Inspection on 16/09/05 for The Gardens Nursing Home

This inspection was carried out on 16th September 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gardens Nursing Home 27/11/08

The Gardens Nursing Home 15/11/07

The Gardens Nursing Home 20/11/06

The Gardens Nursing Home 23/01/06

The Gardens Nursing Home 07/01/05

The Gardens Nursing Home 20/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOME ADULTS 18-65 The Gardens Nursing Home High Wych Road Sawbridgeworth Hertfordshire CM21 0HH Lead Inspector Louise Bushell Unannounced Inspection 16th September 2005 09:30 The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 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 The Gardens Nursing Home DS0000019570.V259077.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 Adults 18-65. 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. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Gardens Nursing Home Address High Wych Road Sawbridgeworth Hertfordshire CM21 0HH 01279 600201 01279 721297 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) Capio Healthcare UK Ltd Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (2), Physical disability (54), Physical disability of places over 65 years of age (54), Terminally ill (54), Terminally ill over 65 years of age (54) The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th January 2005 Brief Description of the Service: The Gardens is a purpose built nursing home, part of the Thomas Rivers Medical Centre in Sawbridgeworth. It provides nursing care and accommodation for adults with neurological disorders and physical disabilities as a result of acquired brain injuries. The home was first registered with Hertfordshire County Council Inspection Unit in January 1992. It is owned by Capio Healthcare UK Ltd. It is situated between the towns of Sawbridgeworth and Bishops Stortford and is easily accessible by public transport. Accommodation is provided on 2 floors served by a passenger lift. The ground floor consists of 18 single bedrooms and 2 double bedrooms, both of which is singularly occupied. All bedrooms have en suite facilities. There is a conservatory with dining area, 2 other dining areas, reception lounge area, a lounge with a computer room, another small lounge area, a physiotherapy room, 4 offices, a staff room and the laundry, all on the ground floor. The first floor consists of 27 single bedrooms and 3 double bedrooms, all with en suite, a dining area, and 2 seating areas. Catering facilities are centrally situated in the Rivers Hospital kitchen. One of the units on the ground floor is now designed, following refurbishment and redecoration to support the needs of younger adults. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place in the morning, through to the afternoon. Time was spent sampling care plans, observation of work practices, and discussions with many service users and staff. This unannounced inspection revealed many positive aspects. The home is about to commence phase two of the redecoration works. The area’s that are already competed are much brighter, airy and a pleasant environment to reside in. The home offers care to service users with physical disabilities, some with limited or no verbal communications due to acquired brain damaged. Many of the staff have worked at the home for a number of years and had a good understanding of the service users needs. What the service does well: There are many areas in which the home is doing well. The new acting manager of the home is currently undertaking a Certificate in Management Studies and holds a Registered General Nurse qualification. Staff approach through put the inspection was extremely effective. Service users stated that they felt respected and dignified by the staff. Interactions between the staff and the service users were seen to be positive. Service users are supported with effective activities in the home. A new younger persons activity coordinator has been employed specifically for this unit, increasing internal and external activities. An additional mini bus is now in use between two resources and many service users commented on the trips into the community. Volunteers also support with external trips, which supports and, maintains their frequency. Service users, support by staff discussed attending a local college course in September. A physiotherapy department is available and this provides one to one specialist support. Service users have individual physiotherapy programmes support their needs and rehabilitation needs. A key worker system is in place to further support the service users. Each service users bedroom is individualised, empowering them to actively make choices over their persona space and belongings. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Area that require attention are as follows; There is a need for all of the care plans to be fully up and running, to ensure that service users changing needs are being adequately monitored and needs being meet at all times. All documentation pertaining to the service users must be accurately completed and fully monitored at all times. The service users meal choice system needs full implementation to ensure service users choice and empowerment of individual needs is maintained. Where oxygen is stored, suitable signs must be erected for safety management. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 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. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service users and the home to continuously review the individuals care package provided. Information provided to the service users about the home and its terms is suitable to meet their needs and therefore enables the service users to make an informed choice about where to live. EVIDENCE: A comprehensive Statement of Purpose is held in the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about where to live. The content is suitable to meet individual needs. The statement of purpose is continuously reviewed to ensure the information provided to the service users is up to date. Full assessments of each service users needs and aspiration are made before the service user moves into the home. The assessments carried out in the home are continuously undertaken supporting and monitoring individual progress and needs identified. Qualified and competent people complete the assessments. The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. A contract is then drawn up between the home and the service user. The contract includes the terms and conditions in the home and the rights of the service user. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 10 Following a discussions with service users, it was determined that the referrals process is very clear, with people supported in trial visits to the home, prior to any long duration stay. Support is also provided to people on a short term basis, for example a one or two week stay. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Individual needs and choices in the home are being promoted to encourage and empower service user self-determination, participation and consultation. Individual plans do not fully reflect the needs of the service user with documentation sporadically recorded, thus personal goals and changes need are not clear. EVIDENCE: The registered manager and staff team develops and agrees with each service user an individual Plan, which includes treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The home is currently adapting and implementing a new care planning system. The care plan is clearly a working document, which is being regularly reviewed. The focus of the new care plan system ensures that service users are involved throughout the process. The new care pan focuses on not only medical needs of the service user, but also highlights the social needs of the individual. The current care plans in place were not holistic and person centred. Many documents were observed partially completed and not reviewed. It is The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 12 anticipated that once the system is fully operational that this will improve immensely. Once complete, the care plans in place are a good working example of meeting individual and changing needs. Following discussion with the clinical manager it was felt that these would be fully operational by the end of the year. All information within the home is handled in accordance to the Data Protection Act 1998. All records are held securely. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 & 17 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported EVIDENCE: Service users have the opportunity for personal development in the home and that many options are available to them within the home. All service users in the home access services within the community and were able to confirm that they were received effectively and through professional channels. On the day of the inspection an abundance of activity was occurring in the building which included, skittles, music and exercise and physiotherapy sessions. All service users are supported in gathering relevant information regarding employment, further education, employment skills and benefit advice if required. Some service users have an activities plan in their care plan which they have agreed and signed this is aimed at promoting motivation and user participation and integration into community living. All service users are encouraged and supported to maintain links to the local community. The home is close to the town centre and is close to a residential area . The home values The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 14 and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. During the inspection staff and service users were observed to interact equally with one another. Routines within the home promote service user independence. Service uses are unrestricted in movement around the home. The home employs activity coordinators. Following the last inspection the younger persons unit has been allocated there own activity coordinator working a total of 30 hours per week. The provision of activities within the home appears to be high with positive feedback being sought from many of the service users engaged with. Activity plans are visible and displayed within the home, service users are encouraged to engage in activities with peer groups and also access service and groups outside of the home. A number of service users following a group discussion expressed that they are happy with the activities provided and the staff are extremely helpful and kind. One service user wished that the external group events could be more frequent but was content. A new mini bus has recently been purchased for the use across two services, this will further support in the provision of community based activities. Volunteers are also supporting the service users with external and internal activities. One service user, discussed the opportunities that they were supported in gaining, through the attendance at college. Courses being attended including clay work and music therapy. Hydrotherapy services are also accessed by the home, supporting the exercise and rehabilitation. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 15 Following the last inspection the sensory room has been completed, thus allowing for additional communal space for all service users. Meals are well presented and all service users appeared to enjoy the food. Each service users nutritional needs are assessed during the pre-admission assessment and there is a choice of main meal on offer, from which service users select in advance. A number of service users are fed via a PEG, which is monitored by a dietician and by regular monthly weight checks recorded on care plans. The inspector meet with the dietician to discuss the process and monitoring and support that service users receive. Modified eating utensils were in place where needed. Staff were observed to support service users with their meals in a relaxed and unhurried manner. Meals are prepared in the main kitchen of the River Hospital in the adjacent building and then brought over to the home in heated trolleys. There is a small kitchen within the grounds of the home for the preparation of small snacks, drinks, supper and breakfast. Following feedback from a number of service users, the meal choice system is causing some concern because they would usually have to choose their meals a week in advance. This creates difficulties in ensuring that service users were being empowered to make choices that were realistic. Often they were unable to remember what they had ordered. Following discussion with the clinical manager a new system has recently been introduced which enables the service users to make daily choices over meals. Although this is a new system and minor teething problems are being experienced, once running smoothly, this will allow for greater choice and user self determination. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Service users receive care in a manner that they prefer, thus respecting and dignifying their choices and preferences. Service users needs are monitored, however systems in place must be fully and accurately recorded to ensure all physical, emotional and health needs are supported. EVIDENCE: Personal support is provided in private, and intimate care by a person of the same gender where possible and if the service user wishes. Times for getting up/going to bed, baths, meals and other activities are flexible including evening and weekends. Where needed, guidance and support regarding personal hygiene is provided. Service users choose their own clothes, hairstyle and makeup and their appearance reflects their personality. Service uses have the technical aids and equipment they need for maximum independence, which has previously been determined by a professional assessment. All equipment is reviewed and serviced regularly to ensure compliance and safety for all. The home maintains positive links with the local pharmacy that supplies the medication each month. There is a medicine room on both floors to store stock medicines and a medicine trolley for the daily administration of The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 17 medicines to service users. Medication is stored and administered from medical rooms situated on both floors of the home. There are suitable controlled drug storage cupboards, medication fridges and medicine trolleys. Medication systems were not fully inspected. However, following the last inspection a new audit system has been introduced. This involves a total of four service users medication administration records being double-checked within a 24-hour period. This is a good audit system and appears effective in minimising errors and thus lowering risk to the service users. Following the last inspection the care planning system in the process of being changed and upgraded. However currently there were numerous area identified in the current system that was not being adequately reviewed, updated or documents accurately and regularly completed. This showed concern regarding the monitoring systems in place in the interim prior to implementation of the new care plan. Following discussion with the clinical manager it is envisaged that the new system ill be fully operational by the end of the year. In the mean time, there is a need for the manager to ensure that all implemented recording and monitoring systems are completed to ensure health care needs of the service users are met. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained of complaints made, detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. Feedback from service users revealed that there complaints are listened to and appropriate actions are taken. Comments were received from the service users regarding the relationship they hold with the staff and how they feel listened to and supported within the home. A new updated complaints leaflet has been devised, which ensures that all of the required details are contained. Clear records are maintained regarding the complaints that have occurred. There is a need though for these records to be centrally located, logged and available for inspection. The home has adopted the Hertfordshire County Council Adults Protection procedure and has its own Whistle Blowing policy, which are displayed in various locations in the home. Staff members are aware of the Whistle Blowing policy. Part of new staff induction entails watching a video on Whistle Blowing and Abuse. The manager is aware of actions to be taken if abuse of service users is suspected and has done so in the past. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Each service user’s individual space within the home is well decorated and maintained, reflecting individual choices and preferences. The areas of the home that have been redecorated are well presented. EVIDENCE: All resources and equipment is provided in abundance ensuring specialist and individual needs are promoted and changing needs met at all times. Shared space both compliments and supplements service users individual space ensuring that individual space is tailored to personal style and taste. All service users bedrooms are ensuite and have a large personal and private space available to all. All bedrooms are well maintained and decorated. All service users are supported and empowered to decorate and personalise their rooms to match their own taste and personalities. Toilet and bathing facilities ensuring that choices and preferences can be met, and specialist equipment is available as per individual service user need. The main areas of the home were clean and hygienic throughout. The home employs a maintenance person. Following the last inspection there was a need for the home to ensure that the redecoration and refurbishment was completed The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 20 to ensure a functioning, homely environment was provided for all service users. Whilst some works have continued, there still remains to be a number of areas requiring considerable general redecoration. The Clinical Manager informed the inspector that the works were due to recommence at the end of September. The work that has been completed is also wearing slightly now, due to the high usage of manual handling equipment and wheelchairs. There is a need for a renewal and redecoration plan to be in place, to ensure works can be completed on a cyclic basis and always maintained to a satisfactory level. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None Standards not inspected on this occasion. EVIDENCE: Standards not inspected on this occasion. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41 & 42 The home is well managed, thus ensuring that all service users are provided with a quality service individually tailored to meet needs. Health and Safety systems are maintained, there is a need for some minor actions to occur to ensure continued safety. EVIDENCE: Feedback from service users spoken with stated that the home is well managed. Comments received were positive regarding the running and the management of the home. Service users expressed that they felt their views were listened to and that the service was run in their best interests at all times. Many service users gave positive comments regarding the staff on duty and that they are very caring, friendly, kind and helpful. The manager of the home is to start the Registered Managers Award in October. The management of the home promotes an open, consultative participative approach ensuring effective leadership and management of the home. The manager of the home yet to be registered, following recent appointment. This must occur as soon as possible, following her probationary period. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 23 Oxygen is stored in the home, there is need for a sign to be added to the area where it is stored for safety reasons and identification purposes in such an emergency event in the building. Records pertaining to the service users are required to be fully and accurately completed. The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X 3 3 X Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 X X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Gardens Nursing Home Score 3 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 3 X X 2 2 x DS0000019570.V259077.R01.S.doc Version 5.0 Page 25 No 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 YA6 Regulation 15 (2) Requirement The new care planning system must be implemented to ensure needs are being meet. Timescale for action 31/12/05 2 3 4 YA17 YA19 YA22 16 (2) (i) 12 (1) (b) 22 5 YA24 23 (2) (b) & (d) 6 7 YA37 YA41 10 17 (3) (a) Service users must be supported with an effective meal choice system. The new care planning system must be implemented to ensure needs are being meet. A clear record of complaints must be held in the home, with actions and al documentation available. Redecoration and refurbishment must recommence, a renewal and redecoration plan be implemented ensuring the environment is maintained to a satisfactory level. The manager must become registered following completion of the probationary period. All documentation pertaining to service users must be up to date DS0000019570.V259077.R01.S.doc 15/11/05 31/12/05 15/11/05 01/01/06 01/01/06 31/12/05 The Gardens Nursing Home Version 5.0 Page 26 and accurately recorded. 8 YA42 13 (4) (a) & (b) An oxygen sign must be erected in the area where oxygen is stored. 15/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 The Gardens Nursing Home DS0000019570.V259077.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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