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Inspection on 12/01/07 for Ashlea Grange Residential Home

Also see our care home review for Ashlea Grange Residential Home for more information

This inspection was carried out on 12th January 2007.

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

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

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

What the care home does well

The manager and operational manager have identified a number of problems at the home, including: poor staff practices, staff not following instructions and, lack of teamwork. They have brought these to the attention of CSCI and are actively putting measures in place to improve the service. The expert by experience said `I had a lovely, well cooked fish and chips (my favourite) with a lovely lady resident who entertained me throughout the meal. I had a walk around a well decorated, warm home. All the rooms were light and airy and homely with lots of personal things on show. One lady had a visitor so I took the opportunity to speak to them both. The lady was settled well and her relative was happy with the level of care she was receiving`.

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Ashlea Grange Residential Home Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES Lead Inspector Mrs Katie Tucker Unannounced Inspection 9:30 12 and 15 January 2007 th 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 Ashlea Grange Residential Home DS0000034293.V319595.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. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashlea Grange Residential Home Address Philadelphia Lane Newbottle Houghton-le-spring Tyne And Wear DH4 4ES 0191 584 8159 0191 512 0089 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) Winnie Care Limited Joseph Patterson Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (40), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (3) Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The SI (E) and MD (E) service user categories relate to current service users only. The service may from time to time admit person(s) who are under the age of 65, but who fall within the currently registered service user categories. 13th June 2006 Date of last inspection Brief Description of the Service: Ashlea Grange is a large modern, purpose built care home that provides 40 places for older people some of whom may have dementia care needs, physical or sensory disabilities. The accommodation is within 40 single rooms, all with en-suite facilities. There is a good range of sitting areas and sufficient bathrooms, some with specialist lifting equipment, to meet the needs of the people who live here. The fees charged at the home range from £346 to £361 per week. There is level access into the home, and wide corridors allow easy access by people who use a wheelchair. The accommodation is over 2 floors, which are served by a passenger lift. The home has good links with the local community. It is close to local amenities such as shops, pubs and churches and is on a direct bus route to Sunderland. The Provider, Winnie Care Limited, operates a number of other homes for older people in Sunderland and the North East region. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. This unannounced visit was carried out over 2 days. While at the home time was spent talking with people using the service, staff and visiting relatives. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at their records. Some of the people have difficulty with speech and stating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. Also information from POVA investigations was used to make decisions about the quality of service. During this inspection all of the key standards were checked. What the service does well: What has improved since the last inspection? Staff have worked hard writing out new assessments records. These records are much improved and starting to show people’s care needs. Records now discuss the resident’s personality, strengths and what the person wants. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 6 Lack of activities has always been a problem at the home. The manager has employed an activity co-ordinator and made staff aware that this is very important. The expert by experience found ‘after a while I heard music and followed the band to find about four people in the lounge listening with one lady ‘wanting to be Bobby’s Girl’ and dancing – boy was she enjoying herself. One member of staff watched her carefully and encouraged her – even danced with her, which was lovely to watch’. Residents said ‘we have been out to the theatre recently and on trips, which was great’. All of the care staff have either finished NVQ awards or are in the process of completing the award. Also the operational director has helped senior staff organise training specific to the needs of the residents. 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. The summary of this inspection report can be made available in other formats on request. Ashlea Grange Residential Home DS0000034293.V319595.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 Ashlea Grange Residential Home DS0000034293.V319595.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Although staff are improving records this work only recently commenced. The information in the majority of assessments is extremely limited and therefore, will impact on how the service can adequately plan to meet someone’s needs. EVIDENCE: Case tracking showed that social worker assessments and a basic assessment of people’s physical needs are provided. The manager has introduced new assessments. Staff are completing these and they include more detail about people’s social, emotional and cultural needs. This work has just started and staff still need help to sort out what needs to put in the assessment. On the dementia unit some staff recognise the importance of people’s life histories but this information is not used in practice. When upgrading records staff need to bear in mind that residents need to show they have been involved in completing this record and many could write some of it. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Although there is some evidence of improvement overall the systems for recording are not yet effective in ensuring staff meet the needs of residents. EVIDENCE: The flaws in the previous assessment document led staff to fail to complete care plans around people’s greatest needs. The new assessment tool is starting to help staff find out the main needs people have. Plus, help staff write more about people’s emotional, social and spiritual needs. And, staff are just starting to write care plans that take account of information about each person’s social background, lifestyle preferences and interests. This is in the early stages and the manager is hoping to make sure staff always use this sort of information when working with residents. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 10 The manager and staff are now trying to show how people’s aims and goals are met. However, when case-tracking there was no evidence of residents or relatives being involved in the assessment process. Or that they agree with the proposed care plans. Although risk assessments are being used they need to be reviewed, as they do not include all of the actions associated with risk management. The manager was made aware of guidance that would help him develop an appropriate risk management tool. Also risk management strategies must be applied more widely, as currently staff routinely discourage residents from taking everyday risk such as making their own drinks. Research shows that to maintain a sense of well being we need to continue to take everyday risk. Staff impose limitations on some residents because of their dementia or physical health needs such as needing to be accompanied when outside the home. When any restriction are in place to be recorded and the resident or relative need agree that it is acceptable. The manager was made aware of the effects of the introduction of the Mental Capacity Act 2005 in April, and how those people who were found to have capacity must be allowed to take any risk they see as fit and those who lack capacity must be cared for in ways that are the least restrictive. Staff at times forget to record how much medication has been received. This makes it difficult when completing an audit trail, and monitoring the use of medication and recording returning medication. Some of the recording sheets are photocopied but these copies has missed the last two days of the month off. This mistake can lead to over ordering and medication wrongly being sent back. The manager has developed new recording sheets and is planning to increase his oversight of the administration of medication. The storage area for medication is far too small and this leads to staff overstretching to reach medication in the cupboards. Plus it causes staff to have difficulty booking in the monthly medication. Also staff inappropriately store returns in the manager’s office. Staff were just doing enough to get by and not actively supporting residents to meet their personal care needs. The manager has recognised this and is putting measures in place to make sure that resident’s basic personal care needs are met. Thus, he is closely monitoring whether all of the residents receive regular baths. Whilst in the office, one of the staff members came and checked the record to see who needed a bath that day and shouted down the corridor to other staff ‘X is the only one for a bath’. However, this was inaccurate as several other less able residents were needed a bath according on the record. The manager was made aware of this incident and took further action to make sure staff made sure residents needs came first. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Some staff are directing care at people and running the shift to meet their own preferences rather that residents. Thus the needs of residents are not consistently being met. EVIDENCE: Lack of activity has been a major issue for residents. An activity co-ordinator has been employed but is not yet able to fully take on this role as they are covering care staff absence. Residents talked about entertainers who had recently visited and regular trips they had gone out on. However, it was evident that day-to-day activity was very limited, as some of the staff did not see this as important. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 12 During the observation of one shift it was clear the staff did not see the need to talk to residents or involve them in any sort of basic activity. They only engaged with more able residents. However, on the following shift and completely different behaviours were seen, staff chatted with all of the residents, encouraged them to join in various activities, used life histories to get people to talk to them and knew people’s preferences. Case tracking showed that one resident was confused and difficult to engage, as they did not want to use any care staff. Yet, staff on this shift gave her a newspaper and for over an hour she happy looking through the papers and often discussed the contents with the staff. On the first visit staff had completed ignored this person, and they had bored and extremely fed up. Residents said they would like to be able to go out to local shops but had to wait until their relatives could accompany them. The staff tend not to go out with people to the shops and wait for relatives or organised trips. Staff do bring items in for people but many residents said they would just like to ‘pop out once in a while, even just up the street for a bit of fresh air’. Some of the residents could still safely go out but are discouraged. Staff need to show that before stopping people doing these everyday activities that risk assessments are completed. Although the food was well cooked and the home has a relatively good catering budget limited choices of meals are offered. Another person has certain likes and dislikes, yet they found that these were not catered for so ‘made the best of a bad job and ate what they could’. Meals are served from the hot lock but staff do not check what people would prefer to eat. One person who had recently moved to the home asked several simple things such as salt and vinegar, jam for their rice pudding and a cup of tea. The last two requests staff said could not be met and the first one took so long to do the meal was nearly over by the time they got what they had asked for. On the downstairs dining room residents are more able but still are at risk of choking, falling and need some help. Yet staff left the dining rooms unattended but it was clear that it would be better for residents in this dining room to have someone near by in case they needed help. The manager discussed the range of measures he is in the process of introducing to tackle these problems. It was clear from seeing the differences between the two visits that some of the strategies are starting to work. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The manager and regional manager have shown that they will check that the service is working for residents, help people to raise concern, work in partnership and take all actions necessary to resolve issues. Thus, residents can expect that poor practice will not be tolerated and the service will improve. EVIDENCE: The home has a Complaints Procedure, which is written in plain English, and this explains how to make a complaint and to whom. All the bedrooms have a Service Users Guide (information pack), which contains the Complaints Procedure, so that residents can refer to it at any time in the privacy of their own rooms. The Complaints Procedure is also published in the home’s Statement of Purpose and provided on cassette tape so that people with poor sight can listen to the information, and there is a spare cassette player for this. Ashlea Grange has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. Recently a number complaints and allegations have been made about the service and Winnie Care Limited in partnership with other agencies are investigating these matters and where possible have put measures in to resolve them. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The home is provides a clean, comfortable and well maintained environment, which on the whole meets the needs of the residents. EVIDENCE: Winnie Care Limited has completed a full refurbishment of the home. The lounges, dining rooms and a number of bedrooms have been redecorated. New furniture has been purchased for the bedrooms and communal areas. Case tracking showed that the upstairs unit has been set up to provide dementia care but some aspects of the environment do not meet people’s needs such as colour scheme and lack of aides to help people find their way around. The regional manager is very aware of changes that could be made to make the environment more user friendly, such as using different colour schemes in different areas. These changes have started to be introduced. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Although there are marked shortfalls in care practices, which impact on the quality of care residents receive, recent action by the manager has resulted in some improvements to the service offered to residents. EVIDENCE: The minimum care staffing levels for Ashlea Grange are 5 care staff (including one senior) on duty throughout the day and 3 night staff (including one senior) on duty throughout the night. These hours exclude the Manager’s hours, which are supernumerary. Winnie Care Limited plan to increase staffing levels to 6 care staff during the day once 35 people live at the home. Currently some of the staff behaviour does not help residents to meet their needs. Some of the senior care staff feel they should be office based and do not oversee the care being delivered or offer assistance. This means care staff are allowed to work in a way, which suits their and not resident’s needs. When certain staff are on duty residents personal care, social and emotional needs are not being adequately met. Also when senior staff do not make themselves available less staff are working with residents. During these shifts, only four staff are available to assist residents meet their care needs. The manager is Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 16 taking decisive action to resolve the problems of staff compliancy and poor care practices. The regional manager and manager have alerted CSCI to the problems they are encountering and the action being taken. It is clear that the manager has put a number of strategies in place, which should speedily resolve these issues. These strategies had already improved some aspects of the service and it was observed that during one visit the care practices were extremely person-centred and residents readily responded to this type of care. Staff receive a range of training but there were marked gaps. Thus not all of the staff had received all of the mandatory training. Some staff have received training on dementia care and working with people who have mental health needs. The manager and senior staff need to have training on risk management. 55 of care staff have completed NVQ Awards and the remaining staff are enrolled on the course, as are the domestic staff. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The manager continues to make changes to improve the service and ensure management systems support the service make the changes needed to deliver a good service to residents. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 18 EVIDENCE: The manager has recently successfully completed the registration process. He is currently making changes at the home to improve the service offered. This is being met with some resistance. The manager has looked at the concerns staff have expressed, the practices adopted by staff and areas where the changes he requested are not being made. He outlined the plans he is putting in place to resolve all of these issues. The actions he had already taken were making a positive impact on the service. But he is aware that a large number of changes need to be made to bring the service up to a good standard. Winnie Care Limited has a quality assurance procedure, which is now being used to review the service provided. The outcomes from the reviews provide the basis for an annual development plan for the home. And, the quality assurance system has helped the manager to identify areas of poor practice. But some of the systems do not readily support the manager gather useable evidence around poor practice. Also the risk management policies, procedures and templates need to be reviewed and updated so they comply with Fire Authority requirements and Health and Safety guidance. The personal allowances are in good order. Only small amounts of money are held on behalf of residents. When money collects this is sent to the appointee or relative to put in people’s savings accounts. Staff used poor moving and handling practices such as drag lift throughout the visit. The moving and handling assessments gave them inadequate information about the actions they needed to take to resolve issues such as location of seating or, any equipment to be used. All of staff have not received updated training in this area. The manager has taken action to address the training issues and will make the owners aware of the contributory factors such as the poor risk assessment format. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 19 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 X X 1 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 20 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. Standard OP3 Regulation 14 Requirement Staff must complete the new assessment record for all of the residents. Life histories must enable staff to gather useful information for the care of people with a dementia. (Required at the last inspection – timescale 26/12/06 Service users or their representatives must be involved in the writing of assessments. 2. OP7 15 When residents needs change staff must make sure they have reflected this their plan of care. Risk-taking assessments must be in place. (Required at the last inspection – timescale 20/2/07) Risk assessment formats must meet recognised guidelines. All limitations imposed by the home on service users must be identified and the reasons for this recorded. (Required at the last inspection – timescale Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 21 Timescale for action 13/08/07 16/07/07 20/2/07) Service users or the representative must record that they are involved in the drawing up of plans. (Required at the last inspection – timescale 20/2/07) Staff must record the amount of all medication received into the building. (Required at the last inspection – timescale 3/10/06) The manager must ensure staff work in ways to promote and support the needs of residents. The activity co-ordinators hours must not be used to cover care hour shortages. The manager must ensure staff are equipped, via training and supervision, with the skills needed to deliver person-centred care. The manager must review catering arrangements to make sure residents particular dietary needs are met. The manager must review staff practices at mealtimes to make sure staff provide sufficient support and supervision. All of the staff must receive mandatory training. The manager and senior staff must receive risk assessment and management training. All of the staff must receive dementia care training. 9 OP38 13 (4) (b) Staff must receive refresher training in moving and handling. Risk management strategies must be in place and cover Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 22 3. OP9 13 (2) 18/06/07 4. OP10 12(1) (a) 18/06/07 5. OP12 16 (2) (m) & (n) 12 (1) (b) 23/04/07 6 OP14 25/06/07 7 OP15 16 (2) (j) 23/04/07 8 OP30 18 (1) (c) (i) 13/08/07 23/04/07 changes to the environment such as moving furniture, which would facilitate staff adopting safe moving and handling techniques. 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 OP15 Good Practice Recommendations Condiments should be provided in accessible containers. Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South of Tyne Area Office St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ashlea Grange Residential Home DS0000034293.V319595.R01.S.doc Version 5.2 Page 24 - 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. 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