Inspection on 08/09/08 for Brookside

This is the latest available inspection report for this service, carried out on 8th September 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brookside 08/12/05

Brookside 11/04/05

Brookside 14/09/04

Brookside 13/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Brookside Ruskin Avenue Melksham Wiltshire SN12 7NG Lead Inspector Roy Gregory Unannounced Inspection 8th September 2008 09:05 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 Brookside DS0000028405.V369843.R01.S.doc Version 5.2 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. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookside Address Ruskin Avenue Melksham Wiltshire SN12 7NG 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 706695 01225 703181 manager.brookside@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Mr Richard Dyer Care Home 50 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (37) Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 13 service users with mental disorder or dementia at anyone time. 30th May 2006 Date of last inspection Brief Description of the Service: Brookside is a purpose-built residential home for 50 older people, 13 of whom may have needs associated with dementia or other mental health issues. The home is one of a large number of homes provided by the Orders of St John Care Trust in Wiltshire and in three other counties. Accommodation is in single rooms, located on two floors, with a passenger lift to the first floor. All bedrooms have wash hand basins and each corridor has shared toilets and bathrooms. The home has seating areas rather than identifiable lounges. In addition there is an attractive enclosed garden with summerhouse and greenhouse. Three rooms are used exclusively for short stay residents. The home is situated in a residential area, a short walk from Melksham town centre, where shopping and social facilities are available. There are good bus links to neighbouring towns, and the home has its own car park. Weekly fee levels range between £435 and £510, according to assessed dependency. Where people are placed and part-funded by the local authority, the contracted fees are slightly less. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We visited Brookside unannounced on Monday 8th September 2008 between 9:05 a.m. and 6:05 p.m. and returned the following day from 9:30 a.m. to 4:30 p.m. During the inspection there was direct contact with a number of residents, in the communal rooms and individual rooms, and by joining three residents for lunch in the dining room. This allowed for observation of the service of meals and administration of medications. The entire home was toured. Richard Dyer, the manager, was available throughout the inspection time. We spoke with various staff on duty, including the head of care, a care leader, carers, a housekeeper, kitchen staff and the administrator. The home’s locality manager from the Orders of St John Care Trust joined Richard Dyer and the inspector for feedback at the end of the inspection. Records examined during the inspection included care plans and records of care, medication records, evidence of activities provided, incident records and records of staff training and supervision. It was also possible to look at the results of the home’s annual internal survey of residents’ and relatives’ opinions, from July 2008. Prior to the inspection visit, Richard Dyer had returned the home’s Annual Quality Assurance Assessment, which gave some descriptive and numerical information. We also sent out a number of survey questionnaires. These were returned to us by ten of the people living at the home, five members of staff, two GPs and a chiropodist. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. We also took account of a random unannounced inspection made to the home in May 2007. This was undertaken in connection with concerns about staffing levels in the home at that time, following an incident that had been reported to us. What the service does well: There were comprehensive assessments of people’s needs before they were admitted, to establish the range of needs to be met, and whether the home would be able to meet them. Life history information was gathered so that a “whole person” view could be obtained. People recalled being visited for the Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 6 purposes of assessment. A comment in a survey form was, “The staff were helpful and answered all questions and gave us all the information we wanted without any problems.” For every resident there was a care plan in a format introduced by the Trust since the previous inspection. The head of care had responsibility for overseeing how care planning operated. She demonstrated considerable enthusiasm and commitment to this task. In several examples seen, there was meaningful monthly evaluation by key workers of how care plans were operating. People living in the home had signed their care plans, or relatives had done so on their behalf. It was noted as good practice that the implications of issues such as diabetes, poor memory or hearing problems were considered in the care plans concerned with other aspects of a person’s life. A person told us the home had adjusted to their changing needs over time. All respondents to the survey of residents, and people we spoke to, said they “Always” receive the medical support they need. One person wrote, “If the staff spot a problem they will call a doctor. I have seen a doctor several times.” Another wrote, “Nurses call twice a week and doctors check and call to see you in your room if need arises.” A visiting community nursing sister confirmed there was a twice-weekly commitment to visiting the home, with extra visits made if needed. She was pleased with the level of liaison and said matters were appropriately referred for nurses’ attention. They had never had any concerns about observed care practices, and care staff complied with nurses’ advice and directions. Staff observed people taking medicines and recorded after each one that they had done so. The manner of administering medicines was an example of care being provided with dignity, and respectful of people’s privacy. All respondents to the resident survey said staff listen to them and act on what they say. Care plans drew attention to communication difficulties, temporary and long-term, with guidance on how to address these. For example, there were care directions to “write down communications to aid understanding” and “X will need more prompting for self-care at present”. In both instances, observations showed these directions were known and complied with. In terms of every day living, people said they got up and went to bed when they chose. Bedrooms were quite generous in size and people had televisions etc. as they wished. One person spoke of keeping in touch with close family by telephone, which they had in their room. People made choices for themselves, and for receiving visitors, between using their rooms, sitting areas in the home, and the garden in good weather. Tables at lunchtime had printed menus and we saw many people use these. The menu was also displayed on a board during the morning. People made their selection at the table. There was a photographic menu book for use as a communication aid, for example where someone’s first language was not English. The home’s menu was based on “traditional” home cooking choices. There were systems in place to identify and meet the needs of special diets. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 7 Currently two vegetarians were being catered for. There was a pleasant atmosphere in the dining room. Service was efficient and courteous. Where a person needed some assistance to eat, this was given discretely. A number of residents were served meals in their rooms, either through choice or owing to ill health. People said meals delivered this way were generally hot. The home had received a small number of written and verbal complaints since the previous inspection. These were about food, the assessment process for new residents, and cleaning standards. Records of how they were each addressed showed that solutions were actively sought, responses were courteous and apologies were made where appropriate. A resident who had made a complaint told us they were satisfied with how it had been handled, and it had resulted in a change that they had sought. All individual bedrooms that we saw were very personalised. People said they liked their rooms. There was a rolling programme of redecoration, including upgrading vanity units. Rooms were provided with new suites of furniture at the same time. All corridors were carpeted, and pictures and items of furniture made them feel cosy. All resident survey responses said the home was “Always” fresh and clean. One person added, “Rooms and carpets are cleaned and vacuumed every day. Even the plants are watered for me.” People we spoke to were equally pleased with the attention to cleaning. The kitchen had been given a five star rating by the Environmental Health Officer. We found no odours in the home. Our checks on the standard of recruitment of staff showed people could be sure staff working with them had been through a thorough recruitment process and did not present any known risk to their safety. New staff underwent an induction, designed to fit with current expectations of induction. This meant new workers had a reliable introduction to the values as well as skills necessary to work in a care home. Staff showed in person and through the survey that they were very committed to the work of the home. Training courses were booked for several months ahead. All care staff received dementia training, accredited by The Alzheimer’s Society, as a part of core training. Support staff also received training in understanding dementia. All staff that returned survey forms were very positive about the training made available to them, from induction onwards. One wrote, “The amount of training courses etc. that staff are put on from the day they commence at Brookside is first rate, including encouragement to further their knowledge with NVQ (National Vocational Qualification). All this instils confidence to carry out every day tasks. Also the training sessions are made very interesting and enjoyable”. The structure of manager, head of care, care leaders and administrator appeared to work well and there were regular senior team meetings. Good working relationships were in evidence between all groups of staff. Care staff Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 8 considered they had good information about people’s needs, and they saw good communication as a strength of the home. An annual quality survey of residents and their relatives had taken place in the home in July 2008. It showed that measures had been taken to address things people were not happy with. For example, one person disliked the colour scheme of their room, and it was repainted in a colour of their choice. Residents’ meetings were held, as another means for management to know how residents felt about how the home provides them with a service. What has improved since the last inspection? What they could do better: The community nursing sister was surprised that the home were using “Waterlow” assessments of people’s risk of incurring pressure area injury. All health providers and most social care providers in Wiltshire have adopted a different form of pressure area risk assessment, which non-nursing staff would in fact find more intuitive and useful. The community nursing sister and head of care agreed to liaise further over this issue, and we have recommended seeking agreement on this issue. Care plan guidance about pressure area care was limited to monitoring the condition of skin and reporting any red marks seen, at which point a referral would be made for community nursing assistance. By the time a mark is Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 9 apparent, however, actual damage has already occurred. Care plans should explore how the integrity of an individual’s pressure areas is to be maintained, for example, by encouraging movement, use of skin care products, or by nutritional means. Only those care staff who administered medicines to residents received training about medication use. It would be desirable for all care staff to do so, so they can appreciate the serious issues related to this area of practice, and to understand how people’s medication care plans fit with the rest of the care plan. It is also recommended that, on evaluating care plans for “as needed” medicines, care staff should show precisely how much the medicine in question has been used during the evaluation period. A touch-screen computer with internet access had been supplied for residents to use, for example to help people establish e-mail and web-cam contact with friends and family. It had as yet seen little use. The manager agreed that a “champion” from among the staff might be a way of considering best uses of the computer, and ways of making people familiar with what it could achieve for them. Many toilets had tiled floors dating from when the home was built. These are unattractive, cold, difficult to keep clean, and very dangerous when wet. In bathrooms, these floors had been successfully covered with modern non-slip flooring. In Brookside, all residents have to use the shared toilets, which for some bedrooms are at a distance of over ten metres. Therefore it is important for the toilets to be as user-friendly as possible, as well as safe, and we have required that all toilet floors be brought up to a modern standard. We found that in an upstairs sluice room, brackets under the sink were very badly rusted, posing a risk of harbouring infection. Commode liners, used by most residents in their rooms in the absence of en suite facilities, were not numbered, so they were returned to any room rather than the ones from which they were taken for cleaning. These shortfalls in maintaining good hygiene must be made good. The home could carry out a routine survey of all areas, such as around waste traps and mobility aids, that pose possible risks to infection control in toilets, sluices and bathrooms, to ensure they are kept in good repair. The handyman, by virtue of his duties, may be well placed to do this periodically. Please contact the provider for advice of actions taken in response to this Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 10 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 11 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 Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. (Brookside does not provide Intermediate Care, so Key standard 6 is not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Efforts are made to ensure that as much information as possible is gained about prospective residents to ensure their needs can be met. People and their families are encouraged to visit to see for themselves what is being offered. Good information is made available. EVIDENCE: In the postal survey of ten residents, nine considered they had been given good information about the home before deciding to move there. The statement of purpose had been updated with staffing information, as required after the random inspection. There was a useful brochure available, and we saw that people were made welcome and given plenty of time when they visited to see what the home is like. Mr Dyer said it was always preferred if a prospective resident was able to visit. This was not always possible, but relatives frequently visited as part of their family decision-making about care home placement. We saw a visit being conducted. A comment in a survey form Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 13 was, “The staff were helpful and answered all questions and gave us all the information we wanted without any problems.” The manager or a care leader assessed prospective residents, using the Trust’s assessment tools, in order to establish the range of needs to be met. This enabled a decision to be taken about whether the home would be able to meet the identified needs. Three examples seen were comprehensive in content. They showed how information was obtained, and by whom. Life history information was gathered so that a “whole person” view could be obtained. People recalled being visited for the purposes of assessment. Mr Dyer said a decision to offer a place took account not only of individual needs, but also of the range of needs already being met within the home, so that resources would not be over-stretched. At the random inspection in May 2007, it was recognised that two emergency respite admissions of people with particular mental health needs had created unacceptable pressures for staff and other residents. The manager had recognised a need for caution in agreeing such admissions. A member of staff wrote in a survey form, “We always have adequate information from assessment prior to a resident coming into the home, but emergency admissions are not always accompanied by sufficient information”. Two rooms were designated as “guest rooms”, for use by short-term residents on a respite basis. We saw these admissions were planned, and people’s needs were assessed. One person who had been admitted for a respite period was now under consideration for a long-term placement. The person was unclear about their current status and prospects. Records, and talking with manager and staff, showed they were being included in discussions about their future. There was a care plan in place directing staff to ensure reassurance was given, and how to do so. Four weeks after permanent admission, there was a review of a person’s needs and of the home’s ability to meet them. This provided an opportunity to refine care plans in the light of any matters that had not been apparent from initial assessment. There was an example of a review in which it had been decided that the home was not appropriate to meet a person’s identified needs, and they had subsequently moved to a nursing home. For another person, there was evidence of discussions with family and professionals about the ongoing suitability of Brookside to manage specific needs, resulting in a decision to seek an alternative placement. When people went to hospital for significant periods, assessment visits were made to ensure they were sufficiently recovered before returning to the home. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans direct how care is to be provided and receive regular review. There is prompt awareness of and response to health needs, including good liaison with health professionals and emergency services, although practice to reduce risk of pressure area damage can be improved. People are protected by the home’s policies and procedures for the safe handling of medication. The approach to the care task is based on respect for diversity and privacy. EVIDENCE: For every resident there was a care plan in a format introduced by the Trust since the previous inspection. This system ensured that information gathered at initial assessment, and through experience of delivering care, was used to direct various aspects of care in line with people’s needs and preferences. The head of care had responsibility for overseeing how care planning operated. She demonstrated considerable enthusiasm and commitment to this task. In several examples seen, there was evidence of meaningful monthly evaluation by key workers of how care plans were operating. The monthly review process Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 15 in turn led to amendments to care plans, showing they were working documents. People living in the home had signed their care plans, or relatives had done so on their behalf, and people had also signed acknowledgement of six-monthly reviews. It was noted as good practice that the implications of issues such as diabetes, poor memory or hearing problems, as well as being subject of discrete care plans, were considered in the care plans concerned with other aspects of a person’s life. A person told us the home had adjusted to their changing needs over time. We joined a handover meeting, in which a care leader gave updating information about residents’ wellbeing and care needs to staff coming on duty. This was a two-way process. It was followed by delegation of various tasks. These meetings took place every morning, afternoon and night. They were aided by the good quality of records that care workers made in people’s individual care planning folders. Also in the folders were records of all visits to or by GPs and other health professionals, with outcomes including care advice. Sometimes visiting professionals had made their own entries in these multidisciplinary records. Through the survey, and in person, staff considered they had good information about people’s needs, and they saw good communication as strength of the home. Members of staff acted as “key workers” to individual residents, which helped maintain oversight of how essential needs were being addressed. Every day, on a rolling programme, one person was “resident of the day”. This entailed a specific check and update on several key areas of service provision and documentation. All respondents to the survey of residents, and people we spoke to, said they “Always” receive the medical support they need. One person wrote, “If the staff spot a problem they will call a doctor. I have seen a doctor several times.” Another wrote, “Nurses call twice a week and doctors check and call to see you in your room if need arises.” Two GPs returned surveys, one being more satisfied than the other about liaison with the home. Mr Dyer and the head of care said GP home visits were not easy to accommodate if made during the serving of lunch, when the care leader on duty would be committed to administration of medicines around the home. They had rightly insisted that visits must take place in a person’s private accommodation, i.e. their bedroom, rather than creating a treatment room as some health personnel would like. Mr Dyer was to seek a meeting with one of the GP practices as a matter of urgency. We were able to speak to a visiting community nursing sister. She confirmed there was a twice-weekly commitment to visiting the home, with extra visits made if needed. She was pleased with the level of liaison and said matters were appropriately referred for nurses’ attention. They had never had any concerns about observed care practices, and care staff complied with nurses’ advice and directions. Nursing notes were kept in the home, so staff could look at them at any time. However, the community nursing sister was surprised that the home were using “Waterlow” assessments of people’s risk of incurring Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 16 pressure area injury. All health providers and most social care providers in Wiltshire had adopted a different form of pressure area risk assessment, which non-nursing staff would in fact find more intuitive and useful. The community nursing sister and head of care agreed to liaise further over this issue. Consideration of pressure area integrity was a standard part of each care plan. There was a pre-printed aim: “To promote skin integrity and reduce risk of developing skin damage”. But the interventions that had been written in response did not explore how those aims were to be pursued, for example, by encouraging movement, use of skin care products, or by nutritional means. Care plan guidance was limited to monitoring the condition of skin and reporting any red marks seen. By the time a mark is apparent, actual damage has already occurred. When that was the case, interventions for managing the injury were guided by advice and provision of pressure-relieving equipment from the community nursing service. Significant changes, such as declining mobility or weight changes that were recorded elsewhere in care records, were not always reflected in the pressure area care plans. One of the care leaders had specific responsibility for the home’s ordering, storage, recording and disposal of medications. The administration of medicines to residents was a task restricted to care leaders, and carers “acting up” as care leaders. They had received training to undertake this responsibility and their competence was re-examined six-monthly. Other care staff did not receive training about medication use. It would be desirable for them to do so, so they can appreciate the serious issues related to this area of practice, and to understand how people’s medication care plans fit with the rest of the care plan. The Trust’s audit earlier in the year had identified some ways in which the home’s practice was out of step with the Trust’s medications policies, and these shortfalls had been corrected. We observed parts of morning and lunchtime medicine rounds. These were undertaken methodically and with patience. Staff observed people taking medicines and recorded after each one that they had done so. The process was as unobtrusive as possible. The staff member undertaking the duty wore a tabard marked “do not disturb”. This safety measure had been implemented after a drug administration error reported to us earlier in 2008, when the person responsible had been distracted by another matter arising. The storage and recording of medicines were orderly, although some improvement to “controlled drug” storage may be necessary to comply with the most recent regulations. The Medicines Administration Record (MAR) charts were clear, and gave extra explanatory information where necessary, including when and why “as needed” medicines were given. In line with a requirement made at the previous key inspection, there were care plans to guide staff on individual practice with “as needed” medicines. Examples of these care plans were appropriate, but their evaluation would be improved by always showing Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 17 the extent of use of the medication, information that is readily available to the key worker from the MAR chart. This again shows the desirability of extending medication training to the whole care staff group. The manner of administering medicines was an example of care being provided with dignity, and respectful of people’s privacy. All respondents to the resident survey said staff listen to them and act on what they say. Care plans drew attention to communication difficulties, temporary and long-term, with guidance on how to address these. For example, there were care directions to “write down communications to aid understanding” and “X will need more prompting for self-care at present”. In both instances, observations showed these directions were known and complied with. People said staff always knocked at their doors and always respected their privacy. Care plans indicated if a person wished to receive care only from female carers, and for some men a male key worker had been specifically allocated. People in the home, and members of staff, spoke in positive terms about the key worker system, through which individual needs and experiences were recognised and promoted. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home seeks to identify and meet people’s social, religious and recreational needs. There are no barriers to contact with family and friends, and people are able to make some decisions about every day life. People are offered a choice of good quality meals, which take account of dietary needs and preferences and are served in a pleasant environment. EVIDENCE: The staff complement includes an activity co-ordinator post for 25 hours per week. Owing to retirement this post was vacant at the time of inspection. There had initially been little response to the advertised post, but an appointment had been made to commence after our inspection visit. One resident wrote on a survey form, “Until April 2008 activities were arranged and were very good. The home has advertised for a replacement, but so far (Aug 2008) nobody has been appointed”. This demonstrated that people in the home were kept informed of issues that affect them. Five respondents to the survey indicated there were “Always” activities they can take part in and four said “Usually”. One person wrote, “I’m not an activities person but they try and get you involved”. Another liked the home’s newsletter that is circulated monthly, and includes Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 19 details of recurring and specially organised events. This information was also posted on notice boards. It had been possible recently to make a room available specifically for activities. This had a sink and table and chairs and was ready for the incoming activities co-ordinator to develop as she saw fit. Hopefully the activities role will be concerned with a broad view of “activity”, linking with occupation and quality of life generally. There is scope for the activities co-ordinator to develop personcentred social needs care plans that recognise potential benefits of different forms of activity and occupation for individuals. At present these were sparse, with interventions such as “to inform of activities and invite to take part”. “Life history” sheets, compiled with each resident, were in place and offered a good starting point. These were non-intrusive but gave indications of people’s preferences and interests. One person living in the home told us they would like to undertake some dusting, to feel they were still useful. Another would have liked a wider range of books available. Several residents said they would simply welcome more opportunities for conversation. Opportunities to go out into the local community were reduced during the period without an activities coordinator. Care staff said in person and through the survey that they were endeavouring to maintain some activity provision on many shifts, but inevitably it was a reduced amount because of their primary duties. Staffing of the home had not been increased during the shortfall of an activities co-ordinator. We saw provision of a quiz, and ten residents went on a pre-arranged canal boat trip, with adequate staff in attendance. The administrator has always produced the newsletter and worked with staff to help sustain some activities, including gardening. There was a schedule of regular church services provided by several different denominations. The Trust promoted a number of inter-home events through the year, which gave opportunities to go out and socialise. They had also started a scheme of supplying boxes of items to prompt reminiscence work on various themes. These were to be circulated between the Trust homes in the county, so people could enjoy different topics through the year. In terms of every day living, people said they got up and went to bed when they chose. Bedrooms were quite generous in size and people had televisions etc. as they wished. One person spoke of keeping in touch with close family by telephone, which they had in their room. People made choices for themselves, and for receiving visitors, between using their rooms, sitting areas in the home, and the garden in good weather. Smoking was only possible in the garden, as the home had nowhere to create an exclusive smoking room as the law would require, but this was said not to have caused any difficulty. A touchscreen computer with internet access had been supplied for residents to use, for example to help people establish e-mail and web-cam contact with friends and family. It had as yet seen little use. The manager agreed that a “champion” from among the staff might be a way of considering best uses of the computer, and ways of making people familiar with what it could achieve Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 20 for them. A person living in the home said they had seen the computer in the dining room and would be interested in learning to use it for finding information. As expected in a home for fifty people, there was a range of opinion about the meals served. Two out of ten respondents to the survey “Always” liked the meals, and seven “Usually” did. One person wrote, “Food is improving”. Another wrote, “Meals are good and ample and you normally have a choice”. We saw that choices were offered at each meal. Tables at lunchtime had printed menus and we saw many people use these. The menu was also displayed on a board during the morning. People made their selection at the table. A notable good piece of work was a photographic menu book, for use as a communication aid, for example where someone’s first language was not English. The home’s menu was based on “traditional” home cooking choices. One person told us they found it unadventurous. Mr Dyer said that the home had experienced a year of inconsistent staffing in the kitchen, but was now up to full staff complement and quality. Kitchen staff that we met were confident in their role and projected a good knowledge of the residents as individuals. There were systems in place to identify and meet the needs of special diets. Currently two vegetarians were being catered for. There was a pleasant atmosphere in the dining room. Service was efficient and courteous and second helpings were offered. Where a person needed some assistance to eat, this was given discretely. A number of residents were served meals in their rooms, either through choice or owing to ill health. People said meals delivered this way were generally hot. However, one person commented on the large size of meal delivered, which they found off-putting. Another person had made a decision about dropping a vegetarian diet; their discussions with staff about this were recorded, but they told us they were not completely comfortable with this decision, saying it was due to insufficient vegetarian choices having been made available. Care plans have a section about nutrition, eating and drinking. Review meetings and the “resident of the day” system provide opportunities for key workers to check details such as meal preferences, and how people like to maintain their intake of fluids. So the home has the means to review the dietary requirements of the person identified above, and should do so, to ensure diverse needs are recognised and met. People were complimentary of the provision of morning and afternoon drinks, whether they were served in private or communal areas, although one person said an accompanying short conversation would make it feel a less impersonal provision. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: All residents responding to our survey said they knew who to speak to if unhappy with the service provided, and how to make a complaint. The Orders of St John Care Trust has clear systems for receiving and addressing complaints. The home had received a small number of written and verbal complaints since the previous inspection. These were about food, the assessment process for new residents, and cleaning standards. Records of how they were each addressed showed that solutions were actively sought, responses were courteous and apologies were made where appropriate. Richard Dyer considered complaints and their outcomes to be an important measure of quality assurance. Mr Dyer’s operational manager checked the home’s record of complaints monthly, to ensure compliance with the Trust’s policies. A resident who had made a complaint told us they were satisfied with how it had been handled, and it had resulted in a change they had sought. All staff received abuse awareness training and were issued with the “No Secrets” abbreviated guide to local safeguarding procedures. It had not been necessary for the home to refer any matters to the procedures since the previous inspection. One (non-care) member of staff had been dismissed for Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 22 matters that had not affected residents, but which had demonstrated a potential for doing so. Senior staff in the home had undertaken training in the Mental Capacity Act. There were plans to widen this to all care staff. Records showed that dementia awareness training and external professional advice assisted staff to understand behavioural issues presented by some residents, so they could plan care and monitor outcomes effectively. When it was considered that alternative accommodation might be more appropriate for a person, records showed a great deal of liaison with relatives and health and social care professionals. There was up to date information about the availability of an independent advocacy service. Where bed rails were in use, records showed an appropriate risk assessment had been undertaken to ensure the use of rails had more potential benefit than risk of harm. The risk assessment had been shared with relatives, who had signed consent for use of the rails. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well-maintained and homely environment, although some toilet facilities are not up to the standard of the rest of the home. Personal accommodation is excellent. Communal and private areas are kept clean & hygienic to a high standard, subject to specific improvements being made. EVIDENCE: The home had a five-year and an annual maintenance programme. Replacement of windows was almost complete. The “flagship” addition to the home has been creation of a new hairdressing salon, which had the feeling of a shop, complete with a bay window onto the corridor. This improvement had in turn freed up the room that is now available for use as an activities room. Otherwise, the home is not well provided with communal rooms. A sitting room off the dining room is primarily for the use of people attending for day care. Sitting areas between the entrance hall and dining room were popular places for people to meet each other. They were provided with comfortable Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 24 chairs. People were aware of how to go out into the garden, to which there was unrestricted access. All corridors were carpeted, and pictures and items of furniture made them feel cosy. There had been efforts made to make toilets and bathrooms more homely, for example by addition of framed mirrors and wooden towel rails. Many toilets, however, had tiled floors dating from when the home was built. These are unattractive, cold, difficult to keep clean, and very dangerous when wet. In bathrooms, these floors had been successfully covered with modern seamless flooring. In Brookside, all residents have to use the shared toilets, which for some bedrooms are at a distance of over ten metres. Therefore it is important for the toilets to be as user-friendly as possible, as well as safe. All individual bedrooms that we saw were very personalised. People said they liked their rooms. There was a rolling programme of redecoration, including upgrading vanity units. Rooms were provided with new suites of furniture at the same time. This posed a practical problem for the home in terms of storing furniture until a room was redecorated ready to take it. People were given the option of having a key to their room. There was evidence that associated risk assessments were reviewed, but Mr Dyer agreed additionally that a person’s choice to have or not have a key would be revisited when they were the “resident of the day”. A person’s relatives had made a complaint about a bad odour in the home. The source of this had been identified as a problem with a sluice washer, which had been rectified. We found no bad odours. Housekeeping staff that we spoke to felt they were well resourced, although they would like more relief cover when anyone is absent. One appreciated that there was now a senior housekeeper, whose duties included monitoring housekeeping standards. All resident survey responses said the home was “Always” fresh and clean. One person added, “Rooms and carpets are cleaned and vacuumed every day. Even the plants are watered for me.” People we spoke to were equally pleased with the attention to cleaning. The kitchen had been given a five star rating by the Environmental Health Officer. We found that in an upstairs sluice room, brackets under the sink were very badly rusted, posing a risk of harbouring infection. Commode liners, used by most residents in their rooms in the absence of en suite facilities, were not numbered, so they were returned to any room rather than the ones from which they were taken for cleaning. In a toilet next to the sluice, there was significant rusting on a steel hand frame around the toilet. We were told that all such aids in the home were due for replacement. They had also identified that some items in toilets, such as soap and paper towel dispensers, could be better positioned, and there was a programme for attending to this, and for boxing around ugly pipe work. Through undertaking such jobs, the home’s handyman would be well placed to undertake a systematic survey of all areas, such as around waste traps and mobility aids, that pose possible risks to Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 25 infection control in toilets, sluices and bathrooms, to ensure they are kept in good repair. The handyman receives infection control training. All laundry needs were met within the home. There was a laundry person working every morning, otherwise care staff had some involvement with laundry tasks. The laundry presented as clean and well organised. There were no current indications of any dissatisfaction with how the laundry operated. The home’s internal quality survey in 2008 received fewer negative comments about the laundry service, such as items having been lost or returned to the wrong person, than in the previous year. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have support from competent staff who are provided in numbers sufficient to maintain essential care. People are protected by sound recruitment practices that ensure nobody works at the home until checks on their background are complete. The provider invests in the development of staff, to maintain a trained and mainly qualified team. EVIDENCE: The level of staffing in the home was the focus of the random inspection carried out in May 2007. An event in the home had required maximum staff attention and yet there were only four staff on duty at the time. We found that this was not an isolated occasion at that time; many care staff not only felt under pressure due to their workload, but also identified that residents were missing staff attention in various ways. A requirement was made for the home to commit to its stated minimum staffing level of six care staff by writing this into its statement of purpose, so people contracting with the home would have a clear baseline level of staffing to expect. This was complied with quickly, and the care staffing levels have been largely sustained. We also recommended in May 2007 that in allocating additional staffing hours to meet residents’ needs, priority should be given to maintaining core staffing levels at weekends; and increasing levels at times that are found consistently to be the most pressured. By this inspection the home had as a temporary measure introduced threehour shifts from 7:30 a.m. and from 6:00 p.m., additional to the usual five Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 27 care staff plus a care leader, in recognition that some residents presented additional needs, particularly in respect of use of a hoist for moving, which requires two staff. The home also now had an increased budget for staffing, to allow the staffing on each whole shift to be increased by one. Since our visit, Mr Dyer has confirmed that new staff have been appointed, thereby achieving the planned staffing levels, so the temporary arrangements had ceased. At night there were three care staff, which Mr Dyer said was proving sufficient. Staff we spoke to said the top-up shifts had made a big difference, as did “care support” when available; this is a non-caring role, taking care of tasks such as bed making to free up care staff time. Late mornings, however, could still see staff so committed to specific duties that one person might be answering all calls. One member of staff wrote on a survey form, “If there is a full number of staff on shift from all departments – carers, care support, housekeepers, admin – it works very well. If not…it’s a very hard and stressful place to work”. All staff survey responses considered there to be a need for more staff. Another comment was, “At this present time we have a few service users who need extra care e.g. hoisting, which takes 2 carers off the floor. We also have several with dementia who regularly place extra demand on staff time.” At the same time, however, staff conveyed in person and via the survey that they were very committed to the work of the home. They felt part of a team, and staff retention has not been a problem. The care leaders had some “off rota” time in which they could undertake some of their more administrative duties without being part of a care shift. A post of Head of Care had been created, which again gave some relief to care leaders in particular, and was never counted as part of the care shift. Staff at all levels seemed to really appreciate this development. There had also been some recruitment to the home’s “bank” staff. This reduced the need to take on agency staff, who might not be familiar with the home, to fill gaps in the rota, although we saw some agency cover was still being used. At the random inspection in May 2007, of four residents spoken to, three identified no issues about staffing availability. They got the help they wanted, when they needed it. The fourth person said there was a “definite shortage of staff”. They saw staff as having to concentrate on high-needs residents, especially those with dementia, at the expense of those who were superficially more able. In the survey for this inspection, nine out of ten residents ticked that they “Always” receive the care and support they need; the other ticked “Usually”, adding “within limits of staff”. Several residents told us they saw staff as rushed and thus unable to spend time with them other than to undertake specific care tasks. One person described morning and afternoon hot drinks being given with no added time for interaction, and assistance with dressing being given in a perfunctory way. They sometimes waited a long time for a call bell to be answered, and we were aware of a person waiting several minutes for a response to a call bell. This inspection, therefore, showed care staff were well organised and meeting most of the essential demands on their Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 28 time, but that the increases in the pipeline should allow for more attention to the less pressing and more interactive aspects of their work. All staff considered they usually had the right support, knowledge and experience to meet people’s needs. The Trust had a centralised system for monitoring when individual members of staff needed to go on refresher courses. The same system allowed the head of care to identify when and where courses were available and to book places on them. There was evidence of training courses booked for several months ahead. All care staff received dementia training, a “Quality Dementia Care package” accredited by The Alzheimer’s Society, as a part of core training. Support staff also received training in understanding dementia. All staff that returned survey forms were very positive about the training made available to them, from induction onwards. One wrote, “The amount of training courses etc. that staff are put on from the day they commence at Brookside is first rate, including encouragement to further their knowledge with NVQ 2&3. All this instils confidence to carry out every day tasks. Also the training sessions are made very interesting and enjoyable”. An additional small office had been created opposite the care leaders’ office, as a base for the head of care. Training was organised from here, and there was an “e-learning” facility for staff. The Trust had a commitment to ensuring all care workers achieved at least NVQ (National Vocational Qualification) in care to level 2, with care leaders going on to level 3. More than 50 of Brookside’s care staff had NVQs and others were working towards an award. The head of care was working towards NVQ level 4. Newly appointed staff spent time shadowing experienced staff as a part of induction. Staff in support roles in the home had opportunities for development. For example, the chef was due to attend a chefs’ development day with others employed by the Trust. We checked the recruitment records of four staff who had recently been appointed. In all cases there was an application form and it was clear that a full account of people’s previous employment history had been obtained. Two written references had been received for each person, three in one instance. People did not start work until criminal records checks had been completed. There were job-specific lists of interview questions, which were scored by both the manager and head of care at interviews. Thus people could be sure staff working with them had been through a thorough recruitment process and did not present any known risk to their safety. New staff underwent an induction, designed to fit with current recognised expectations of induction. This meant new workers had a reliable introduction to the values as well as skills necessary to work in a care home. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from an effective chain of management. The views of people living in the home are sought and acted on to ensure the home is run in their best interests. The support people receive is enhanced by regular supervision of the care workers. People are safeguarded by the arrangements made for handling their finances. The environment is safe for residents and staff because of sound health and safety policies and practices. EVIDENCE: Richard Dyer has been managing Brookside for over a year but the registration process was not yet completed at the time of this inspection, as the application was made late. (His registration application has since been approved). We also noted the Annual Quality Assurance Assessment, which services must supply to us when requested, was over a week late. However, good working Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 30 relationships were in evidence between Mr Dyer and all groups of staff. The structure of manager, head of care, care leaders and administrator appeared to work well and there were regular senior team meetings. Certain areas of work were delegated. For example, the head of care had primary responsibility for overseeing staff training. Office systems were orderly, making it easy to access up to date information. Home managers are required by the Trust to carry out an annual quality survey of residents and their relatives. This had taken place in the home in July 2008. An overview of responses showed measures that had been taken to address identified areas of dissatisfaction. For example, one person disliked the colour scheme of their room, and in response it was repainted in a colour of their choice. Some responses reflected the difficulties the home experienced in appointing a full staff team in the kitchen, and an activities co-ordinator. There was an action plan prepared as a result of the survey, and it was accompanied by evidence of how the findings of the previous year’s survey had been addressed. In addition to this exercise, there was an annual external audit that tested the home’s compliance with Trust policies and procedures, so that identified shortfalls could be corrected. Residents’ meetings were held, as another means by which satisfaction levels could be gauged. These had been held in January and July 2008, with a further one planned for October 2008. Minutes showed the main issues raised had been food, activities and environmental issues. Many residents, or their families, placed small amounts of their personal monies for the home to hold safely. We looked at the systems for managing this. Only the manager and administrator had access to the safe. Amounts of cash were kept separately for each person that made use of this facility. The resident concerned, or another member of staff, countersigned the cash sheets kept and receipts were in place to demonstrate expenditures. The records were regularly audited within the home and by visiting Trust managers. The most common items of expenditure were hairdressing, newspapers and chiropody. Mr Dyer agreed that “Resident of the Day” checks would begin to consider with people whether individual arrangements for looking after their money were working in a satisfactory way. There was a chain of supervision in the home, the manager supervising the senior staff and they in turn supervising care staff. A matrix showed when supervisions had happened, and were due. The Trust’s audit earlier in the year had found a shortfall in the frequency of supervision, and so it had been a priority area to bring it into line with Trust policy (and National Minimum Standards). An example of a record of a person’s supervision by the head of care showed appropriate recording on a standard form, and issues raised had been explored. One of the care leaders had specific responsibility for supervision of night staff. Mr Dyer had recently attended the home at night, past midnight, as a spot check on how the home ran at night. The Trust had introduced a personal development and appraisal system, which accounted for Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 31 two one-to-one meetings each year for members of staff and helped identify training needs. Trust managers made regular unannounced monitoring visits. These included checks on health and safety procedures and recording, including checking accident records, fire precautions monitoring and staff training in fire procedures. Care plans included individual fire evacuation plans, and contained evidence that a member of staff had discussed fire precautions with the resident. These documents were reviewed; for one person, a temporary hearing loss had been added as a risk factor. A health and safety group met quarterly in the home to review risk assessments. There was evidence of quarterly health and safety refresher training for all staff. As mentioned under “environment” above, we identified some toilet floors as posing a slip risk that needs to be addressed. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 32 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 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 4 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 3 X 2 Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 33 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 OP9 Regulation 13 (2) Requirement Timescale for action 31/10/08 2. 3. OP21 OP38 OP26 13 (4)(c) 13 (3) The controlled drug cupboard must be checked for compliance with the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007), and arrangements made to purchase and install a replacement cupboard if necessary. All toilets with original tiled floors 31/12/08 must be fitted with non-slip flooring. Rusted brackets in the identified 31/10/08 sluice must be made good or replaced. 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. Brookside Refer to Standard OP7 Good Practice Recommendations Care plans for skin integrity should identify individual risk DS0000028405.V369843.R01.S.doc Version 5.2 Page 34 OP8 2. 3. 4. 5. OP7 OP8 OP9 OP9 OP12 6. 7. 8. OP12 OP13 OP15 OP26 factors, and associated proactive interventions that may reduce the risk of pressure area injury occurring. Seek agreement with the community nursing service regarding how to assess risk of pressure damage. All care staff should receive at least basic training about the use of medication in care homes. Evaluation of care plans for “as needed” medicines should always indicate the actual extent of usage of the medicine in question, during the period being reviewed. The activities co-ordinator should be given time to become familiar with care plans, in order to identify indicators of individuals’ activity and occupational needs. She should be involved with key workers in devising social needs care plans with residents. Consider inviting a member of staff to be a “champion” for developing residents’ use of their computer. The dietary requirements of the identified person should be reviewed with them as a priority, including examination of the range of menu options for vegetarians. Carry out periodically an audit of “hidden” areas that could pose infection control risks if not maintained to be free of grime and rust. Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brookside DS0000028405.V369843.R01.S.doc Version 5.2 Page 36 - 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!