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Inspection on 31/01/06 for Alderson Resource Centre

Also see our care home review for Alderson Resource Centre for more information

This inspection was carried out on 31st January 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home continues to offer a very good standard of care to all of the residents. The staff group are committed to delivering the care in a person centred way ensuring that the residents are treated with respect and dignity at all times, good practice was observed throughout the day. A variety of training courses including dementia care mapping, dealing with aggression, depression, epilepsy, Parkinson`s are accessible to the staff group ensuring that their skills and knowledge are kept up to date. The home is warm, comfortable and residents present as settled and content. The menu is of a high standard and the food is varied and nutritious.

What has improved since the last inspection?

The previous requirements have been met and a new carpet has been purchased for the main dining room. Staff have been identifying specific training needs through their personal development plan and undertaking training in relation to a variety of issues, mental health, depression, dementia, parkinson`s, epilepsy, giving them a better understanding of the residents` needs and making the home safe for residents. Out of the 40 care staff 37 have either obtained or are nearing completion of the NVQ level 2 in care, ensuring that the residents are looked after by competent and confident staff.

What the care home could do better:

Although the home has good documentation in place, this is not always completed and therefore the lack of information could result in errors regarding what care is offered and pose a risk to the residents health and well-being. The medication procedure is clear, but the recording is not always accurate, medication that is in stock must be recorded on to the appropriate recording sheet to ensure that there is a clear audit trail for stock control. Some of the policies including the complaints, statement of purpose and service user guide require amendment to ensure that the residents are fully informed about what they can expect when living in the home.

CARE HOMES FOR OLDER PEOPLE Alderson Resource Centre Linnaeus Street Kingston Upon Hull East Yorkshire HU3 2PD Lead Inspector Angela Sizer Unannounced Inspection 31st January 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alderson Resource Centre DS0000034408.V263726.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. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Alderson Resource Centre Address Linnaeus Street Kingston Upon Hull East Yorkshire HU3 2PD 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) 01482 585166 judith.lawtey@hullcc.gov.uk Kingston upon Hull City Council Thetis Eastwood Care Home 26 Category(ies) of Dementia - over 65 years of age (17), Physical registration, with number disability (9), Physical disability over 65 years of of places age (9) Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: Alderson Resource Centre is a Local Authority provision with Hull City Council’s Social Services Department. It is a purpose-built establishment in a busy area of Anlaby Road, opposite the Hull Royal Infirmary. There is a bus route into and out of the city centre and further if necessary. The home is registered for up to 26 residents, 17 permanent beds are for Older People with dementia and there is a Stroke Unit situated upstairs offering support for up to 9 people who are subject to a physical disability. The home is on 2 floors, serviced by a passenger lift, and provides permanent accommodation and care for up to 17 service users and rehabilitation and care to a further 9 service users who are victims of a stroke and require intermediate care. The home has a dedicated stroke unit. There are 4 lounge/dining rooms, 4 bathing/showering facilities, and 8 WCs. There are internal garden areas, which are secure and provide seating and potted plants. The stroke rehabilitation unit, located upstairs has a treatment/therapy room, which contains specialist hoists and electronic moving beds and couches. The unit also has a rehabilitation kitchen. The home is equipped with the necessary and appropriate furniture, equipment and fittings. The home has GP and hospital services close by, as well as local pubs and some shops. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted for 7 hours, prior to the visit 2 hours work was carried out in preparation. Some of the residents were spoken to throughout the day and three residents’ files were looked at and case tracked. Staff were observed when interacting with the residents and two members of staff were interviewed. Two staff files were inspected and other records including the medication and complaints procedure. Some of the residents were spoken to in order to find out what it was like for people who live here. The manager, who is currently going through the registration process with CSCI assisted with the inspection, feedback was given throughout the inspection. The inspector would like to thank the residents, manager and staff for welcoming her into their home and contributing to the content of this report. What the service does well: What has improved since the last inspection? Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 6 The previous requirements have been met and a new carpet has been purchased for the main dining room. Staff have been identifying specific training needs through their personal development plan and undertaking training in relation to a variety of issues, mental health, depression, dementia, parkinson’s, epilepsy, giving them a better understanding of the residents’ needs and making the home safe for residents. Out of the 40 care staff 37 have either obtained or are nearing completion of the NVQ level 2 in care, ensuring that the residents are looked after by competent and confident staff. 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. Alderson Resource Centre DS0000034408.V263726.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 Alderson Resource Centre DS0000034408.V263726.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 & 5 Residents are not fully informed about what facilities and support are available within the home. Some of the residents do not undergo a social care assessment and therefore some of their needs may be unmet. EVIDENCE: The statement of purpose does not include sufficient detail regarding the stroke unit, it does describe what facilities, support, whether they need to move rooms part way through their stay or how they can complain if necessary. From discussion with the residents in the stroke unit it was evident that they had been unaware of what the home was like or what to expect prior to being admitted. They explained that they had come straight from hospital for rehabilitation having suffered a stroke, all of the residents could not praise the staff and home enough, but had been unsure about what to expect prior to coming. None of the residents knew how to complain nor had they been given a complaints leaflet. From speaking to the manager and staff it was evident that the permanent residents are given a statement of purpose and service user guide, but the stroke unit residents are not. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 9 Each resident is given a statement of terms and conditions, and this describes what facilities, support, room to be occupied, food and fees payable. One paragraph states “in some cases it may be necessary to allocate another room to you during your stay. The Registered Manager reserves the right to carry out this action as and when necessary”. It is recommended that this paragraph be re-worded to ensure that this procedure is only carried out in exceptional circumstances and the decision is clearly documented. From speaking to the staff and manager about residents moving rooms it is apparent that this is usually undertaken with residents in the stroke unit, this should be made clear in the statement of purpose and service user guide. For permanent residents this is less likely to occur, but should only be applied in ‘exceptional’ circumstances. Permanent residents are subject to a full community care assessment and then the homes daily living assessment following admission. The residents on the stroke unit undergo a medical assessment whilst in the hospital and then on the day of admission undergo further assessment from the Physiotherapist and the Occupational Therapist, but at no point is a social care assessment undertaken by the home’s staff and given that the residents are staying in a care home these needs should not be ignored. From speaking directly to the five residents in the stroke unit they stated that they were “worried what to expect and would have like more information before coming here”, others felt that it was “a good idea to meet staff and for them to find out a little bit more”. There is a good range of professionals located within the building and the medical support is very good, but there is a lack of multi-disciplinary working in relation to assessment and documentation. Alderson Resource Centre DS0000034408.V263726.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 & 11 Resident’s health care and social needs are not always met. The medication procedure is sound, but the recording is inaccurate. Residents who are ill or dying are treated with respect and sensitivity. Care plans are in place for all permanent residents, but lack consistency in relation to recording what care tasks have been undertaken. EVIDENCE: From looking at the residents’ files it was clear that there is a care plan in place for each person identifying what their needs are and how these needs should be met. The home has implemented a recent change in how staff record what care has been delivered and for a lay person to read the care plan it was difficult to ascertain what care had been delivered, as in some instances there was little or no daily recording. Two of the resident’s files showed that there was a bathing record, but that some residents were not bathing for up to 6 weeks and were the care plan stated that this was a need and prompting was required there was no written evidence to confirm that this had been carried out. For the residents in the stroke unit the care plan is drawn up by the health team and instruction given to the care staff about how to assist the Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 11 person, any rehabilitation techniques are carried out under the guidance of the Occupational Therapist or Physiotherapist. The home has a medication policy and procedure and on whole is followed closely. Upon inspection of the medication administration record (MAR) it was clear that not all medication stock is carried forward, therefore making it extremely difficult to audit what stock should be there. Overall the recording was of a good standard with no gaps on the MAR sheets. There is a controlled drugs cabinet and a controlled drugs register, two staff always sign when administering the controlled medication. There is a refrigerator in the medication room and the temperature is recorded on a regular basis. The shift leaders administer the medication and two have attended the new accredited course run by the Local Authority, the remainder of the shift leaders are awaiting dates to undertake this training. It was clear from speaking to residents in the stroke unit that they felt their privacy was respected, one resident stated “the staff always knock before coming into my room”, “if I need anything they are there”, other comments included “it is a lovely here and the staff are wonderful”. The permanent residents who endure memory impairment were less able to verbalise how they felt, but from observation their non-verbal behaviour suggested that they were content in their surroundings. Staff spoken to about the death of residents talked about previous situations where they had tried to support the individual in a sensitive and caring manner and also for as long as possible if this was the person’s choice. Family are made welcome and offered refreshments. Loss and Bereavement training is available to all staff through the council’s training section. Alderson Resource Centre DS0000034408.V263726.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): 12,14 & 15 A range of recreational and rehabilitative activities are provided in the home and daily choice for residents is supported. Residents are encouraged to maintain outside links and contact with friends, local community is encouraged. Residents are offered a varied and nutritious menu. EVIDENCE: All of the residents who were able to verbally communicate stated that the level of care, accommodation and food provided was of a very high standard. One resident said, “I cannot fault the home, it is beautifully clean, the food is lovely and the staff are wonderful”. Another resident commented, “my room is very comfortable”. Residents in the stroke unit confirmed that regular activities occur including bingo, soft bowls, tai chi, quizzes and games and sing-a-longs with the staff. The permanent residents who endure memory impairment are offered activities, but these tend to be individual and for short time periods. Staff could describe how they would interact and were aware of the needs of individuals. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 13 The home operates a six-week rotating menu and this is written in large print on a white board. Since the last inspection the manager stated that breakfast is now written on the board too, this should also be recorded on the menu or service user guide. Lunch was observed and sampled, it consisted of chicken casserole or pork steaks, mashed potato, swede, sprouts and gravy and there was a very good choice from the sweets trolley including trifle, chocolate sponge, fruit salad, jelly and custard or cheese and biscuits. It was well presented and plentiful. From speaking to the Registered Manager it was clear that fresh produce is used and the menu is varied, nutritious and wholesome. One resident said, “The food is beautiful and a good choice”. The home has a catering team all of which have their food hygiene certificates. There are no outstanding requirements from the Environmental Health Department. The home has achieved the Heartbeat Award. Alderson Resource Centre DS0000034408.V263726.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 complaints procedure is sound but more attention needs paying to the process by which complaints may be received on the stroke/intermediate care unit. The service provider offers good protection to service users but needs to make explicit the extensive use of security or restraining mechanisms and support staff in the occasional need to restrain persons with organic brain disease. EVIDENCE: The home has a good complaints policy and procedure and part of this process is included in the statement of purpose, therefore information is available to residents and their representatives informing them of what they need to do if they had a complaint. The residents on the stroke/intermediate care unit do not receive a statement of purpose and when interviewed did not who to complain to. The home has a multi-agency policy and procedure for the prevention of abuse, staff have a good understanding of this and training is mandatory. Although the home has developed a variety of risk assessments including the use of bedrails, this had not been agreed within a multi-agency setting. Alderson Resource Centre DS0000034408.V263726.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 & 26 The environment is homely and comfortable; some areas require attention in order to ensure that cleanliness and safety standards are maintained. A malodour was detected in two of the resident’s bedrooms. EVIDENCE: Since the last inspection the main dining room carpet has been replaced and the radiators in the resident’s bedrooms downstairs can be individually controlled, the upstairs bedrooms are not and a complaint had been made about the heating being too hot and the person not having any control over this. A tour of the building was undertaken and on the whole the environment is warm, homely and comfortable. The main entrance has some minor damage to the decoration, which requires correcting. There was a strong odour in bedrooms 1 and 2, although the rooms were tidy and the bedding was clean the manager stated that domestic staff were having difficulty in managing the mal Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 Although the home maintains a good staffing level and has committed trained permanent/temporary staff, there is a shortfall during the night shift. The home’s recruitment and selection procedure does protect the residents. EVIDENCE: Staffing levels have been maintained to a level that ensures all of the residents needs are met. Currently the home offers a total of 1120 care hours and is broken down into 4 care staff and 1 shift leader – 7–3pm and 3–11pm downstairs and in the stroke unit 3 care staff 7-3pm and 3-11pm and 1 shift leader 8.30-4pm, there are 2 care staff and 1 shift leader on the waking night shift. From speaking to the manager and staff it would appear that the current staffing levels are sufficient. The only concern highlighted was regarding the night shift and only having 3 people on duty and although the actual care hours meet the minimum standard consideration should be given to the allocation of care hours through the night. All residents are of high level need and more than 5 permanent residents require 2 staff to move and assist, in addition some of the stroke unit residents require intensive support when first arriving in the home. The home’s recruitment and selection procedure is robust and ensures that staff have a CRB, two references, application and health declaration in place prior to commencing work. From checking three staff files it was clear that the Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 17 home maintains records in relation to identity, a photograph, relevant training and supervision. Other records are held at Brunswick House, the Local Authority’s head quarters and this agreement has been made with CSCI. 37 out of the 40 care staff have now achieved or are working towards NVQ 2, the Local Authority offers a wide range of training courses to all staff. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,22,35,36 & 38 The management of the home is carried out with leadership and appropriate guidance; ensuring residents receive a quality of care and a resident centred ethos is promoted within the home. Resident’s financial affairs are safeguarded by the homes policy. Supervision is not offered to all staff and therefore the resident’s health and safety could be compromised. EVIDENCE: The manager has been in post since June 2005 and is currently going through the registration process with the CSCI, she has many years experience in the care industry. She has completed NVQ level 4 in Management and has commenced NVQ level 4 in Care and two components of the Registered Managers Award, she is aiming to complete by September 06. From speaking to both residents’ and staff it was evident that the manager operates an open Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 19 door policy offering support whenever necessary. Staff stated that the manager is approachable and offers support whenever required. Throughout the inspection the manager was observed interacting with both residents and staff in a caring and sensitive manner and has developed a very good understanding of the needs of the client group catered for in the home. There are clear lines of accountability within the home and with external management. The home takes care of residents’ personal allowance, written records are kept of all transactions. All monies and valuables are held in suitable secure facilities. Staff confirmed that they receive supervision, but that this is not always regular and from inspection of records this was confirmed. The manager has been in post since June 05 and has received two supervision sessions with her line manager. The health and safety of the residents and staff are promoted and there are systems for safe working practices in place. All staff receive a thorough induction and foundation training within 6 months and on-going training as and when required. Records confirmed that training in relation to fire, health and safety, infection control, food hygiene, protection of vulnerable adults and moving and handling are all offered and up to date. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 1 X 3 Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 21 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 OP1 Regulation 4 Sch 1 Requirement The registered person must provide information in the statement of purpose regarding what facilities, care offered, complaints procedure and the need to change rooms in relation to the stroke unit residents, The care staff should become involved in the assessment and care planning process for the stroke unit residents. Care plans must be implemented and all care tasks undertaken recorded clearly. Regular monthly reviews by the Key Worker must take place and be recorded. Personal care for residents must be encouraged and recorded appropriately. Medication must be recorded and any carried forward amounts to be written on to the MAR. The complaints procedure must be made available and information of how to make a complaint be given to all residents including those on the stroke unit. DS0000034408.V263726.R01.S.doc Timescale for action 31/04/06 2 OP3 14,17 31/04/06 3 OP7 14,15,17 31/04/06 4 5 6 OP8 OP9 OP16 12,13,15, 17 12,13,16, 17 16,17 31/04/06 31/04/06 31/04/06 Alderson Resource Centre Version 5.1 Page 22 7 8 9 10 OP19 OP26 OP31 OP36 16,23 16,23 9 17,18 All radiators in resident’s bedrooms must be individually controlled. The home must be free from offensive odour. The manager to complete NVQ level 4 in Care. All staff including the manager must receive supervision at least 6 times per year or more frequently if required. 31/01/07 31/04/06 31/01/07 31/04/06 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 2 3 Refer to Standard OP2 OP18 OP27 Good Practice Recommendations The statement of terms and conditions/contract should be amended (point 10) to state in exceptional circumstances a resident may need to move rooms. Risk assessments relating to the use of bedrails should be developed in a multi-disciplinary setting. Staffing levels should be reviewed in relation to the actual number of staff on duty throughout the night. Alderson Resource Centre DS0000034408.V263726.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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