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Inspection on 20/04/05 for Throckley Nursing & Residential Home

Also see our care home review for Throckley Nursing & Residential Home for more information

This inspection was carried out on 20th April 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

There is a stable core staff team who have worked at the home for many years. They are keen to raise standards and try to give consistent care as needed by each resident. Residents said they are well looked after and they get every thing they ask for. They were happy with the range of activities provided and looked forward to getting out and about in the mini bus. Two residents looked forward to the weekly visit by the artist and enjoyed painting. There is a four weekly varied menu offering choices and variety. Residents said that the meals were nice and special diets are catered for. Residents and visitors said they knew how to complaint and were happy that any concerns were dealt with well.

What has improved since the last inspection?

The decoration and refurbishment of the home has improved greatly since the last inspection. The communal areas have been redecorated, provided with new curtains and lounge furniture. Many of the bedrooms have been redecorated, refurnished and recarpeted. Hot water problems have been remedied and action taken to reduce the risk of scalding. Moving and handling methods and the examination of lifting equipment have been improved and a record is now kept of checks. Laundry equipment is now in working order and the treatment room floor has been replaced. Qualified nursing levels have been improved and the home rarely uses agency nurses.

What the care home could do better:

Redecoration and refurbishment of the whole home must continue as agreed. Extra time has been given for some improvements to be made. These include replacing flooring and reviewing bathing arrangements and the use of bathing facilities. How staff are used at mealtimes could be improved and snacks should always be available. To help prevent the spread of infection, liquid soap and paper towels could be put in residents` rooms. Staff should wash their hands often, especially after handling commodes. Bins should be stored securely and safely at all times. To promote fire safety staff should follow fire procedures. Nursing records must be dated and signed.

CARE HOMES FOR OLDER PEOPLE Throckley Nursing & Residential Home Ponteland Road Throckley Newcastle upon Tyne NE15 9EP Lead Inspector Irene Bowater Unannounced 20 April 2005 08:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Throckley Nursing & Residential Home Address Ponteland Road Throckley Newcastle upon Tyne NE15 9EP 0191 267 5655 0191 229 1119 throckleygrange@highfield-care.com Highfield Home Properties Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Elizabeth Ann Brennan CRH 50 Category(ies) of OP - Old Age (50) registration, with number of places Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 25th November 2004 Brief Description of the Service: The home is purpose built and located in the centre of Throckley. It is close to all local amenities and is on a local bus route. The home caters for up to 50 older persons and has a maximum of 35 nursing care beds. There are spacious communal areas, dining rooms,separate smoking lounge and a passenger lift services all areas. The home has 44 single bedrooms and 3 companion rooms,including 3 with ensuite facilities. The home has assisted bathing facilities situated close to residents bedrooms. Externally there are accessible gardens, patio areas and car parking is available. The home has access to a shared mini bus for outings. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 6 hours. The last inspection was carried out following an anonymous complaint and resulted in action being taken by the Health and Safety Executive and the Commission for Social Care Inspection. Action was taken to meet immediate requirements and this inspection focused on the other areas that required attention as well as the quality of life experienced by the residents. The home was toured and eight staff, fifteen residents and two visitors were spoken with throughout the day. Various records were also inspected. What the service does well: What has improved since the last inspection? The decoration and refurbishment of the home has improved greatly since the last inspection. The communal areas have been redecorated, provided with new curtains and lounge furniture. Many of the bedrooms have been redecorated, refurnished and recarpeted. Hot water problems have been remedied and action taken to reduce the risk of scalding. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 6 Moving and handling methods and the examination of lifting equipment have been improved and a record is now kept of checks. Laundry equipment is now in working order and the treatment room floor has been replaced. Qualified nursing levels have been improved and the home rarely uses agency nurses. 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. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5. The admission procedure is comprehensive and follows assessments by Care Managers and the Home uses nursing assessment tools. The care plans and the documents inspected showed that individual resident’s care needs will be met. EVIDENCE: Individual records and care plans are available for each resident that moves into the home. The records inspected showed that they have detailed assessments carried out by a Care Manager and the Home Manager. The Home Manager confirmed that visits are carried out at the hospital or the resident’s home if required. The residents spoken with said that they and their representatives were fully involved in the admission process and were able to visit before making any decision to move into the home. The staff spoken to were able to describe the individual needs of the residents. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 10 There is a clear, consistent care planning process that provides the staff with the information required to meet resident’s needs. The staff have a good understanding of the support resident’s require. Positive relationships have been formed between the staff and residents. EVIDENCE: Each resident has an individual plan of care, which is based on the admission assessment. The care plans inspected were generally completed to a good standard. There was evidence that relevant risk assessments are available for the prevention of falls, nutrition, pressure sore and wound care, moving and assisting, catheter care, continence promotion and mental health status. The care plans showed that six monthly reviews are carried out with residents and their representatives. Residents have access to all NHS facilities and services as required. GP cover is provided from three surgeries and one GP visits the home on a weekly basis. The district nursing service provides nursing care for the residents receiving personal and social care. Although the staff record significant and daily events in the care plans there were shortfalls in dating and signing individual plans. Throughout the inspection staff were observed to assist residents in a professional friendly manner. The residents spoken with all spoke very highly Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 10 of the staff. One resident who was poorly in bed was able to say that he was comfortable, felt safe and well cared for. Fluid and turning charts were in use and these were well recorded and presented. Staff were able to discuss residents individual needs, preferences and abilities and the relationships were based on respect and trust. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 standard(s) 12, 14, 15. Social and recreational interests of individual residents provide variation and choices. The food provision is good, offering choice, variety and the home provides catering for special dietary needs. EVIDENCE: A number of residents were spoken with and everyone commented on the content of all meals and said they were offered choices. There were choices of a cooked or continental breakfast and the lunch meal consisted of three courses. All of the meals were well presented and of ample portion size. The menus were balanced and special dietary needs are catered for. The staff served both breakfast, lunch and snacks in the area chosen by residents. Several resident’s remained in their rooms; some had their meals in the lounge and others in the dining rooms. There were jugs of cold drinks and fresh fruit available in the lounges, these were regularly offered to the residents. There was a choice of mid morning drinks and fortified drinks were also provided. One resident was waiting for breakfast at 9 am. He had refused supper the previous evening because it was too late and therefore he had had nothing to eat since 4pm. Several of the residents needed full assistance of the staff to eat their meals. and two members of staff were designated to ensure that the residents ate Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 12 sufficient food and had a drink. It was observed that this routine continues to cause some difficulty for the staff given the numbers of residents who need assistance. The home has a dedicated activities person who organises events according to the resident’s wishes. There is relevant information about the home’s activities and events, which was extremely well presented on the notice boards that were colourful and enjoyable to read. The home has access to a Company mini-bus and residents said they had enjoyed trips out for shopping and a visit to the coast. Residents were looking forward to a visit by an artist who visits the home weekly. Some of the resident’s artwork was available in the home. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 standard(s) 16, 18 All complaints are dealt with appropriately. Residents and their representatives are aware of how and to whom they can make complaints. The staff have received training and have understanding of Protection of Vulnerable Adult procedures, which protects residents from possible harm. EVIDENCE: The complaints policies and procedures are readily available in the home and are given to residents on admission. The records show that four complaints have been received at home level. These have been actioned within twentyeight days and to the complainant’s satisfaction. Residents spoken with said they are able to voice their concerns about the service and the staff always listen and respond. One relative said that the staff resolves any concerns as soon as possible. One complaint received by CSCI has been investigated and requirements made are being actioned within specified timescales. Many of the residents were spoken to throughout the inspection. The universal and only complaint offered was relating to the bathing arrangements in the home. The training records show that thirty-nine staff have received Protection of Vulnerable Adults training via Future Strategies based at Gateshead College. The staff spoken with were able to discuss the action they would take should there be any suspicion or allegation of abuse. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,24,26. Improvements have been made with the decoration and maintenance of the home. As a result of outstanding issues, residents are not provided with safe surroundings or appropriate bathing facilities. The home is clean, pleasant and fresh. EVIDENCE: Following the last inspection requirements were made regarding the maintenance, renewal and redecoration of the home, including timescales. The Health and Safety Inspectorate also made requirements following an inspection. There was evidence that the home continues to comply with the previous requirements and many areas that required attention are now well presented and comfortable. Several of the bedrooms have new carpets, flooring has been replaced in the treatment room, the boiler has been replaced and thermometers are available and used in bathrooms. The communal areas and corridors in the home have been decorated and furnished to a high standard and a selection of new lounge chairs were delivered on the day of the inspection Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 15 A tour of the building identified the following: Redecoration of wall damage is needed in some rooms. There is damage and wear beneath soap dispensers and the boxing in communal toilets. The sluice rooms have damaged and worm areas to the shelving and wooden surfaces. There is no provision of liquid hand soap and paper towels in resident rooms to protect both staff and residents from infection. The management of used commode buckets that have to be emptied down an open hopper and hand cleaned prior to using the sluice machine is also an infection risk. Most of the bedding was good quality but very thin bed sheets were in use on some of the beds. The flooring in communal toilet 14 was badly split. The carpets in the lounge have shrunk and the carpet grips are exposed at the edges. The ground floor lounge carpet was very badly split, fraying and lifting. Staples and tape have been used in attempts at repair. Carpets in several bedrooms still have to be replaced following the requirements of the last inspection report. At least ten bedrooms have had replacements carpets since the last inspection. The laundry was clean and tidy and all the machines are in working order. The flooring in the laundry is starting to lift and break up. The kitchen flooring is still uneven, split and difficult to clean. High standards of cleanliness were being maintained. All areas were tidy and fresh smelling and the resident’s bedrooms personalised and welcoming. The inspector met with the care staff and several residents. They all confirmed that the only assisted bath, located on the middle floor, is used for the majority of baths in the whole home and this causes severe problems and inconvenience for them all on a daily basis. The resident’ said they did not like the portable bathing slings and they could not use the wheel in shower as there was a lip at the edge which made it difficult to get into. The staff were confident and well informed and their concern for resident safety well being and rights was a clear priority. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30. The staffing levels are adequate to meet the current needs of the residents. The deployment of staff at mealtimes requires reviewing. The home benefits from a stable core team who work in a positive manner to provide a quality service. The home has training and development programme, which is audited, to ensure staff are suitably trained to meet service users assessed needs. EVIDENCE: Since the last inspection the home has recruited over seas qualified nurses’, which appears to have resolved some of the qualified staffing problems in the home. There have been instances where the home has been short staffed due to carer’s absence and sickness and the Home Manager has endeavoured to source agency staff. The Home Manager confirmed that the recruitment of staff is ongoing. On the day of inspection staffing levels were: 2 Qualified Nurses from 8am to 9pm 1 Qualified Nurse 9pm to 8am. 7 Care staff from 8am to 2pm 5 Care staff from 2pm to 4pm 6 Care staff from 4pm to 9pm 4 Care staff from 9pm to 8am. The Home employs adequate ancillary staff including an Activities Coordinator, Maintenance Person, Chef, kitchen assistants, domestics, laundry and an Administrator. The Home Manager usually is supernumerary and a Deputy Manager supports her. The home benefits from a core staff team who have been employed at the home for some considerable time. The Home has staff deployed over three floors and there remains a concern which has been identified in previous inspections regarding the staffing levels at mealtimes, given the number of residents who require full assistance to eat Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 17 their meals. The lunch meal for these residents remains disjointed. Four staff personnel and training records were inspected and found to contain evidence of induction and ongoing training for all grades of staff. Staff receive statutory training and other training includes Palliative Care, Abuse, Continence Care, Eye Care and NVQ training. The Home has a Training and Development programme which is audited on a yearly basis to assess its’ effectiveness. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36,38. The home is run in the best interests of the residents. The staff have regular supervision, which ensures they are trained and are given clear direction to improve standards. There continues to be issues in the maintenance of the building that pose potential hazards to health and safety. EVIDENCE: The Home has regular meetings with residents and relatives. The residents and relatives spoken with said that their views are taken into account and the Home Manager is always available should they wish to discuss any issue. The Manager is to introduce a Resident and Relative Surgery on a monthly basis. Information about this is displayed in the home. There are regular staff meetings to discuss all aspects of care and service provision. Minutes of all meetings are available with actions and outcomes recorded. The staff files showed that all staff have supervision at least six times a year, Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 19 which covers all aspects of practice, training and future needs. Records show that staff have a yearly appraisal. Old items of furniture such as armchairs and nursing equipment that were awaiting removal were being stored outside and obstructing fire doors. An internal fire door opposite room 38 was also obstructed by furniture. The outside household refuse bin’s were full and open with additional rubbish on the floor. The clinical waste bins were also full and not locked. The records for health and safety maintenance in the home were inspected and found to be up to date and signed. These included checks for hoists, slings, bed rails and window restrictors. Contract service certificates were available and up to date. There is a fire risk assessment, which is up dated yearly, and the staff have completed all mandatory training to safeguard the residents, and all other visitor’s to the home as far as possible. Accident recording is comprehensive with evidence of action and outcomes recorded. The Home Manager collates all incidents and accidents that occur in the home to assess trends and prevent further falls. There remains a tripping and falls risk due to the identified rippled and damaged carpets. The carpets were identified at the last inspection and a programme of renewal has been implemented. Care staff were noted to be wearing large items of jewellery and wristwatches. This will not allow the staff to wash their hands properly and creates a risk of injury the resident’s skin. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x 1 x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x 3 x 2 Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 21 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. 2. Standard 7 15 Regulation 15 12,16 Requirement Ensure all recordings in the care plans are dated and signed by the author. Review the staffing levels and practices at mealtimes for residents who require assistance. This is outstanding from 1st November 2004. Replace worn torn carpets to ensure the health and safety of residents as part as the ongoing refurbishment programme. This is an outsatnding requirement. Review the bathing practices in the home to ensure all the facilities,including the shower room are operational to meet residents needs. Continue to replace worn,torn, threadbare carpets. This is an outstanding requirement. Redecorate rooms where there is wall damage. Replace thin bed linen. Repair the damage to walls and shelving in the sluice. Timescale for action 1st August 2005. 1st August 2005. 3. 4. 19 13, 23 1st December 2005. 5. 21 23 1st August 2005. 6. 24 16,23 1st December 2005 7. 26 13,23 1st September Page 22 Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 8. 9. 27 38 18 13,23 10. 38 13,16,23 11. 38 13 Review the practices of cleaning the soiled commode pots. Repair the laundry floor . Ensure there are adequete staff available at all times to meet the needs of the residents. Replace or repair the kitchen flooring.Make good the metal trim to prevent tripping hazards in the kitchen. This is an outstanding requirement. Ensure all fire exits are clear at all times. Enusre the houdehold waste and clinical waste storage areas are always secure. Review the practices and understanding regarding hand washing and the prevention of infection. 1st September 2005. 1st August 2005 1st August 2005 20th April 2005 1st August 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 26 Good Practice Recommendations It is highly recommended that liquid soap and paper towels are provided in residents rooms. Throckley Nursing & Residential Home B53-B03 S40481 Throckley Nsg Res V220953 200405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington, Northumberland NE23 6UR 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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