Inspection on 04/08/05 for Ashburnham House

This inspection was carried out on 4th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashburnham House 01/12/08

Ashburnham House 18/09/06

Ashburnham House 31/01/06

Ashburnham House 03/02/05

Ashburnham House 19/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashburnham House 33/35 Westminster Road Morecambe Lancashire LA4 4JA Lead Inspector Joy Howson-Booth Unannounced 4 August 2005 11:00am 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. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ashburnham House Address 33/35 Westminster Road, Morecambe, Lancashire, LA4 4JA 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) 01524 413508 Mr Nashir Kasmani CRH Care Home 11 Category(ies) of DE Dementia 7 OP Old Age 4 registration, with number of places Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home shall at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 3rd February 2005 Brief Description of the Service: Ashburnham House is a small, family type environment providing residential care for up to 11 people of either sex. At present, the home is registered to accommodate up to 7 people with dementia and up to 4 older persons. The home comprises of two terraced houses which have been developed into one large property and it is situated in the West End of Morecambe, close to local shops, amenities and the promenade. In early 2004, the home had a change of Proprietor and is now owned and managed by Mr Nashir Kasmani. Since Mr Kasmani’s purchase, the home has enjoyed redecoration and refurbishment and Mr Kasmani continues to develop and improve both the care provided and the fabric of the building. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which meant that the registered owner, staff and residents did not know it would be taking place until the inspector arrived. The inspection was carried out by over 4.5 hours and as well as looking at documents and records in the home we spoke with staff on duty, five residents, the registered provider/manager and the assistant manager. A number of comment cards were received from relatives and all provided very positive feedback over the care provided by the owner/manager and staff at the home. What the service does well: The care provided to the residents of a high quality. Ashburnham House is a small home and is run as a family business with friendly staff and a lot of input from the owner/manager and his family. There is lots of laughter and it was seen that the owner/manager and care staff have excellent relationships with the residents. The environment has much improved, with new carpets and redecoration in most rooms. A number of residents own rooms have been redecorated and refurnished in a modern theme and are very pleasant. The remaining rooms are to be redecorated and refurbished in the coming weeks. The home is kept clean. The manager seeks the opinions of the residents by talking to them on a daily basis and time is also spent with relatives. Comment cards and discussions with relatives all stated that the owner/manager is very approachable and keeps them informed about their relatives. In order to develop the service further, the owner/manager is asking someone who can advise him on making the service better to visit and provide information and guidance. This will be a positive move for the home, as it will give an official way of measuring how good the service is. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Information about the home could be provided in a different way for people who may have difficulties in reading or understanding. The plans of care for people in the home are much improved but need to include people’s routines for getting up and going to bed and what they like to do each day. The plans of care should also give staff information over any special care that needs to be provided. The plans of care should also include people’s social activities and things they like to do and people they like to keep in contact with. Where there are areas of care that may pose a danger, for example, when a client may need to be physically moved, the home needs to consider these and make sure the concerns and any instructions are written in an understandable way on a form which is then reviewed on a regular basis. There are training courses that would help the named person to become more familiar with risk and help to make sure any written information or instructions are clear. Whilst residents said they liked the food at the home, advice was given that the menus could be checked out to make sure they give the residents some variety and are of a high quality. Staff must be employed correctly so that people living in the home are protected from people who should not be working there. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 7 As part of the redecoration and refurbishment work, the owner/manager needs to speak with the fire safety officer to get some advice to ensure the home continues to protect the people who live there. 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. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 8 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 Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 9 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) 1, 5 and 6 Information and visits are provided to enable prospective residents and their family/relatives to assess the quality of the service prior to moving in. EVIDENCE: There is a range of information regarding the home that is available for prospective residents and their family/relatives. Conversation with visiting relatives confirmed they were given a Statement of Purpose, Service User Guide and a copy of the complaints procedure. Previous inspections have recommended that information over the home could be provided in a different format as the majority of people who would be living at this home would lack the capacity to read and understand the Statement of Purpose, Service User Guide and/or the complaints procedure. This is an area for development in the future. It was also confirmed by relatives that they were able to look around the home and find out exactly what would be provided. The relatives spoken with felt that the opportunity to meet with the owner/manager to personally pass on their relatives needs and address concerns and anxieties, etc., was extremely important and began a process of confidence building with the home. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 10 This home does not offer an intermediate care facility. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 11 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, 9 and 10 The arrangements to provide personal and healthcare are excellent and residents are very well cared for. EVIDENCE: Three care plans were examined and found to contain reasonably comprehensive information regarding practical care needs and how these are to be met by the home. Advice was given that the care plans should also include routines, preferences and demonstrate that each person’s individuality and lifestyles is recognised. For example, whilst bathing is included in personal care, how often, preferred time of day, any specialist needs, likes and dislikes should be included. Similarly, rising and retiring times, routines and likes – for example, a resident may wish to go to bed at 9.00 p.m., have a drink of milk and have a bedside light left on, etc. Advice was given that additional care plan information needs to be included. For example, for one resident who is demonstrating some management needs and who is also at risk of falling. Another resident needs a specific care plan as they prefer to sleep downstairs at present. These specific care plans provide information and guidance to staff over how these additional and individual needs are to be met. Staff could also sign these to indicate they have been read and understood. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 12 A risk assessment was seen and it was confirmed that these are currently being developed for both individual residents and on working practices (moving and handling for example). Advice was given that, where necessary, a risk assessment should also be completed for areas of risk (for example, for one resident who has been identified as potentially self-harming). Comprehensive reviews of care take place, both weekly and an overall picture for the month is provided. At present, these take the form of a narrative which is very useful. However, it is recommended that the written reviews should look at and comment on each individual part of the care plan (e.g. mobility, personal care, health and medication, nutrition, etc) and make comment as to what changes (if any) have been required. It is confirmed that whilst the reviews should take place monthly a review may be required as individual needs change. This then means that a separate and individual plan of care can be put in place – for example, if someone is not eating adequately and food monitoring charts need to be maintained, food supplement drinks given; or should pressure care be needed, etc. Healthcare records are maintained and evidenced that a range of Healthcare Professionals are accessed. These include – Psycho-Geriatrician, Continence Adviser, GP, District Nurse, Community Psychiatric Nurse, Specialist Parkinson’s Nurse and Chiropodist. In addition, a record was seen of visits to Hospital Clinics. Appropriate records were seen for weight monitoring. Observations during this inspection confirmed that residents are treated with dignity and respect. Relatives spoken with and comment cards received all confirmed that they are always able to visit their relatives in private and feel that their relatives are treated with dignity and respect. One relative spoke of the owner/managers attitude as being approachable and non-confrontational. Observations during this inspection demonstrated that resident’s anxieties are acknowledged and dealt with in a sensitive and caring manner. Medication Records were examined and found to be accurately maintained. Medication was stored appropriately and cleanliness maintained. Advice was given that when a GP or Specialist alters the medication dosage this instruction should be recorded on the professional visits sheet along with the name of the specialist involved and the reduction/increase advised. For one resident the GP has advised either 1 or 2 tablets to be taken. It was advised that either a 1 or 2 be recorded alongside the signature to indicate exactly how many have been administered. Relatives spoken with confirmed that they had serious concerns about their relative’s health prior to her being admitted to Ashburnham House. The relatives were very praising of the care provided by the home saying that “since her admission the home has managed to get her eating again” and they continued that if their relative “hadn’t come into the home and been so well Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 13 cared for I think she would have died”. Three comment cards have been received about this home and comments include “excellent caring environment. Nash and his daughter are always very willing to discuss our relative …… overall we are extremely happy with the care that Ashburnham House is providing”. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Social activities are being developed and those currently organised provide stimulation and interest for the people living in the home. There are no restrictions for families and friends of the residents to visit the home which results in residents benefiting from seeing their families when they want. Meals appear limited in choice and need to be reviewed to ensure they provide a varied, balanced and nutritious diet for the residents. EVIDENCE: On arrival at the home an exercise session was being enjoyed by some of the residents. Discussions with the residents later confirmed that they had enjoyed this very much. Discussions with the owner/manager confirmed that the area of activities is currently being developed with a part-time recreational therapist being employed two afternoons a week. At present, the therapist has provided music and movement sessions, arts and crafts sessions and the residents recently took part in a craftwork session making cards. As well as this, the home has a range of board games, puzzles, and one resident (along with a weekend carer) enjoy playing the organ and having a sing-a-long. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 15 The home has two televisions and the owner/manager was advised to perhaps look at providing a video or CD player so that “older” films can be purchased and enjoyed by the residents. It was also advised that a separate record should be maintained for all activities, etc., that take place so that visiting relatives can be reassured that their relatives receive social stimulation. It was recommended that the care plans should record preferred routines, lifestyles, and interests and relatives could provide a social history so that past employment, social and other events can be talked about and can provide some prompts for activities. Importantly, the owner/manager is aware of the importance of spending time with residents and instructs his staff to sit and talk with the residents as often as possible. Certainly observations during this inspection confirmed that the owner/manager has developed some very positive relationships with the residents. Discussions with relatives confirmed that they are free to visit at any time and are made welcome and included as part of the family. Comment cards received also confirmed that relatives can be seen in private and they are kept informed of important matters. The inspector had lunch with the residents. The meal was presented well and residents were provided with support in a sensitive and caring way. Although a choice of main course is not provided an alternative is always available. The menus were examined and advice given over the need to review the teatime menu as these indicate that sandwiches are the main provision. It was confirmed that other options are provided. Information regarding the nutritional needs of older people will be sent separately and should be used to review and develop the menus in the future. Information over dietary likes is obtained from speaking with both the residents and relatives. Residents who were able to do so all said that they enjoyed the food at the home and had plenty to eat. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The arrangements for dealing with complaints are good. Residents and relatives can speak up and feel listened to and their concerns addressed. EVIDENCE: There is a formal complaints procedure in place and discussions with relatives all confirmed that should they have any concerns the owner/manager deals with these promptly. Comment cards received confirmed that all were aware of the home’s complaints procedure and none had had to make a complaint The majority of the residents in the home lack capacity to read or understand the formal complaints procedure and, for these people, the owner/manager stated that issues are dealt with as they arise. The owner/manager was advised that the Regulations require complaints to be recorded and it is good practice to record any issues that arise along with the action taken to address these. There have been no complaints received at the home since the last inspection. The Commission has received one complaint which raised issues over staffing in the home, food provided and communication. The issues over staffing and food provided were not upheld and the issue over communication was unresolved. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 17 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) 19 The standard of the environment within this home is very good providing residents with an attractive and homely place to live. EVIDENCE: The home continues to have redecoration and refurbishment, with the communal areas being recarpeted and redecorated and individual residents rooms redecorated with colours and furnishings of their choice. A number of rooms have been provided with new modern wardrobes and other furniture which has improved the rooms tremendously. Residents spoken with were happy with their rooms. Relatives felt the home was clean, tidy and providing a homely environment. Relatives also commented on the open fires in the two lounges, which are used to warm the rooms and provide a conversational topic for the residents. The communal areas have ornaments, pictures and fresh flowers which add to the homeliness of the environment. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 18 The registered owner/manager was advised to seek advice from the Fire Safety officer over the upstairs banister and landing areas. This is an area that may pose a risk to the more confused residents and should be addressed. It was noted that some residents prefer to have their room door open at night. Advice should be sought over the provision of door stops which are activated by the fire alarm which would mean that residents doors can be open at night but provide safety should a fire occur. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 19 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) 29 The procedures for the recruitment of staff are not robust and do not offer protection to the people living in the home. EVIDENCE: Three recently appointed staff files were examined and found to be lacking in the information as required under Schedule 2 of the Care Homes Regulations. For example, one member of staff had been employed without a Criminal Record Bureau disclosure being obtained. Another file lacked references and had a copy of a Criminal Record Bureau disclosure form. The owner/manager was advised that staff must not be employed until a satisfactory Criminal Record Bureau disclosure has been obtained for them. In addition, staff files must contain all the required information as outlined in Schedule 2 of the Care Homes Regulations. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 20 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) 31, 33, 36 and 38.1 The home is well managed and staff are appropriately supervised. There is a clear development plan for the home and it is intended this will encompass quality monitoring of all areas. EVIDENCE: The owner/manager has recently completed the National Vocational Qualification Level IV in care and is intending to achieve the Registered Managers Award by the end of 2005. The owner/manager is to meet with an ISO Quality Auditor to undertake a full audit of the home and provide advice and guidance over both quality standards and the National Minimum Standards. Daily communication takes place with all the residents and staff. Both relatives spoken with and comment cards received confirmed that the Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 21 owner/manager and the assistant manager are always “on hand” and available to provide information or advice over their relative. Supervision forms were seen for two members of staff and the owner/manager was advised that supervision should cover all the areas outlined in Standard 36 of the National Minimum Standards. Discussion took place with the owner/manager over the need to ensure fire doors close effectively. Further advice should be sought over the use of fire door stops for any doors which residents prefer to remain open, particularly at night. Similarly, where new carpets have been fitted some doors need attention as they are not closing. The upstairs banister area needs to be reviewed with possibly railing or spindles being put in place as it may pose a risk. The owner/manager was advised to discuss these issues with the Fire Safety Officer. Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 22 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 3 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x 2 x x 3 x 2 Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 12 7 Regulation 16 15 Requirement Residents social activities, interests, and preferences must be recorded in the care plan Care plans must provide information when a specific needs has been identified (e.g. for the resident who may self harm) Risk assessments must continue to be developed for individual residents and safe working practices The menus must be reviewed to ensure they provide a varied, nutritious and balanced diet Robust recruitment checks must be carried out for all staff prior to commencement of employment. Staff files must contain all the require information as outlined in Schedule 2 of the Care Homes Regulations The owner/manager must obtain the Registered Managers Award by 31 December 2005 Advice must be sought from the Fire Safety Officer over the provision of door stops. A risk assessment must be carried out for the upstairs landing areas to F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Timescale for action 31 August 2005 31 August 2005 3. 7 15 31 August 2005 31 August 2005 31 August 2005 4. 5. 15 29 16 18 6. 7. 31 38 10 13 31 December 2005 31 Augus t2005 Ashburnham House Version 1.40 Page 24 8. 38 13 ensure they are safe and do not pose a risk to residents. If a risk is identified appropraite action must be taken to maintain the residents safety. The laundry floors and walls must have impereable finishes (Previous timescales of 30.11.04 and 31.3.05 not met) 31.10.05 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. Refer to Standard 8 9 Good Practice Recommendations When an individual need has been identified a separate care plan should be put in place to ensure staff are clear as to how this need is to be met Changes to medication authorised by the GP or other healthcare professional should be clearly recorded in the professional input chart, along with the date and name of the person authorising the change. A book to record issues and actions taken to address these should be put in place. This is something that an ISO system will facilitate Activities enjoyed and provided to residents should be recorded The supervision provided to staff should include all areas as outlined in this standard Reviews of care plans should indicate that all areas have been reviewed as detailed in this rerport The redeocration and refurbishmen programme should continue as this is having a postive effect on the environment 3. 4. 5. 6. 7. 16 12 36 7 19 Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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 Ashburnham House F57 F09 S56670 Ashburnham House V217547 040805 Stage 4.doc Version 1.40 Page 26 - 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!