Inspection on 24/11/05 for Barchester Tower

This inspection was carried out on 24th November 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

Barchester Tower 21/05/07

Barchester Tower 30/06/06

Barchester Tower 21/07/05

Barchester Tower 09/02/05

Barchester Tower 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Barchester Tower 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA Lead Inspector Jason Denny Unannounced Inspection 24th November 2005 11:25 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 Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Barchester Tower Address 31 De Cham Road St Leonards-on-sea East Sussex TN37 6JA 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) 01424 435398 Mr Paul Hughes Mrs Indra Hughes Mrs Indra Hughes Care Home 22 Category(ies) of Dementia (22) registration, with number of places Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty two (22) Service users must be aged sixty-five (65) years or over on admission Service users with a dementia type of illness only to be accommodated Date of last inspection 21st July 2005 Brief Description of the Service: Barchester Tower is a large detached property situated in St Leonards-on-Sea approximately 1 mile form the sea front. The home is set within its own grounds, and is a close walk to local amenities including public transport links. The external grounds offer a large garden and parking area. An alarmed gate separates the property form the outside road. The home is not ideally suited for people with mobility needs who would have difficulty with the lack of level access in the home, or steep steps in the rear garden. However those Residents who can walk easily with the aid of a Zimmer frame or minimal support can be accommodated in the home. The home has a chair lift. The home has a stair-lift, which some residents can safely access. The home is registered to provide care for up to twenty-two older people with dementia needs. Accommodation consists of twelve single rooms and five shared rooms. Communal areas comprise of a large lounge and dining room. There are two bathrooms and additional toilets. The home also has smoking area for those service users who wish to smoke. This is subject to a risk assessment and safety considerations. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 11.25am and 3pm. The Inspection found that 4 of the 14 National Minimum Standards inspected, had been fully met with some nearly met. Discussions with Residents, staff, and management, took place along with looking at paperwork records. The inspector focused on new Residents and those at a higher risk of falling. Care, accident records, and other paperwork such as Complaints records, and health care was looked at. At least 6 residents were spoken with, along with others observed, although their varying level of dementia affected their participation. Two staff and both managers were spoken with. This report should be read in conjunction with the more detailed inspection, which took place on July 21, 2005, which involved two inspectors and covered areas not covered here such as the environment, activities, food, medication, and recruitment. Comment cards were sent to the home prior to the inspection for circulation to residents, relatives, and professionals who work alongside the home. 9 of the 20 residents completed these cards, and overall, made positive comments. What the service does well: What has improved since the last inspection? The home carried out a detailed written reassessment on a resident before she returned from hospital following a hip operation. Although progress is slow the care-plans continue to develop into a more suitable format. Some bedrooms have been redecorated. A Fire drill has been carried out. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 6 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. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 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 Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 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. The home has improved the written assessments of those residents who are readmitted back into the home from hospital. The pre-assessment of prospective new residents needs to improve in terms of comprehensiveness and clarity, and include where necessary social care assessments, along with confirmation that the home can meet needs. EVIDENCE: The home never admits anyone without doing their own assessment, which benefits from the experience and skills of the owner/manager who has a background in dementia. The inspector sampled the assessment of the two newest resident’s where some information was lacking and other parts difficult to read. The lack of comprehensive information was impacting on the plan of care, which was basic. One of these residents was supposed to have a social care-assessment due to being funded and referred to the home by social services. The other resident was in the process of being transferred onto socials service funding. With the owner stating that a social care assessment is due. No evidence was seen to show that at the point the person moved into the home the home, they could meet assessed needs such as a letter to the Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 9 resident and his/her representatives. Both were said to have a diagnosis of dementia, with one with an additional learning disability. One of the residents was described as having a mental health consultant although no notes where obtained. Staff confirmed how one of the owners of the home who did the assessments gave staff on duty one day, a verbal briefing on a new resident. The inspector spoke with both residents who confirmed that they had settled into the home and indicated some of the things they liked. One of the residents was confused about his rights and how long he was due to stay at the home. Through observation it was clear that there was some confusion and related difficulties with remembering previous conversations where such questions had been answered. The home was found to have carried out a detailed reassessment at the hospital before a resident who had broke her hip had been readmitted back into the home. The assessment clearly showed the observed practice whereby the person concerned requires two people to support her to access and safely use her Zimmer frame. The home has taken this risk despite not having level access throughout the home although they intend to limit her movement to the level parts of the home. The inspector spoke with this resident and found her to be relaxed and aware of waiting for staff before attempting to walk. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 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, & 10. Care plans though improved need to be fully completed and to show how assessed needs will be met in practice including the whole needs of the person whether it be social, personal, or occupational. Once the home more promptly transfers all residents to the new care-planning system then clearer evidence of outcomes will be seen. It is not possible to assess if health needs of residents are being fully met due to shortfalls in the care-plans. The home are required to work harder to protect residents privacy and dignity by ensuring that the home is conducted in their best interests especially where they cannot speak up for themselves. EVIDENCE: The Inspectors examined 3 care-plans including two of newer residents. The inspector again saw the new care-planning book where information from old care-plans is being transferred over. The two newer residents did not have fully detailed assessment information, which had led to their care-plans being basic. One of these residents had moved into the home on 04/08/05, 3 months before the inspection. The care- plan booklets are comprehensive in terms of the areas they cover although not all sections are filled in. Under the first section relating to the Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 11 specialists involved in one residents life it only indicated a GP without a full address with sections on dentist and other parts left blank with no explanation given. The monthly review of one resident was found to be several weeks overdue. Another of a new resident said “All remains the same”5.10.05. “Happy home has a dog” 10.11.05 under hobbies and interest one plan simply stated dog walking. In another plan no information was entered for wishes in the event of death. In the section under, how life can be improved it stated mini-bus trips and garden visits which are occurring anyway as confirmed by the resident in discussion. The manager responsible for the care-plans indicated that she is trying to find time to complete care-plans. The inspector again advised that more admin time is freed up to the complete task in a timely and effective manner. A resident was observed to have a bruised left eye. Staff and the accident record showed this had occurred during the night due to a “falling In her bedroom” An occurrence described as more frequent 24/110/05 with an initial strategy of moving furniture out of the way, to a new strategy of having furniture nearby to reduce the space in the room and give her something to hold on too. Staff and the manager stated that the district nurse who visits the home would diagnose if her eye injury needs further treatment. Some staff believed that the nurse was due to visit on the day of the inspection. The manager believed it to be the following day. Staff who had worked the night said that cold compress had been applied to her eye injury, although this treatment had not been recorded ion the accident book. The inspector formed the view that the home had not planed to take any further action unless guided by others as confirmed by the manager. The owner/manager who was present during the morning and afternoon of the inspection said that she had not seen the resident’s injury. The inspector visited the room of a resident who had returned from hospital following a broken hip. This room is shared with another resident. Whilst in the room the inspector noted marked files visible on top of a wardrobe, which was openly confirmed by the manager as relating to other residents. The manager went on to explain that this was “convenience” as the room is generally used as “Surgery” for a number of residents who receive visits by a district nurse. It was explained that some residents can take up to 15 minutes to go to their room for treatments, and that residents who sleep in this room do not mind and are not in their rooms at these times. The inspector explained that this was a resident’s room and that their dignity needed to take precedence. The home was immediately required to ensure that resident’s bedrooms are not used by other residents for personal care. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 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): 13, & 14. The home supports residents to maintain existing relationships with a freedom of movement afforded to them based on needs. Residents are supported to make some choices. EVIDENCE: A new resident confirmed in discussion that he was pleased that the home allowed him to move his dog into the home. Staff confirmed how they support him with the care of the dog. This resident was found to have almost daily visits from his family Another new resident explained that he enjoyed the mini-bus outings organised by the home and would like even more. He also attends a Methodist church in the nearby community supported by staff. Some resident were observed exiting the house and walking around the secured grounds. Most residents were observed to choose to sit together in the dining room for the Main meal of the day. Care-plans recorded some basic choices such as sugars in drinks and other dietary requirements. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The home operates in an open and supportive manner with relatives with minor concerns clearly recorded and promptly responded to so avoiding these escalating to serious complaints. No formal complaint or concern has been upheld over the last year. The home maintains a clear record of complaints made. EVIDENCE: The last formal complaint, which was communicated directly to the Commission, which was found to be upheld, occurred over a year ago. The inspector found a record of 3 concerns raised with the home by visitors or residents. No fault on the home’s part was found. All 3 concerns were promptly resolved by the home as seen in records. One concern involved getting additional advocacy for a resident to support her understanding of the mail system. Another concerned the temperature of a bedroom leading to a radiator being repaired and the offer of a smaller room. No written complaints were found to be have made to the home since the last inspection. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The home now shows how they protect the rights of residents who cannot always speak up for themselves in relation to when the location of their bedroom is changed. This approach needs to be taken to the daily use of rooms as remarked upon in relation to standard 10. Standards 19 and 26 were assessed at the last inspection with 26 met and standard 19 having minor shortfalls which the home are exempt from regulations relating to level access which apply to newer homes. Standard 24 in relation to bedrooms were inspected at the last visit EVIDENCE: The home was advised at the last inspection to record the decision-making and where possible consent for when residents change room [standard 24]. A case in point being the return from hospital by a resident after breaking her hip, whereby a bed was found on the ground floor by moving someone upstairs. The home was found to have improved it practice by recording in a written way including liaising with the residents family/advocate a decision to move a Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 15 resident to a ground floor room on mobility grounds and also based on the fact that it is hazardous for the person to use the home’s stair-lift to access the first floor. Residents have a sophisticated door locking mechanism which affords them privacy whilst at the same time maintaining their safety needs with staff having a master key to prevent Residents locking themselves in their room, this policy is also in compliance with fire-safety. When Residents are out of their rooms they are locked to prevent wandering Residents gaining unwelcome access. This policy has been discussed in resident meetings and is continuously reviewed. A new resident [and staff] confirmed that on moving into the home he was given a key to his own room. The need for the home to ensure that residents use their own, as opposed to other residents bedrooms for personal care, has been commented upon elsewhere [standard 10.] page 11-12. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 16 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. Staff training needs to improve further in terms of enrolling sufficient staff on National Vocational Qualifications so the home can meet the minimum target as soon as possible. The home’s rota needs to clearly show management hours. The home maintains basic staffing levels day and night. The staff team has now worked together for several years. EVIDENCE: Staffing levels remain at what was reported at the last inspection Day shifts include three staff, which includes the day [registered] manager with the owner/manager available where necessary. There is a number of ancillary staff such as two cooks, supper assistants, and domestic general housekeepers whose duties include cleaning enabling care staff to focus on Residents. Two staff that work the night shift, receive support from 7am by one member of the day shift, with helping Residents morning routines such as getting ready for the day. Staffing levels will continue to be under review due to numbers increasing to 20 along with at least 1 resident observed to need 2 staff to mobilise. The provision of two waking night staff means that there is enough staff to meet assessed need if any resident needed to mobilise. The management were again asked to record those hours worked on shift along with those dedicated to admin tasks and the management of the home. This followed a discussion with the manager/owner, and her manager who is said to have 7 hours admin /management time per week although this is not clearly recorded on the rota. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 17 The inspector was informed that 3 staff have at least NVQ level 2 or equivalent. One staff spoken with confirmed that they continue to make progress on this course. The owner/manager previously stated at the last inspection that by September [2005] all remaining staff [5-6] will be on NVQ’s with 2 senior staff going on to NVQ 3. The owner/manager stated that this had not yet happened due to delays with a training provider. The home is advised to access other training providers if delays continue in order to ensure that training standards are met as soon as possible. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 18 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, 35, 37, & 38. The owner/manager demonstrates a good understanding of the needs of people with dementia type illnesses. The home lacks a suitably qualified manager. The home need to ensure that all times the privacy of residents is maintained by the correct storage of confidential information. Greater care and attention needs to be given to reporting tasks. An Immediate requirement was made in relation to both the underreporting of accidents in the home and towards the Commission. EVIDENCE: The home confirmed at the last 2 inspections [February and July 2005] that it requires the manager to have the appropriate qualification namely an NVQ level 4 in Care. The home has 2 registered managers one of whom predominantly works shifts. The other manager is the Owner. The manager on the care-side was on shift and completed an advanced City and Guilds in the Management of Care in 1998 The Commission’s expectation is that the home Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 19 moves to having one registered manager. The owner/manager previously confirmed in July that it would be the other registered manager who will be doing the National Vocational Qualification level 4 in Care starting in September 2005. The manager concerned confirmed at this inspection that she does not intend doing this course. It was evident through some of the observed care practices highlighted as needing attention that the management’s understanding of the National Minimum standards needs to improve. The owner/manager is a Registered Mental Health Nurse. Her role alongside the other owner involves managing the business and offering specialist clinical advice including assessments. Resident’s finances are correctly managed by the home ‘s owner/manager as confirmed in records previously inspected. The home’s practice is to invoice resident’s families for monies spent to avoid them as afar as possible handling any money. The home is aware of not agreeing to being appointee’s unless there is no proven alternative. An immediate requirement was made when personal care records relating to some residents were visibly on display on top of a wardrobe. The home was immediately asked to find a better solution in the best interests of residents. A particular resident who was observed to have an eye injury was reported by staff and confirmed by records and the manager to have increased the number of falls in her room. This has been included earlier in this report under standard 7 [page-11-12] where a review of 14.9.05 entered in her care-plan described her as knocking into furniture due to falling in her room causing skin breaks such as those seen on her legs with injuries dressed by the district nurse. Some staff believed this occurred particularly at night, some all the time. The inspector could only find one accident report for the last year. This related to the eye injury with no record of what follow up action such as first aid, which followed. Another resident was found to have an additional mattress, which is placed, on the floor to one side of her bed. This is as a precaution due to her at least once recently falling out of bed. No record of this accident was found in the accident book as a confirmed by looking through the documents and talking to the management of the home. It followed that such incidents where not reported to the Commission. The commission has written to the home since last inspection due to some incident reports being sent which were incomplete. The home has improved the most recent Reports, which have been sent to the Commission. The home was found to have had a fire drill since the last inspection, which also discussed how to deal with a television fire. The evaluation was not clear and did not describe how residents responded, or how long it took for evacuee’s to leave the building. Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 20 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X 2 X X STAFFING Standard No Score 27 2 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X 1 1 Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 21 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[1] Requirement That the Registered Person must ensure written pre- assessments shows evidence that all necessary areas have been assessed with all-relevant parties involved. That the written up assessment demonstrates how it forms the comprehensive plan of care. That the service user and, or, their representative is written to confirming that the home is suitable to meet needs before the new person moves into the home. Those Social- Care assessments necessary for identified service users [Residents] are in place and form the plan of care, by the date shown. That the Service User [Resident] Care Plans must fully outline individuals assessed needs and show how these will be met in practice. That preferences and choices are fully recorded. That all section of the Plans are completed and reflect information contained in assessments. That the plans DS0000021038.V260770.R01.S.doc Timescale for action 24/03/06 2 OP7 15[1] 24/03/06 Barchester Tower Version 5.0 Page 22 3 OP10 12[4][a]& 12[1][b] 4 OP37 12[4][a] & 17[1] 5 OP38 37 show how the persons holistic needs will be met. Requirement made at the last 2 Inspections. Requirement first made July 21,2005. That the Registered Person must ensure that the dignity and rights of Service users [Residents] is protected by ensuring that service users [Residents] do not receive medical treatment in other Residents [Service users] rooms. This was made an Immediate Requirement on the day of the Inspection. That the Registered Person must ensure that service users [Residents] confidential information is stored securely and not left in full view in other Service user [Residents] bedrooms. This was made an Immediate Requirement on the day of the Inspection. That the Registered Person must ensure that all accidents such as falls are appropriately recorded and reported to the Commission. This was made an Immediate Requirement on the day of the Inspection. 24/11/05 24/11/05 24/11/05 Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 23 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 OP8 Good Practice Recommendations That Care-records clearly show how service users [residents] are being supported to access health care services with records showing why someone is not registered with services such as dental clinics. That the managers hours devoted to the administration and management of the home is clearly recorded on the Rota. That 50 of all care staff in the home achieve at least NVQ Level 2 as soon as possible That the Registered Manager[s] Commences and Completes a NVQ Level 4 in Care, without delay. That a clear written evaluation of Fire Drills is carried out 2 3 4 5 OP27 OP28 OP31 OP38 Barchester Tower DS0000021038.V260770.R01.S.doc Version 5.0 Page 24 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. 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