CARE HOMES FOR OLDER PEOPLE
Adamstan House Nursing Home 187 Mill Lane Sutton St Helens Merseyside WA9 4HG Lead Inspector
Mrs Lynn Paterson Unannounced Inspection 18th July 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Adamstan House Nursing Home DS0000005446.V295309.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. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Adamstan House Nursing Home Address 187 Mill Lane Sutton St Helens Merseyside WA9 4HG 01744 819815 01744 850330 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) Adamstan Limited Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 34 OP The Service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. One named service user under pensionable age may be accommodated within the overall number of registered places. Date of last inspection Brief Description of the Service: The home is registered to provide nursing care for up to 34 older persons over 65 years of age and is situated in a residential area with good access to St. Helens town centre and local amenities The home provides accommodation over two floors and has 34 single bedrooms. A passenger lift and stair lift are provided for ease of access to the upper floor. The home is purpose built and offers single accommodation only. Service Users are encouraged to personalise their private bedrooms. The home benefits from a variety of communal seating areas to include a large lounge, separate dining room, library area, quiet room and a conservatory that provides a pleasant view of the gardens and lake setting at the rear of the home. All garden areas are accessible to the residents with outside seating and awnings and car parking facilities are provided to the front and side of the property. The registered providers of the home are Adamstan Limited and fees are currently charged at £460.00.per week. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Adamstan House took place over a period of seven hours on 18th July 2006 and was undertaken on an unannounced basis. The inspector met with the registered provider, manager, senior nurses, senior care officer, six care staff members, cook and kitchen staff and 30 of the 33 residents living in the home. Records care files, policies procedures and other documentation was examined and a tour of the premises was carried out. Fieldwork included case tracking four residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and the staff who were associated with their care. What the service does well:
Staff spoken with revealed they were knowledgeable and experienced in the care of older people and committed to the provision of good quality care. Staff revealed that the home had experienced some changes of management during the past year, some of which they felt did not benefit the home. However they said that the home is now very well managed and they feel totally motivated and happy in their work. Comments from staff included: “We all now work together as a team”,” “I just love coming to work now”, “The atmosphere in this home is just great”, “We feel valued by our managers”, “We have a new system of information sharing so we all now know about the running of the home and the full needs of the residents in our care”
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 6 “The new manager has only been in the home for a few months but we have noticed the difference already. We all feel motivated and content”. Records show the service is good at obtaining assessment information prior to a resident coming to live within Adamstan House. Documentation viewed showed the service is good at identifying the health needs of residents through the assessments process, including them within care plans and facilitating visits to medical agencies. Observation of medication systems identified the service is good at providing a safe system of medication to include the security, the storage, administration recording, receipt and disposal of all medication. Residents said the service provides food that they are most satisfied with. Menus showed that food provision is varied and choice is offered at all times A tour of the premises revealed the service is good at providing a clean and home-like environment. The home is free of odour and well decorated. Staff rosters showed that the service is good at providing staffing levels, which meets the needs of residents and are directly linked to their levels of dependency. Comments made by residents during the inspection included: ‘I can’t fault it’ ‘Without these people I would have given up living years ago’ ‘I have my health needs met’ ‘I am free to go out whenever I want” ‘I have no complaints whatsoever’ ‘The food is good and I get a choice’ ‘I couldn’t wish for nicer people’ ‘I have settled in’ ‘It is very nice’ ‘I could not understand why anyone would complain about this place’ ‘I am happy with my room and I can get to it with no problem’ ‘I could not wish for better treatment’ ‘Staff are marvellous’ “Staff are kind and work very hard to make sure we are all very well looked after”. “I have been here for a few years and like it very much”. “My family feel that I am safe here and they feel better knowing that. I feel more happy in here than I have felt for a long time”. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
In discussions with the manager it was agreed that the service should provide a care planning system that is in a consistent format. It was noted that work has been started to change this format to a more detailed document and the need to provide consistency has been highlighted as a good practice recommendation in this report. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 8 Most care plans have not been signed by residents their families or any other person who played a significant part in their lives. Again in discussion with the manager it was agreed that the service must be more consistent in gaining the agreement of residents or their families in respect of the contents of their care plans. In addition to this, it was noted that some care plans are reviewed at least on a monthly basis while others are not. The service must be more consistent in its review of care plans. These have been raised as requirements in this report. Records showed that staff supervision had not been in place and staff training reviews and updates not undertaken. However documentation viewed revealed that the manager was in the process of introducing systems to ensure that staff supervision and training were given a high priority. Whilst activities are arranged for the residents, the home do not currently have an activities programme to identify what activities are in place each day. It was agreed that a programme would be placed on show in the home to enable everyone to know what activities were happening each day. Although some shortfalls have been identified in this summary it was noted that the newly appointed manager had already identified these shortfalls and as a consequence had commenced a total revision of all the policies, procedures and practices carried out in the home. 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. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 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 the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home manager has identified that she carries out a full assessment of need on each resident prior to admission being agreed. EVIDENCE: The assessments of two individuals who had been admitted into the service since the last inspection were examined. In both cases, assessments from the Funding Authorities were available and had been obtained prior to the person coming to live within the home. Documentation showed that in addition to the funding authority assessment, the home conducts its own assessment. This assessment includes the social and health needs of residents as well as the level of personal care needed to assist that person. Needs identified on these assessments could be readily linked to the subsequent care plan.
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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 Quality in this outcome area is now generally good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are addressed, however care -planning documentation does not fully identify how care practices should be carried out to meet assessed need. It was noted that the newly appointed manager has addressed this and has started to put systems in place to fully identify care needs, choices and care delivery. EVIDENCE: A new system of care planning has been introduced which utilises the twelve activities of daily living. This change to the new format is ongoing and it is recommended in this report that a deadline of October 2006 is set for the completion of this process. The new care plans include a detailed statement of residents’ needs in relation to their health, social and personal care needs. Information on sampled care plans was consistent to the original assessments in place. In discussion with the manager it was agreed that risk assessment would also be revised to ensure all documentation on file is an accurate reflection of the assessed needs of the individual.
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 13 Care plans were looked at in general and total of four care plans were examined in detail. It was noted that care plans have not been signed by the resident confirming their agreement with the contents of the plan and no input had been recorded re input form any other person who had played a significant part in the residents life. It is required that all residents and /or their relatives have the opportunity to do this. In addition to this, not all care plans identified that they had been reviewed on a monthly basis. This is also raised as a requirement in this report. However all residents were seen to have a care plan in place although the formats appeared inconsistent. The health needs of residents were held within care plans. These included a running commentary of doctors’ appointments and visits by other medical agencies. In addition to this, weight monitoring and reference to continence, tissue viability, and nutritional information was also included within the documents. Medication storage was in a portable, locked trolley, which was stored in a locked room when not in use. The room was noted to be locked at all times. In addition to this, controlled medication that has been prescribed was locked within a cupboard and subject to separate medication records. These records evidenced that all administration of controlled medications had been signed and countersigned by staff. No residents self-administer at present and reasons for the reliance on staff to deal with medications are included within care plans. All records were appropriately signed. A refrigerator for the storage of items such as eye drops is also available as required. All staff spoken with identified they had full knowledge and understanding of all aspects of medication management. Staffs observed carrying out their care practices, were seen to provide a high level of care and support for residents whilst enabling them to retain their dignity. Staff spoken with revealed clear knowledge and understanding of the residents needs and of the care and support necessary to meet individual need. All staff presented as fully motivated and competent to carry out good quality care. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 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 the following standard(s): 12.13.14.15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities and interests are arranged to suit the wishes of the residents. Food provision is varied well presented and of a high standard. EVIDENCE: Evidence for this standard was gained from the comments made by residents as well as viewing menus, speaking with the cook and kitchen staff and observing residents eating a lunch -time meal. Residents said they were provided with many options as to how they spent their time to include arranged activities, outings, reading, general conversations or enjoying time in their private rooms. Staff, were seen to be providing activities during the site visit although the manager advised that although activities were arranged daily the home did not currently advertise the activity programme in the home. It was agreed that an activities programme would be drawn up and notices would be put on show to ensure everyone knew “what was going on”.
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 15 Residents said they had frequent visitors who could come and go as they pleased. The visitors book confirmed that people visited the home whenever to see their relatives and friends who were living at Adamstan House. Staff revealed that they worked with the residents on a key worker basis which involved one member of staff having responsibility for two or three residents to ensure that their individual needs were noted and recorded to include the resident being assisted to have full choice and control over their lives wherever possible. Comments by residents relating to the food provided included: ‘The food is very nice’ ‘I can’t eat a lot but what I get is sufficient’ ‘Food is very good’ ‘I can’t fault the food’ ‘We get a choice’, “The food is always good. “If you don’t like what is on the menu they get you what you want’ The inspection coincided with lunchtime. Residents were seen to be able to sit in comfort in a well- lit spacious dining room, situated next to the kitchen. Staff advised that this ensures meals can be served as promptly as possible after being prepared. Residents advised that the usually sat with their friends at meal times and it was noted that several separate tables were utilised to enable the residents to have a choice of where they sat. The cook and kitchen staff demonstrated they had full knowledge of residents dietary needs and provided menus and choices according to individual tastes. It was noted that the lunchtime meal looked appetising well presented and all residents said they very much enjoyed the meal. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 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 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. Staff, are trained and knowledgeable in all aspects of adult protection and the complaints system in the home is know to residents and their families, is accessible and residents feel any complaints will be listened to and quickly acted upon. EVIDENCE: It was noted the complaints procedure outlined the process for making a complaint, the timescale for investigation as well as the contact details for the regulator. The home has a system for recording complaints but has not received any since the last inspection. All residents spoken with said that if they had a complaint they knew how to complain and felt that any complaints would be taken very seriously. However none of the residents said they had made a complaint as they felt the home was well run. The Manager is aware of the procedure for the protection of vulnerable adults having a copy of this for staff reference in the main office. In addition to this, the home is aware of the process of making referrals to the Local Authority. All staff showed full awareness of adult protection procedures. The service has a whistle-blowing procedure. Staff advised that they are aware of the process involved if they needed to pass on any concerns about poor practices observed in the home.
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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): 19.26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is clean pleasant and hygienic and has a clear maintenance programme to ensure that residents live in a safe environment. EVIDENCE: A tour of the premises noted it to be well decorated, clean and free of offensive odour. Flowers and other ornamental decorations were spread about the home and the atmosphere during the site visit was one of calm and comfort. Residents said they were able to mobilise throughout the building independently or with some assistance from staff. A passenger lift provides access to upper floors. The grounds of the home are accessible to residents and appeared very well managed and all exit and entry doors have ramps for ease of access.
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 19 Resident’s comments about the premises included: “This home is always fresh, bright and comfortable”, “Work is always being done to make sure this place stays nice”, “The home owner does a regular quality assurance check to make sure the home is always clean, well decorated and smells good”. “Just look at this place its comfortable, clean, well furnished, what more could we ask for”. The manager advised that all essential service checks were recorded and records showed that the home benefits from a maintenance person who ensures that regular building risk assessments are carried out and any necessary work is undertaken to ensure that residents and staff are subject to a safe, well maintained environment. . Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is generally very good. This judgement has been made using available evidence including a visit to this service. Staffing levels meet the needs of the current residents and staff are trained and fully motivated to carry out good quality care for all the individuals living at Adamstan House. EVIDENCE: A duty rota is available outlining staff on duty at any week. Staffing levels on the day of the inspection included: 1x 1x 1x 6x 1x 2x 1x 1x Manager senior nurse. senior carer. Care Assistants Cook Domestic staff Maintenance. Laundry. This level of staffing meets the staffing notice issued by a previous regulator. The Manager said that she would review staffing levels periodically to ensure that the staffing levels are consistent with the changing needs of the residents. The Manager intends to become supernumerary to the staffing numbers in the
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 21 near future to enable her to concentrate on administrative issues such as the changeover of information to the new care planning format. The home has experienced a fairly low turnover of staff since the last inspection with the result that two care assistants have been recruited of late. Discussion with staff identified that they had been asked to provide two references, proof of identity, a complete application form outlining experience and an application form for a police clearance check prior to interview. The manager advised that staff were provided with induction training which was followed by all mandatory training to include first aid, moving and handling, infection control. She further advised that she had instigated in house training which was delivered by the Local Primary Care Trust with the first session being provided nest week on Catheter care. However it was noted that prior to the appointment of the current manager, staff training needs had not been fully identified. Although this has now been addressed it has been recorded as a good practice recommendation in this report. Staff advised that they now had a good line management structure that enabled them to seek information and advice on a need to know basis. They revealed that this made them feel very much supported to carry out good quality safe care for the residents living in Adamstan House. Resident’s comments about staff practices included: “Without these people I would have given up living years ago’ ‘I have my health needs met’ ‘I have no complaints whatsoever’ ‘I couldn’t wish for nicer people’ ‘I could not wish for better treatment’ ‘Staff are marvellous’ “Staff are kind and work very hard to make sure we are all very well looked after”. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33.35.36.38. Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The manager is respected by staff and residents, who perceive her to be a very good manager and say she works with the residents to make sure the home is run in their best interests. EVIDENCE: Discussion with staff and residents of Adamstan House revealed that the home manager was admired and respected for her management skills. Comments included “she is very approachable and listens to what we have to say” ”her office is open to everyone”, ”she is new to this home but we have seen the positive changes already”, ”the morale in here was very low before the new manager came but it is very high now”.
Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 23 Discussions with the manager identified she was fully committed to her role and was continuously updating her knowledge to ensure she was able to fully discharge her management responsibilities. She revealed that she had reviewed all the systems in the home and was making necessary changes to ensure compliance with The National Care Standards and associated regulations. Residents said they had discussions about what they wanted to do in the home to include activities, outings and menus. Residents also commented on the nice atmosphere in the home and the fact that everyone spoke to each other and passed on information. Staff said that the manager was seen to be honest and fair and “had a very happy staff team due to her excellent ability to manage the home”. Other comments included “the manager has only been here a short time but she values us and gives us with stability and encourages us to do well”, ”she has already arranged our supervision sessions and identified our training needs”. It was noted however that staff supervision had not been carried out prior to the appointment of the current manager. It has therefore been recorded as a good practice issue that staff supervision be implemented as quickly as possible to ensure all staff are supported to develop their skills. Health and safety records appeared well managed and it was noted that the organisation used the services of a maintenance person to deal with appliance and safety checks. Up to date documentation was in place to include fire safety, essential service maintenance and building risk assessment. Records also showed that all staff in receipt of annual mandatory health and safety training as an ongoing process. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 24 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement Evidence of the residents’ or their representative’s agreement with the content of care plans must be provided. Care plans must be reviewed monthly. Timescale for action 01/12/06 2 OP7 15 01/12/06 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 OP7 Good Practice Recommendations Care plans must continue to detail all aspects of assessed need and risk and how care will be delivered to meet assessed need. Daily activities programme to be displayed in the home to ensure residents and their representatives are fully aware of the daily events that are happening within or external to the home. Staff training needs must continue to be recorded and staff be given the opportunity to develop their skills. 2. OP12 3. OP30 Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 26 4. OP36 Staff supervision should continue to be arranged to enable staff to discuss any issues/areas of concern and identify strategies for their continuous personal development. Adamstan House Nursing Home DS0000005446.V295309.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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