Inspection on 26/06/06 for Beech Lawn Residential Home

This inspection was carried out on 26th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

Other inspections for this house

Beech Lawn Residential Home 16/05/08

Beech Lawn Residential Home 21/06/07

Beech Lawn Residential Home 23/11/05

Beech Lawn Residential Home 11/07/05

Beech Lawn Residential Home 24/11/04

Beech Lawn Residential Home 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Beech Lawn Residential Home Limited Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG Lead Inspector John Goodship Key Unannounced Inspection 26th June 2006 09:00 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 DS0000060475.V294433.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. DS0000060475.V294433.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Beech Lawn Residential Home Limited Address Elton Park Hadleigh Road Ipswich Suffolk IP2 0DG 01473 251283 01473 251283 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) Guyton Care Homes Ltd Miss Fay Ulah Veronica Millwood Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places DS0000060475.V294433.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 2005 Brief Description of the Service: Beech Lawn is a registered care home for older people. It is registered for a maximum of 26 older people. The Home is owned by Guyton Care Homes Ltd which also owns a second Home in Ipswich. Beech Lawn is a large detached house situated in a private road on the outskirts of Ipswich. Accommodation is sited over two floors. The Home provides one shared room and twenty-four single bedrooms, all with en-suite toilet facilities. There is a platform lift to the first floor. Communal facilities include two lounges and a spacious conservatory. DS0000060475.V294433.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken as part of the new policy on “Inspecting for Better Lives” published by the Commission in March 2006. The intention was to cover all the key standards, which are indicated under each outcome group. Two inspectors conducted the inspection, spending seven hours in the home. The manager was present throughout. The inspectors examined staff and residents’ files, toured the home and spoke to several residents and staff, and inspected maintenance records. Comment cards and survey forms were received from eight residents and eight relatives. Their comments have been included in the report. Although the last full inspection was in November 2005, the home has been visited four times since then by the Commission’s pharmacy inspector, as there were major areas of non-compliance with the aspects of Standard 9 regarding the safe administration of medication. The last of these visits found that almost all the requirements relating to this area had been met. What the service does well: What has improved since the last inspection? The home has appointed an activities co-ordinator from amongst the care staff. This person has developed a much wider range of activities for residents so that there can be something for everyone. These activities are publicised in a newsletter which goes to each person. The owner has bought several items of equipment and materials to allow this development. A survey of all residents had been conducted asking for their choices around meals, outings and activities. A copy of the survey and the survey results was given to the Commission. Two residents commented on the better choice and quality of meals. Staffing recruitment documentation and supervision arrangements now meet the standards and provide protection for residents. As part of the quality assurance system, the owner is now preparing a monthly report on the home, including information from his discussions with residents. DS0000060475.V294433.R01.S.doc Version 5.1 Page 6 A programme of redecoration and refurbishment is underway and is improving the appearance of the home. 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. DS0000060475.V294433.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 DS0000060475.V294433.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. The home has a comprehensive assessment system in place to ensure that all service users needs are identified prior to admission. The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Intermediate care is not specifically provided by the home. The home has a pre-admission assessment policy. This ensures that staff who visit prospective service users are made aware of the requirements to complete the assessment. The policy includes statements for example, to establish a personal relationship with the service user, to provide prospective service users with the aims and objectives for the home and to provide the assessor with an holistic overview of the care needs. Two care plans were examined and both were found to include the required assessments. The information in one of the care plans stated clearly that the service user required assistance with manual handling and the other identified the DS0000060475.V294433.R01.S.doc Version 5.1 Page 9 medication being taken by the service user. Neither of the completed assessments were signed or dated by the assessor. One resident commented that although their admission had been very quick because their previous home had closed, the staff were very welcoming as were the residents. DS0000060475.V294433.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): 7,8,9,10. Quality in this area is adequate. Residents have their needs assessed, recorded and regularly reviewed. However the information should be better organised both for the benefit of staff and to ensure that residents’ changing needs are highlighted. Residents are now better protected by the home’s compliance with the standard on medicine storage and security, systems and records. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of three residents were examined and case-tracked. One person had been resident since 1999, a second since late 2005, and the third since April 2006. Two files contained the pre-admission assessment, together with the initial care plan compiled at the time of admission. The admission details included the date when the contract for residency had been given to the person, and the date when the service user’s guide had been given. The care plans contained appropriate information about the care needs of the resident, and were reviewed monthly by the keyworker. However when a keyworker left, two of the above residents had not had a review in May this DS0000060475.V294433.R01.S.doc Version 5.1 Page 11 year. Concern had been reported about one of these residents that they had eaten little food recently. This led to them collapsing and being taken to hospital. No reason for this collapse was found but their medication was changed. However, there was no evidence that their weight had been monitored at the home. The manager explained that it was difficult to weigh residents whose ability to weight-bear was poor. The home had no weighing chair which would overcome this problem. The plans had records of all visits by health professionals, as well as visits made to hospital clinics. One resident confirmed that the district nurse came regularly to dress their ulcer. They commented that they were very well looked after here. Although the contents of the care plans were adequate, they were poorly structured which did not allow staff to pick up changes of care needs easily, nor did they include fuller information within the subject pages to back up the changes reported at reviews. The inspectors discussed with the manager where to access help on care planning. It was noted that one resident was dressed in an obviously old cardigan which had holes at the elbows. The staff explained that the person was very fond of it and would not be separated from it. However the family had been asked to bring in a replacement. One resident stated that they were very satisfied with the care received. That morning, one of the night staff had brought in a glass of orange at 6.00am instead of their usual cup of tea. They rang the bell and it was replaced at once. Another resident said that when they were admitted, the staff asked them how they wished to be addressed. This resident was happy to be called by their Christian name. No overall assessment of Standard 9 concerning medication was made at this inspection. The home had been subject to several unannounced inspections by the Commission’s pharmacy inspector leading to the issuing of a statutory enforcement notice in March 2006 because of the failure to comply with statutory requirements. A further unannounced inspection in June 2006 found that almost all the requirements had been met and further enforcement action was not taken. Further action was required on risk assessments for residents self-medicating. However during the inspection, the person giving out the medication in the dining-room during lunch was reminded by the inspector to watch residents actually taking their tablets before signing that they had. DS0000060475.V294433.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. Service users have the opportunity to participate in the activities programme and they maintain contact with family and friends. Meals are prepared to ensure that service user’ choices are met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities programme for the home was seen and was displayed. Various activities were scheduled for five days of the week. Examples were that on Monday there was ten pin bowling, Tuesday ‘what the papers say’ and on Wednesday, memory lane cards. On the morning of the inspection two care staff were playing snakes and ladders with a large floor version. Six service users were participating, each throwing the dice. The manager stated that one of the care staff had been appointed to organise and coordinate the activities. The home had a wide range of games and puzzles available for the service users. Most of those had been purchased by the new owner. One service user stated that ‘I choose if I want to play the games or stay in my room.’ A popular activity was the art club, and examples of the work produced was seen. A visitor was observed to be in the home at the time of the inspection. One service user stated that they had planned to go out for lunch with visitors who DS0000060475.V294433.R01.S.doc Version 5.1 Page 13 were travelling from Surrey. The service user stated that ‘I can go out when I wish to.’ Both the breakfast and lunchtime was observed in relation to the preparation, serving and choice of food. The dining room was used by a number of service users, with five tables available. Each of the tables was set with a cloth, place settings and condiments. One of the service users required assistance with their meals and staff were seen to be assisting and sitting beside the person. There were some service users who were having meals in their own rooms and the food was seen to be placed on a tray and taken to each person. The breakfast choice was porridge or cereals with toast followed by scrambled egg. One service user stated that ‘we can choose what we want and we do have a choice’. At lunchtime there were 13 service users in the dining room with two people requiring assistance with their meals. There were cold drinks on the table. The lunch was prepared by the chef who was seen to make a sausage and onion pie as one of the choices and chicken chasseur as the alternative hot choice. Vegetables accompanied the lunch that was served on individual plates in the kitchen and brought to each of the service users in the adjoining dining room or, alternatively, in their own room. The pudding choices were pineapple upside down sponge, rice pudding or flan. The feed back from the service users was positive in relation to the choice and presentation of the food. “The meals are good and wholesome with two choices each time.” The chef stated that the fresh vegetables, dry goods and frozen products were delivered to the home. The store cupboards were seen and there was evidence of ample stocks available for the number of service users. DS0000060475.V294433.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): 16,18. Quality in this outcome area is good. Residents are protected by the home’s policies and training of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy and procedure which was displayed in the hall. Unfortunately it was headed: “Thurleston”, the other home owned by the proprietor. It also still referred to the NCSC instead of the Commission for Social Care Inspection. The complaint log was inspected. It was noted that a complaint had been made in March 2006 concerning the temperature of a radiator in a resident’s room. This was noted as repaired. Six care staff had attended a refresher training session on the protection of vulnerable adults the previous month. This had been run by an external training provider. Other staff had received training in the previous twelve months. New staff covered this aspect in their Foundation training and NVQ courses. Previous inspections had confirmed staff knowledge of abuse and the action they must take. A relative had commented that as staff did not wear name badges, it was difficult to recognise who was in charge at any one time. The manager explained that afer the hall had been redecorated, it was intended to put up a photo board showing who was on duty and indicating who was in charge. DS0000060475.V294433.R01.S.doc Version 5.1 Page 15 DS0000060475.V294433.R01.S.doc Version 5.1 Page 16 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. This outcome group is judged as adequate. There is a positive approach to redecoration of the home and whilst the service users are warm and comfortable, the home has health and safety issues that need be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were assessed on this occasion to ensure that it was suitable and well maintained. On arrival at the home the guttering at the front of the home and over the conservatory, was spilling over with the rainwater. The grounds were tidy; the maintenance person stated that the grass was cut each week and the flowerbeds kept tidy. There was access from the home for those in wheelchairs. The maintenance person was seen to be undertaking a programme of redecoration in the home. The dining room and one of the lounges was complete with the hallway partially complete. The owner, who was present for DS0000060475.V294433.R01.S.doc Version 5.1 Page 17 part of the inspection, stated that he is committed to improving bedrooms with redecoration and furnishings and carpet. The home has three lounge areas, one of which is a large conservatory area. No service users were seen to be using either this area or one of the other lounges. There were eight service users in the remaining lounge and the other service users were in their own rooms. The kitchen in located adjacent to the dining room across a corridor and has access from two separate doors. One of the fridges in the kitchen had cardboard boxes and other items stored on top. Therefore there was a restriction to the circulation of air and a health and safety issue. The laundry and sluice areas were inspected and found to have items stored on the floors and generally untidy therefore constituting a health and safety hazard for the staff who enter the rooms. The home operates on three floors. The ground floor includes three lounges, dining room and bedrooms and the first floor has bedrooms. On the second floor the administrator is located. This is accessed up a very steep and narrow staircase. The manager and other staff also access the administrator during a shift. A recent fire assessment has been completed and a report forwarded to the owner. Referring to the second floor the report states that ‘ the offices can only be used for short periods of time during working hours or the corridor and doors need to be made up to provide at least 30 minutes fire resistance.’ DS0000060475.V294433.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. The numbers of staff are appropriate to support the current needs of residents. Training programmes ensure that staff are trained and competent to care safely for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several comments were received from residents and relatives that staffing numbers were not always adequate. The home’s policy is to have four care staff on the early shift, three on the late shift and two on at night. This was found to be sufficient for the number of residents bearing in mind their current needs. However there are periods when staff may be stretched, for example when two carers are needed to support a resident in moving, or during a medication round. The home acknowledged and dealt with some of these points last year by employing a kitchen assistant, and re-timing the person doing the evening medication round. The home also had week-end morning cleaners. Any extra cleaning needs outside this time was undertaken by the care staff. One resident did tell the inspector that although they sometimes still had to wait for attention in their room, staff usually came in to explain if they were busy with another person and to check how urgent their need was. The home was carrying several vacancies: two senior carers, one day care assistant and one night care assistant. The manager was having some difficulty DS0000060475.V294433.R01.S.doc Version 5.1 Page 19 recruiting. During the inspection she was expecting a person for interview, but they did not turn up. Gaps in the rota were covered by existing staff, by staff from the proprietor’s other home, and as a last resort by agency staff. Files for those staff who had started since the previous inspection were examined. Their files contained all the required identification and protection documents. Their induction training record was included, as well as the three monthly appraisal for one of them. One had completed the Skills for Care induction programme, and one was currently on that course. There was evidence that staff had many opportunities for updating training. Certificates were seen for staff attending sessions on COSHH, POVA, and Fire training. The cook was about to attend a refresher Food Hygiene course in July 2006 and four staff were doing a distance learning course on health and safety with a local college. The manager was arranging sessions on First Aid and Moving and Handling. Evidence was seen for those staff who had completed the “Safe administration of medication” course with a local college, and those who had attended a one day course with Boots. NVQ training is as follows: One person has Level 4, one has Level 3, two have level 2 and two are undertaking Level 2. Unfortunately, two staff who had recently left had Level 2. The training undertaken was commendable, but it was difficult to determine how the manager ensured that all those needing training, received it. There was no annual plan of training against which to check progress. It was suggested that the manager should prepare an annual plan in matrix form to show training that each member of staff needed to complete in the next twelve months. DS0000060475.V294433.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,33,35,36 and 38. This outcome group is judged as good. The health, safety and welfare of service users under this section is promoted and staff are trained to ensure that safe working practices are adhered to. EVIDENCE: The manager has been registered with the CSCI and is in day to day charge of the home. There are clear lines of accountability with the care staff responsible to the manager who in turn is accountable to the Responsible Individual. The manager has attended regular training including fire, medication and health and safety. Regulation 26 notices are submitted by the owner to the CSCI and evidences that service users are spoken to. They are asked about the services, food and environment. The manager stated that she speaks with the relatives and friends of the service users to assess the satisfaction of the home. DS0000060475.V294433.R01.S.doc Version 5.1 Page 21 It was noted that the Certificate of Registration was not displayed in the home. This was due to the person decorating the hall removing the notice boards temporarily. However, when informed of the legal requirement to display the Certificate, the manager immediately arranged for it to be displayed. The administrator stated that each of the service users’ representatives were sent invoices for their fees or standing orders were set up. Each of the service users manages their own petty cash therefore the administrator does not handle cash. The manager ensures that all staff receive training relevant to the job they are employed for. This includes health and safety, medication and first aid. The chef and her assistant are scheduled to attend a food hygiene certificate update. The schedule for staff supervision sessions was up-to-date. The maintenance person evidenced that a number of the required tests had been completed. Examples were the electrical testing completed on 19.06.06, gas safety certificate on 03.02.06 and the lift was checked and a safety certificate issued on 11.01.06. Two pre-admission assessments were not signed or dated. This means that the standard on record-keeping cannot be fully met. DS0000060475.V294433.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 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 2 X X X X X X 2 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 3 X 3 X 2 3 DS0000060475.V294433.R01.S.doc Version 5.1 Page 23 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 OP7 Regulation 15(2) Timescale for action The registered person must 31/07/06 ensure that care plans are reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. The registered person must 31/07/06 ensure that the nutritional needs of residents are monitored, a record kept of weight gain or loss, and appropriate action taken. The complaints policy must 31/07/06 indicate the correct name of the home and include reference to the CSCI not the NCSC. The registered person must 31/12/06 ensure the safety of residents and staff, by adhering to the fire officers report dated 25th May 2006. Particular attention must be paid to the safety of the administrator’s office on the top floor. The registered person must take 31/08/06 steps to ensure the external DS0000060475.V294433.R01.S.doc Version 5.1 Page 24 Requirement 2. OP8 14(2) 3. OP16 16(1) 4. OP19 23.5 5. OP19 13.4 (a) guttering of maintained. 7. OP26 13.4 (a) the home is The registered person must 31/08/06 ensure that all parts of the home are kept free from hazards, for example items on top of the kitchen fridge. The registered person must 26/06/07 ensure that all assessments of residents must be signed and dated by the person undertaking the assessment. 8. OP37 17 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. Refer to Standard OP7 OP27 OP30 Good Practice Recommendations The manager should investigate how the care plans could be better structured in line with best practice. The manager should conduct regular reviews of staffing levels based on the needs of residents. These reviews should be shared with residents. The manager should prepare a training plan for the home each year to ensure that all staff receive the required training, both initial and refresher, to meet the standard. DS0000060475.V294433.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000060475.V294433.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!