CARE HOMES FOR OLDER PEOPLE
Trowbridge Oaks Nursing Home West Ashton Road Trowbridge Wiltshire BA14 6DW Lead Inspector
Susie Stratton Unannounced Inspection 10:00 7 December 2005
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Trowbridge Oaks Nursing Home Address West Ashton Road Trowbridge Wiltshire BA14 6DW 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) 01225 - 774492 01225 - 776965 BUPA Care Homes (CFC Homes) Limited Keeley Simpson Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (8), Terminally ill (5), of places Terminally ill over 65 years of age (5) Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The staffing levels set out in the Notice of Decision dated 16 June 2003 must be met at all times No more than 5 service users with a terminal illness may be accommodated at any one time 24th May 2005 Date of last inspection Brief Description of the Service: Trowbridge Oaks is registered to provide nursing and personal care for 60 people. At the time of the inspection, there were 59 persons resident in the home. The home is owned by BUPA, a national provider of care homes. Mrs Keeley Simpson is the manager, she is supported by a deputy, a team of registered nurses, care assistants, administrator, activities coordinator and ancillary staff. The home was purpose built, providing many single rooms with en-suite facilities and a variety of different sitting and dining areas, on two floors. The home benefits from pleasant surrounding grounds and a patio area, which is easily accessible for residents. Car parking is available on site. There is a bus stop close to the entrance. The centre of the Wiltshire market town of Trowbridge is a short ride away. Trowbridge has a railway station and the M4 can be reached in about 30 minutes. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Wednesday 7th December 2005 between 9:35am and 3:15pm, in the presence of the deputy manager. During the inspection, the Inspector met with ten residents, observed care for seventeen residents who were not able to communicate, observed two large group activities and a lunchtime meal. The Inspector met with three registered nurses, four carers, the laundress, the chef, the activities coordinator and the administrator. During the inspection, the Inspector toured the home and reviewed, among others, records relating to fourteen residents, three newly appointed staff, training records, supervision records, the fire log book and the complaints book. What the service does well: What has improved since the last inspection?
Three requirements were identified at the previous inspection, all had been met by this inspection. Seven recommendations were made, six of these had been addressed. A copy of the summary of the inspection report is now included in all service users’ guides. All residents assessed as being at risk of falls have a care plan in place to direct staff on how to manage the risk. Where medicines administration records need to be completed by hand, these have been signed and verified by a second person. Falls risk assessments now include an assessment of the resident’s footwear. Care plans for residents with diabetes include precise terminology to describe
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 6 how their diabetic care needs are to be met. Residents’ wishes in the event of their sudden collapse are documented. Concerns are monitored as part of the complaints audit. A policy and procedure on taking residents out of the home has been developed. 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. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 4: The home does not provide intermediate care. Residents are given full information about the services provided by the home. The home demonstrates that it can meet the needs of residents in the home. EVIDENCE: Trowbridge Oaks has a comprehensive service users’ guide, a copy of which is available in each resident’s bedroom. The guide includes all relevant information, including a copy of the summary of the most recent inspection report. Discussions with residents, staff, observations of care and reviews of records showed that the home were able to meet the nursing and care needs of residents in the home. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Residents are protected by regular assessments and care plans. Residents need to have their bowel habits monitored properly, to ensure that their individual needs are being met. The home has safe systems in place for management of medicines, however the home needs to provide adequate information for nurses dispensing drugs and adequate storage is needed for certain categories of drugs. Residents needs for privacy and dignity are met, however the home does not have effective systems to prevent communal use of certain clothing. EVIDENCE: All residents have detailed assessments and care plans in place. All nursing and care needs are regularly assessed and care plans evaluated as residents’ needs change. The home have delegated responsibilities for completing documentation on daily care and some evaluations to senior care staff. Care plans are clear and avoid judgemental language. Where residents are assessed as being at risk of falls, care plans are in place to direct staff on how residents are to be protected from risk. All resident have manual handling care plans, these are regularly evaluated and direct care.
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 10 Care plans do not include an assessment of need for variable height beds (see standard 22 below). One resident said how competent the staff were at moving them with a hoist. Several residents had been assessed as being at risk of constipation, however their daily records had not been consistently completed to show if care plans had been effective, this is particularly important as many of the residents would not be able to inform staff accuracy of their bowel movements. Constipation can affect the general health of frail residents. The home needs to improve its consistency in approach to some areas of care planning. Residents who are assessed as being at risk of pressure damage generally have care plans in place, however this is not consistently applied and while 12 of the 14 resident notes reviewed showed detailed care plans, two did not. Many of the residents in the home had additional mental health care needs, the majority of these had clear care plans in place directing staff on how these needs to be met, however one resident with mental health care needs did not. Some of the residents were very frail and nursed in bed most or all of the time. Such residents looked comfortable, with clean fingernails, hands and nightwear. Care provision is monitored by the use of frequent care charts, all of which were fully completed, to provide evidence that residents were turned and offered fluids and meals regularly. Some residents or their relatives have expressed wishes in the event of sudden illness or collapse, one did not have this signed by the resident/relative or their GP. Such residents may benefit from the drawing up of end of life care plans with them or their relative, to ensure that all their personal wishes at the end of their lives are respected. Medicines are safely stored and all required records kept. Larger Controlled Drugs cupboards have still not been provided, despite this being recommended for the previous two inspections. This is of concern as if a resident is admitted or prescribed large amounts of such drugs, there would not be space in the cupboard to safely store all the drugs. Action needs to be taken to address this recommendation. The home has only one medicines refrigerator, again this was very full and the home would find difficulty in properly storing medicines which need cold storage if any further residents are admitted with or prescribed such drugs. The British National Formulary on the first floor is over a year out of date and needs to be replaced, so that registered nurses can be properly advised of the action of drugs. The home has put system in place for the disposal of medicines in accordance with current legislation, it is recommended that all registered nurses are trained in the new systems as some registered nurses appeared not to be fully aware of all the new systems. All staff were observed to knock on residents’ room doors prior to entry. Residents were called by their own preferred names. It was observed that whenever residents were being bathed, that a sign was placed on the
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 11 bathroom door to show that it was occupied. One resident whose first language was not English, had communication cards provided to staff to assist them in communicating with the resident. Another resident had a communication whiteboard, which they used effectively. One carer was observed to go into the room of a very frail resident, although the resident did not show any signs that they could communicate, the carer went up to them first called them by their name and chatted before getting on with providing care. The laundress had clear systems to ensure that residents’ clothes are returned to them. There appears to be some confusion in relation to net underwear, while the deputy manager reported that it is the home’s policy to dispose of all net underwear after use, some items were observed in the laundry, these are washed and returned to a central store for communal use. This must be discontinued and the home’s policy applied to prevent communal use of clothing. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 A comprehensive activities programme, which resident said they enjoyed, is available. Visitors and trips out of the home are encouraged. Residents are able to choose how their spend their days. Meals are a social occasion and staff are responsive to individual resident needs. EVIDENCE: Trowbridge Oaks offers an extensive activities programme. One resident said “I’ve got so much to do here.” Another commented on how many interesting people they had met in the lounge and another said that the activities coordinator “tries hard at everything he does.” Events which had been planned prior to Christmas were on display in the hallway and many resident knew about the programme and what they wanted to attend. During the afternoon, the activities organiser was supporting the residents in decorating the large Christmas tree in the lounge, this was followed by mulled wine and mince pies. The activities organiser ensured that all residents who wanted to were involved in the activity. Where residents do not wish to or are unable to leave their rooms, the activities coordinator visits them. Full records of activities participated in by residents are maintained. Residents are supported in going out of the home. One resident said that they regularly went out to the local church. Another has been taken out to plays
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 13 and concerts in the local theatre. Visitors are encouraged and the visitors book showed that visitors regularly came into the home. On resident said that they liked how their family could come and visit whenever they liked. Some visitors were helping the activities coordinator dress the Christmas tree. One resident who was admitted for respite care in the afternoon was accompanied and staff greeted them both with an atmosphere of welcoming an old friend. Residents said that it was up to them when they got up and went to bed. One resident said that they liked to go to bed after 11:00 pm and that this was respected. This was also documented in their care plan. One resident said that they had never liked mixing and appreciated that staff did not try and make them join in with activities. Residents are enabled to bring in items of their own and some rooms looked very personal, reflecting the resident’s likes and preferences. Meals are seen as a social occasion, with residents sitting at tables together and chatting with each other. The chef serves the meals so that she can see what residents want to eat, discuss the meals with them and respond to individual needs. A range of drinks including wines, beers and spirits are available to residents at mealtimes. Two residents described the meals as “excellent”, one said the meals were “well cooked” with a “good variety” and another said “I look forward to my meals.” Where residents need to be assisted to take their meals, staff sit with them. One member of staff was observed to be carefully feeding a resident in bed, without rushing and letting them continue to watch their television, while they concentrated on ensuring that the resident ate all they wanted to. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Trowbridge Oaks have a complaints procedure, which functions in practice. There are systems in place to ensure that vulnerable adults are protected from abuse. EVIDENCE: A complaints procedure is displayed and is also included in the service users’ guide. Complaints records are maintained centrally and reviewed monthly. Those reviewed showed that the home investigated complaints using their policies and procedures. Residents said that they knew how to bring up issues of concern. One said “If anything bothers me, I get hold of them.” Another said that they had discussed a certain matter with the manager, who had investigated the issue and set up a monitoring system. Several said that they would inform of the registered nurse of any concerns when they brought them their pills and others said that they would tell the “Matron”. The home’s file shows that they have worked within local vulnerable adults procedures and have good working relationships with local multi-agency teams, to ensure that vulnerable adults are protected. Where resident needs restraints such as safety rails, this is regularly evaluated. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 Trowbridge Oaks provides an environment which meets the needs of its residents. It is well-maintained, clean and provides comfortable furniture and equipment, to give residents a homely setting in which to live. The home does not have enough electrically operated variable height beds to meet the needs of all residents with complex manual handling care needs, so both residents and staff could be put at risk. EVIDENCE: Trowbridge Oaks is well maintained. The home was purpose-built as a care home, all bedrooms have en-suite facilities and a range of baths and showers are available. There are two sitting rooms on the first floor, a dining room and sitting room on the ground floor and a patio garden area. Some residents also like to sit in the front entrance hall. All communal areas are warm, comfortable and welcoming. The kitchen is also small but staff are used to working within the environment and manage the space available effectively.
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 16 The laundry is also cramped, the laundress has organised her working environment well to maximise the working space available. There are a range of bathrooms and showers which are suitable for disabled persons. Equipment such as hoist and pressure relieving mattresses are provided. It was noted that two of the dials on pressure relieving mattresses were not set at the correct level for the resident’s weight and the home should regularly monitor this to prevent risk of pressure damage to resident. As noted in standard 7 above, residents are assessed for manual handling needs, however the assessment does not include an assessment for variable height beds. The home does have some electrically operated variable height beds, some foot-pedal variable height beds and some static variable height beds, but not enough to meet the needs of all residents with complex manual handling care needs. In order to meet the needs of residents with such needs, an audit of residents with complex manual handling care needs must take place and an action plan submitted to the Commission detailing when all residents who have complex manual handling care needs will be provided with foot-pedal or electrically operating variable height beds. All residents had been left with access to their call bell and there is an electronic monitoring system for response times which is audited, to ensure that staff respond promptly when the call bell is used. All clinical waste was properly disposed of. There are clear systems for the management of potentially infected laundry, which the laundress reported that staff always complained with. There is an ample supply of gloves and dressing packs and the deputy manager reported that all wounds and other clinical procedures were carried out using aseptic technique. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 A full range of staff with a skill mix to meet service users’ needs are in post. There are safe systems for the recruitment of staff to ensure that residents are protected. Training in a wide range of areas to meet residents’ needs is supported to ensure that staff are competent to perform their roles. EVIDENCE: Trowbridge Oaks is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. A registered nurse manages each floor of the home, these nurses are supervised by the deputy manager, who is supported by the home manager. A range of senior care and care staff are in post. A full team of ancillary staff are employed, including domestic, catering, laundry and maintenance staff. An activities coordinator and an administrator support the home. Staff at all levels showed a sound knowledge of the needs of the service users they were caring for. There is a low turnover in staff at all levels. Standard recruitment systems are in place for all staff and all files examined showed evidence that the recruitment systems are consistently applied. Training records showed that a range of opportunities are offered to staff at all levels. NVQ training is supported by the providers and over 50 of staff are trained to NVQ 2 or above. Systems are in place to ensure that all staff receive mandatory training. Other opportunities such a catheter care and use of wound dressings which have recently been put on. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 & 38. The home’s manager is an experienced nurse and manager. Safe systems are in place for management of residents’ moneys. Staff are regularly supervised. Systems for ensuring health and safety are in place apart from procedures for oxygen cylinders, which would put residents and staff at risk. EVIDENCE: The manager was appointed by the provider in May 2005, she has since been assessed by the Commission in accordance with their “fit person” procedure. The manager is an experienced registered nurse and manager. The home uses an invoicing system for services such as hairdressing and chiropody, all accounts are regularly audited by qualified auditors. An induction and supervision system is in place. All newly employed staff work supernumerary for two to three days or more, according to their needs and past experience. There was evidence that staff are regularly supervised, however records of
Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 19 supervision are not maintained in full. Systems are in place to ensure the safety of residents and staff and there is regular training in all areas relating to health and safety. The fire log book is kept up to date and a contractor was reviewing fire safety systems at the time of the inspection. All hoists had been regularly serviced. Two residents were observed to have oxygen cylinders in their rooms, neither of them had required fire safety warning signs on their doors and the cylinders were not placed in carriers or chained, to prevent injury. Oxygen cylinders must not at any time be transported about the home, apart from in carriers. Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 2 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 3 x 2 Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12(1a) 17(1a) Requirement Timescale for action 31/01/06 2. OP9 3. 4. OP10 OP22 5. OP38 Where a service user has a care plan relating to bowel care needs, a record of their bowel movements must be maintained. 13(2) A copy of an up-to-date British National Formulary must be made available on both floors of the home. 12(3) Net underwear must not be used 16(2)(f) communally. 13(4c) (5) An audit of all service users with 23(2n) complex manual handling care needs must be carried out. An action plan must then be submitted to the Commission detailing when service users with complex care needs will be provided with foot-pedal or electrically operated variable height beds. 13(4,a,c) British Standard fire safety signs 23(4a) must always be used on room doors where oxygen is in use or stored. Oxygen cylinders must always be securely stored and transported about the home in oxygen cylinder carriers. 28/02/06 31/01/06 28/02/06 31/12/05 Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 22 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. Refer to Standard OP11 Good Practice Recommendations End of life care plans should be developed where indicated for service users. If this includes service users/relatives wishes in the event of sudden collapse, this should be signed by the service user/representative and their GP. Larger Controlled Drugs cupboards should be provided. (This is an unmet recommendation from the past two inspections. An additional drugs refrigerator should be provided. All registered nurses should be trained in the new systems for disposal of drugs. All electrically operated pressure relieving mattresses should be regularly checked to ensure that the pressure indicated on the dial relates to the service user’s weight. All staff supervisions should be documented. 2. 3. 4. 5. 6. OP9 OP9 OP9 OP22 OP36 Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Trowbridge Oaks Nursing Home DS0000015947.V266548.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
