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Inspection on 13/06/06 for Ashwood Nursing Home

Also see our care home review for Ashwood Nursing Home for more information

This inspection was carried out on 13th June 2006.

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

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

What the care home does well

The service provides homely care with nursing within a village location. The home and gardens are well maintained. The Registered Manager and owner has established links with the local community and uses those to the benefit of the residents. The home has a positive attitude to training. The individual needs of the residents are assessed and well managed and residents were positive about living in the home. In the six surveys returned prior to the inspection all residents were positive about all aspects their care at the home from a well established and experienced staff group and especially the quality of the food provided.

What has improved since the last inspection?

The requirements from the last inspection have been actioned to provide the Commission for Social Care Inspection`s name for contact in the statement of purpose, to institute a programme of quality assurance, update care plans and formalise supervision. There has been a considerable investment in the home this year. An industrial kitchen was installed onto an impermeable floor earlier in the year. A locked room contains all the medication. The laundry room has been totally refurbished with an impermeable floor, new industrial machines and a locked cupboard for Control of Substances Hazardous to Health (COSHH). The sluice has also been upgraded with new equipment. Most of the windows have been re-curtained and new carpet has been laid in all the corridors and front hallway with some new pictures have been hung in bedrooms. Sky television is being installed as some of the residents like to view the sport.

What the care home could do better:

All accidents are recorded but there is a lost opportunity to analyse and explore trends and patterns, as the record does not confirm the review of risk assessments. Only one member of staff is trained in basic food hygiene and first aid; each shift should have a trained first aider working. The RegisteredManager has purchased a quality assurance package but as yet not completed the programme. Though supervision meets the needs of the staff spoken to at the inspection it remains informal and should be recorded.

CARE HOMES FOR OLDER PEOPLE Ashwood Burwash Common Etchingham East Sussex TN19 7LT Lead Inspector Lindy Latreille Unannounced Inspection 13th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashwood Address Burwash Common Etchingham East Sussex TN19 7LT 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) 01435-883434 Ashwood Nursing Home Ltd Miss Ann Elizabeth Morrissey Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (19) of places Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is nineteen (19). Service users must be older people aged sixty-five (65) or over on admission, and those with a physical disability. Two named service users under sixty-five (65) years on admission with a learning disability only to be accommodated. 28th February 2006 Date of last inspection Brief Description of the Service: Ashwood is a nursing home that provides care up to nineteen older people or those with physical disabilities over the age of 65 years and two residents less than sixty-five years with a learning disability. At the time of inspection, eighteen residents were accommodated. Ashwood is in the hamlet of Burwash Common and set in grounds with flat access for residents. A well-stocked and managed garden is available to be used by the residents. There is ample off road parking for visitors. The nearest town is Heathfield; the village of Burwash is two miles away. The home is situated on the bus route and there is a railway station in Stonegate a nearby village. The home provides eleven single rooms, and four shared rooms over two floors. Eight rooms provide en-suite facilities. There is a well-decorated combined dining and lounge area. A passenger lift allows level access throughout the home. Residents have access to all parts of the home and gardens, with the exception of the staff office, pharmacy and the laundry room that are locked when not in use. The last inspection report is available to be seen at the home. Current weekly fees are £550.00 - £950.00; information being provided on the 23/05/06, and there are no additional charges. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 10.10 and 17.15. All eighteen residents were spoken to in their rooms or in the lounge. The Registered Manager was interviewed, as three were carers, the handy man, the cook and a visitor. Documentation was read including care plans, menus, shift management records, rota’s, staff personnel files, complaints file and a tour of the home and gardens was undertaken. Six care home surveys from residents were returned prior to the inspection. What the service does well: What has improved since the last inspection? What they could do better: All accidents are recorded but there is a lost opportunity to analyse and explore trends and patterns, as the record does not confirm the review of risk assessments. Only one member of staff is trained in basic food hygiene and first aid; each shift should have a trained first aider working. The Registered Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 6 Manager has purchased a quality assurance package but as yet not completed the programme. Though supervision meets the needs of the staff spoken to at the inspection it remains informal and should be recorded. 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. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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 Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are only admitted when the Registered Manager is confident that the home can provide the required care. EVIDENCE: The statements of purpose and resident’s guide have been updated and contain all the required information. Pre- admission assessment is carried out by the Registered Manager or her deputy; on many occasions the referral is made by the local General Practitioners knowing the capacity of the home and in that event the Registered Manager admits the resident on the basis of the detailed medical report which informs her assessment of the resident. On numerous occasions the prospective residents is already known to the Registered Manager through the local village community. A visiting relative was spoken to during the inspection described the service that his mother had received prior to and on recent admission, which detailed an improved quality of life and holistic health. He confirmed that he was confident that his relative had been admitted to a service that met her needs. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 9 Intermediate care is not provided. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is well planned for each individual resident, assessed daily to meet changing needs and delivered to provide good outcomes for residents. EVIDENCE: Care plans are in place for all the residents and their care is assessed on a daily basis which informs the daily report sheets that are written to guide staff in the daily care needs of the residents. A designated Registered General Nurse (RGN) now has the responsibility to review the care plans within her contract of work to ensure currency of care is recorded. Where possible residents and their families are involved in this process. The daily report sheet identifies each resident and his or her health needs to be met. Care of pressure areas is assessed and monitored, with specialist equipment provided to maintain skin care. Generally the Registered Manager accompanies residents to all off site appointments; especially to hospital to ensure professional information is given and received and this arrangement offers support to the resident. A physiotherapist was visiting one resident and Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 11 instructing staff on her mobility needs in the light of her changing care needs. This professional visits the home twice a week and sees some residents routinely and others, as necessary, to address their changing needs. Nutritional screening is not always recorded but from documentation read at the inspection it was clear that this is addressed well in practice. When residents are admitted their instructions, or those of their relatives, in the event of death are recorded if the information is available, and the Registered Manager detailed the arrangements that were put in place for a resident who had died recently. There are no residents that self-medicate. All ordering of medication is done through the group practice and appropriately received and stored. Medication charts are maintained to a good standard. Control drugs are stored adequately and recorded appropriately when administered. All medication is now kept within a locked room where hand-washing facilities are available. Documentation read at the inspection confirmed that the General Practitioner was alerted when staff felt necessary. Medications were seen to be stored appropriately for a resident who had died recently. Staff were observed to maintain the privacy and dignity of all residents. Instructions in the care plans specifically related to how this should be achieved in practice for each resident. Residents spoken to reflected on the good care that they received in the home and the kindness of the staff. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a lifestyle that they choose and enjoy, and maintain links with the community and their families. EVIDENCE: Residents were seen to be relaxed and happy within the home. Many spoke of how they spent their time during the day, their choice to rise in the morning or not, to stay in their rooms or join others in the lounge, choice of meals, walks in the garden, attending church, reading, crocheting and taking part in structured activities. An outside group provide stimulation for mind and body every second week and these sessions are well attended. Communion is available for residents every fortnight in the home. Some residents attend the local Help the Aged group. Aromatherapy is provided for residents at their choice. Staff interacted appropriately with residents who wished to remain in their rooms on that day, but also confirmed that they had taken meals outside during the good weather. Arrangements were being made for a birthday party with eighty people attending, which the home is to host, to celebrate a residents’ significant birthday; with the help of three chefs and all the staff. Feedback received before the inspection from residents was positive in all aspects of the meals provided and that was confirmed at the inspection. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 13 Visitors are welcomed into the home and offered refreshments. Residents spoke of the pleasure that local friends could pop in to visit as they had lived for many years in the village. Three residents attend three different Christian churches in the area, and staff take them when other transport is not available. A visiting vicar spoke of his positive observations when he came to the home every fortnight, of the care that was given and the consistency of the staff in carrying out their duties. The Registered Manager confirmed her reluctance to manage residents’ monies. Where it has proved a necessity the Registered Manager‘s administrator keeps all the accounts that in turn audited by the accountants. The residents spoke highly of the provision of meals, as did the staff. The cook used to work for the home and completed her catering training during that time. She has now returned to the home after a career break and is enjoying working in the new and upgraded kitchen. She has an unlimited budget. All meat and fish is freshly purchased weekly and vegetables are delivered three times a week. There is no re-heating of food and only a few basic items are kept in the freezer. The menus are on a four-week rolling cycle and are only changed if the fresh produce is not available. Special diets are catered for and the menus seen showed a variety of home cooked food. Residents are offered a choice from which to select their meals during the morning and early afternoon appropriately for lunch and supper. Snacks are available and staff working at nights confirmed that drinks and snacks would be provided during the night. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge and understanding of Adult Protection which protects residents from abuse. EVIDENCE: A complaints policy is available for all to see in the hallway of the home. No written complaints have been received by the service and staff showed an understanding of their role in managing the daily concerns for any of the residents. The Commission for Social Care Inspection have not received any complaints about the service. The Registered Manager feels that staff identify the concerns of adult protection best in a practical way. Consequently when there is in-house training on manual handling, from the home’s visiting physiotherapist, the Registered Manager links the knowledge and understanding to the best outcomes for residents. Adult Protection is also linked to the feeding process, to establish that staff understand their role in an essential part of care giving. Staff were able to demonstrate their understanding of their role in physical, verbal and sexual abuse, and were clear that they would refer any concerns to the Registered Manager. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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 and 26. Quality of this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Recent investment has significantly improved the service and appearance of the home creating a comfortable and safe environment for those living there and visiting. EVIDENCE: There has been a considerable investment in the home this year. An industrial kitchen was installed onto an impermeable floor earlier in the year. A locked room contains all the medication. The laundry room has been totally refurbished with an impermeable floor, new industrial machines and a locked cupboard for Control of Substances Hazardous to Health (COSHH). The sluice has also been upgraded with new equipment. Stair gates have been used at exit doors to deter a resident who wanders, so safety is ensured and ventilation in warm weather maintained. Most of the windows have been recurtained and one room remaining will also be painted with the resident’s choice of paint colour. New carpet has been laid in all the corridors and front hallway and some new pictures have been hung in bedrooms. Sky television is Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 16 being installed as some of the residents like to view the sport. Externally the gardens are well maintained by outside contractors. Risk assessments are in place, updated in February 2006, for all the home and gardens that also cover the two ponds. The home is a no smoking home and the one smoker smokes outside when she chooses. When residents are in the garden a call bell is in place so that they can easily alert a member of staff to their needs. Pots with small Christmas trees were in the garden and the Registered Manager explained that each resident had a tree in their room for Christmas. There are plans for further investment in the garden to provide a raised area on a refurbished patio so that residents can appreciate or work on the flowerbeds. Residents spoken to at the inspection were positive in their comments about the environment of the home Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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 and 30. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: The rota confirmed an experienced skill mix of staff, six Registered General Nurse (RGN)’s and seven carers, many who have worked in the home for many years. At least one Registered General Nurse (RGN) is on duty at all times and in the day there are at least three carers. On the day of the inspection there were five staff and the Registered Manager on duty. Night cover is provided by a Registered General Nurse (RGN) and another member of staff. Staff manage the laundry and cleaning as part of their daily duties and the home was observed as clean and well ventilated with laundry up to date and organised. Staff were able to manage the laundry along side their caring duties without compromise. Two staff are following an adaptation programme to achieve registration as nurses in the UK; they are also attending for day release in London to achieve a recognised qualification in care at National Vocational Qualification level 4. One carer has recently been awarded her registration from the Nursing and Midwifery Council to practice as a nurse. One carer has achieved an National Vocational Qualification at level 2 in care and is set to continue to study at a higher level in September 2006. Staff spoken to during the inspection were resident focused in their practice and displayed a wellorganised and effective team. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 18 There are no agency staff used in the home and all staff follow an induction programme and continue on to study with Skills for Care certified training programme in care. Recruitment is robust and Criminal Records Bureau checks are in place for all staff. Staff training in manual handling is on going with the physiotherapist who attend every other week. Training for fire prevention took place in April 2006 and all staff attended. One carer is trained in first aid and basic food hygiene. As each shift should have a qualified first aider working there is a need to get staff trained. The Registered Manager intends to follow a course with the cook to update their qualifications with regard to basic food hygiene. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has a clear development plan and vision for the home that she effectively contributes to the residents, staff and relatives. EVIDENCE: The Registered Manager is very experienced and has owned and run the home for many years she holds a current registration with the Nursing and Midwifery Council and has achieved an National Vocational Qualification at level 4 in management. Both she and her deputy are qualified mentors and assessors for adaptation nurses with Manchester University. The Registered Manager has also followed a course in the care of people with motor neurone disease, prompted by the needs of a resident, which she took with the University of Brighton. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 20 The Registered Manager has purchased a quality assurance package but as yet not completed the programme. It was clear from interviewing the Registered Manager and her administrator that actions are taken to assure quality assurance, through an annual development plan but that they are not yet formalised. During the inspection the Registered Manager had conversations with relatives to gain their thoughts about their relatives and this information was shared with appropriate staff. One resident has their money managed by the home and the accounts are maintained by the administrator and checked by the Registered Manager, and audited by the home’s accountants and the funding authority. The Registered Manager will only manage residents’ monies when there is no other possible option. Staff supervision is not formalised yet though there is a format in place. Staff spoken to mentioned a very open work environment where they had access to the Registered Manager, whether she was on duty or not, and when a matter of practice needed to be discussed it was done at the time and staff said that they found it a workable arrangement. All staff spoken to felt well supported and have worked in the service for many years were happy to attend in-house training and when speaking about their role within the staff team their work clearly focused on the residents’ quality of life and well being. There are no volunteers working in the home. The Registered Manager ensures safe working practices through ongoing training in manual handling and fire prevention. The visiting physiotherapist assesses all new residents with regard to moving and handling and staff are instructed in the best way to do this to maintain the health and safety of the resident and themselves and prevent the occurrence of abuse. One staff member is trained in basic food hygiene and the cook has a catering qualification. Nurses maintain standards in infection control and instruct carers accordingly. One member of staff has a first aid qualification. Product information is available in the home for hazardous substances, Control of Substances Hazardous to Health (COSHH), and they are maintained securely. Appropriate professionals service the boilers, cooker and hot water for Legionella prevention. The handy man monitors and records the water temperatures and the cook records the temperatures in the kitchen. All accidents are recorded but there is a lost opportunity to analyse and explore trends and patterns as the record does not confirm the review of risk assessments. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 18(1)(c)(i ) Requirement That each shift has a qualified first aider on duty. Timescale for action 13/09/06 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 2 3 4 Refer to Standard OP33 OP36 OP38 OP38 Good Practice Recommendations That a spread sheet be developed to support and record the quality assurance systems in place throughout the year That a record of supervision be kept. That accident records be reviewed for trends and patterns and show when risk assessment are updated. That staff working in the kitchen are qualified in basic food hygiene. Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Ashwood DS0000013957.V290288.R01.S.doc Version 5.1 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. 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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