, ensuring that people were informed of the correct procedure to follow should they wish to make a complaint. A record was kept of all complaints made and included details of the investigation and any action taken to show that complaints received were handled appropriately. Only one complaint had been received by the home during the previous year, showing that people, in general were satisfied with the service provided. A comment received from one service user was “The staff are lovely. I have no complaints”. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19 The premises were found to be well maintained to ensure that service users lived in a safe environment. EVIDENCE: An up to date programme of routine maintenance and renewal of the fabric and decoration of the premises was not in place. However, the premises were found to be decorated, furnished and maintained to a high standard and appropriate fire precautions were in place to ensure that a safe and comfortable environment was provided for those living at the home. However, one comment card received indicated that the lighting in the service user’s bedroom was not bright enough. The inspector felt that the lighting in the bedrooms seen was sufficiently bright enough. However, it is recommended that the registered manager assess the brightness of lighting within each bedroom to ensure that lighting meets individual needs. A comment received from one service user was “I am very happy with my room. It is cleaned every day”. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 15 The grounds of the home were seen to be tidy, safe and attractive and easily accessible to service users, providing them with pleasant external areas for them to use. The inspector noted that developments had been made to erect an extension adjacent to the entrance of the home. The Commission for Social Care Inspection had not been informed of any proposal to make structural alterations to the building. The registered person must give notice in writing to the Commission for Social Care Inspection of any proposals to make significant alterations or extensions to the premises of the care home. At the time of inspection the home was well organised, clean and fresh smelling, providing a homely environment for service users. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Sufficient training was provided to ensure that those working at the home were competent to do their jobs. Staffing levels were not provided in accordance with the assessed dependency levels of those living at the home. EVIDENCE: A recorded staff rota was in place, which showed that, at the time of the inspection the staffing levels met the minimum requirements of the previous regulating bodies to ensure that adequate numbers of staff were on duty for the number of people living at the home. However, although dependency assessments had been conducted, these were not used to calculate the ratio of staff to residents, in order to ensure that sufficient staff were deployed to meet the needs of those living at the home. Guidance provided by the Department of Health in relation to the calculation of care staff hours was discussed at length with the registered manager at the time of the inspection. The registered manager should be able to demonstrate that the deployment of staff has been calculated in accordance with the dependency levels of those living at the home to ensure that all assessed needs are adequately met. A comment card from one relative indicated that there was not always sufficient staff on duty at weekends. Comments received included, “I get a lot of attention from the staff. They help me when I need it” and “I trust the staff 100 . They are very honest”. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 17 At the time of the inspection there were 24 care staff working at the home, of which 13 had achieved a National Vocational Qualification at level 2 or above, showing that an acceptable percentage of care staff were trained to do their job adequately and to supervise more junior staff. Agency staff were provided, when required by the companies agency, who were inducted with the care homes belonging to the company. Therefore, the registered manager was aware of training provided for agency staff, including those with National Vocational Qualifications. All new care staff were provided with comprehensive workbooks, which guided them, with the help of mentors through an induction and foundation period to ensure that staff were adequately trained to do the job expected of them. The company employed a training co-ordinator who was responsible for ensuring that individual training needs were identified through formal supervision of staff. Core training and up dates had been provided for all staff and training specific for the client groups was made available to ensure that all learning was appropriate for the needs of those working and those living at the home. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35. The home was being well managed and was operated in the best interests of those living there. Service users’ financial interests were being safeguarded. EVIDENCE: The registered manager has been responsible for the day-to-day operation of Stocks Hall for a period of twelve years, which shows continuity in the management of the home. She is a first level registered nurse and is in the process of completing a National Vocational Award at level 5, having obtained a management-training certificate. Although, the registered manager had completed a variety of training courses, a number needed to be up dated to demonstrate that she had maintained her personal professional development and kept up to date with current practices. The registered manager of Stocks Hall Nursing Home appoints individual unit managers to ensure effective operation of each separate unit within the home. One comment received from a service user was “The unit manager is Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 19 exceptional. He is very kind and caring”. Staff spoken to felt that they were supported by the management of the home by ensuring that their training needs were being met and by being able to raise any concerns, which would be listened to and advice would be provided as needed. A quality assurance manual had been established and the home had achieved Investors in People accreditation and was therefore monitored by a recognized external professional body to establish the quality of service provided. Service users’ views of the home had been published in the service users’ guide, copies of which were provided to prospective service users and were available within each bedroom so that all relevant people were aware of how the home was achieving goals for service users. The views of family, friends and stakeholders had been sought on how the home was achieving goals for service users. The registered person had implemented an annual development plan and had conducted monthly audits of the home, the reports of which had been submitted to the Commission for Social Care Inspection to demonstrate that the quality of service provided was being adequately monitored. Internal audits were conducted at regular intervals, following which the company correlated a bi – annual report, which incorporated service users’ views of the service to demonstrate that those living at the home were involved in the quality assurance process. The written policies and procedures of the home were constantly being reviewed and updated by an identified forum, in line with changes in legislation and advice from the Commission for Social Care Inspection. Evidence was available to demonstrate that service users were able to manage their own financial affairs if they chose to do so to demonstrate that those living at the home were able to have some control over their lives. The inspector had sight of written records where the personal allowances or valuables of service users were retained on their behalf, which were found to be maintained to a satisfactory standard, demonstrating the protection of service users’ finances and valuables. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 18(c)(i) Requirement The provider must ensure that medication policies and procedures are implemented throughout the home. The provider must ensure that all medication administration records are complete, accurate and up-to-date. (Timescale of 31.07.05 not met). The provider must ensure that all unwanted medicines are promptly segregated The provider must monitor the temperature of the medicines storage rooms and take action to reduce the temperature should it rise above 25oC. The registered person must give notice in writing to the Commission for Social Care Inspection of any proposals to make significant alterations or extensions to the premises of the care home. The registered person should provide the Commission for Social Care Inspection with written confirmation that planning permission has been DS0000025578.V265193.R01.S.doc Timescale for action 17/01/06 2 OP9 13(2) 03/01/06 3 4 OP9 OP9 13(2) 3(2) 03/01/06 03/01/06 5 OP19 39(h) 31/01/06 Stocks Hall Nursing Home Version 5.0 Page 22 granted for the erection of the half built extension and that the relevant authorities have been consulted, including Lancashire fire and rescue service and the Environmental Health Department. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 10 11 Refer to Standard OP9 OP9 OP9 OP9 OP9 OP12 OP15 OP19 OP19 OP27 OP31 Good Practice Recommendations Nurses should consider the Nursing and Midwifery Council (NMC) guidance when delegating tasks to carers. Eye drops and medicines with a limited life on opening should be dated on first use. Handwritten Medication Administration Records (MAR) entries should be signed and countersigned. Consideration should be given to the inclusion of photographs within the MAR file. Should covert administration be agreed; Nurses should follow the NMC guidance on covert administration. The provision of activities should be consistent and in accordance with service users’ preferences. The menu should be displayed within the home in a format suitable for those living there and should provide a choice of meals available. An up to date programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented with records kept. It is recommended that the registered manager assess the brightness of lighting within each bedroom. The registered manager should be calculating the ratio of care staff to service users in accordance with the dependency levels of those living at the home. The registered manager should keep her training up to date. Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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 Stocks Hall Nursing Home DS0000025578.V265193.R01.S.doc Version 5.0 Page 24 - 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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