Inspection on 20/06/05 for Willow Tree Nursing Home

This inspection was carried out on 20th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Willow Tree Nursing Home 11/08/09

Willow Tree Nursing Home 11/08/08

Willow Tree Nursing Home 12/09/07

Willow Tree Nursing Home 09/10/06

Willow Tree Nursing Home 18/10/05

Willow Tree Nursing Home 10/11/04

Willow Tree Nursing Home 06/05/04

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Maple Lodge

Heathlands

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Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Willow Tree Nursing Home 12 School Street Rugby Warwickshire CV21 4BW Lead Inspector Louise Thompson Unannounced 20 June 2005 09.30 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. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Willow Tree Nursing Home Address 12 School Street Hillmorton Rugby Warwickshire CV21 4BW 01788 574689 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) Culpepper Care Limited Carol Anne McCullough CRH Care Home 34 Category(ies) of OP Old age (34) registration, with number of places Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 10 November 2004 Brief Description of the Service: Willow Tree Nursing Home is registered to provide personal and nursing care for up to 34 service users in the category of old age, not falling within any other category.Willow Tree is a single storey establishment converted from a domestic bungalow and extended to include single and shared accommodation. There are two lounges and two dining rooms in the home. The communal areas of the home are situated at each end with bedroom accommodation integrated between them. All service user accommodation has an open outlook either onto the large garden or the inner courtyard.The home is staffed by a complement of qualified nursing staff and care assistants. The home is situated in a local suburb of Rugby and approximately 3 miles from the town centre. Willow Tree is close to local shops and a bus route. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and was unannounced. Limited progress has been made with the achievement of requirements made at the last inspection November 2004. A tour of the premises took place and staff files, care plans, and other records were inspected. Staff, residents visitors and other health and social care professionals were spoken to during this visit. What the service does well: What has improved since the last inspection? What they could do better: There are a number of things that the manager and staff need to do to make sure that the residents get the care that they need from staff who are well trained. Assessment and care planning must improve so that the staff are able to know what to do for each resident. The refurbishment of current bathing facilities and improvements in standards of cleanliness and infection control are necessary to ensure a safe and comfortable environment for people living in the home. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 6 The most serious concerns from this inspection were: staff are being employed without proper employment checks to ensure that they are suitable people to work with residents and staffing numbers falling below agreed staffing levels A letter was left at the home to inform the owner and manager that these should be put right immediately. 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. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 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 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 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 Comprehensive pre-admission assessment assures that residents’ care needs can be met prior to moving into the home. EVIDENCE: The files of two recently admitted residents observed contained evidence of suitable pre admission assessment by the homes manager. Care management assessments and care plans were available for those who are supported by local authority funding, along with evidence of assessments for banding of nursing care by NHS nurses. Discussion with the social worker who had recently placed two residents at Willow Tree and two newly admitted residents confirmed an assessment of care needs had taken place prior to admission to the home. The social worker said that the residents and their families were happy with the placement and residents were settling in well. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 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) 7,8,9 and 10 Limited progress has been made on improving care plans and arrangements to ensure that the health,personal and social care needs of residents are identified and planned for. Systems for the management and administration of medication are poor in some areas. These shortfalls have the potential to place residents at risk. Staff practice in maintaning privacy and dignity are good. EVIDENCE: Individual care plans are available but little progress has been made to ensure that all aspects of health, personal and social care needs of residents are identified and met. Assessment details recorded on admission to the home were incomplete. Plans remain brief in some cases lacking specific detail and are not reviewed monthly in all cases. Daily entries in care records identified changing care needs, which were not always reflected in resident care plans. A risk assessment for moving and handling, nutrition and pressure areas were completed however there was no information on files examined of falls risk assessments. Discussion with staff suggested that needs were being addressed even though there was lack of specific care plans. This approach is dependent upon good verbal communications and staff memory. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 10 Systems and practices for the recording and management of wound care were incomplete. Records seen for one resident documented a broken area to sacrum, there was no further information documented with regards to this. Swabs were sent for MRSA no follow up to this was recorded. The care records of a resident showed a loss of 8kg over three months there was no further documented evidence of action taken by the home. The Speech and Language Therapist said that the home was meeting the needs of a recently admitted resident with a PEG feed well. Residents spoken to during the visit were unaware of their care plans, there was some documented evidence of resident/relative involvement in care reviews, one relative spoken to was aware of her mothers care plan and said “what ever they want is how the care is.” Residents and relatives told the inspector that they were happy with the care provided and were well looked after by the staff. Systems for the management and administration of medications were observed. Medicine administration records were not always completed accurately with a number of omissions noted on the MAR sheets. Medications transcribed by hand did not always specify the frequency/dosage of all medications. Staff were observed treating the service users with dignity and respect during the inspection. Five residents and two relatives said that the staff were very friendly and the atmosphere had a nice feel to it. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 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) 15 Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: The inspector ate lunch with a number of residents. The meal was tasty and nicely presented. Staff were readily available to assist residents where necessary. Residents and relatives said that the meals were good with choices available. There were no menus available to indicate what was for lunch, residents orders had been taken earlier that morning. Staff told the residents what the choices were, one resident changed her order at lunchtime staff readily accommodated this. Menus were observed these are reviewed regularly. Since the last inspection a heated trolley has been provided which ensures that meals served to residents in far dining room remain at the correct temperature. The catering staff have recently received a Good Food Hygiene award from Rugby District Council. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 12 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) These standards were not assessed as part of this inspection. EVIDENCE: Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 13 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) 19,25 and 26 The home is in need of improvements to provide a well-maintained environment with sufficient and suitable equipment and facilities, which ensure safe and comfortable surroundings, are provided for all residents. EVIDENCE: The home is an extended bungalow with accommodation on one level. Residents have access to a courtyard and a number of patio areas in the large back garden. Residents and relatives were observed using these areas throughout the day. Since the last inspection a new heating system has been installed throughout the home. At the time of the inspection work was in progress to box in and make safe exposed pipe work as a result of these changes. The manager said that once completed areas affected by these changes would be redecorated. The existing assisted bathing facilities are poor. Staff tend to use one bathroom for the bathing of residents. This bathroom was observed in a poor state of repair and was in need of refurbishment. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 14 The panel to the bath was cracked and broken, the floor covering was damaged and silver tape was applied to parts of the flooring. The lid on the bin was broken. A plastic apron was tied to the call bell and a large pump container of hand soap was left on the windowsill. The hot water temperature was recorded in excess of 43 centigrade. The manager said that a thermostatic valve had been fitted to this bath and that staff check the temperature of water before residents use the bath. The parker bath in a second bathroom is badly stained and unusable. Current residents are unable to access the third bath and when checked there was no hot water supply to this bath. The manager said that the refurbishment of the bathrooms was planned now that the new heating system had been completed. The premises were observed to require cleaning in a number of areas: Carpets throughout the home were badly stained and dirty some were in need of vacuuming. The floor area around the parker bath and outside corridor was stained and unclean; walls in the lounge area had visible stains. Mop buckets were observed to be stored with dirty water still in them. A number of plastic bowls in resident bedrooms required cleaning. One room had an unpleasant odour. A number of bedrooms contained creams, which had been prescribed for other residents. Coats and belongings were stored in the sluice room next to the sluicing machine. These and other concerns about the standard of hygiene and the control of infection in the home were discussed with the manager. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 15 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 and 29. The procedures for the recruitment of staff are not robust with appropriate pre employment checks not being carried out and potentially leave residents at risk. The number of staff available particularly during the weekends is below agreed levels and is not sufficient to meet residents’ needs. The manager is unable to fulfil her management responsibilities due to covering qualified staff shifts herself. EVIDENCE: Duty rotas examined demonstrated that staffing numbers were not being maintained within previously agreed levels particularly with regards to qualified staff. The manager was covering a number of these shifts herself and thereby reducing the amount of time given to fulfil her management responsibilities. The manager said that this was due to the deputy manager being on maternity leave and another qualified staff member on extended annual leave. This staff member was expected to return to work in early July. A further qualified staff member has been recruited from overseas and the home is awaiting a suitable work permit before the staff member commences duty. There is no domestic cover provided at weekends and no laundry cover on a Sunday. It was not possible to accurately identify hours worked by some staff members as some shifts were recorded as a tick with no times entered on the duty rota, particularly for a staff member who does ancillary and care roles. Staff said that some shifts were busy but that they were able to meet residents’ needs. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 16 Two residents and one relative said that occasionally the home could do with more staff as the carers were very busy and hard working. They went onto say that residents did not go without anything and that their care needs were met even when staff were rushed. The staff files of three recently appointed staff members indicated that the manager had not completed all the necessary recruitment checks to ensure the protection of residents. Two references were only available on one of the three files viewed, gaps in employment were not recorded and files contained no evidence of training. Two of the files contained little/no evidence of personal identification. Only one file contained evidence of suitable CRB/POVA checks. The work permit arrangements for one staff member was unclear the manager said that the home has applied for a new work permit for this staff member. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 17 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) 37 and 38 Issues surrounding health and safety and staff training need attention to safeguard the health, safety and well being of the residents. EVIDENCE: Files are stored in the office and in a small cupboard area close to the office. On the day of the inspection the door to the cupboard area was missing, filing cabinets stored in this area were open and documents and files readily accessible. Regulation 26 visit reports have not been provided to the Commission and were not available at the time of the inspection Certificates for the service and maintenance for most major systems were available the manager said that these were done by appropriately qualified personnel. The heating system has recently been installed and appropriate certification is awaited by the home. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 18 The manager said due to changes in the heating and pipe work a new Legionella risk assessment was planned. Documented evidence of hot water checks for baths etc was not available. The inspector spoke with the person responsible for maintenance who said that thermostatic valves had been fitted to some baths since the last inspection. Fire training was last held 9.06.05, 14 staff attended. The staff-training matrix was not up to date and it was not possible to accurately identify numbers of staff having attended training. The manager said that manual handling and first aid courses are booked. Four staff have registered on an infection control course and 9 staff members have recently completed a food hygiene course and are awaiting their certificates. The fridge in the kitchen had a missing handle and a damaged seal. Care plans examined recorded an accident for a particular resident. This accident was not recorded in the homes accident record book. Monthly audits of accidents had not been completed due to the current staffing situation. Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 19 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 1 x x x 2 2 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 2 2 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 20 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 OP4 Regulation 18 Requirement Timescale for action 31/08/05 2. OP 7 15 3. OP 8 15, 17 schedule 3 The registered manager must ensure that all care staff attend dementia care training and promote a more person centred approach to care. A timed training plan for the achievement of staff training should be forwarded to the inspector. (Old timescale plan to be received by 01/07/04 and 31.01.05 part met some staff have attended training.) No further service users with specialist dementia care needs should be admitted to the home. The registered manager must 31/08/05 ensure that care plans are current and set out in detail each service users health, personal and social care needs. Care plans should be reviewed monthly.(old timescale of 31/01/05 not met.) The manager must ensure that 31/08/05 qualified staff maintains accurate wound care records in line with NMC guidance on record keeping. Policies and procedures for Tissue Viability and wound management are to be reviewed Old timescale of 31/01/05 not Version 1.30 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Page 21 met. 4. OP 9 13 The registered manager must ensure that accurate records are maintained of medications administered. Records must include dosage and frequency of administration. Any changes to medications must be dated and signed.(Old timeframe of immediate not met) The adult abuse policy must be reviewed in line with legislation and local authority vulnerable adults procedure. Particularly with regards to the reporting and investigation of any allegations.Staff must receive training in the recognition and management of abuse.(Old timeframe of 31/03/05 not met) The assisted bathrooms must be refurbished. A timed action plan for this is to be forwarded to the Commission.(old timescale of 31/07/04 and 04/01/05 not met) The manager must complete a risk assessment of hot water outlets with action taken accordingly. A bathing policy must be implemented. Regular checks must be made of hot water outlets and records maintained. Defective thermostatic valves must be repaired/replaced.(Part met bathing policy implemented and valves fitted to some baths.) The manager must ensure that domestic staff are employed in sufficient numbers to ensure that the home is maintained in a clean state and free from unpleasant odours.The manager must ensure that staff are aware of the infection control and disposal of waste policies. (Old time scale of 31/01/05 not met) 31/07/05 5. OP18 13, 18 31/08/05 6. OP 21 23 31/07/05 7. OP25 13, 23 31/08/05 8. OP 26 16, 13 31/07/05 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 22 9. OP 27 10. OP 29 11. OP 37 12. OP38 13. OP 38 The manager must ensure that staffing levels and skill mix are maintained within agreed levels and are based on assessed level of dependency and resident care need. Rotas must accurately record hours worked by staff and identify where the manager has worked in a clinical or managerial capacity. The manager must inform the Commission of any shifts which fall below agreed levels.( old time scale of immediate not met.) 19 , 7 The registered manager must Schedule ensure that recruitment 2 procedures are robust and that staff files contain evidence of all information as specified in schedule 2 Care Homes Regulations 2001.References and Criminal Records Bureau disclosures must be obtained prior to commencement of employment. (Old timescale immediate from previous inspection not met) 26, 17 The responsible individual must complete a report of monthly Reg 26 visits and forward a copy to the Commission for Social Care Inspection.(old timescale of immediate from previous inspection Nov 2004 is not met) The manager must review the storage of files. These must be stored in a secure place at all times. 23,13, 16 The manager must provide written confirmation of receipt of certification for heating systems and Legionella risk assessment. 13, 23, 16 The fire procedure and fire policy must be reviewed with staff made aware of any changes. . (Old timescale 31/06/04 and E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc 18 21/06/05 21/06/05 31/07/05 31/08/05 31/08/05 Willow Tree Nursing Home Version 1.30 Page 23 14. OP 38 17 Schedule 3 31/03/05 not met) Bleach and other hazardous materials must be locked away after use. The fridge in the kitchen must be replaced/repaired. Risk assessments must be completed for all elements within the home and external premises. Accurate records must be 31/07/05 maintained of accidents to residents and reported in accordance with legislative requirements. 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 OP 7 Good Practice Recommendations The inspector recommends that the manager develop the falls risk assessment in accordance with good practice guidelines e.g The National Institute of Clinical Excellence.(NICE) The inspector recommends that tissue viability policy is reviewed in accordance with clinical guidelines and local PCT wound formulary. The inspector recommends that the activity organiser continues to develop the range of social and leisure opportunities available to service users and ensures that this includes the needs of those service users with dementia. The inspector recommends that the manager complete an infection control audit and take action accordingly. 2. 3. OP 8 OP12 4. OP 26 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Willow Tree Nursing Home E53 S4415 Willow Tree Nursing Home V234561 200605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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