Inspection on 14/06/06 for Waterloo House

This inspection was carried out on 14th 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 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

Waterloo House 18/08/08

Waterloo House 25/02/08

Waterloo House 14/09/06

Waterloo House 10/08/05

Waterloo House 02/06/05

Waterloo House 11/08/04

Waterloo House 04/05/04

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Heathlands

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Ravenhurst

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Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Waterloo House Waterloo Road Bidford On Avon Warwickshire B50 4JH Lead Inspector Deirdre Nash Key Unannounced Inspection 11:00 14th June 2006 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 Waterloo House DS0000004260.V291335.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. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Waterloo House Address Waterloo Road Bidford On Avon Warwickshire B50 4JH 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) 01789 773359 01789 774791 Alpha Health Care Limited Care Home 35 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (20), of places Physical disability (1) Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Waterloo house is registered to provide personal care for 35 older people. The registration is for 20 older people, 14 with dementia and one person with a physical disability. The main house is a large Victorian house, which has been converted to house 21 service users. All bedrooms have en suite facilities. The first floor is accessible via a chair lift only. Avon Lodge is a purpose built building behind the main house and accommodates 14 people with dementia. There is a passenger lift to the first floor as well as stairs. The home is within walking distance of Bidford Upon Avon where there are shops, churches and a bus service to Stratford Upon Avon. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection covered the KEY National Minimum Standards. We looked for all of the information that we have received about this home and kept on our records over the past twelve months. The provider organisation has generally had appropriate contact with us about the home during that time and kept us informed. After the last inspection in August last year, we asked them to send us an action plan detailing how they were going to improve the things that we pointed out as being below standard and they did so. We sent the home a questionnaire in March to fill in and bring us up to date with facts and figures about the home. It was properly filled in and sent back to us. Comment cards were also sent to be distributed to relatives and to the service users to find out their views about the home. Many were completed and returned to us and those views are reflected in this report. The Inspector called on the home without notice late morning mid week, spoke with some of the residents, spoke to staff, spoke to some relatives visiting residents, spoke to the acting manager, looked around the home and looked at records. The care of a sample of five particular residents was ‘tracked’ this way in order to see if the home is providing a service that meets the national minimum standards. What the service does well: What has improved since the last inspection? The home is now finding out what the psychological as well as the physical needs of service users are before offering them a place at the home to make sure that it can look after them properly. A ramp has been put in place to make sure that residents with wheel chairs can get into the garden. A larger proportion of care staff are now qualified in social care. Any accidents or falls that occur are put on record and adjustments are made to surroundings to try to avoid them happening again. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 6 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. Waterloo House DS0000004260.V291335.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 Waterloo House DS0000004260.V291335.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, 2, 3, 4 The outcome for this group is adequate. The home does not agree to look after people until it knows what they need. Residents are protected by up to date assessments of their needs. Contracts are not kept in individuals care files. Residents and their representatives do not have access to a copy of the terms of their stay at the home. EVIDENCE: Current charges are £440-£505 per week. Four care files were looked at representing a ‘tracking sample’. All had a social services care management assessment of needs. Risk assessments were on file where necessary. One very recent admission had a comprehensive assessment of need carried out by the home. There were no contacts /terms and conditions for care and accommodation in files. The acting manager says that they are kept at head office. Residents should have a copy in their files A requirement is made to improve this. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 9 There was no evidence of a statement of purpose or service user guide in any care file or in residents own rooms. A requirement is made to improve this. There are at least 16 residents with dementia in the home and from observation it is clear that a number of others experience some confusion/cognitive impairment including two very recent admissions to the home. A check on the training profile of a key worker to one of the residents in the tracking sample showed no specific training in dementia awareness or dementia care. Staff must have the up to date skills, knowledge and understanding to meet the needs of residents. A requirement is made to improve this. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 10 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 The outcome for this group is poor. There is insufficient monitoring and evaluation of the condition of very vulnerable residents over changes in staff shifts. Residents are are risk from changes in their conditions going unoticed. EVIDENCE: The files of residents that were ‘tracked’ showed patchy performance by the home on devising service user plans. Two out of five had no plan. A recent admission did have a clear written plan that included psychological needs- this is an improvement from the last inspection. A requirement is made to improve this generally. There was evidence during the inspection over two days that residents receive appropriate and prompt medical intervention. However, the care of one resident who was observed to have discarded her entire main meal of the day was tracked through records and talking to staff and was not consistent with this general trend. Her care file showed a risk assessment for nutrition because of considerable recent weight loss, weight charts and records of doctors visits. Her care plan said she needed encouragement to eat. There was no food or fluid intake monitoring records. Staff who came on the afternoon shift were asked what she had eaten that day and did not know. The manager did not know that this Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 11 resident had experienced significant weight loss and was at risk. Staff who came on morning shift next day were also asked what she had eaten in the previous 24 hours, they said they did not know. The record made on her file after the inspectors questions on the afternoon before had not been read next day. An immediate requirement was served to improve this situation. The manager says that after the inspection she talked to staff about this and reports that they told her that despite what happened on the day of inspection, they ‘knew’ that this resident had in fact been eating well recently. This is not a sufficiently robust approach to monitoring the condition of someone under risk assessment for considerable weight loss. A requirement is made to improve practice. Rosters show that there is no time allowed for a proper handover of information between shifts, staff report that they try to come in early in their own time to catch up. The manager reports that staff are not sufficiently flexible over shifts. A requirement is made below to improve this. Residents in Waterloo House showed signs of general well being but residents in Avon Lodge showed signs of boredom and listlessness. One resident shook the front door for twenty minutes to try to open it while the inspector was in the adjacent office looking at files. No one came to distract this resident. A requirement is made below to improve this. Medication was checked, sampling one resident in Avon Lodge. It was well organised, tidy, properly labelled, secure and records clearly made without any gaps. One resident told the inspector that she had been bathed in bed that morning and confirmed that staff did it well and with kindness. One resident over one hundred years old seen confined to bed was clean and appeared comfortable. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The outcome for this group is adequate. Food is good and mealtimes are unhurried but not very flexible and the home is not intergrating occupation and stimulation into the everday lives of residents. Residents psychological health may deteriorate. EVIDENCE: Observation across both buildings over one and half days showed very little positive activity going on. The hairdressser was in the home on Wednesday as usual and on Thursday one care assistant was manicuring ladies nails in Avon lodge, which they clearly enjoyed. However this is not the intergrated stimulation and occupation that was deveoping at the last inspection. The activities organiser was carrying out a care asssistants role. There is no deputy manager in the home currently and the deputy had been taking the lead on this important area. There is a summer fete being organised and while community contact is important the time and energy spent on this annual event may, at the moment, be better spent improving variety in the daily lives of the residents especially those with dementia. Nobody in Avon Lodge had anything in their hand to do. One resident in Waterloo House was seen reading a newspaper. The Inspector had lunch with residents in Waterloo House, one lady could not hear what was being said to her but the Inspector found she that could read some ‘conversation off a note pad. Staff were not seen doing this for her She Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 13 asked what the juice was that she was being given and the inspector wrote blackcurrant on a sheet of paper.- there could have been a written or pictorial menu on the table or the dining room wall and the jug could have had a picture on it or with it. More work needs to be done on stimulating residents in an everyday way and communication is essential to this and to being able to make choices. The homes performance has slipped since the last inspection. A requirement is made again to improve this. There have been seven notifications made to us of aggression between residents since the last inspection, these could be accounted for by boredom and frustration and lack of control over small but imprtant aspects of their day. The food was fresh, nutritious, well cooked and well presented. One resident was seen taking breakfast in her room because she wanted to that day. Staff report that efforts have been made in Avon Lodge to keep portions of food hot for slow eaters but that this puts them off their meal on many occasions. The home has more work to do on making sure that residents with dementia get sufficient nourishment. Food and mealtimes at Avon lodge needs to be put under review, they may need to be more flexible to suit the needs of individuals. A requirement is made. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The outcome for this group is good. The home investigates complaints that are made, reports adverse incidents and keeps proper records. Residents are protected by good procedures. EVIDENCE: An account of two complaints, the investigation and outcome was seen in the file of one resident. Regulation 37 notifications are made to the Commission as appropriate. The home is not keeping these complaints in central log of complaints however and it should so that patterns can be monitored by the manager and contribute to service improvement. A requirement is made. The complaints procedure is on the notice boards in both houses. The POVA (Protection of Vulnerable Adults from Abuse) procedure was seen on notice boards and two staff files sampled showed that one out of two had received training in elder abuse. The manager reports that 6 staff had elder abuse training during 2005. POVA procedure training now needs to be undertaken by all staff especially team leaders so that staff understand how to respond to any suspicions or allegations to protect residents. A requirement is made to improve this. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 The outcome for this group is adequate. The old house presents difficulties for people with sensory loss, confusion and limited mobility. Some residents cannot move around the home confidently. EVIDENCE: A resident with sensory loss was seen having some difficulty getting her bearings in the old house. She had injured her ankle soon after she moved in from the half landing stairs outside her bedroom. There is still no indication along the corridor of the main house which direction to the public rooms. This was raised before. A requirement has been made above about improving communication for residents with sensory loss and confusion. The manager has had the garden steps highlighted in paint for safety and extra handrails have been added. Residents do have access to a large enclosed garden. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 16 The old house remains limited in its suitability for frail people with mobility difficulties. Some parts of both houses have a smell of urine although steps had clearly been taken to clean the areas. This was raised before and may be dealt with through better sign posting of facilities already referred to above. The kitchen was clean and well organised. Bathrooms and toilets were generally clean and had sufficient supplies. Bedrooms were clean and looked comfortable. The furniture in the sitting rooms in Waterloo House is worn and tired looking and a plan for replacement should be put in place. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The outcome for this group is poor. There is no formal system of communication between staff shifts. Important information about the daily well being of individual residents is not passed on. EVIDENCE: Five staff including the deputy manager have gone on extended leave of absence recently. The provider company are not replacing the deputy for this period but offering extra responsibility with pay to two team leaders. Evidence above show that this is not sufficient to manage the care over two separate houses. Most residents have high needs The manager confirms staff comments that she spends very little time at Avon Lodge. The manager reports that the home has a good and reliable night staff team at the moment. Staff are clearly committed to the care of residents and many have worked at the home for a long time but evidence referred to already about the resident who ate no main meal and subsequent shifts did not know, demonstrates that the Lodge is not being managed. This is putting residents at risk. See section 7 below where a requirement is made about the management of the home. Staff say they have no time to make records in care files. The Inspector saw that two out of three files picked at random in the dementia care unit on the Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 18 second morning of inspection had no report from the night shift. There seems to be some confusion over what the provider company has told staff to do about records making. This must be cleared up. A requirement is made. Some verbal handover is happening between team leaders but in Avon Lodge it is not sufficient. Staff including the team leaders, are not reading the records that are made. Referred to above stimulation, activity and occupation for residents with dementia is not being sufficiently promoted. The roster for Thursday of the week of this inspection shows seven care staff working in the morning and six working in the afternoon/evening across both houses. These numbers should be adequate if managed well. But close examination shows that there is very little overlap, even between team leaders at shift change times, particularly at 8am and at 2pm. These are crucial communication times and the safety of residents and the continuity of care depends on effective communication between the staff teams. A requirement is made to improve this. There are ancillary staff in the home including a cook and part time handyman. The Manager reports increase in care staff qualified at level 2 NVQ and this is positive progress towards the national government target for qualifying the care workforce. The provider company provides a rolling programme of in house training sessions. Referred to in section 2 above where a requirement is made, staff files sampled show that some key workers of residents with dementia have not had any dementia training. One staff file was sampled for recruitment procedures. Gaps were found in the information necessary to protect residents from people who are not suitable to work with them. A requirement is made to improve this. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 19 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, 32,33, 36, 37, 38 The outcome for this group is poor. Management hours have been reduced and leadership of the home is over focussed and missing the bigger picture. There is no day to day operational management presence in the dementia care house. Residents there are at risk because no one is monitoring and evaluating their condition from shift to shift. EVIDENCE: A new manager took over the home in March 2006, she has applied to register with us. The deputy manager is on extended leave and the company have not fully replaced her. It is clear from the evidence throughout this report that the home is not being sufficiently managed. The manager spends little if no time at Avon Lodge where the most vulnerable residents live and does not know the residents there. She says that she has no time to spend there. Action was not taken immediately the Inspector reported that staff did not know whether a resident under nutritional risk assessment had eaten for 24 hours. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 20 Effective management of both houses is necessary for continuity of care and to safeguard very fragile and challenging residents. The staff team must be effectively and visibly led. A requirement is made to improve this. Regulation 37 notifications have been made to the Commission as they should be . Regulation 26 visit reports have been sent to the Commission on some months through the past year but there are gaps. It appears that there have been no regulation 26 visits from the Provider to this home since the new manager took over. These vists are important for quality assurance but also to support the manager. A requirement is made to improve this. There is no evidence of one to one staff supervision sessions since 2004. The manager reports that she is about to start a programme up again. This is important for continuity of care, quality assurance and the professional development of staff and the staff team. A requirement is made to improve this. A sample of safety check records; lifts and hoists and fire extinguishers show proper maintainence. This paperwork is in good order. The Fire alarm stystem was tested when inspector was in building on Wednesday. The last CSCI inspection report was available on the notice board in Waterloo House. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 21 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 2 2 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 2 x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x x 2 2 3 Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 23 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12 Requirement The registered person must ensure that the amount of food and fluid taken by the individual resident identified at the inspection is recorded, monitored and evaluated and necessary action taken as appropriate to maintain her well-being. IMMEDIATE. COMPLIED The registered person must ensure that residents have access to the statement of purpose for the home. The registered person must ensure that a copy of the service user guide to the home is given to each resident. The registered person must ensure that a copy of the contract/statement of terms for care and accommodation is kept on file at the home for each resident The registered person must ensure that all care staff undertake or update their training in good dementia care practice. The registered person must ensure that every resident has a written plan for their care and that it is regularly reviewed. The registered person must ensure that the care of all residents identified as at risk DS0000004260.V291335.R01.S.doc Timescale for action 15/06/06 2 OP1 4 01/08/06 3 OP1 5 01/08/06 4 OP2 17 01/08/06 5 OP4 18 31/12/06 6 OP7 16 01/08/06 7 OP8 17 01/07/06 Waterloo House Version 5.1 Page 24 8 OP8 12 9 OP12 12 10 OP14 12 11 OP15 12 12 13 OP16 OP18 22 13 14 OP37 17 15 OP27 18 from not eating or drinking sufficient to maintain their health and well being is put under review and that recording systems are put in place to monitor what they eat and drink. The registered person must ensure that all records made about the care and well being of individual residents are evaluated regularly by a manager/supervisor and action taken on this information as necessary to promote their wellbeing. The registered person must ensure that social/leisure activity and occupational stimulation is woven into the everyday and evening lives of individual residents. The registered person must ensure that reasonable steps are taken to promote communication with residents who have sensory loss and confusion. The registered person must ensure that mealtimes and availability of food at Avon Lodge is reviewed against the needs of current residents. The registered person must ensure that a central log is also kept of complaints in the home. The registered person must ensure that all care staff, in line with their job role, undertake training in the Protection of Vulnerable Adults from Abuse procedure and locally agreed multi agency protocol. The registered person must ensure that records are made sufficiently frequently by staff to monitor and promote the wellbeing and safety of individual residents. The registered person must DS0000004260.V291335.R01.S.doc 01/07/06 01/08/06 01/08/06 01/08/06 01/08/06 31/12/06 01/07/06 01/08/06 Page 25 Waterloo House Version 5.1 16 OP29 19 17 OP32 10 18 OP33 26 19 OP36 18 ensure that staffing rosters are organised in such a way as to enable an effective handover of care after each shift. The registered person must ensure that an audit of all personnel files is undertaken to identify any gaps in the information on record about staff working in the home and that steps are taken to obtain that information. The registered person must ensure that both Waterloo House and Avon Lodge are managed competently. The registered person must ensure that visits are made to the home at least once each month by the registered provider or delegate and a report of these is submitted to the Commission for Social Care Inspection. The registered person must ensure that one to one supervision of care staff takes place at least six times per year and that records are kept. 01/08/06 01/07/06 01/07/06 01/08/06 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 OP19 Good Practice Recommendations The replacement of furniture in the sitting rooms at Waterloo House should be planned for. Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Waterloo House DS0000004260.V291335.R01.S.doc Version 5.1 Page 27 - 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. 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