Inspection on 06/06/06 for Willows Christian General Nursing Home

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

Willows Christian General... 22/05/07

Willows Christian General... 15/12/05

Willows Christian General... 24/05/05

Willows Christian General... 04/01/05

Willows Christian General... 01/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Willows Christian General Nursing Home Warford Park Faulkners Lane Mobberley Cheshire WA16 7AR Lead Inspector Denis Coffey Key Unannounced Inspection 6th June 2006 09:00 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 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Willows Christian General Nursing Home Address Warford Park Faulkners Lane Mobberley Cheshire WA16 7AR 01565 880180 01565 880068 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) Trinity Care Limited Mrs Vanessa Bradley Care Home 60 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (40), Physical disability (3) Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * Up to 40 service users in the category of OP (old age not falling within any other category) * Up to 20 service users in the category of DE(E) (dementia- over 65 years of age) * Up to 2 service users in the category of PD (physical disability over the age of 55) * named service user in the category of PD (physical disability) Links must be maintained with specialist services for advise about the care of the named service user in the category of PD The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 15th December 2005 2. 3. 4. Date of last inspection Brief Description of the Service: The Willows is a purpose built 60-bedded nursing home, registered for 40 elderly frail residents, and 20 residents with dementia. Three residents under the age of 65 years with a physical disability can also be accommodated at the home. Forty-eight bedrooms have en-suite facilities, and those that do not, have a wash hand basin in the room. There is a choice of lounges. A dining area is provided on the ground floor of the dementia unit, and on the ground and first floor of the unit for older people. The home caters for residents both male and female aged from sixty-five years onwards requiring nursing care. Trained nursing staff are on duty at the home twenty-four hours a day. The weekly fee payable at the home ranges from £710 to £750. The manager provided this information on 2nd June 2006. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home took place on the 6th June 2006 over a 7hour period. The CSCI regulation inspectors who visited were Denis Coffey and Julie Porter. All areas of the home were inspected and residents, staff and visitors spoken with. Care records and the home records were also examined What the service does well: What has improved since the last inspection? The plans of care for the residents addressed their health and welfare needs along with appropriate plans of care where a need had been identified. Medicines were stored securely, and all medicine bottles and tubes of creams were properly labelled. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 6 The home is now in receipt of a satisfactory gas safety certificate. 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. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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&3 Assessments are carried out with prospective residents prior to them taking up accommodation at the home to ensure that their needs can be met. EVIDENCE: At previous inspections the home’s statement of purpose has been read and this has been found to contain information needed by residents’ and their families about the structure and services offered at the home. The care records of two residents recently taking up accommodation at the home were examined. Both of these contained a pre-admission assessment. The assessments were based on the activities of daily living and addressed such things as personal hygiene, continence, mobility and dexterity. The assessments were dated as to when they took place but were not signed by the person carrying out the assessment. The Willows does not provide intermediate care so standard 6, identified above does not apply. See Recommendation 1 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 Care plans were well documented and reflected the needs of the residents and how these were to be met. Medicines were generally well managed but need improving to ensure that all of the residents receive their medicines as prescribed. EVIDENCE: Four sets of care records were examined at this inspection. All contained relevant assessments with regard to the health care needs of the residents, and where a problem/need had been identified a plan of care was put in place identifying how these needs were to be met. Evidence was seen of relevant daily records being maintained on the health and welfare of the residents, and of the plans of care being evaluated on a regular basis. Risk assessments were in place and were well documented apart for the risk assessment for the use of bed rails for one of the residents. This assessment did not identify the risk of entrapment from using such equipment, nor the measures needed to be taken to reduce such a risk. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 10 All of the residents are registered with a general practitioner and have access to the facilities of the NHS. Records were seen of other healthcare professionals being involved in the care of the residents, e.g. dietician, a speech and language therapist and dentist. Comment cards were received from a general practitioner and a continence nurse advisor who visit the home. Both stated that the home communicates clearly with them, that they are able to see the residents in private, specialist advice is incorporated in the plans of care, and that they were satisfied with the overall care provided. During the course of this inspection, the inspector observed the nurses on the elderly frail unit administering medicines to the residents. This procedure was conducted in a safe and unhurried manner, and the nurses were observed to assist those residents who needed it with help in taking their medicines. When examining the medicine administration record (MAR) sheets of the residents on the dementia unit the inspector noted that one lady was prescribed a cream to be applied twice a day, but her MAR sheet for four days indicated that she had only had this cream applied once a day. The MAR sheet of another resident showed that another resident had received their morning dose of medicine on the 2nd June 2006, but this tablet was still in the blister pack in the medicine trolley. Medicines subject to stricter control measures were found to be correct. The room in which medicines are stored was in need of tidying up as the work surfaces in there were cluttered. Staff were heard to address the residents appropriately and to maintain their dignity and privacy when providing personal care to them. Residents spoken with said that their dignity and privacy was maintained and that they found the staff helpful and supportive. See Requirement 1 See Requirement 2 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15 A range of activities are provided for the residents that hold their interest and provide stimulus for them. Residents are enabled to make choices to ensure that they maintain their independence for as long as possible. EVIDENCE: An activities co-ordinator is employed at the home for arranging leisure and social activities for the residents to engage in. Six residents had returned comment cards prior to this inspection, the majority of who stated that they were satisfied with the activities provided. One resident said that she preferred afternoon activities as all day events were to tiring, and another resident said that there were some activities she could not participate in. Residents’ spoken with were complimentary about the range of activities, and one went on to say that the activities co-ordinator went out of her way to help the residents’. Examples of activities provided are; manicures, foot spas, baking, sewing and board games. A notice advising activities to take place in June was displayed on a notice board by the dining room. These activities included a church service, a prayer group, a visit by the mobile library, birthday celebrations, a canal boat trip, and a cheese and wine evening. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 12 Comment cards were received from four relatives prior to the inspection. All stated that they are made welcome when visiting, that they can see their relatives in private, and are kept informed of important matters. Residents’ spoken with confirmed that they are given choice and are able to exercise control of their lives within the limits of their disabilities. Examples of choice given were choosing what to wear, when to get up and go to bed, and what to eat at meal times. Lunch on the day of inspection was a choice between steak, onions, mashed potatoes, carrots and broccoli, or mushroom curry. A dessert of syrup sponge and custard or bananas and custard or yoghurt was served for dessert. The evening meal was to be tomato soup, prawn cocktail and buttered brown bread, or assorted sandwiches served with a side salad. This was to be followed by an egg custard or fresh fruit. Snacks are available in the evening, such as sandwiches, fruit, yoghurt and cereals. Two of the residents spoken with commented that an extra member of staff was on duty at breakfast and lunchtimes, which enabled these meals to be served in a relaxed manner. They went on to say that the evening meal was noisy and rushed. Both of these residents said that the standard of food provided was good and that alternatives to the menu were available. When informed of the above comments, the home manager said that she is investigating the possibility of having an additional member of staff on duty at teatime. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18 Records of complaints received at the home need to be improved to demonstrate that all complaint received are satisfactorily dealt with. The training of staff in adult protection needs addressing to ensure that all staff are aware of their responsibilities in this topic. EVIDENCE: The home has an established complaints procedure and this was on display at the home. The complaints log was examined during this inspection and contained two complaints from 2005. A record was seen of the investigation and a response being made to the complainants. However, the pre inspection questionnaire sent from the home identified that there had been three complaints. The home manager said that an anonymous complaint had been made directly to the company’s head office. One questionnaire received from a relative said that they had made a verbal complaint to the home and that this had been satisfactorily dealt with. A record of this complaint was not available. The home has a nominated who is responsible for delivering adult protection training with the aid of a training video and questionnaire to the staff. Staff training records were seen in relation to adult protection. These demonstrated that newly appointed staff receive this training as part of their induction, but the records did not identify that all staff had attended, or received updated training since 2004. The home manager has not attended any recent training relating to adult protection. See Requirement 3 See Requirement 4 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 the following standard(s): 19, 21, 22, & 26 The home provides a comfortable environment for the residents to live in. This would be improved by ensuring that unpleasant smells are eliminated. EVIDENCE: The general standards of décor and furnishings have been well maintained, and the home employs a maintenance person who is responsible for general maintenance around the home. Contractors hired by the company carry out work falling outside this person’s scope. Whilst there is storage space around the home this is insufficient as the bathroom on the dementia unit was being used to store wheelchairs, a portable hoist and a shower chair. The majority of the bedrooms are equipped with the ensuite facilities of a toilet and wash hand basin. The remaining bedrooms have wash hand basins in them. Baths and showers are sufficient in number for the number of residents accommodated at the home. Equipment is provided for use with residents who are unable to get into or out of a bath unaided. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 15 A number of specialist beds have been provided at the home for use by residents who require assistance and nursing care whilst in bed. Handrails are fitted in corridor areas and grab rails are sited within close proximity to the toilets. Alternating pressure mattresses and seat cushions were being used by residents identified as being at risk of developing a pressure sore. All areas of the home were visited at this inspection and were found to be clean and tidy. There was however an unpleasant smell in one of the bedrooms on the dementia unit. The home manager said that the carpet in this room was shampooed regularly and that an odour-destroying machine was used in the room, but both of these measures had proved unsuccessful in eliminating the smell. She has now decided to replace the carpet in this room with a hard surface floor covering. See Requirement 5 See Requirement 6 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 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 Recruitment procedures are not thorough enough to ensure that residents are protected from any possible harm. Not all of the staff have received mandatory training to enable them to develop their skills and provide safe care. EVIDENCE: Staffing records showed that twenty-one trained nurse, twenty-seven and seventeen ancillary staff are employed at the home. Comments received from residents indicated that they felt there were not enough staff on duty at all times and that on occasions they had to wait to be attended to. The staffing rotas showed that the home was complying with the agreed minimum staffing levels. The home is committed to providing NVQ training for the staff and the pre inspection questionnaire showed that 25 of the care staff have achieved this qualification. There is a rolling programme established for the delivery of mandatory training, and training records were reviewed relating to fire safety, safe moving and handling practices, food hygiene, and adult protection, (see Standard 18). Only twenty-seven of the staff have recently attended fire safety training and the manager said that more of this training was planned. Two staff have never received training in this matter, and one last received such training in 2004. Twenty-four staff have not attended a fire drill since 2005, and the records showed that fifteen staff have never attended a fire drill. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 17 The manager was advised to prioritise this training. There is a designated moving and handling trainer on the staff who is responsible for the delivery of such training, and to monitor the equipment used for this in the home. However, her training qualifications for this were not current. The manager informed the inspector that this training is planned for. The records showed that five staff have not received moving and handling training since July 2003. Nurses and care staff are responsible for the serving of meals, drinks and snacks. However, only twenty-three staff have received food hygiene training in either 2004 or 2005. The personnel files of five members of staff were examined. The information in these varied and was unsystematically recorded; one member of staff commenced employment prior to a satisfactory Criminal Records Bureau (CRB) disclosure being obtained, and there was no evidence available that a protection of vulnerable adults (POVA 1st) disclosure had been obtained for this person. Two files did not contain details of the staffs’ terms and conditions of employment. One file did not have an application form in it, and therefore the information regarding this person was scant. An immediate requirement was made in relation to employment of people who had not had satisfactory CRB’s and POVA 1st disclosures was made at the time of inspection. See See See See Requirement 7 Requirement 8 Recommendation 2 Recommendation 3 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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, 33, 35 & 38 Residents’ money is well managed and protects them from their finances being abused. Management systems are in place that address the health and safety needs of the residents and staff. This aspect of care was generally well managed, but there were two areas identified as requiring attention to ensure that safety is maintained. EVIDENCE: The home manager is a trained nurse and has been in this post for a number of years. She is registered with the Commission. Staff spoken to said that they are supported by the manager and that she is approachable. One member of staff also said that she felt the atmosphere in the home was positive and that she would not wish to work anywhere else. Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 19 Records were seen of a representative of the company visiting the home unannounced on a monthly basis during which time they toured the premises, spoke with residents and staff, and reviewed the home’s records. The home regularly conducts a quality audit of the services it provides, and the last report was on the whole positive. Residents’ money held by the home on their behalf is held in a non-interest bearing account. Two residents records were examined during the inspection, and records were seen of deposits and expenditure for them being maintained appropriately. An environmental health officer visited the home in January 2006 regarding the “safer food better business” document, and last inspected the home in January 2005. The report from this inspection stated that there were “no contraventions in the kitchen service area”. Service certificates were seen for the following and were satisfactory; • • • • • • Maintenance of the portable hoists. The fire alarm and nurse call systems. The arrangements for the disposal of waste. Portable appliance testing. Gas safety. Passenger lift. The electrical installation for the premises was last checked on 14th September 2000 and was satisfactory. However, this check should be undertaken every five years and is therefore overdue. The home’s records were examined relating to weekly/monthly checks made on the fire alarm and emergency lighting systems, the temperature of the hot and cold water supplied, and bed rails safety fitting. The records showed that these checks were being carried out. See Requirement 1 See Requirement 9 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 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 1 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP38 Regulation 13 Timescale for action The registered person must 05/08/06 ensure that a satisfactory risk assessment is carried out for all residents who have bed rails fitted to their beds. The registered person must 05/08/06 ensure that the residents medicine administration sheets are be filled in accurately at all times, and medicines be administered as prescribed. This requirement remains outstanding from the previous inspection. The registered person must 05/08/06 ensure that all complaints made under the complaints procedure are fully investigated with records kept. The registered person must 12/08/06 ensure that staff receive regular training in relation to adult protection. Suitable provision must be made 12/08/06 for storage for the purposes of the home. This requirement remains outstanding from the previous inspection. Requirement 2 OP9 13 3 OP16 22 4 OP18 13 5 OP21 23 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 22 6 7 OP26 OP28 16 18 8 OP29 19 The registered person must 05/08/06 ensure that the home is kept free from offensive smells. The registered person must 12/08/06 ensure that staff receive training relevant to the work they perform. An enhanced Criminal Records 06/06/06 Bureau disclosure must be obtained for all staff employed at the home. This requirement remains outstanding from the previous inspection. The registered person must 12/08/06 ensure that the home is in receipt of a satisfactory electrical installation certificate. 9 OP38 23 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 OP3 Good Practice Recommendations It is recommended that all pre admissions assessments are signed by the person carrying these out to demonstrate that these have been done by a person trained to do these. It is recommended that an assessment of dependency be carried out on all the residents to verify if the number of staff on duty is sufficient to meet their needs. 2. OP27 Willows Christian General Nursing Home DS0000018825.V294069.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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