Inspection on 28/01/06 for Brookfield Nursing Home

This inspection was carried out on 28th January 2006.

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

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

Other inspections for this house

Brookfield Nursing Home 01/08/07

Brookfield Nursing Home 25/01/07

Brookfield Nursing Home 15/08/06

Brookfield Nursing Home 26/07/05

Brookfield Nursing Home 24/01/05

Brookfield Nursing Home 10/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brookfield Nursing Home Grange Road West Kirby Wirral CH48 4EQ Lead Inspector Les Smith Unannounced Inspection 28th January 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 Brookfield Nursing Home DS0000020903.V280931.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. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brookfield Nursing Home Address Grange Road West Kirby Wirral CH48 4EQ 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) 0151 625 5036 0151 625 2037 Brookfield Nursing Home (West Kirby) Limited Mrs Jean Buckley Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty Four (24) Older Persons (aged over 65) and one (1) named male person (aged under 65 years) within a total of 25 26th July 2005 Date of last inspection Brief Description of the Service: Brookfield is a medium sized care home providing care for older people requiring nursing care. It is located in a quiet residential area of West Kirby on the Wirral. Local amenities such as shops, library, cafes, restaurants, churches and pubs can be found nearby. The care home is also situated near to the local beach and Dee estuary. Accommodation is provided over two floors with all rooms offering single occupancy. There is a small enclosed, private garden to the rear of the home and a car park to the front. Wheelchair access is provided to the home and a lift to the first floor. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of 7 hours in the presence of the manager. Examination of residents care files; staff personnel files and associated documentation was examined and showed that residents’ assessed needs were being met and that they were supported and protected by a welltrained and competent staff. The requirements from the last inspection had been met. A tour of the building and the homes own records showed that there was a backlog of maintenance but there was evidence of an ongoing programme of redecoration. There has been another change in the position of manager due to promotion of the previous manager. The new manager is knowledgeable about the home and residents and fully qualified to undertake her role. An application to register with the CSCI is being processed. What the service does well: 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 6 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 Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 7 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): 1,2,3,4,5 Pre-admission assessments are carried out on all prospective residents to help ensure that the home is able to meet their individual assessed needs EVIDENCE: The homes Statement of Purpose requires updating to include all of the information detailed in schedule 1. The Service Users Guide is a more comprehensive document but also needs updating. The Service Users Guide is available on request but also needs to be supplied to residents or their representative in accordance with the regulations. The manager or a trained member of staff carries out pre-admission assessments on all prospective residents. The documentation used is appropriate and includes all of the information required to identify care needs and enable an initial care plan to be prepared. Any specific equipment required is also identified and the home is able to arrange for this to be obtained and available prior to admission. Pre-admission assessments are, wherever possible carried out in conjunction with the prospective resident, their family and other health care professionals currently involved in their care. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 8 Prospective residents are able to assess the capacity of the home to meet their needs via the pre-admission assessment, discussion with the manager and members of staff. Prospective residents and their family or representative are positively encouraged to visit the home as often and for as long as they wish whilst assessing the suitability of the home. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 There is a care planning process in place that provides staff with most of the information to meet most of the residents needs. Medication management is fully compliant with current good practice requirements and guidelines. EVIDENCE: Care plans are in place for each resident in order to provide the staff with the information needed regarding care needs. Files are organised and easily accessible to staff. Whilst full assessments have been carried out there are no distinct risk assessments and the documentation can be confusing as problems, goals, interventions and assessment of risks are merged together. Care plans for mobility are titled manual handling and include interventions that may or may not be relevant or required by that resident. On one resident care plan it stated ‘mobile with carer’, it did not make clear whether one or two carers were required. Assessments do not clarify the risks for specific activities e.g. Transferring from chair to chair, chair to bed, toileting etc. The care plan defining the care required and the associated risk assessments should be discrete documents with clear and unambiguous functions. This enables a clear picture of the care needs required, the identified risks and relevant control measures in place and avoids any possible confusion. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 10 The case tracking process revealed that wound assessments and associated records are not being kept. Full mapping of wounds must be undertaken to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. Residents using bed rails did not have risk assessments in place nor agreements for their use by either the resident or their representative. Evidence was seen in the documents examined of referrals to GPs’ and members of the multi-disciplinary team (MDT) including treatments and recommendations. However, it was seen that recommendations from members of the MDT are not always acted upon by modification of the care plan, interventions or the use of associated documentation e.g. turn or fluid charts. It is essential that the recommendations of specialist nurses and professionals are acted upon promptly and documented with clear evidence that the care required is actually delivered. It is recommended that records of visits by GPs’ and Professions Allied to Medicine e.g. dietician be separated. The standard of evaluations and daily entries was variable with some entries being detailed and providing all of the required information in relation to care delivered whilst others were not. There are no residents currently self-medicating at Brookfield and receipt, storage, administration and disposal of medications are in accordance with current good practice guidelines and best practice. All residents are accommodated in single rooms and the inspector observed that care was taken by staff to ensure that personal care was carried out in the residents’ room or bathroom as appropriate. Residents spoken to confirmed that they are treated with respect and that their dignity was always protected. Policies and procedures are in place for to help ensure that care of the dying patient and their family is managed with care and sensitivity. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Daily routines are as flexible as possible and residents’ are supported to exercise their autonomy in satisfying their social and recreational interests. Dietary needs are met with variety and choice of food whilst accommodating special dietary needs and cultural preferences. EVIDENCE: Residents’ spoken to stated that they went to bed and got up at times to suit them and this was observed by the inspector to be the practice. Residents’ are supported by staff to exercise their choice in as many aspects of their life as possible, ranging from the clothes they wear to how they choose to spend their day. There are currently a total of eight hours of activity co-ordinators’ time with a total of three personnel (1 x 6hrs, and 2 x 1hr each). Activities range from bingo, shopping trips, special themed teas and religious services supplemented by external entertainers on three occasions per year. One resident has close links with the local church and takes part in many activities with them. The participation in activities is not recorded and it is recommended that it be recorded in the individual care files. This would produce a clear picture of preferences and enable activities to be tailored to suit residents’ needs. Activities for residents’ are limited and should be expanded and include more Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 12 one to one activities. Several of the residents and staff spoken to expressed the view that ‘there isn’t enough to do’ and ‘there aren’t enough activities for the residents’. Visitors are welcomed at the home at any time and visits either early or late evening are facilitated by discussion with the manager. Residents’ take breakfast as and when they rise and a cooked breakfast is always available if required. There are currently two residents’ who have a cooked breakfast on a regular basis. Menus seen demonstrated a varied and nutritious choice with alternative meals available if required. The practice of liquidising all elements of a meal together is not acceptable. The stimulation of colour and different textures is an integral part of food enjoyment and should not be lost because the meal is liquidised. Residents’ have the choice of taking their meals in their own room, the lounge or the dining room as they wish. The kitchen was clean and organised with refrigerator temperatures recorded and the food stores were well stocked. The food stores had unpainted wooden shelving and it was a requirement of the last Environmental Health Inspection that these be painted. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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): 16,17,18 Residents and their families can be confident that any complaints or concerns will be listened to and appropriate action taken. The home has an adult protection policy and procedure in place that helps protect residents from abuse EVIDENCE: There has been one concern expressed directly to the CSCI since the last inspection by a member of the multi-disciplinary team. The home is aware of this concern, which is related to failure to demonstrate that recommendations made are carried out and this has been addressed under standards 7 and 8. There have been no complaints since the last inspection. The inspector was informed of one incident where a resident ingested nail polish. Appropriate action was taken at the time of the incident but no notification was made to the CSCI under regulation 37. Information on how to make a complaint is detailed in the Service User Guide and displayed in a prominent position within the home. The inspector was informed that all residents’ are registered on the electoral roll but that only a few actually exercise their vote. Those who wish to vote are supported to do so. Staff spoken to demonstrated a good understanding of the types and recognition of abuse. The home has a copy of the Wirral Adult Protection Protocol and ‘No Secrets’ and staff are encouraged to read them. The inspector was informed that formal training in adult abuse and protection is being arranged for March 2006. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25,26 The backlog of maintenance and decoration at the home is not conducive to safe comfortable surroundings and potentially places residents at risk of harm or injury. EVIDENCE: Management at the home conducted a Health and Safety audit in December 2005 and identified a total of 33 maintenance issues that compromised health and safety. The inspector undertook a tour of the home with the manager. The following observations were made in addition to the previously mentioned list. The inspector was informed that there is an ongoing problem with the supply of hot water to rooms on the top floor and that staff fill and carry bowls of hot ( 430C) water to rooms to overcome this. Although the temperature of the water eliminates the possibility of scalding there remains a risk of accidents to both residents and staff. It is understood that quotes have been obtained for what the inspector was informed is complicated remedial work to rectify this problem. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 15 Room 13 is a very large room and has lighting provided by two fluorescent tube lights. Such lighting is not appropriate for a bedroom. The bathroom has had a bath hoist removed and the floor covering were the base plate was situated is missing. The fire door to the back stairs does not close properly. Room1 had a rusty commode and lancets used to take blood samples were found left in the room. There were a number of hot radiators that were unprotected Room 5 had no bulb in the over bed light The seat on the scales was badly damaged The edge of the double fire doors were damaged negating their effectiveness Bathroom 1, the bath had a broken panel The condition of some window frames particularly at the rear of the home appears to be in very poor condition and require repair and painting if not replacement. The floor covering in the lounge/dining room has been renewed since the last inspection and there is evidence of an ongoing redecoration programme. There are sufficient and suitable toilets and washing facilities, which include walk-in showers and assisted bathrooms. The home has appropriate and relevant aids in place throughout the home to help maximise independence for residents’. Hand rails, a nurse call system, raised toilet seats and pressure relieving aids were all seen and a lift to all floors gives access to all areas of the home. Residents are encouraged to bring their own possessions into the home and personalisation of rooms was seen to varying degrees throughout the home. On the day of inspection the home appeared clean and hygienic and was free from any odours. Staff members have received training in infection control and were observed working in accordance with the homes policies. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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): 27,28,29,30 The policies for recruitment and induction of staff are good and staff members have a clear understanding of their roles and responsibilities. EVIDENCE: The home has a registered nurse on duty at all times, supported by four care assistants in the morning, three in the afternoon and early evening and two at night. The manager has an allocation of six hours per week for management duties the rest of her time is as the clinical nurse on duty. The inspector was informed that the new general manager is also a registered nurse and as such will be helping with some of the managers’ administrative work. It is still considered that the number of hours allocated for management duties is low and it is again recommended that consideration be given to increasing these hours. The organisation of staff personnel files has been reorganised and improved since the last inspection. A random selection of personnel files were examined and found to contain all the required documents with the exception of registered nurses PIN number verifications due to them being held in the administrative office. The inspector was assured that these verifications are carried out and all registered nurses currently employed at the home have a valid registration with the Nursing and Midwifery Council. All new staff undertakes a TOPPS compliant induction course based upon a commercially produced induction to care programme. The manager is currently working towards the registered managers award (NVQ 4). There is currently Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 17 one member of staff with NVQ 3 and one with NVQ 2. One staff member has commenced NVQ 3 and there are 6 staff working towards NVQ 2. Training in Manual handling for care staff was held in December 2005 but no ancillary staff have received this training and this needs to be addressed. Pova training is scheduled for March 2006 and must include the ancillary staff. Food hygiene training is in place. The inspector was informed that registered nurses are regarded as being qualified in first aid. This is not acceptable as trained nurses have received no special training and are not qualified in this area and suitable training in first aid must be obtained for all staff. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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): 31,32,33,35,36,37,38 The home regularly reviews all aspects of the service it provides through a programme of audit and consultation with residents’ and their representatives. EVIDENCE: The acting manager in post at the time of the last inspection has been promoted to general manager of the group and a new manager of the home is now in post. The new manager has a lot of knowledge of Brookfield and the residents’ and is currently having her application for registration with CSCI considered. The homes senior management have devised their own quality assurance programme and regularly survey the residents and their representatives and staff in relation to the service provided and produce monthly reports. The health and safety audit carried out in December 2005 is evidence of the process and its’ effectiveness. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 19 The last inspection made a requirement regarding residents’ monies in relation to one resident. The inspector was informed that this requirement has been met and the monies concerned are now held in a separate bank account. Records were seen to demonstrate that staff supervision and appraisal is in place. Safety certificates were seen for gas, PAT tests, fire extinguishers, Fire alarm system and emergency lighting. A service contract was seen for the lift but no LOLER 6 monthly certificates were available for either the lift or any of the hoists. Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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 2 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 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 3 2 2 Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 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 OP1 Regulation 4(1)(c) Requirement The registered person must ensure that the Statement of Purpose is updated to include all of the information listed in schedule 1 The Registered Person must ensure that all residents or their representative is supplied with a copy of the service users guide The registered person must ensure that all patients care plans are kept up to date and reflective of the care delivered, and all recordings in the care notes are in accordance with current good practice guidelines. (Refer to wound records, bed rails and risk assessments) The registered person must ensure that records are kept in accordance with schedule 3 items k, m and n The registered person must ensure that liquidised diets are prepared in a manner that is attractive and appealing in terms of texture, flavour and appearance. DS0000020903.V280931.R01.S.doc Timescale for action 28/02/06 2 OP1 5(2) 28/02/06 3 OP7 15 28/02/06 4 OP8 17 28/02/06 5 OP15 16(2)(i) 28/02/06 Brookfield Nursing Home Version 5.1 Page 22 6 OP19 7 OP19 8 OP19 9 OP19 10 OP19 11 OP19 12 OP38 13 OP38 The registered person is required to ensure that the home is reasonably maintained both internally and externally (Refer to external window frames) 23(2)(c) The registered person is required to ensure that equipment provided for residents and staff is maintained in good working order (Refer to rusty commode and damaged scales) 23 (j) The registered person must ensure that all washing facilities have hot and cold water provision. (Refer to provision of hot water on top floor) 13(4)(c) The registered person must ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated (Refer to provision of hot water on top floor) 23(4)(c) (1) The registered person must ensure that adequate arrangements are made for containing of fires (Refer to faulty fire doors) 13(4) The registered person must ensure that all parts of the home are free of hazards to residents safety (Refer to radiator covers and lancets left in room) 37(1)(e) The registered person must ensure that any event, which adversely affects the wellbeing or safety of any resident, is notified to the CSCI. 13(4) The registered person is required to make arrangements for all staff to receive suitable training in first aid. 16(2)(j) The registered person is required to carry out the requirements as detailed by the Environmental Health Officer following his visit. DS0000020903.V280931.R01.S.doc 23(2)(b) 31/03/06 31/03/06 30/04/06 28/02/06 28/02/06 31/03/06 28/02/06 31/03/06 14 OP38 28/02/06 Brookfield Nursing Home Version 5.1 Page 23 15 OP38 13(4)(a)(c) The registered person must arrange for all safety checks to be carried out and forward copies of relevant certificates to the CSCI. (Refer to Loler certificates for lift and hoists) 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard OP7 OP7 OP8 OP12 Good Practice Recommendations It is strongly recommended that discrete risk assessments be carried out for falls, manual handling, skin integrity, continence and nutrition for all residents. It is strongly recommended that training be provided to all nursing staff in relation to record keeping. It is strongly recommended that training be provided for all care staff in relation to tissue viability. It is recommended that the activities available be expanded and include one to one activities and that participation in social and recreational activities are recorded in individual care files. It is strongly recommended that the number of supernumerary hours allocated to the manager for management functions be increased. 5 OP27 Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Brookfield Nursing Home DS0000020903.V280931.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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