Inspection on 11/07/05 for Alexander Heights

This inspection was carried out on 11th July 2005.

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

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

Other inspections for this house

Alexander Heights 30/06/09

Alexander Heights 19/08/08

Alexander Heights 05/09/07

Alexander Heights 21/09/06

Alexander Heights 06/12/05

Alexander Heights 17/02/05

Alexander Heights 21/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alexander Heights Winsley Hill Limpley Stoke Bath BA2 7FF Lead Inspector Alison Duffy Unannounced 11 and 12th July 2005 th 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. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Alexander Heights Address Winsley Hill Limpley Stoke Bath BA2 7FF 01225 722888 01225 723017 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) Avonpark Care Centre Limited Mrs Joyce Margaret Amor Care Home 28 Category(ies) of OP Old Age (28) registration, with number of places Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2005 Brief Description of the Service: Alexander Heights is a residential care home registered to care for 28 older people. Nursing or intermediate care is not provided. The home is located within a Care Village in Limpley Stoke near Bath. The home is on the first floor of a purpose built unit. Access is gained via a passenger lift or stairs. There is a terraced area, adjoining the air conditioned conservatory style lounge. Residents also have access to well maintained gardens at ground level. There is a small shop, library and a GPs surgery within the complex. Residents have their own room with an en-suite facility. Communal areas consist of the conservatory, a separate dining room and a games room. There is a central kitchen and all laundry is undertaken within facilities also used by other units on site. Staffing levels are maintained at three members of care staff on duty throughout the waking day. There are also two domestic staff. The complex provides central catering, laundry and maintenance staff. At night there are two waking night staff. The Registered Manager is Mrs Joyce Amor. Mrs Amor is not part of the working roster although assists as required. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10.15am and 4.30pm on 11th July 2005 and 10am and 1.45pm on the 12th July 2005. Mrs Joyce Amor was available throughout and received feedback at the end of the inspection. The inspector made a tour of the building and spoke with a number of residents in the lounge and in their rooms. Care planning information, daily records and the fire log book were viewed. The medication systems were also examined. Discussion also took place with Mrs Amor regarding training and staff recruitment. Residents’ feedback was generally very positive. Positive comments were made about kind staff and how quickly they responded to a call bell. Some reported appreciation for their room and the ability to have personal belongings from their previous home. Another resident reported pleasure from the gardens. Positive feedback was given regarding the food and being able to eat in your room if you chose to. Some residents however expressed the need for greater activities, more staff and improved provision at mealtimes including a summer menu. These matters are addressed within the main report. Two family members of a resident who had lived in the home for a number of years reported ‘without blemish this is a wonderful home. It’s just like a hotel. The food is excellent and the staff are so caring.’ What the service does well: What has improved since the last inspection? What they could do better: Although it is acknowledged that the inspection took place on a very hot day, the home was extremely hot and poorly ventilated. Propping the kitchen door Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 6 open to aid this difficulty within the kitchenette, is unacceptable practice and must be addressed. Consideration must also be given to other areas such as the corridor. As from August 1st 2005, when domestic staff are due to be deployed at weekends, the home is meeting its minimum staffing requirements. Further consideration must however be given to meeting residents’ individual needs during the busier parts of the day. Such consideration must also be given to meeting residents’ social and emotional needs. Care planning contains varying levels of information. However, some require additions, clarity of terms and consistency with assessments. 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. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 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 standard(s) 3 and 5 The home has an established admission procedure yet insufficient clarity within assessment records, compromises the meeting of need. EVIDENCE: Since the last inspection there have been a number of admissions. Mrs Amor reported that she always undertakes an initial assessment before the admission. All prospective residents are also encouraged to visit the home. Many prospective residents however, are known to staff, through previously living within other units on site. Some assessment records were viewed. It was noted that although matters had been addressed, further detail would be of benefit. For example one resident was noted to have ‘Type 2 Diabetes’ although there was not an explanation of this. Another resident had weakness to the right side. It was not clear however how this affected the resident’s daily life. Other entries stated ‘needs assistance.’ In such instances greater clarity is required. Alexander Heights does not provide intermediate care. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 9 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 and 9 Some omissions within care planning information compromises the meeting of individual need. Healthcare is generally well managed and well-organised medication systems minimise the risk of errors to service users. EVIDENCE: A number of care plans were viewed. All were up to date although some additions were required. For example one plan did not reflect the process and responsibilities of insulin administration. Another did not reflect intervention required with managing leg soreness or the criteria of informing the Community Nurse. Explanation of terms such as ‘needs assistance’ would also be of benefit. Manual handling assessments and risk assessments regarding falls were in place for all residents. Some also had pressure care management and nutritional assessments. Mrs Amor was advised to develop these assessments for all residents. Discussion took place regarding one resident and the need to address pressure care management as a specific area of the care plan. Specific instructions within daily notes should be included. GPs and District Nurses are based within the complex. Weekly visits are made to the home on a designated day and in addition, visits can be requested as Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 10 required. Mrs Amor reported that high priority is given to proactive measures and regular medication reviews take place. During discussion it appeared that residents have little control over their allocated GP due to the system used within the complex. Residents are able to request a preference of a male or female, although generally see which ever GP is visiting. Mrs Amor was asked to address this matter on behalf of a resident. It was noted that one resident was in need of foot care. Mrs Amor reported that a chiropodist regularly visits although some family members arrange appointments. Attendance is noted within a dairy. In order to monitor such care it was agreed that a format should be developed within the care plans. The home operates a monitored dosage system for administering medication. Appropriate system‘bulk medication’ s signed by the GP and agreed by a CSCI Pharmacy Inspector are being maintained. Records demonstrated satisfactory receipt, disposal and administration of medication. A large amount of unused medication was waiting to be returned to the pharmacy. Mrs Amor confirmed however, that this was due to a GP recently reviewing medication. All staff administrating medication have received medication training. The home does not have a homely remedies policy although consideration is being given to this. Mrs Amor was advised to gain authorisation of such from the GP. Staff were seen to promote residents privacy by knocking on doors before entering. Some male residents expressed appreciation for receiving personal care from a male carer although female residents were reported to prefer female staff. Mrs Amor was advised to record such wishes on individual care plans. A gender working policy is also required. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 11 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 and 15 Visitors are made welcome by the home and hospitality is evident. Current staffing levels do not promote sufficient opportunities for social activity and stimulation. While a varied menu with a regular choice is available, mealtimes do not meet the needs of some residents. EVIDENCE: Residents confirmed that visitors are welcomed at any time. Some residents reported going out or walking around the gardens with their families. On the day of the inspection, all staff were friendly and hospitality was evident. Some residents reported enjoying their own company and spending time in their room either reading or watching television. Others reported enjoying developed friendships and the time spent together. There was however, very little other activity evident although on the second day of the inspection a BBQ and entertainment were planned. Some residents reported that there used to be various things going on including quizzes and keep fit. One resident stated that enjoyment was gained from reading the ‘what’s on’ information for the forthcoming week. However all such activity has ceased and two residents reported that the days sometimes appear long and boredom is a challenge. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 12 Other residents confirmed that staff are too busy to undertake activities or spend time chatting to residents. Meals are cooked within the main kitchen of the complex. All meals consist of three courses and there is a choice for each. There were many positive comments about the food although some residents stated that a summer menu would be appreciated instead of having soup and items such as casseroles in hot weather. The dining room was very pleasantly presented. Some residents however reported that the room is very cramped and generally very hot. Two residents reported that mealtimes were not a pleasing experience due to the length of the meal and the high level of waiting around between courses. This was discussed with Mrs Amor and it was agreed that the games room opposite the dining room could also be allocated to an additional dining area. This would give greater space and residents could keep their walking frames with them during the mealtime, which would enable greater independence. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 13 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 Complaint information is readily accessible to residents. The risk of abuse to residents will be minimised following the implementation of arranged adult protection training. EVIDENCE: The home has a clear complaints procedure, which covers all information required by regulation. The procedure is displayed within the Statement of Purpose located on a table near the office. Some residents spoken with reported that they would address issues with the manager or a member of staff. One resident however stated ‘I don’t complain as I’m truly grateful for what I have.’ Since the last inspection, the home has had one complaint. This was in relation to an ineffective door, which remains unresolved. Various parts have been tried but as yet all have been unsuccessful. The complaint was documented within the complaint log. Alexander Heights has a copy of the Wiltshire and Swindon Vulnerable Adults procedure. Mrs Amor reported that all staff have also been given the ‘No Secrets’ documentation. Both matters are to be discussed within a number of arranged adult protection training sessions. Residents are offered the choice as required of receiving their personal care from either a male or female carer. Such wishes however should be recorded within individual plans of care. A gender working policy must also be developed. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 14 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) 20, 21, 24 and 25 The home is furnished to a good standard and residents are able to personalise their rooms. Attention must be given as a matter of priority to the poor ventilation of the home. EVIDENCE: Alexander Heights is situated within a rural setting. The home is located on the first floor and is accessed via stairs or a passenger lift. Residents’ private accommodation is located at one end of the building and communal areas are together at the other end. There is a conservatory style lounge, a separate dining room, a games room and two bathrooms offering a choice of a bath or a shower. The home has a terraced area and residents are also able to access the well-maintained communal gardens. Within the gardens there is a summerhouse and various seating areas. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 15 Residents’ rooms are of a good size, have en-suite facilities and are personalised according to individual wishes. All radiators have been fitted with covers although at the last inspection, it was noted that the controls had been covered up. A requirement was therefore made to address this issue. Mrs Amor reported that a number of quotes had been gained. She was unsure however of further progress. Mrs Amor was advised to contact the CSCI on receipt of this information. Throughout the inspection the home was very hot and ventilation was very poor. This was particularly so in the corridors and the small kitchenette. Air conditioning units had been used in the corridors although a requirement was made at the last inspection, to remove such on the instruction of the Fire Officer. This had been undertaken and some fans were in place. However these were insufficient and both residents and staff were struggling with the atmosphere. Within the small kitchenette, staff had propped opened the fire door in order to gain the benefit of the air-conditioning in the lounge. This is unacceptable and therefore the kitchenette must receive attention as a matter of priority. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 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 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, 29 and 30 Staff levels are maintained at a minimum and do not enable residents’ individual needs to be met. Good staff selection is compromised by poor recruitment procedures and the absence of the manager’s involvement. EVIDENCE: There are three care staff on duty throughout the waking day and at night there are two waking night staff. During the week there are two domestic staff and a laundry assistant. Domestic staff do not work at weekends and therefore the home is currently not meeting its minimum staffing requirements. Mrs Amor reported that this is being addressed and as from 1st August 2005 there will be domestic staff will be in place. On the morning of the inspection the home was very busy. One resident was waiting for some attention and had been doing so for a while. She reported that the ’staff are run off their feet and you rarely ever see them.’ She continued by saying ‘they are all so good, it’s not their fault but there’s just not enough of them.’ This was apparent after lunch when residents were being assisted back to their rooms. Many service users had to wait for assistance making the meal a lengthier process. Within care planning information one resident was noted at times to need input from two members of staff. A number of residents also required checking two hourly in the night. The home does not have an activities organiser and therefore as stated earlier in this report, care staff do not have sufficient time to formalise an activities Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 17 programme. Staff confirmed that they are very busy and Mrs Amor reported that although dependency levels are lower at this particular time, an additional member of staff in the morning would be beneficial. The personnel file of the most recent member of staff was viewed. This member was recruited via an agency specialising in overseas staff. The application form however was dated the day after the arrival in the UK and references were not specifically addressed to the home. Within discussion it was evident that Mrs Amor is not involved within staff selection of overseas staff and therefore consideration must be given to this matter. Training is given priority and a number of topics have been covered since the last inspection. All day staff are up to date with manual handling and a session has been booked predominantly for the night staff. First aid is booked in September for those staff needing refreshers and adult protection has also been arranged. Some staff have undertaken medication administration, infection control and health and safety training. Mrs Amor was advised however to monitor manual handling practise as despite having received training, an inappropriate technique was noted. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 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 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) 38 Health and safety is given priority, yet the heat and poor ventilation within the home is compromising the wellbeing or staff and residents. EVIDENCE: The home has a number of environmental and individual risk assessments. Mrs Amor reported that all such assessments were in the process of review as new forms had been allocated. It was noted that cot sides had been addressed within the risk assessment process. The use of cot sides had been agreed following consultation with the residents’ family and the GP. Mrs Amor was advised to gain this agreement in writing and also notify the resident’s care manager if appropriate. The fire log book demonstrated satisfactory testing of the fire alarm systems. Mrs Amor reported that the fire officer had checked the fire risk assessment and documentation demonstrated external servicing. The temperatures of hot water are regularly monitored. A number of regulators have recently been replaced as a result of such monitoring. Attention, as stated earlier in this report must be given to the kitchenette environment. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 19 Propping the kitchen door open in order to gain benefit from the airconditioned lounge is not acceptable. Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION x 3 3 x x 3 2 x STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 21 No 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 7 and 8 Regulation 12(1)(a) Requirement The Registered Person must ensure that all plans of care fully reflect individual need. This must include matters such as foot care, insulin administration and pressure care management. The Registered Person must ensure that staffing levels enable residents to be involved in meaningful activity in relation to their wishes. The Registered Person must ensure that a policy regarding gender working is developed. The Registered Person must ensure that fire doors are held open only by a device linked to the fire alarm system. The Registered Person must ensure that consideration is given to improve the heat and poor ventilation within the home. Particular attention must be given to the kitchenette and corridor. The Registered Person must ensure that the CSCI is contacted regarding the requirement made at the last inspection of residents controlling the temperature of Timescale for action 31st August 2005 2. 12 16(2)(n) 30th September 2005 31st August 2005 From 12th July 2005 1st August 2005 3. 4. 18 25 and 38 12(1)(a) 13(4)(c) 5. 25 23(2)(p) 6. 25 23(2)(p) 31st August 2005 Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 22 their room. 7. 27 18(1)(a) The Registered Person must ensure that sufficient care and support staff are on duty during the 24 hour period with increased staffing at busy times to meet the care needs of residents. (Not actioned at the previous inspection with a timescale of 16.2.05). The Regsitered Person must be involved in the recruitment of staff including those staff recruited via an agency. 30th September 2005 8. 29 19 30th September 2005 9. 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 3 Good Practice Recommendations The Registered Person should ensure that clarity is demonstrated within the initial assessment. Any medical terminology should be explained in relation to protrayal of need. The Registered Person should ensure that all residents have a nutritional assessment. Documentation should demonstrate monitoring of intake and weight if a risk is identified. The Registered Person should ensure that authorization is gained from the GP in the event of developing a homely remedies policy. The Registered Person should give consideration to how mealtimes can meet the needs of all residents. Matters such as space, a lighter menu and the length of time the meal takes to serve should be taken into account. The Registered Person should ensure that residents preferences regarding receiving personal care from a male or female carer is recorded within individual plans. The Registered Person should monitor manual handling practices and give additional training as required. 2. 7 3. 4. 9 15 5. 6. 18 30 Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexander Heights D51_S28312_ALEXANDERHEIGHTS_v228923_090605_STAGE4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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