Inspection on 13/12/05 for Ashbourne House

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

Ashbourne House 02/10/07

Ashbourne House 16/01/07

Ashbourne House 05/09/06

Ashbourne House 17/05/05

Ashbourne House 18/01/05

Ashbourne House 20/05/04

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 Ashbourne House 2 Henleaze Road Durdham Down Bristol BS9 4EX Lead Inspector Nicky Grayburn Unannounced Inspection 09:30 13 and 14th December 2005 th 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 Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashbourne House Address 2 Henleaze Road Durdham Down Bristol BS9 4EX 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) 0117 9628081 NONE Ashbourne House Care Homes Limited Mrs Michaela Jane Hill Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2005 Brief Description of the Service: Ashbourne House is a listed Georgian property, which is situated opposite the Downs in Bristol. It is registered to provide accommodation and personal care for up to 17 people who are 65 years and over. The house is close to local facilities and amenities, including public transport. The premises are over three floors, all of which are accessible by a lift. Some of the bedrooms have ensuite facilities. The communal areas consist of a lounge and dining room, which are located on the ground floor. Whilst there are some aids and adaptations throughout the premises, the home is not purpose built and as such has some limitations. The house is not ideally suited for people who use a wheelchair. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two days. The first day was spent talking to 15 of the 17 residents; spending time with the manager; following up the previously made requirements and recommendations and looking around the property. During the second day, the inspector spent more time with the manager and examining the documentation kept at the home. Further, the inspector was invited to the Christmas Party and met some of the relatives. What the service does well: What has improved since the last inspection? 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. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 6 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 Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 7 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, 4, 5, 6 Pre-assessments and trial visits are carried out to ensure that the home can meet the potential residents’ needs. The Service User Guide presents all the necessary information for potential residents, but would benefit from being in a more presentable format. EVIDENCE: Ashbourne House has a Service User’s Guide and a Statement of Purpose. The Service User Guide was looked at and the requirement regarding including the arrangements for night staff has been included. It was discussed with the manager that it needs updating in the near future to be a more user-friendly (large print and pictures/photos) and attractive guide. Contact details for the CSCI need to be updated. Terms and conditions are included in the Service Users Guide. The inspector was told that translation of the Guide was completed for a resident whose first language is not English. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 8 Within the care files looked at, it was evident that there are varying payment arrangements. Contracts with Social Services are valid and up-to-date. However, some privately funded residents’ contracts are in need of updating. Further, contracts should have the stated room numbers. There are letters within the file stating the increase of rates every year. If the residents are referred to the home by professionals, pre-assessments are carried out by social services. The admissions process was discussed with the manager alongside the policy. The home carries out a one-day assessment to allow the potential resident to meet the other residents and for staff to spend time with them further ensuring that the home is the right home. The manager carries out a ‘top-to-toe’ needs assessment, which forms the basis of the care plan. The home asks to meet the family and then allow the resident to spend time on their own in the home. The inspector met a resident who was staying just for three weeks for respite care and was leaving imminently. They were very happy with the care received and felt ready to return home. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10, 11 Development of risk assessments and health needs will make the residents safer. Residents are protected by a robust medication system, and those who are able, can self-medicate. EVIDENCE: From the four care folders examined; clear care plans were in place. However, risk assessments were sparse and none indicating any prevention of falls. There are a number of residents who are frail and are at risk of developing pressure sores. This must be assessed and recorded as to how the staff are preventing such risks. Key worker reports are carried out monthly. On the whole, these are done. However, the format has not changed since the last inspection when it was recommended that they be developed. This was discussed again with the manager. The care plans are reviewed annually and as such, the key worker reports are important to monitor any changes and to evidence that they are reviewed monthly. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 10 Many residents confirmed with the inspector that the visiting optician had visited last week, and the nurse had visited on one day of the inspection to tend to certain residents’ needs. Care plans address all areas of need such as chiropody, continence, sight, dental, diet, mobility, and medication. Some residents have more complex needs than others and this is documented in their care plans. It was unclear as to when the residents had last seen the relevant professionals. This was discussed with the manager to formulate a clear method of recording such appointments for ease of monitoring for staff. Staff do not monitor weight as it is an institutional practice. However, it was evident and the manager confirmed that due to the staff team being so stable, any visible changes in weight and/or appetite would be noted and acted upon. The medication cabinet and relevant documentation was examined. There is one resident who self-medicates. The manager confirmed that a risk assessment is in place and the resident has a lockable space for the storage of it. It is recommended that the manager contact the GP to raise concerns regarding residents’ medication. The home uses a monitored-dosage system. Policies and procedures are in place for the administration, dispensing, errors, refusal and surplus of medication. There is also a separate folder with relevant information for staff such as common side effects of common medications for the elderly. Five Medication Administration Record sheets were examined and signatures indicated that all medication had been administered duly. Some residents are becoming less independent in terms of continence difficulties. However, through discussion with the residents, the staff support those who are particularly worried about loss of dignity and humiliation. Bedrooms have personal phones to retain privacy. There has been one recent death in the home. The resident was a prominent figure within the home and chaired the resident’s meetings. His wishes at time of death were fully respected and staff and residents miss his presence in the home. At the last resident’s meeting there was a 5-minute silence in respect. A policy is in place stating what measures staff must take during this time. However, within the files looked at, there was no indication of what the resident wishes are for at their time of death. Despite the manager knowing what some of the residents wish, it must be documented to ensure all staff are aware of what action to take. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15 Residents benefit from relatives being welcome at the home. Residents are well catered for and enjoy the food, which is served in a pleasant manner and allows for choice. Residents enjoy accessing the local day clubs and the social activities within the home. EVIDENCE: It was observed throughout the inspection that residents are able to choose how to spend their day. They can get up and go to bed as they wish. Staff are aware of individual routines and habits, and accommodate such wishes, such as serving breakfast when they are ready rather than at a set time. The visitor’s book showed; it was observed and residents said that they have family and friends visiting in the home. It was seen how visitors are free to go into resident’s rooms and spend as much time as they wished. Only two residents are going out on Christmas Day – most said that they wanted to stay in the home – and others said that relatives are coming to visit. The inspector was invited to the Christmas Party. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 12 Residents told the inspector about the different activities they partake in. Some residents attend social clubs within the local community, whilst others take advantage of the in-house entertainment provided during the day. The inspector met one of the activities organiser who said that “it is a pleasure working here…I am made to feel part of the team…always welcomed…the residents are lovely”. She makes notes after each session to monitor any changes and would have no issue about raising any concerns with staff. Residents also spoke happily about the other organiser who visits to play the keyboard. The 4-week (changeable) menu was seen and presents a balanced and varied diet. The care assistants do all the cooking and serving. Serving the meals can take up to half an hour. It was observed on both days how residents are offered a choice of meal. The menu needs updating to reflect what the residents have chosen. Notes from the residents meetings showed that food is always a point for discussion, noting that everyone likes it. The opportunity was taken to join the residents for lunch in the dining room. Residents told the inspector that they had asked for one of the particular dishes a few days ago. All residents spoke positively of the food with comments such as “we don’t go short on food” and “there’s always plenty of it”. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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 the following standard(s): 16, 18 Complaints are acted upon ensuring that residents and relatives are listened to. Residents would benefit from staff undergoing training relating to areas of abuse. EVIDENCE: The requirement for staff to undertake Protection of Vulnerable Adults has still not been completed. This was discussed with the manager who now has the phone number to contact Bristol City Council who provide such training. The requirement remains. Consideration of enforcement action will be taken if this is not achieved within the agreed timescale. The No Secrets document was in the office. Finance records were not inspected but will be a focus of the next inspection. The manager assured that they are keeping all receipts for resident’s outgoings, which is mainly the chiropody and hairdresser. Some residents confirmed that their relatives look after their monies but they leave money for them to pay for little things. The staff file showed that all staff have an enhanced criminal records bureau check. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 14 A complaints policy is in place, and is present in the Service User’s Guide stating that Ashbourne House will acknowledge the complaint in 24 hrs and a reply or action will happen in 7 days. The manager understands that elderly people may worry and feels that 28 days would be too long to wait. The last formal complaint was recorded in September 2004. Staff are to record all complaints, despite them being resolved instantly. There were many thank-you cards also in the complaints folder from relatives thanking the staff for their work and care. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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, 20, 21, 22, 23, 24, 25, 26 Residents enjoy living in a well-maintained house in their own personalised bedrooms. The home is clean and comfortable. Refurbishments are carried out when the need arises ensuring that residents are safe. EVIDENCE: Ashbourne House is a large listed Georgian property. Residents spoke favourably of the building; the views over the Downs and the fairly busy roads. The home was decorated for Christmas and residents said how lovely all the trimmings were. The home employ a maintenance man to carry out small jobs around the house, and the care staff carry out the domestic chores. The home was very clean considering the staff’s busy schedules. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 16 The inspector took the opportunity to tour the property and was able to individually talk to many residents in their bedrooms or in the lounge. The garden is accessible to a veranda with armchairs for residents to use, and steps to the main part of the garden. The kitchen is in need of refurbishment to ensure that hygiene is maintained. Cupboards do not shut properly; the lino is old and is coming away from the floor and sides; there was a leak under the hand washing sink into the cupboard below and the main sink and outer area is in need of replacement. The manager said that she is aware of this and plans are in place to rectify the problems. All the bedrooms were personalised and residents showed the inspector some of the pieces of furniture they had brought with them. The hallway and stairs carpet has recently been replaced and one resident commented how the banisters and knobs are so well placed. One bedroom was being fitted with a new carpet during the inspection which was in need of replacement. The floors are accessible by lift, which hadn’t been working since the previous evening, but was fixed within 24 hours. When this occurs, residents who are unable to manage the stairs stay in their rooms and the staff bring up their food on trays. The residents didn’t seem to mind, and some prefer being on the upper floors for the views. There are only two ground floor rooms. One resident particularly wants to move rooms as she doesn’t like the lift, but it will only be possible when one becomes vacant. It was observed how the call bell works and staff attend quickly to the needs of the residents. The upper bathroom has also been recently redecorated and residents commented upon how much nicer it is. Bathrooms and toilets have appropriate grab rails and chairs, which lower into the bath aiding independence. The recommendation of establishing a larger office space has not been developed. There are two ‘box’ rooms, which the staff use as offices, inclusive of the medication cupboard. There is no ‘work space’. The manager said that there are plans to convert the garage into an office. The recommendation remains. Further, there is no staff sleep-in room and staff have to sleep in the lounge. This could restrict access for residents. The potential office could be also used as a staff sleep-in area. There are no unpleasant odours within the home. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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 Staff are well trained and competent to care for the residents. The home’s recruitment practices are well maintained to protect the residents. A continuation of monitoring the number of staff relative to the residents’ needs would be beneficial. EVIDENCE: There is a stable staff team at Ashbourne House who know the residents, and the residents spoke fondly of the team. Relatives further confirmed that the Manager is “so so kind, will do anything for us”. One resident said, “They are a God send”. The home has linked with Bristol City College and provides work placements for care qualifications. The manager and the staff rota confirmed that the volunteers do not replace staff numbers. There are three members of staff on duty during the busiest periods of the day and two staff sleep-in who respond to the call bell if it is called. A requirement was made at the previous inspection to review the staffing levels, and even though the manager said that the provider had done this, there have been no changes due to financial restraints. The residents would benefit from being able to spend more time with the staff if an extra member of staff is employed in terms of a housekeeper and/or chef. Many residents commented that they “don’t like to bother them sometimes as they’re so busy all the time”. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 18 The staff are commended on their efforts; however, residents’ needs may be neglected due to the amount of work the staff carry out. It is recommended that the manager continue to monitor the residents’ needs relative to the number of staff. All staff have either completed or are currently in progress of NVQ level 3 in Care. One member of the senior staff is undertaking Level 4. Three staff’s files were looked at and all Enhanced Criminal Records Bureau checks were seen. These were discussed with the manager, and she has decided to keep the certificates on site. It was advised that staff are given a copy of the General Social Care Council’s ‘Code of Practice’ to ensure that staff are fully aware of their duties and responsibilities. The volunteer’s undergo the same recruitment practices as permanent staff members. Levels of training for staff are good. Mandatory training such as Food Hygiene, Infection Control and Emergency First Aid is completed. The home was awaiting their Manual Handling certificates from July 2005. Staff also engage in distance learning through Weston College such as Nutrition and Health, further benefiting the residents and staff’s knowledge of care. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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, 32, 33, 36, 37, 38 The home is well managed and has an open and inclusive environment allowing the residents to be well looked after and be safe. A developed quality assurance system to monitor and improve the home would further benefit the residents. EVIDENCE: The manager was on duty on both days of the inspection and was available for any questions the inspector had. She has worked at the home for 10years; has completed her NVQ Level 4 in Care Managements and is an NVQ Assessor. She stated that she would like to achieve her Registered Managers Award. There were nothing but positive comments from residents and relatives regarding the manager. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 20 Staff, especially the manager, would benefit from the use of a computer on site. The manager uses her personal computer at home. Internet connection at work would enable the manager and staff to contact the provider more effectively. It was evident that there is an open and inclusive environment within the home. Residents confirmed that they could approach any of the staff with any concerns or worries they had. The Quality Assurance system is an area for development. Questionnaires were found in the office from the majority of the residents. The manager said that the residents didn’t like this approach. Various methods were discussed to include relatives’ and professionals’ views. However, there are regular resident’s meetings where residents do voice their opinions. The CSCI also receives bi-monthly reports, called ‘Person-In-Control’ Reports. The author of these reports was met and it was discussed how they can be improved and used more effectively for the home’s development. Some supervision notes were seen and evidenced that they occur around every six weeks. The manager and the three other senior staff carry these out to share the workload. However, the manager does not receive any supervision or appraisals herself and is recommended to do so. This was discussed with the manager and with the ‘Person-In-Control’. Records held in the home are in good order and are well maintained. Personnel records are kept secure and the manager was aware that the residents could gain access to their records. The manager ensures that safe working practices are upheld through training; re-fresher training and in-house sessions. Generic policies are held regarding aspects of the operations of the home. There are some localised policies specific to Ashbourne House. JNC Fire Protection carried out a comprehensive annual fire training session for all the staff earlier in the year. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 3 3 Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES 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. 2. 3. 4. Standard OP7 OP7 OP8 OP18 Regulation 13(4) 15(2b) 13(1b) 13(6) Requirement Risk assessments must be developed for each resident. Care Plans be reviewed monthly. Counselling service to be sought and acted upon. Ensure all staff have Protection of Vulnerable Adult training. Written confirmation to be sent to the CSCI. (Outstanding requirement, previous timescale 30/06/05). Timescale for action 31/01/06 31/01/06 28/02/06 28/02/06 5. 6. OP19 OP33 23(2b,c, d) 24(1,3) Kitchen is refurbished and leak to be fixed. Develop a quality assurance system to monitor and improve the service. 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Update the service users guide and include the current CSCI’s contact details. DS0000026494.V270239.R01.S.doc Version 5.0 Page 23 Ashbourne House 3. 4. 5. 6. 7. 8. 9. 10. 11. OP8 OP9 OP11 OP19 OP27 OP29 OP31 OP32 OP36 Develop a monitoring system for contact with relevant professionals. Manager to contact GP to raise discussed concerns regarding resident’s medication. Staff to ascertain wishes at time of death for residents. Establish/develop larger office space. Continue to monitor residents’ needs proportionate to the number of staff. Update staff’s contracts / terms and conditions. Manager to commence her Registered Manager’s Award. Use of a computer for the manager and staff. The manager to receive supervisions on a regular basis. Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Ashbourne House DS0000026494.V270239.R01.S.doc Version 5.0 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. 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