CARE HOMES FOR OLDER PEOPLE
Ackworth House The Beach Filey North Yorkshire YO14 9LA Lead Inspector
Mary Slattery Unannounced 1 September 2005 09:15
st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ackworth House Address The Beach, Filey North Yorkshire YO14 9LA 01723 515888 01723 515888 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ackworth House Ltd Miss Anne Catherine Boland Care Home with Nursing 35 Category(ies) of OP Old Age (35) registration, with number of places Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 4th November 2004 Brief Description of the Service: Ackworth House provides personal care, gerneral nursing care and accommodation for up to 35 service users. Day and respite care is also provided. The home is situated on the seafront at Filey and is with easy reach of the local amenities and facilities of a seaside town. The home has four floors and there is a passenger lift for access to the upper floors. The communal accommodation is on the ground floor and the service users bedrooms are on the upper three floors. There is ramped and level access to the home, a large veranda to the front and a small garden area at the side. Parking is limited on the roadside opposite the home. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection carried out on the 1st September 2005. The inspection took 5 hours plus preparation time. A tour of the premises was carried out which included the service users’ private accommodation. A selection of the homes’ records were inspected and time was spent observing the activity in the home talking and listening to service users and staff. The focus of the inspection was on a number of key standards, inspecting the case records of a number of the service users to see if they corresponded with their experiences of life in the home. A member of staff was available throughout the inspection and the findings were discussed with her at the close of the inspection. An immediate requirement notice was issued requiring immediate action to be taken to improve the fire safety standards throughout the home and to increase the numbers of staff on duty overnight. The registered manger was contacted and informed of the concerns regarding the safety of service users. A follow up visit was done on the 16th September 2005 to check that the serious issues identified at the inspection had been addressed. All the wedges had been removed from the fire doors, the fire risk assessment has been completed and arrangements made for fire safety training for all staff. No arrangements had been made to increase the staffing levels on duty overnight. Agreement was reached and action is to be taken to increase the staffing levels from 2 to 3 overnight. What the service does well:
Good information had been gathered about the service users and the care plans provided staff with clear guidance about their individual needs and preferences and the arrangements that needed to be made to ensure their care was delivered as agreed. Risk assessments had been carried out and the outcomes of any identified risk recorded. There was information about what to do to minimise risk with regard to service users mobility, prevention of falls, pressure area care and management of continence. There was evidence to show that the service users had contact with a variety of other health care professionals including their general practitioner. The service user met with said they were happy living in the home, that they were respected by the staff, well cared for and had a good choice of food.
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 6 Some had chosen Ackworth House because of its location and reputation for good care, others because they wanted to remain living in Filey. The majority of the staff are local and this makes a difference because they can all discuss things that are happening in and around Filey. All of the service users looked well cared for, well dressed and attention to their hair and manicures are available regularly. On the day of the inspection the weather was good and a number of the service users and relatives took advantage of this by going down to the beach bring back lunch to enjoy on the veranda. There is a staff training and development programme in place and a member of staff has responsibility for the delivery of the in house training. A number of the care staff have achieved NVQ Level 2 and the qualified nursing staff have access to suitable training courses to continue to update their knowledge and skills. The staff met with were aware of their responsibility to protect service users from abuse, they were aware of the whistle blowing policy and agreed that they would benefit from adult protection training which would include the local authorities policy for reporting any allegation or suspicion of abuse. They said they worked well as a team and were well supported by the registered manager. They enjoyed working in the home and they liked to ensure they provided good quality care to the service users and to access training on a regular basis. They demonstrated that they knew all of the service users well and how each person liked their care to be delivered. The staff would like to see an improvement in the premises and have available more assisted baths. This would improve the living and working environment, enable service users to have more baths and prevent the staff having to escort service users to another floor for their bath. What has improved since the last inspection?
Arrangements have been made to test the water on a regular basis and to take appropriate action to ensure the temperature does not exceed 43 degrees centigrade and therefore reducing the risk of injury to service users. There has been an increase in the number of staff who have attained NVQ level 2 and the registered manager is near to completing the certificate in management. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 7 What they could do better:
To take immediate action to improve the fire safety standards throughout the home by removing all wedges, completing the fire safety risk assessment and arrange fire safety training for all staff as required. To meet the recommendations made by the fire safety officer following his requested visit to the home. The staff would like to see an improvement in the premises and have available more assisted baths. This would improve the living and working environment, enable service users to have more baths and prevent the staff having to escort service users to another floor for their bath. To provide to the Commission for Social Care Inspection a full and detailed plan for the refurbishment of the premises and for the fitting of sufficient assisted baths for the service users. Make the statement of purpose and service user guide available to current and prospective service users. Ensure that all staff are aware of the document and the contents. To review both and make sure that they accurately reflect what is offered and provided. To stop the practice of secondary administration of medication and signing the medication records before service users have taken their medication. To review and change the institutional practice of giving out medication whilst service users are eating their meals unless medication has been prescribed to be taken with food. To clearly show that service users have opportunities to be involved in the activities of their choice and preference and to employ staff to organise activities other that the care staff. To fit locks to service users bedroom doors and provide them with lockable facilities to store valuable and to ensure they have access to their money at all times. To make arrangements for all staff to attend abuse awareness training and to commence staff supervision. To increase the staffing levels on duty overnight from 2 to 3 to make sure that all care needs can be met and that service users are safe. Where 2 staff are attending to one service users there is no one available to respond to an emergency situation and maintain the safety of the service users as required and as detailed in the statement of purpose. The majority of the requirements and recommendations identified at the previous inspection carried out on the 4th November 2004 have not been met.
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 8 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. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 and 5. People are provided with limited information about what the home offers to provide. Information is gathered about people before they move into the home to ensure that the service is suitable to their needs. EVIDENCE: A statement of purpose and a service user guide has been produced but there was no evidence to show that had been made available to prospective service users and their representatives or to the current service users. The documents give details of the service and facilities, the staffing arrangements and how to make a complaint about the service. The staff met with at the inspection were not familiar with the statement of purpose or the service user guide. They reported that when people came to enquire about the service and to look round the home they would give them a brochure which when looked at gave basic information about what was provided. Information in the statement of purpose needs to be reviewed, as the home does not currently provide sufficient assisted bathing facilities for the number of service users accommodated.
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 11 The terms and conditions/contracts that should be issued to service users were not available for inspection. The policy of the home is that all service users will be assessed prior to admission. There were detailed assessments in the service users care plans, which covered all aspects of their personal, nursing, social and psychological care. Risk assessments were in place for moving and handling, falls, the use of bed safety rails, tissue viability and continence. Prospective service users and their family and or representatives are invited to visit the home and move in on a trial basis before making the decision to move in on a permanent basis. The home does not provide intermediate care. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. The service users receive a good standard of personal and nursing care from a trained and motivated staff group. EVIDENCE: Individual care plans were in place for the service users. There was information about their personal, nursing, social care needs and action plans in place for staff to meet the assessed needs. Risk assessments were recorded in detail about the assistance they need with their mobility, the care and treatment of pressure areas and the actions to be taken to minimise risk without to much restriction of the service users independence. There was information about contact with external health care professionals and any treatments and interventions and special feeding techniques. Nutritional assessments were carried out and there was information about the type of diet and any food supplements required. There was evidence that advice is sought from the tissue viability nurse and the continence advisor to ensure that the service users receive the appropriate pressure relief and continence aids. There were a number of height adjustable beds some of which had been provided by the home. Two service users had purchased their own height
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 13 adjustable beds and whilst this is their prerogative it is important that there is written evidence to confirm this and details of what will happen to the beds in the event of the service users leaving the home or dying. There are systems in place for the review of the service users care and information about their care is recorded over a twenty -four hour period. The monitored dosage system for medication is operated by the home. The qualified nursing staff are responsible for the storage, administration and recording of service users medication. It was observed that medication was not being administered as required and that the administration records were being signed prior to service users receiving their medication. Medication was being administered whilst the service users were having lunch. This practice is institutional and unless service users have been prescribed medication to be taken with food there is no reason why this practice should continue. All medication must be administered from the original container and the administration record must not be signed until the service users have taken their medication. All of the service users looked well cared for they were well dressed and well groomed. Staff were observed speaking to the service users in a respectful way and knocked on their bedroom doors before entering. The service users met with said that all the staff were kind, caring and made them feel important. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Visiting arrangements are flexible allowing service users to maintain good contact with family and friends. The menu looked at showed that a nutritious balanced diet with choice is offered. EVIDENCE: The care plans gave information about the service users family and friends. Some of the service users met with at the inspection said they had specifically chosen to live at Ackworth House because of its location and reputation for good care. Other chose it as they are from Filey and wished to remain close to their families. The said that the home meets their expectations and that they were well cared for, the food was good and where able they went out and about either independently or with friends and family. The menus looked at showed that the service users are provided with a wellbalanced nutritious diet with plenty of choice. The service users and the staff said that there is choice about when they go to bed and get up each day and they were enabled to maintain their independence with regard to making decisions about their lives and their mobility. There is ramped and level access to the home and along the ground
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 15 floor corridor, which enables those service users who need to use wheelchairs to be independent in the home and in the local area outside the home. The home does not employ an activities organiser all activities are organised by the care staff. This situation is not ideal as the care staff are primarily responsible for the care of the service users. The statement of purpose states that each service user will have their own individual activities plan in accordance with their personal wishes and choices. These arrangements are not in place and therefore action must be made to provide regular and appropriate individual activities for the service users. The service users bedroom doors are not fitted with locks and they are not provided with lockable facilities in their own rooms. To enable service users to maintain their privacy locks must be fitted and lockable facilities provided for the safe storage of valuables. Should any service users wish to administer their own medication they would need lockable storage facilities for the safekeeping of medication. A number of the service users are supported with the management of their personal monies and the systems and facilities were inspected. Good accounting systems were in place and receipts were in place for all transactions made on behalf of service users. There is a safe in the main office where service users may deposit money and/or valuables but they do not have access to these at all times. Arrangements are being made to ensure that service users have access to their money and valuables at all times. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The home has a relevant complaints procedure. Staff demonstrated an awareness of abuse but would benefit from abuse awareness training. EVIDENCE: Service users and visitors to the home are given information about how to make a complaint against the service. There were systems in place to record all comments, concerns and complaints. The procedure assures people that their complaints will be taken seriously, investigated and any outcome will be given in writing. There were a number of letters available from service users, relatives and other visitors to the home, which commented very favourably about the care provided and the quality of the staff working in the home. The staff records were available for inspection and they confirmed that the required CRB and POVA checks had been carried out on all staff and the qualified nursing staff had been checked with their professional body. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The standard of the environment must improve to provide service users with a safe, well-equipped and homely place to live in. EVIDENCE: The service users bedrooms were personalised with items that reflected their past and present lives, some had family photographs and chosen personal items. The home was clean and free from offensive odours. Staff are employed to carryout catering, domestic and laundry duties. There was a large wellequipped kitchen and laundry. There is a large lounge, two dining areas and a veranda all accessible to the service users. At the time of the inspection the majority of fire doors were held open by the unauthorised use of wedges. The fire risk assessment had not been completed as required and the records to show that the fire safety equipment was being tested on a weekly basis were not available for inspection.
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 18 It was not established if the night staff have fire safety training six times each year. An immediate requirement notice was issued requiring all wedges to be removed and all fire door to be kept shut. The fire safety officer was consulted during the inspection and arrangements made for a fire safety inspection to be carried out. The standard of decoration, furniture, fixtures and fitting were found to be of poor quality and a detailed plan must be submitted with timescales for the following work to be carried out. Redecoration and refurbishment of the communal lounge and dining rooms. Redecoration of service users bedrooms. Redecoration of the corridors. Replacement floor coverings throughout the home. The window frames in the veranda require replacing and the veranda needs to be decorated and kept tidy. Locks to be fitted to service users bedroom doors and lockable facilities in their rooms provided. There are insufficient numbers of assisted bathing facilities. A number of the bedrooms have en-suite facilities. One of the rooms had an en-suite shower, which was being used by the service users currently living in that room all the other facilities were not suitable for the service users. The majority of service users home need assistance with bathing and as there is only one suitable bath available this restricts the number of baths service users can have and increases the distance they have to go from their rooms to the bathrooms. This situation compromises their privacy and dignity. There must be one usable and suitable bath for every eight service users and therefore this situation must be addressed as a matter of urgency. The required safety certificates were in place and evidence that all equipment such as the passenger lift and hoists are serviced on a regular basis. There was a current insurance certificate. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. The service users receive a good standard of care from a motivated staff group. The number of staff on duty overnight is not sufficient and leaves service users at risk. EVIDENCE: The home employs qualified nursing staff care and ancillary staff. There is a staff development and training plan in place and one of the qualified nurses has responsibility for arranging and for the delivery of training to all staff. The training includes NVQ Level 2, health and safety, infection control, COSHH, moving and handling, first aid, tissue viability and the management of continence. Staff supervision is planned to commence in the near future. The home does not meet the staffing levels staffing as required by the previous regulatory authority. The staffing notice requires 2 qualified nursing staff on duty at all times during the day. There are times when there is only one qualified nurse on duty during the day. The staffing levels overnight are not sufficient to meet the needs of the service users, to ensure their continuing safety and the security of the building. A number of the service users need the assistance of two staff and the current staffing levels of two on duty overnight leaves no staff available to respond to an emergency call therefore compromising the safety of the service users.
Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38. The registered manager is aware of the areas in which the home needs to improve. EVIDENCE: The registered manager is a qualified nurse and has a number of years of experience in managing a service for older people and is currently working toward completing a certificate in management. The staff and the service users commented favourable on the registered manager, the staff felt they were supported and the service users said they were respected and well cared for. The registered manager was not on duty at the time of the inspection and therefore a number of the records were not available for inspection. The home has a health and safety policy and procedure and all staff are subject to health and safety training. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 21 Action needs to be taken to ensure that the fire safety requirements are met at all times and the staffing levels overnight are increased to ensure the continuing safety of the service users. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 3
COMPLAINTS AND PROTECTION 1 1 1 1 1 1 1 1 STAFFING Standard No Score 27 1 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x x x x 1 Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(2) 5(2) Requirement The registered person must make a copy of the statement of purpose and the service user guide available to each service users. The registered person is required to cease the secondary dispensing of medication. The registered person is required to fit locks on all bedroom doors and provide lockable facilities for individual storage of valubles to respect the privacy of service users.To forward a plan with timescales for this work to be completed. The registered person is required to make arrangements to implement a programme of social and recreational activities suited to individual preferences. The registered person is required to forward a plan with timescales for the redecoration and refurbishement of the premises. For the provision of sufficient assisted bathing facilities as detailed in the report. The registered person is required to keep all fire doors in the closed position. To keep fire Timescale for action 30th September 2005. 30th September 2005. 30th Novemeber 2005. 2. 3. 9 14 13(2) 4(a) 4. 15 16(n) 30th Novemeber 2005. 30th October 2005. 5. 19,20,21,2 2,24 23(2)(b)( d)(n)(o0 6. 19 23(4) 1st September 2005 and
Page 24 Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 7. 27 18(a) records available for inspection. To consult with the fire safety department. To complete the fire risk assessment. To evidence that the required fire safety training has been undertaken by night staf. The registered person is required to increase the staffing levels overnight from 2 to 3. To have the required numbers of qualified nursing staff on duty at all times during the day. thereafter. 1 September 2005 and thereafter. 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. 2. Refer to Standard 9 18 Good Practice Recommendations It is recommended that medication is not administered at meal times unless medication is specifically prescribed to be taken with food. It is recommended that arrangements are made for all staff to have abuse awareness training. Ackworth House J53 J04 S27996 Ackworth House V245427 250805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York, YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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