Inspection on 18/04/05 for Brockhurst

This inspection was carried out on 18th April 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

Brockhurst 30/09/08

Brockhurst 13/06/07

Brockhurst 12/04/06

Brockhurst 20/09/05

Brockhurst 07/10/04

Brockhurst 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Brockhurst Brox Road Ottershaw Surrey KT16 0HQ Lead Inspector Helen Dickens(with Cathy Clarke) Unannounced 18 April 2005 10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Brockhurst Address Brox Road Ottershaw Surrey KT16 0HQ 01932 872635 01932 872862 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Surrey County Council - Adults & Community Care Mrs Tina Marie Davis Care Home 46 Category(ies) of DE(E) Dementia - over 65 (20) registration, with number OP Old Age (32) of places SI Sensory Impairment (1) Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Intermediate Care may only be provided in Aster Unit for up to a maximum of 4 Service Users. 2. Camellia and Carnation Units will be used solely by Service Users who require dementia care. 3. Accommodation and Services may be provided to named persons aged 6065 years with the prior written agreement of the CSCI. 4. Respite Care may be provided to a maximum of 5 persons at any one time, these persons should be grouped in the same unit. 5. A maximum of 6 Service Users with Dementia may be cared for in other parts of this Home. Date of last inspection 7 October 2004 Brief Description of the Service: Brockhurst provides care and accommodation for older people over the age of 65. It was purpose built in the 1970s and is owned and managed by Surrey County Council. It is located in Ottershaw, near Addlestone, in a quiet residential area, close to local amenities. Accommodation is arranged in seven units on two floors all with single rooms. Each unit has its own bathroom and toilet facilities, a kitchenette, and a communal lounge/dining area. The reception area, main kitchen and laundry are on the ground floor and there are offices on both floors. There is a shaft lift and stairs to the first floor. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. All comments received from residents, staff and visitors to Brockhurst have been kept in confidence except where they have given permission for the inspectors to use them in this report. The unannounced inspection took place over 9 hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. This inspection was carried out by Helen Dickens, Lead Inspector for the service, with Cathy Clarke as the second Regulation Inspector. Mrs. T. Davies was present as representative for the establishment. The inspection included speaking to 6 staff, 12 residents and 2 visitors. In addition a small number of‘ ‘comment cards’ were handed out to those staff, residents and relatives who indicated they would like the opportunity to reply in writing. The majority of residents spoken to preferred to give their comments directly to the inspector. The inspectors also toured the building, inspected records (both on the day and prior to the inspection) and observed an unplanned fire procedure when the alarm went off during the morning. This was a positive inspection. The inspectors would like to thank residents and staff for their time, assistance and hospitality. What the service does well: Every resident spoken to was happy with the service they received at Brockhurst and in particular praised the staff and the home’s management. The inspectors observed the staff interacting well with residents and there was a good atmosphere in the home. The two relatives interviewed were very complimentary and both compared Brockhurst with experiences of other homes; they said Brockhurst was by far the better home and gave examples of how staff had been particularly helpful to their respective relatives. Staff who spoke with the inspectors were happy at Brockurst and got a good deal of satisfaction from working with the residents. The residents and staff were very pleased with the chef and the meals provided at the home. The food served during the lunch was observed to be of a good standard and enjoyed by the residents. The fire alarm went off during this inspection and the full fire procedure had to be carried out. . This turned out not to be an actual fire but the home’s staff are to be complimented on their prompt and efficient actions. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 standard(s) 1, 2 and 3 Progress has been made with regard to the information available to new and prospective residents. This is important because it helps them to make an informed choice about whether this home is likely to be suitable. More progress needs to be made with regard to admission procedures. Without thorough procedures and record keeping, residents cannot be assured that their care needs can be met. EVIDENCE: The Service User Guide now contains details about the self-administration of medication, which was recommended at the last inspection. This informs new and prospective residents that they have the option of managing their own medicines if they are willing and able to do this. Information about staff qualifications, the availability of the Service User Guide in other formats, and some comments from existing residents still needs to be added. The terms and conditions of admission were found on some resident’s files but those residents did not always sign the contracts. There was no notice period mentioned for general discharges, only for those coming to Brockhurst for respite care. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 9 Admission records and procedures are not sufficient to guide staff on the actions to be taken to meet the needs of new residents. One recently admitted resident did not have his records fully completed and important information was not recorded. Another had no index in his file (making it difficult to find the relevant information) and staff were not signing their names properly when indicating they had completed part of the assessment, thus making it harder to check who was responsible. Some items, for example the risk assessment, were not signed at all. The newer residents did not yet have a photograph on file. Though there were some good examples of accurate assessments and record keeping, greater consistency is required. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 standard(s) 7,8,9 and 10 Good progress has been made with regard to meeting the health and personal care needs of residents but there are still some shortfalls, which could potentially put resident’s health and welfare at risk. EVIDENCE: Residents care plans contained too many forms, but not enough detail was filled in. For example lack of information about ongoing health conditions; unsigned, undated entries by staff; and some care plans unsigned by residents. There was little evidence that residents were involved in drawing up their care plans. Communication methods require updating and the manager said a consultant was being used to do this. A communication book had been set up (and was examined by the inspectors) to pass referrals to the visiting district nurses; generally this was working well. However, there was no formal referral tool (as required at the last inspection) for service users whose needs are challenging the service in terms of their health care, to be referred for a comprehensive health assessment. The manager said such referrals would always go through the care manager. There was evidence of good relationships with local surgeries, one of which was currently doing some preventative work by reviewing all their high need patients who are resident at Brockhurst. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 11 A chiropodist visits 6-weekly and hearing and sight tests are available. Brockhurst is only registered for one named service user with a sensory impairment relating to their sight. The inspectors observed three other residents who also have a significant impairment with their vision and Brockhurst will need to apply for a minor variation to their registration to encompass these residents. Medication cabinets were examined on 4 units and generally the record keeping and procedures were good. There were currently no Controlled Drugs in use. Photographs of residents were on all medication administration records (MAR) except the very new service users who the manager said were about to have them taken. Lists of commonly prescribed drugs and their side effects were available in each cabinet and the majority of the MARs were correctly signed and up-to-date. One self-medicating resident did not have a locked cabinet in her room, though the room itself locked. Staff were aware, when questioned, that the medication belonging to the resident who had recently died, had to be kept for seven days following the death. Speaking to residents, the inspectors gained the impression that they were generally happy with the way they were treated by staff and that their dignity and privacy were respected. There were many examples of respectful relationships between staff and residents; one member of staff came on duty in the afternoon and was overheard to go to each individual resident on that unit to greet them and ask how they were. There was no observed instances of privacy or dignity being infringed but the inspector noted that the name of ‘Brockhurst’ is still clearly visible on wheelchairs and getting this removed is an overdue requirement from the last inspection. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 standard(s) 12 and 13 The activities co-ordinator is making good progress with the social and recreational activities in Brockhurst, thus improving the quality of life for residents. Family and friends are encouraged to visit and made welcome at Brockhurst, enabling residents to receive care and support from a wider network of people. EVIDENCE: The activities co-ordinator is currently working on a one-to-one basis with residents to gain some insight into their past and present interests and capabilities. This was documented on resident’s plans. In addition, a number of residents enthused about the ‘lovely outings’ provided by Brockhurst. Two residents said staff had recently asked about whether anyone would be interested in exercises, and they hoped that a class would soon be organised. Both these residents also enjoyed the quizzes organised at Brockhurst. Visiting at Brockhurst is very flexible and one visitor explained that he often came at times which fitted in with his work and was always made welcome – staff offered him tea and were always courteous and pleasant. He said that staff had been particularly helpful to the family following a bereavement – the resident he was visiting reinforced this positive report. Another visitor to the dementia unit had come over the lunch period and she was able to support her husband during his meal. The inspectors observed plenty of help available on the dementia units at lunchtime so the assistance from his wife was a preferred option for this couple, rather than a necessity. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 standard(s) 18 Staff have a good knowledge of, and a positive attitude towards, adult protection issues, which goes some way towards safeguarding residents. However, ongoing work is needed to ensure residents are protected from harm or abuse. EVIDENCE: All but 2 staff have been trained on the multi-agency procedures for the protection of vulnerable adults and have recently had further guidance from management about reporting of injuries and instances where residents may be at risk. A number of residents have sustained minor bruising injuries over the last three months and investigations are ongoing. Staff have not been consistent in the way incidents affecting the well-being of residents are being reported and some which have been noted as accidents only, should have been reported to CSCI under Regulation 37 notices. Management and CSCI have agreed further guidance to be issued to staff on this issue. There was no risk assessment for the use of members of the community offenders team at Brockhurst. This team, with their supervisor, are assisting with internal decorations. On the day of the inspection there was painting in Angelica Unit and paint was seen to be left unattended, there was no floor covering being used, and a member of staff got paint on her trousers. The management at Brockhurst had not seen CRB checks and did not have sufficient knowledge of the history of team members to make an informed judgement about using them in a home where vulnerable adults reside. The home agreed to do a risk assessment as a matter of urgency. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 standard(s) 19 and 24 Improvements to the décor have been made and are ongoing but there is no evidence of the requested budget review to ensure adequate funds are made available for this purpose. Staff actions during a fire alarm showed high regard for the safety of residents and strict adherence to fire procedures. EVIDENCE: The overall appearance of the home is satisfactory and, as it was purpose built, it provides a well set out environment for its residents. Inspectors visited some resident’s bedrooms and found these residents to be pleased with their surroundings. There was evidence of many personal belongings and the rooms visited had combinations of colour co-ordinated bedlinen, curtains and décor. One resident had had her new room decorated at the expense of her family, as Brockhurst does not routinely redecorate between residents. Staff mentioned that they had done some of the decorating in the home themselves. The last inspection questioned whether there were sufficient funds available in the budget to carry out a programme of internal decoration and maintenance. A requirement was made for the budget to be reviewed and sent to CSCI showing that adequate funds had been made available. This has not happened and the budget has now been set for this financial year, with no inflationary Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 15 increase; staff said that therefore savings would have to be made. The new Responsible Individual, Jon Muller, recently visited the home and has indicated to the manager that money may be made available from an alternative budget such as minor works. A fire alarm sounded during the inspection and a full fire procedure was carried out in a very efficient, calm, and professional manner – staff were complimented on their actions. Inspectors noted that residents were temporarily left unattended whilst staff gathered in the reception area; there was concern that residents in the dementia unit in particular might be distressed at this time. The manager assured the inspectors this was not the case and that this risk had been considered when drawing up the fire procedure. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 On the day of the inspection there were sufficient staff with suitable training and skills, and staff morale was good. However continuity and quality of care could be compromised by the high reliance on agency staff. EVIDENCE: During the day the dementia units have 2 staff on duty and other units have one member of staff. The dementia unit staff never leave residents without a single member of staff on the unit (except during a fire alarm) and inspectors saw evidence of this during their visit. The night staff are now assisted by the use of bed sensors for residents assessed as needing help to get out of bed during the night. Staff shortages due to high levels of sickness have meant that up to 50 of the staff were agency staff. However, the agency staff spoken to on the day were used regularly by Brockhurst and therefore they knew the residents well. Staff on one unit commented that they disliked being moved around the units (which had been happening recently) as this provided less continuity for residents and was unsettling for staff. A visitor who overheard this conversation confirmed that she thought the residents preferred regular staff looking after them. The manager said this had been done recently out of necessity during staff shortages and staff rotas were about to revert back to having designated staff on each unit. The difficulties recruiting staff in this area are well recognised by management and a number of actions (such as advertising throughout the year) had begun. The inspector suggested a documented strategy needed to be in place. There were no issues raised by residents about shortages of staff. The Registered Manager and two deputies have commenced NVQ Registered Managers Award 4. Another 3 staff were Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 17 involved in NVQ3 and another had already completed it. 4 members of staff had completed NVQ2 and 8 more were near completion. Brockhurst said they were on course to reach the 50 target for their own staff but the inspector reminded them that they need to include agency staff in their calculations. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The promotion of many good health, safety and welfare practises is evident in Brockhurst and this helps provide residents with a comfortable and safe environment. However, some work still needs to be done to provide a consistently safe environment. EVIDENCE: Staff were given basic induction training plus additional training on other relevant topics (moving and handling, dementia care, first aid, protection of vulnerable adults) though examination of the training records showed some staff needed to up-date their training. The fire procedure witnessed by the inspectors during the inspection was carried out with exemplary professionalism. Food hygiene courses were being started for staff who served and helped residents with their food on each unit – this had been instigated by the chef and was received positively by the manager. The certificate from Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 19 Runnymede Borough Council saying the Environmental Health Officer had inspected the premises was displayed. It was noted that water temperatures in areas accessible to residents, and in particular in some resident’s bedrooms, were above 43C and therefore may have posed a risk to residents. Staff confirmed they were not monitoring water temperatures (as requested at the last inspection), except in communal bathrooms. A recent inspection by a plumber suggested the thermometers had been set to provide water at around 43C in each unit but this was not the case on the day of the inspection. The manager agreed to start monitoring water temperatures and to recall the plumber. Health and safety issues for non-smoking residents had not been consulted on, as requested in the previous inspection report. However, there were now only two residents who smoked (they were on the same unit) and both only smoked in their own rooms with their doors closed. A non-smoking resident on this unit did not realise that people were smoking in the building and pointed out that it was not allowed in any communal areas which he was very happy about. Staff went outside to smoke. Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x 2 x x STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x 2 Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 2 3.1 3.3 Regulation 5 Requirement Timescale for action 18.06.05 18.07.05 3. 7.6 4. 5. 9.3 10 6. 18.1 7. 19.1 19.2 All service user contracts to be signed by service users. 14(1)(a) Assessment documentation and record keeping to be improved to ensure that for each new service user.and there is an appropriate and complete record of their assessment. 15(1) Service users to be more involved in production of their care plans and to sign the completed plan. (Outstanding from 07.01.05). 13(2) Medication administration records must always be signed and dated. 12(4)(a) The name of the home should not be displayed prominently on service users wheelchairs. as this interferes with dignity and privacy. (Outstanding recommendation from last report). 13(4)(a-c) Ensure the health and safety of 13(6) service users by carrying out a risk assesment on the use of the community offending team for internal/external decorations. 25(3)(a) The registered provider must 23(2)(d) review the homes budget to ensure that there is adequate H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc 18.06.05 25.04.05 25.05.04 18.05.05 18.06.05 Brockhurst Version 1.20 Page 22 8. 38.3 25.8 9. 10. 38.7 provision for ongoing redecoration.(Outstanding from 06.12.04) 13(4)(a-c) Ensure the health and safety of 13(6) service users by regulation of water temperatures to control risks from hot water. Monitoring of water temperatures should be recorded in bathrooms as well as service users bedrooms, and any other area where service users have access. 37(1)(2) More consistent submissions of Regulation 37 notices as discussed and agreed. 18.05.05 18.05.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 1.2 8 Good Practice Recommendations The Service User Guide should contain qualifications of staff, comments from residents, and information about the availability of the Guide in other formats. A referral tool should be developed by the home in order to initiate an assessment from a healthcare professional. This is is relation to the changing needs of service users who may need nursing input/care. A minimum of 50 of care staff should be trained to NVQ level 2 or above by 2005; any agency staff should be included in the 50 ratio. 3. 28.1 28.2 Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Brockhurst H58-H09 s33514 Brockhurst v215936 180405 Stage 4.doc Version 1.20 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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