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Inspection on 02/11/06 for Alistre Lodge Nursing Home

Also see our care home review for Alistre Lodge Nursing Home for more information

This inspection was carried out on 2nd November 2006.

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

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

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

What has improved since the last inspection?

The information available to prospective service users has been updated and explains how the home operates and what to expect when living at Hill Lodge. Service users liked the new menus that have been recently introduced at the home. They thought that the food was well prepared and tasty.

What the care home could do better:

Care plans must be improved to make sure that all health needs are met. Service users must be able to benefit from specialist advice if needed, for example a dietician or speech therapist could be involved in the care of some people who live at the home. Some service users felt that the routines of the home were not flexible. They thought that staff were under pressure to get their work done and this meant that their personal choice about some things, such as bedtimes were ignored. Some of the ways in which the home operates do not recognise the social needs of service users as well as their health needs. Activities need to be provided and a chance for service users who are not independently mobile to meet and chat with each other. Particular attention must be paid by the staff that service users are not left for long periods of time without staff being in the room or accessible by a call bell. The staffing numbers and the way in which the staff rota is organised must be changed to better suit the needs of service users. The way in which medicines are stored and given must be improved to make sure that service users have the full benefit of any medication prescribed. The manager must act on complaints and concerns raised by service users or relatives. The views of service users should be regularly sought and their ideas and suggestions should be considered to make sure the service works in a way, which meets their expectations and needs.

CARE HOMES FOR OLDER PEOPLE Hill Lodge Nursing Home 67 St Annes Road East St Annes on Sea Lancashire FY8 1UR Lead Inspector Mrs Felicity Lacey Unannounced Inspection 02 November 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 Hill Lodge Nursing Home DS0000063623.V307852.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. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill Lodge Nursing Home Address 67 St Annes Road East St Annes on Sea Lancashire FY8 1UR 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) 01253-726786 J Parker (Care) Limited Mrs Charlotte Brennan Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (1) of places Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The home is registered for a maximum of 25 service users to include: 24 service users in the category of OP (Old Age) and 1 named service user under 65 years of age in the category PD (Physical Disability). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18th October 2005 2. Date of last inspection Brief Description of the Service: Hill lodge Care Home with Nursing offers care and nursing to 25 service users within the category of Old Age: within the registered number of 25, the home may also accommodate one named person under the age of 65 years of age. There are 14 single bedrooms, one of which is ensuite and 5 double rooms, three of which are ensuite. There are adequate toilet and bathing facilities as well as three lounge spaces. The home is situated within ten minutes walk of St.Annes and is within reach of local shops, post office and churches. The weekly charges at the home at the time of the site visit ranged from £376£476. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to this home was unannounced and was one way in which evidence was gathered for this report. The visit was undertaken by two inspectors one of whom is a qualified nurse. Comments were gathered by comment cards, questionnaires, and discussions with service users, relatives and staff members. The manager and owner provided information at the time of the visit and also in a pre-inspection questionnaire. Records and care plans kept at the home were looked at as part of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 6 Care plans must be improved to make sure that all health needs are met. Service users must be able to benefit from specialist advice if needed, for example a dietician or speech therapist could be involved in the care of some people who live at the home. Some service users felt that the routines of the home were not flexible. They thought that staff were under pressure to get their work done and this meant that their personal choice about some things, such as bedtimes were ignored. Some of the ways in which the home operates do not recognise the social needs of service users as well as their health needs. Activities need to be provided and a chance for service users who are not independently mobile to meet and chat with each other. Particular attention must be paid by the staff that service users are not left for long periods of time without staff being in the room or accessible by a call bell. The staffing numbers and the way in which the staff rota is organised must be changed to better suit the needs of service users. The way in which medicines are stored and given must be improved to make sure that service users have the full benefit of any medication prescribed. The manager must act on complaints and concerns raised by service users or relatives. The views of service users should be regularly sought and their ideas and suggestions should be considered to make sure the service works in a way, which meets their expectations and needs. 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. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 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 Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 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, 3 Quality in this outcome group was adequate. This judgement has been made using available evidence including a visit to this service. The information gathered at the time of admission is not always comprehensive and is not consistently included in the care plan of the service user. EVIDENCE: The statement of purpose has been updated to give accurate information of the aims, objectives, services and facilities offered at Hill Lodge. Service users who completed comment cards confirmed that they had received information prior to moving to Hill Lodge, and had been given the homes brochure. They also confirmed that they had been visited in hospital prior to admission and that they had a chance to ask questions, which enabled them to make an informed decision. The examination of case files showed that a full assessment of need was not always obtained prior to admission, and there were no social services assessments held on file. It is important that where a social services assessment has been completed that a copy of this is obtained prior to admission. This assessment together with a nursing needs assessment, and the homes own assessment give a clear picture of a potential service users Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 9 needs. The home does compile a care plan for each aspect of care, however this did not always include all identified needs. For example a service user who was visually impaired did not have a specific care plan relating to this which would ensure that staff provide consistent support. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place but they do not always contain sufficient detail and this means that the care needs of service users are not consistently met. EVIDENCE: All service users had a care plan, and these were consistently drawn up with involvement from the service user or their representative. However the care plans seen lacked sufficient detail to ensure that care needs were consistently being met. For example a term such as ‘regularly’ appeared frequently on care plans but this does not give clear direction; one care plan stated that ‘Pressure area care to be given regularly’ this is open to misinterpretation by staff. The care plans were currently being reviewed on a 4 monthly basis and this should be increased to monthly to ensure that all needs are being met and any change is included. Risk assessments were found on some care plans however again these lacked detail. For example a risk assessment relating to falls was seen which detailed incidents rather than an assessment of risk and strategies implemented to prevent falls. Other risk assessments that were not in place included those relating to the use of cot sides and lap belts. All care plans should be reviewed Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 11 and risk assessments completed to provide sufficient guidance for staff to provide safe and consistent support for service users. The health care needs of service users were in the main detailed on the initial assessment, however they were not always supported by a care plan. In the case of one service user an initial assessment had indicated that the risk of pressure sores was very high however there was no detail of how pressure area care was to be provided on the care plan and no pressure relieving equipment in place. There was little evidence of the involvement of other health professionals with the exception of GP services. Although the home is registered to provide nursing care, it is still probable that specialist advice may need to be sought, for example the tissue viability nurse could be involved in ensuring that correct pressure relieving equipment was being used and was in place. Another care plan described a service users ‘swallowing’ difficulties however the speech therapist or the dietician had not been involved. The home has a dedicated storage room for medication that is sited in the adjoining home; this is in preparation for the imminent amalgamation of the two homes. The medication administration and auditing arrangements were difficult to follow. Medication is secondary dispensed and some medications were seen to be out for date. A referral was made to the pharmacy inspector for a thorough assessment of medication storage and administration in the home. The GPs who returned questionnaires were positive in their responses. They felt that staff communicated the needs of the service users clearly and made appropriate referrals. They confirmed that all visits were carried out in private. Relatives felt that they were kept informed of any changes in health or care needs. Service users were seen to be using their own rooms, some service users preferred to stay in their bedrooms and to have their meals in private. Visitors are welcome at any reasonable time. There is a telephone sited in the hall, and the office can be used for privacy, some residents have their own telephones in their rooms. A number of service users are unable to mobilise independently and during the visit the difficulties in summoning assistance was evident for the people who liked to spend time in the lounge or conservatory. Staff did not place alarm calls in easy reach and for long periods of time the lounge was unattended by staff. This meant that if assistance was needed to go to the toilet service users found it difficult to summon help discretely which shows a lack of regard for the privacy or dignity when providing personal care. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The routines of daily living are not flexible and therefore do not reflect individual choice. EVIDENCE: The routines of daily living did not appear to be flexible at Hill Lodge. Although staff were considered to be good and kind by some service users and relatives, a number of service users felt that the staff sometimes acted in ways which showed little consideration for their needs. For example there are routines at the home which show little regard for personal choice, several service users commented that they had to go to bed very early, and this was also indicated by the times that most tea time medications were given which was 4 pm. A staff member said that most service users chose to go to bed early, and that only 3 service users remained up until after 8 pm. A relative also said that she had raised the question of early bedtimes with the manager but had not seen any change. The service users felt that the staff were very stretched in their roles and sometimes completed personal care task for service users rather than having the time to enable the person to act independently where possible. It is important that staff have the time to enable service users to retain their independence where ever possible. Some service users were occupied in their own activities such as reading or doing puzzles. There appeared to be a lack of meaningful, organised activities Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 13 on offer. The service users are dependent on their families for trips out of the home. Some service users felt isolated and thought that there was limited opportunity for social contact. Some service users like the organised entertainment which was arranged by the home. One service user commented that they were unable to take part in any activities arranged because they were disabled. Another service user said that they were very happy, and liked to watch sport on T.V in their room. Some service users have dementia and there is no specific activities or training offered to staff to help them provide meaningful activities during the day. Visitors are made welcome at the home. The home is located near to local churches and amenities. Visiting clergy are arranged in line with individual preferences. Financial affairs are handled by the service user or their representative. The manager does not act as an appointee for any service user. Service users are able to bring their own furniture to the home if they wish. Ways to access to advocacy and advice services are included in the homes Service User Guide. The standard of meals at the home was considered to be very good by service users. A new choice menu has been introduced and all service users spoken with confirmed that there was always the opportunity to have an alternative meal. As commented earlier there was a lack of involvement of the dietician in some cases where nutritional needs had been identified. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 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 quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The manager must demonstrate that she consistently acts on complaints received and in doing so improves the service at the home. EVIDENCE: The home has a clear complaints procedure. The Commission for Social care Inspection has received two complaints about Hill Lodge and asked the owner to investigate these. One complaint related to the arrangements at the home whilst building work was being conducted and one related to the length of time it took for a call bell to be answered. The building work has now been completed and staff have been reminded of the need to stagger breaks to ensure that cover is always provided. A relative said that she had raised issues with the manager, for example about the laundry system at the home but had not seen any improvement. The manager acknowledged that the laundry system was unsatisfactory and a new system is being introduced. A record of complaints was not maintained at the home and so it was not possible to evidence if all concerns are being dealt with. The manager will establish a system which logs complaints and the action taken in response. Staff receive training during induction and through National Vocational Qualifications relating to adult protection and abuse procedures. A member of staff is to attend a course about the Protection of Vulnerable Adults. The manager and owner are aware of their responsibilities under local procedures. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 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 quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and well maintained providing a pleasant place for service users to live. EVIDENCE: There has been significant improvements in the environment at the home since the new owner has taken over. The conservatory and communal rooms have been redecorated. The bedrooms are being refurbished to a good standard and redecoration is ongoing. A new kitchen has been installed. Building work has been carried out to join Hill Lodge to Alistre Lodge, which will eventually be one establishment. Service users were please with their bedrooms. Many rooms are spacious. There are a variety of rooms that service users can use. There is a garden area to the front of the home. The home is warm and clean. There are infection control procedures in place and staff were seen to be following these. There was no odour in the building. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 16 The home has a separate laundry, and there are plans to improve the system used to ensure that all service users get their clothing returned to them. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels of the home provide the minimal supervision and do not allow for the holistic needs of service users to be consistently met. The home offers training which can ensure that practice is based on understanding of good practice. EVIDENCE: The number of staff available given the range of tasks that need to be undertaken was not sufficient. This was evident through observing the periods of time that service users were left unattended, in discussion with service users and relatives, and by the staff rota. The owner explained that the rota was going to be changed, as currently between 8pm-8am there are only 2 members of staff. At other parts of the day the numbers of staff on duty allow for minimal supervision and support for service users. Some service users require the assistance of 2 members of staff for personal care and to have their nursing needs met. All service users should expect that the home is staffed to meet their personal, health and social needs and currently staffing levels and the way in which the rota is arranged does not enable this to happen consistently. The home employs qualified nursing staff. The home is progressing towards meeting the recommended ratio of National Vocational Qualified staff at level 2 or above. Current 40 of the care staff hold this qualification. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 18 The recruitment practices at the home are thorough. All required checks are completed and references obtained. A clear system for auditing the status of the trained nurses is to be put in place, which will ensure that proof is obtained when a PIN number is renewed. Staff training opportunities are offered at the home. Recently staff have competed courses in Moving and Handling, Continence Care, First Aid, Fire Safety and Food Safety. Staff spoken with confirmed that they were encouraged to undertake further training. The manager has completed a training audit. All staff complete initial induction training. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home safeguards the interests of service users, and must now work to develop the home incorporating the views of service users. EVIDENCE: The manager is an experienced nurse, who has worked in hospital settings and must now establish ways of working at Hill Lodge which move away from institutionalised practices, to provide nursing support in a social care setting. The new owner is experienced in social care and will be able to ensure that standards are improved at the home. The home has an Investors in People quality assurance award. There are plans to conduct a service users survey. It is important that service users are able to make their views known and that the manager demonstrates that these views Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 20 are considered in the continued development of the service offered at Hill Lodge. The new owner has consulted and informed service users and their representatives of the plans to merge the home with Alistre Lodge. The home will retain its nursing registration. All policies and procedures at the home have been reviewed in June 2006. Regulation 26 reports are received by CSCI. Small amounts of money are retained on behalf of service users, for example to pay for hairdressing. Records are maintained of all transactions undertaken on behalf of service users. The manager does not act as appointee for any service user. The Pre Inspection questionnaire details the health and safety checks conducted at the home. The need to conduct routine legionella checks was discussed and the owner is to ensure that these are carried out. The building works at the home have now been completed. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 22 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 OP3 Regulation 14 Requirement The registered person must ensure that the needs of the service user are assessed prior to admission. All care plans must be sufficiently detailed to ensure that the health and welfare needs of the service user are being met. The registered person must make arrangements for service users to receive treatment, advice and other services from any health care professional. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. A record of complaints made by service users or representatives or relatives of service users or by DS0000063623.V307852.R01.S.doc Timescale for action 02/12/06 2 OP7 15 02/12/06 3 OP8 13(1)(b) 02/12/06 4 OP9 13(2) 15/11/06 5 OP10 12(4)(a) 02/12/06 6 OP16 17(2) Schedule 4 02/12/06 Hill Lodge Nursing Home Version 5.2 Page 23 7 OP27 18 persons working at the care home about the operation of the care home, and the action taken by the registered person in respect of any such complaint must be kept. The registered person must 02/12/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified and competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 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 4 5 Refer to Standard OP7 OP7 OP12 OP28 OP33 Good Practice Recommendations The care plan such be reviewed on a monthly basis. The care plan should contain detailed risk assessments in line with the identified needs of the service user. The routines of daily living and activities should be available which are flexible and varied to suit service users’ expectations, preferences and capacities. A minimum of 50 of care staff employed at the home should hold an NVQ in care at level 2 or above. Service users views should be actively sought and this should inform the future development of the service. Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Hill Lodge Nursing Home DS0000063623.V307852.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!