Inspection on 23/01/06 for The Gardens Nursing Home

This inspection was carried out on 23rd January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 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 16/09/05

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 June Humphreys Unannounced Inspection 23rd January 2006 10:00 The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 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.V279890.R01.S.doc Version 5.1 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.V279890.R01.S.doc Version 5.1 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.V279890.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 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.V279890.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of the inspection year, conducted by two inspectors visiting the home throughout the day. The inspection highlighted the high level of need of service users and the complexity of the service trying to be provided. The manager and staff team were interviewed and observed working with service users. The overall standard of care is of a satisfactory standard. The service is not registered to provide a specialist service to adults with a learning disability; further information is required regarding the young people living at ‘The Gardens’. The manager is relatively new into post and is actively making changes to the way in which the service is delivered. Service users and staff spoke positively of the changes and were enthusiastic towards her approach. The service has several areas, which require improvement. Firstly the new care plan system must be extended to all service users with an overall improvement in recording. Secondly two immediate requirements were made, of which one is outstanding from the previous inspection. These relate to the storage of oxygen, and also COSHH products. The manager has confirmed that action has been taken, but staff need to be made aware of the possible dangers to service users and ensure that working practices are changed. What the service does well: A varied activities programme is available to service users; including access to specialist physiotherapy services, and a new sensory room. There are increased opportunities to go out with staff and volunteers to participate in community based activities. A comprehensive rehabilitation programme is offered to service users who have suffered traumatic brain injury or spinal injury. The standard of palliative care is also very good, with caring and empathic staffs that work hard with both service users and relatives in what is a difficult area of work. The service provides specialist-nursing care, and the home is well equipped with a wide variety of equipment, hoists bathing aids etc to maximise comfort and choice for people who live there. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 6 The staff have a range of qualifications and experience. A good ratio of qualified nursing staff is available to deal with the complex medical needs of service users. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 7 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.V279890.R01.S.doc Version 5.1 Page 8 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): 2 A comprehensive assessment is completed by qualified and competent staff, prior to admission. This is reviewed and updated in the first six weeks. The service users who are admitted to the ‘Gardens’ have high health needs, and these are well detailed to provide sufficient guidance for staff. Greater information regarding social and education needs is required. EVIDENCE: The service has a referrals and admissions policy. This ensures that the staff have sufficient information prior to admission. There is a guide, which is available to perspective service users, which explains the service and what is offered. Many of the people living in the home have varied and complex needs, including a group of people with learning difficulties. The guide would benefit from being made more user friendly, with greater pictorial input. The inspectors looked at several recent assessments prior to admission, and were able to see that the format had been completed and updated. Service users had also had the opportunity for trial visits. The service is registered to meet the needs of service users from different and varied groups. One person was admitted due to terminal illness, whilst another group of admissions were young people who had previously been based in a residential school and now required continued health support in adulthood. The assessment is very detailed with regard to health needs and the care to be provided, but limited when setting out possible social needs and how the service will meet them. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 9 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): 6&9 The manager has actively been working with staff to improve and develop the old care plans, which were very much based on a medical module. There is a new format but further work is required. EVIDENCE: On the day of inspection a random section of care plans were looked at from service users based on both the two floors. The service is divided up into different sections providing care for a range of people with high, complex needs. Some care plans had been fully updated and reviewed and were seen to be good working documents. Others were incomplete, with some sections having not been filled in. One care plan reviewed did not appear to have been updated since 2004 and in this period the service user had improved but then their health had further deteriorated. Several care plans were observed having been left out, with no apparent staff using them. Care plans seen were in the main not signed by service users and there appeared limited consultation. NHS PCT continuing care reviews were regularly occurring, and some adaptation to the care plans had been made as a direct result of the outcome of the review. The service needs to improve overall The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 10 consistency in working, and demonstrate more clearly how they involve service users with complex needs in making choices about the care provided. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 11 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): 15,16 and 17 Service users are able to access community based activities with support. There is no restriction on when family and friends visit, and with agreement some service users go home for short breaks. Service users stated the food offered was generally good but there were some issues relating to the length of time it remained in the food trolley. EVIDENCE: The inspectors observed a range of activities being offered inside the home for service users to join in. There is a group of people with learning difficulties who live at the ‘Gardens’ they receive adult education provided by the “Bridge project”. The activities were specially adapted to enable adults with both physical and learning difficulties to join in. This group of young people will require on going continued care throughout their life. It is very important that if these service users are to remain permanently at the Gardens that specialist support is provided, and that their needs are reassessed at regular intervals to ensure continued development. There is also concern relating to how the present members of staff are able to communicate with these service users. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 12 From my discussion with staff none were able to use Makaton signing, or devise communication boards. This must be addressed. The new menu system, which was introduced prior to the last inspection, is now running smoothly. Service users spoken to said the food was ‘very nice’, and most seemed to remember what they had ordered. This previously had been a problem as service users were making their choice of meals a week in advance. Meals are prepared in the main kitchen of the Rivers Hospital, and then brought across in heated food trolleys. On the day of inspection the food was observed to be stored in the trolley for a period of 30 minutes prior to being served. This practice could be problematic, particularly in hot weather. However feedback from service users when asked was that the food was hot and enjoyable. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 13 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 and 20 Interaction between staff and service users appeared very positive. Staff must however give greater consideration to service users dignity when undertaking personal and medical care. Monitoring systems are in place to record the needs of service users but greater consistency in recording is required. The procedures for storing and managing medication are generally satisfactory but some errors were found which could be addressed by regular auditing. EVIDENCE: Some care plans viewed lacked essential information regarding service users ongoing medical needs and the level of care required. Charts seen relating to pressure sore management were a further example where recording was inconsistent. The service appears to rely on communication within the staff team rather than the clarity of recording. The manager was advised of the above and reported that she is working with the team to improve overall recording in the home. The inspector observed several service users receiving personal and medical care. This was being provided with their bedroom doors open. Staff must consider the necessity for this and ensure that people’s personal dignity is respected at all times. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 14 The service provides care for service users with a high level of need, the administration of medication is therefore often complex and varied. On the day of inspection several errors in recording were found. Several boxes of medication were not dated when opened and as MAR (medication administration records) sheets were started on the day it was difficult to check if medication had been administrated as prescribed. Regular auditing had not been completed, furthermore restricting safe monitoring practices. There were also found to be inaccuracies in the recording of PRN medication. It was difficult to ascertain if one of two tablets had been administrated, as the total had not been carried over correctly from the previous MAR sheet. The manager advised that night staff would be completing the auditing of medication and she would discuss the concerns raised and endeavour to improve on the present outcome. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 15 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 and 23 The company has a clear procedure for the investigation and monitoring of complaints. The policies and procedures are satisfactory. EVIDENCE: Some service users were aware of the complaints procedures and said that staff did listen to their concerns, others were severely disabled and would be unable to articulate their concerns and would be very much reliant on family or advocates to raise concerns on their behalf. The manager reported that regular forums for carers are held, but not always as well attended as she would have hoped. Minutes were viewed and actions from discussions were followed up. Records regarding complaints were viewed and seen to be unclear. Dates relating to review and subsequent action were not apparent. This appears to relate to the format rather then actual practice. The policies and procedures regarding service users money and financial affairs are managed effectively and efficiently. Records viewed clearly showed money spent, the purpose and how each person was invoiced. The finances are managed by the central office, and not within the two homes. There is a ‘pocket money’ book, which allows service users freedom to buy personal items from the Tuck shop. Those who are unable to manage their own finances are able to buy things, and families are invoiced. The system works well and actively allows service users to chose things they would like to buy. Staff also provide sufficient support for people to shop in the community, making a trip enjoyable. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 16 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): 24 and 30 The home has two floors providing care to a large number of service users who require equipment and adaptations, to allow comfortable and sufficient care on a daily basis. The environment is clean and tidy, but gives a clinical rather then homely impression. Service users would need to be organised into smaller groups, with staff and facilities separate to each group to achieve this. EVIDENCE: Maintance work is being undertaken within the home, the manager confirmed that since the last inspection flooring had been replaced outside the lift area and the stairwells. There is no plan for re decoration of the bathrooms. The nature of the provision means that the building is extensively used all the time and therefore the service requires a revolving plan of continued refurbishment. Without this the necessary finances cannot be successfully utilised and therefore there will always be parts of the building, which require attention with no timescale for action. All health and safety checks were found to be up to date. This included fire, and electrical fittings. The manager has introduced an audit to ensure that items are regularly checked and maintained. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 17 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): 31,32,34 and 35 Service users spoke highly of staff and were complementary about the care they received. Staffing levels are adequate, but could be better. Recruitment policies and practices are robust and efficient. EVIDENCE: The staff that work in the home appear committed to providing a service of a good standard which meets service users needs; this was evident from those interviewed. There are however several on going issues, firstly consistency of care is variable as staff are allocated to work on different floors. This obviously has a significant effect on the quality of care. Service users with such complex needs, find difficulty in communicating and require stability. The second is that a good percentage of staff interviewed reported a shortage of staff, especially since December. The staffing rotas showed that staffing levels have been maintained of both care, and qualified nursing staff. Experienced agency staff supplements the permanent team when necessary. On the day of inspection there were 9 staff on duty in the Morning, 6 in the afternoon (2pm to 8pm) and then 4 night staff. This was to care for 28 service users. Senior staff explained that shifts were managed well and therefore service users were allocated the time they require, but this was not expressed overall and the afternoon shift certainly lacked numbers of staff to allow for any creative working. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 18 Induction for new staff working in the home is very good. New staff are offered a programme of induction training. There is also a ‘buddy’ system, which works well. New staff are allocated to more experienced staff until they feel confident to do the job independently. Staff also commented that the new manager actively encourages members of the management team to complete daily checks. This staff felt very positive about. Recruitment documentation was seen to be accurate and files were in good order. All necessary checks for references, and CRB’s had been completed. There were no concerns on the day of inspection and service users are protected by the services policies and procedures in the employment of new staff. The service offers good opportunities for staff development and training. Several staff was considering starting their nursing training, and other junior care staff were working towards N.V.Q in care. There was however no apparent discussion relating to specialist training in working with the group of people with learning disability. This group of people are young and it is likely that this will be their home for the foreseeable future. LDAF training (Learning disability accredited framework) or similar should be offered has part of induction, and also on going N.V.Q assessment and training. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 19 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): 37,39,41 and 42 The manager is committed and to providing a service of a good standard, and appeared ‘open’ and supportive to staff. Two immediate requirements were made regarding the storage of oxygen, and COSHH products. EVIDENCE: The manager has now completed her probationary period, but has yet to sbmit an application to register as manager. She assured the inspectors that this was in the process of completion. The manager clearly appears to be making positives changes in the home, and is working actively to meet the needs of service users. The new care plan system is a significant part of this and although the work has been started, it is not in place for all service users. This undoubtedly promotes inconsistency in care and regular verbal discussions cannot be a replacement for a written agreed plan, which is regularly reviewed. The service clearly has policies and procedures regarding the safe keeping of COSHH products, but staff not following these diligently. Inspectors found The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 20 descalers, dishwasher detergent and various medical crèmes and applicators left out with no staff apparently using them, or returning to put them away. The manager must stress the possible dangers to service users to members of the staff team and actively encourage a change in working practices. A previous requirement was made regarding the need for signs to be erected in the area where oxygen is stored. Inspectors were disappointed to find that that this had not happened and an immediate requirement was made at the inspection. It has been reported that the manager has now corrected this. The manager has begun to ensure that the environment is maintained to a satisfactory level but must clearly demonstrate that redecoration and refurbishment is a continuous process. This will ensure that service users live in a comfortable and homely way as far as is possible within the present design of the building. Work has been undertaken on the recording of complaints. The manager clearly demonstrated that she encourages service users to make complaints and ensures that they are listened to. However the documentation does not clearly show how the complaint was effectively dealt with in the set timescales. Letters were sent to service users and carers advising of the outcome of the complaint, which is good practice. This was not easily seen in the recording process and was spotted by asking for the outcome, and copies of letters being provided. This recording system needs to be reviewed. The manager has developed a system to ensure that all staff receive supervision, there are also regular team meetings. Staff interviewed also remarked on how supportive she is and willing to listen. This is a good basis to build a strong team, which provides a high standard of care in a working environment, which can be very demanding. The service would benefit from a higher ratio of staff, especially regarding the necessary care provided to the adults with a learning disability. The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 21 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 Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 2 2 x 2 2 x The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 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 YA6 Regulation 15 (2) Requirement The new care planning system must be implemented to ensure all service users needs are being meet. (Carried forward from the previous inspection) The manager must involve advocacy services for the adults with learning difficulties who have limited communication skills. The new care planning system must be implemented to ensure needs are being meet; including how service users communicate / express their wishes/needs. Clear records of complaints must be held in the home, with actions and all documentation available. (Carried forward from the previous inspection) The manager must ensure that there is an up to date maintance and re redecoration plan, including refurbishment of the bathrooms. Records to be kept on work carried out. Timescale for action 03/04/06 2. YA7 12 (2)(3) 31/03/06 3. YA19 12 (3) 03/04/06 4. YA22 22 31/03/06 5. YA24 23 (2) (b) & (d) 28/02/06 6. YA35 18(1)(c)(i) The manager must ensure that staff working with adults with DS0000019570.V279890.R01.S.doc 03/04/06 The Gardens Nursing Home Version 5.1 Page 23 7. YA20 13(2) 8. YA42 13(4) 9. YA42 13(4) learning disabilities have accredited training. A medication audit system must be put in place to ensure that discrepancies are investigated and corrected. The manager must ensure as far as reasonably practicable the health, safety and welfare of service users and staff. An oxygen sign must be erected in the area where oxygen is stored. An Immediate requirement was made. All COSHH products must be stored in a locked cupboard, and be put away once used. An Immediate requirement was made. 28/02/06 23/01/06 23/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gardens Nursing Home DS0000019570.V279890.R01.S.doc Version 5.1 Page 24 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. 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