CARE HOMES FOR OLDER PEOPLE
Cedar Court 27-29 Long Street Wigston Magna Leicestershire LE18 2BP Lead Inspector
Mrs Janet Browning Unannounced 22nd July 2005 09:00 am 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. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cedar Court Nursing and Residential Home Address 27-29 Long Street Wigston Magna Leicestershire LE18 2BP 0116 2571330 0116 2812378 cedarcourt@highfied-care.com Southern Cross Care Centres Limited 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) Mrs Jill Fontaine Kitchen Care Home (CRH) 52 Category(ies) of Physical disability over 65 years of age (PD(E)), registration, with number Old age, not falling within any other category of places (OP) Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To be able to admit the named person of category PD named in the variation application V15280 dated 15/12/2004. Date of last inspection 8th March 2005 Brief Description of the Service: Cedar Court is a care home providing personal care and accommodation for fifty-two older people which includes older persons who have a physical disability.The premise is owned by Southern Cross Care Centre group of homes, operators of a number of care homes within Leicestershire. The home is located in Wigston Magna close to the town centre of Wigston where service users have access to shops, pubs, the post office and other amenities. The home is easily accessible by private or public transport with a large car park. The home is a purpose built three-storey building with level entry access. Access to all floors can be gained by using the passenger lift or stairs. Residents have access to a number of amenities such as washing, bathing and toilet facilities situated on all floors. There is a choice of dining and lounge space.The premises have forty-eight single bedrooms and twenty-one of these single rooms have ensuite facilities. There are two double bedrooms without ensuite facilities. The home has a garden to the front and rear of the building which is well maintained and which is accessible to all residents residing on the premises. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 22nd July 2005. The inspection commenced at 9.00am and finished at 4.30pm. When undertaking inspections, the Commission for Social Care Inspection (CSCI) focuses on the outcomes for clients living in a home. To support this, four residents living at Cedar Court were ‘case tracked’. This means that the care records of four clients were checked; the clients themselves were spoken with where possible, as well as three members of staff supporting their care. Opportunity was taken to speak three other residents in the home and two relatives visiting the home at the time of the inspection and some of the home’s documentation was also examined. The inspector received no residents’ comment cards, five relatives’ comment cards, one General Practitioners (GPs) comment card and two health professional comment cards. The home also completed a pre-inspection questionnaire, which was received prior to the inspection. The recommendations and requirements arising from this inspection are a direct result of case tracking, comment cards and other observations made by the inspector during the inspection. The Registered Manager was on holiday at the time of the inspection and the home’s office manager was present throughout the inspection. Southern Cross Regional Operational Manager also visited the home during the inspection. What the service does well:
The home has some highly dependent residents requiring a variety of differing needs. The home ensures that staff have a training programme to meet the residents’ needs. The NVQ qualification is supported by the home with many staff now qualified with the indications being that new members of staff can start NVQ training not long after commencing at the home. The home’s admission assessment is robust with the home ensuring that the residents’ needs can be met before being admitted to the home. Risk assessments are performed on all aspects of care and equipment and the standard of nursing care is generally good. Wound assessment and treatments are of a good quality with the home being able to demonstrate success in their treatment. The home environment, although having many residents with high nursing needs, provides comfort and security. Equipment is provided to meet needs and comfort. Meals provided by the home are of a good quality providing choice and variety. Relatives are encouraged to visit and can visit any time, as long as the resident wishes.
Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 6 The home has good complaints and recruitment procedures and the indications are that any concerns raised are taken seriously. Quality assurance is sound with the home encouraging suggestions from residents and their visitors in the form of regular meetings and questionnaires. What has improved since the last inspection? What they could do better:
Care plans are of a generally good quality, but some care needs can either be missing, lacking in detail or confusing. Robust care planning is essential for all residents but especially those with high dependency levels of care and for those who are unable to voice their needs, as the care plans give clear direction to staff as to what care is required. Also the monitoring of conditions sometimes relies on carers’ memories when records or charts would be more reliable. Staffing levels indicate that they meet the minimum requirement as recommended in the Department of Health Residential Forum guidance. However, the home should review its procedure for covering sudden staff sickness, as indications are that it may result in residents’ needs not always being met with occasions of residents being left in bed until late morning. Regarding preference of routine of daily living, some residents are being woken up or put to bed at times not chosen by themselves. This is poor practice, which the home must address. The home has many highly dependent residents who, when sitting in the lounge near reception, are not always able to call for assistance. The residents can be left for periods of time without adequate supervision or monitoring of their needs. Safety is taken seriously by the home as indicated by risk assessments, but poor moving and handling practices put residents’ safety at risk. The home is addressing this immediately. Further issues that can affect resident safety are that the storage of medication requiring refrigeration was not adequate to ensure residents’ safety and the staff did not have a complete understanding of the correct procedures for reporting any instances of adult abuse under adult protection. The home must address these issues.
Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 7 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. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 8 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 Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 9 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) 3, 4 and 6 The quality of the assessment process is good and services provided by the home are sufficient to ensure that all residents’ needs can be met. EVIDENCE: New residents received a complete and thorough health needs assessment prior to being admitted to the home by a Registered General Nurse (RGN). The nurse visits the person wherever they are being admitted from, and completes a holistic assessment covering all aspects of the persons care needs. The assessment is ongoing once the person has been admitted. Full risk assessments are performed covering many areas such as pressure area care and the use of bed rails. The staff in the home have received a variety of training in all aspects of care and are able to provide some specialist care with the support of external agencies. The RGNs attend courses on areas such as palliative care and tissue viability. The home does not provide intermediate care services. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 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 Indications are that the home provides good nursing care, but care planning can be variable thus not ensuring that all needs are being met. Medication storage is insufficient to ensure that residents’ safety is being maintained. EVIDENCE: On the whole, the care plans evidenced during the inspection indicated a good standard with sufficient detail for care assistants to provide the physical care required. Evidence was that psychological aspects were covered, but not always in the same detail. For example, one resident case tracked, was described as having “aggressive and distressed behaviour.” There was no care plan detailing how this behaviour manifests and what techniques the staff must use when dealing with it. Staff spoken to stated that the resident could be confused and had “off days”, but did not give details of “aggression.” Generally, the care plans when providing nursing care were also of a good standard, but varied. For example, two residents case tracked had urinary catheters requiring treatment to prevent blocking, but did not have detailed care plans in place. Charts were used for monitoring changes of position and drinks but not regularly used for monitoring exact fluid input and output.
Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 11 To monitor dehydration nurses asked carers how many drinks the residents had taken during the day and urine output which can rely on memory. Observations throughout the inspection gave indications that a good quality of care is being performed; for example, evidence of regular mouth care and change of position for the high dependent residents. A visiting professional and health professional comment card stated, • “I feel that there is a high standard of care.” • “…its excellent care all round.” Residents spoken to stated, • “I am well looked after.” • “My care is reasonable.” Relatives stated, • “My mum is happy so I’m happy.” • “The care that the girls give is good, caring.” Wound care was of a high standard with details of wound assessments and utilising outside agencies such as community tissue viability nurse. The regular assessments and photos gave evidence of wounds healing. Care plans detailing treatment for wounds were not so clear with many wounds being on one plan. The home’s policy states that each wound should have a separate care plan. This made it confusing as to know which wound the evaluations and treatments were referring to. Indications were that the care plans of established residents are evaluated regularly, but two new residents had not been evaluated since admission, which was over eight weeks ago. The content of those plans, which had been evaluated were, not detailed enough to establish the effectiveness of the care plans. Evidence was seen of the Registered Manager’s acknowledgement of this and her intention to address evaluations of care. Indications were that the medication procedure was sound, but records of the fridge temperatures used to store certain medications had been constantly higher than the recommended temperature and this had not been addressed. Medications not being stored as per the manufacturers’ instructions could cause the effectiveness of the medication to be reduced. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 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, 13 and 15 Activities are sufficient and meals provide choice and variety to meet residents’ expectations, but residents’ routines of daily living are inadequate to ensure that residents’ preferences are being satisfied. EVIDENCE: There are two lounges, one is a “quiet” lounge and the other is where activities take place, giving residents a choice. On the day of inspection, the activities organiser was on holiday so no activities were performed that day. Evidence was seen of an activities programme on the wall in reception such as quizzes, reminiscence and videos. The office manager stated that there are no organised trips out, but it was acknowledged if residents requested this then it would be investigated. The recent newsletter produced by the home stated that a questionnaire would be circulated for ideas from residents, relatives and friends on activities and entertainment. Two residents spoken to stated that they go to bed and get up at a time suitable for them. However, one resident case tracked stated that she has woken at 5:30am, washed and dressed, and sat in her chair by 6:15am, when she wanted to stay in bed. This was verified on her night chart. The resident had not been asked her preferred time of waking. Another resident stated that he goes to bed too early when he wants to watch the television and that night staff do not respond to his requests regarding emptying his catheter bag to give him comfort.
Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 13 The food seen during the inspection appeared to be a good quality with a choice provided. Indications on the day of inspection were that the experienced cook keeps a clean kitchen and she stated that she caters for different diets as required and follows instructions left by dieticians. Residents spoken to state, • “The food’s good and we have a choice.” • “Food’s acceptable.” • “I like the meals, you get enough.” Relatives can visit at any time and are encouraged to be involved with the care. Due to the high dependency of the residents, community activities are invited into the home. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Although the home’s complaints procedure is robust, adult protection awareness within the home is insufficient to ensure residents are completely safe from risk of harm. EVIDENCE: Both residents and relatives spoken to felt confident that any concerns and complaints would be dealt with satisfactory and one relative stated, • “Complaints are dealt with appropriately, and if I wasn’t satisfied I would take it higher, but I’ve never had to.” A resident stated, • “I would speak to one of the girls.” The complaints record gave details of complaints received, the investigation that was undertaken, actions taken and outcome. Details of the complaints procedure were also in the reception area. Staff discussions revealed that residents’ complaints about members of the night staff had been reported to the Registered Manager and were being dealt with. All staff spoken to were not aware of the correct reporting procedures for any incidents of abuse, with some giving unsafe responses. Staff reported not receiving training on this. Discussions with the office manager and operational director indicated that training had been provided, but felt that junior staff reporting to senior staff was sufficient. All staff needs to be aware of whistle blowing. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22 and 26 The home’s environment and standard of hygiene is very good providing residents with safe and comfortable surroundings. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 16 EVIDENCE: All of the rooms seen during case tracking were clean and had comfortable furniture in place. One resident described how she was able to bring her own special reclining chair, which she used throughout the home. The back of the home is built into an incline, so there are two outside patio areas on different levels that can be accessed by residents. The home has now got two satellite kitchens for the storage of the hot food trolley, for relatives to make hot drinks and for staff to make snacks for residents. Evidence was seen of specialist equipment required for residents’ comfort in sitting out and also specialist beds for those residents who remained in bed for most of the day. Air mattresses were evident for the prevention and treatment of pressure sores and set at correct settings for residents. The home also has equipment for ensuring residents who are unable to swallow medication still are able to receive medication for symptom control. Indications are that the home takes infection control very seriously with rooms having adequate facilities for hand washing and disinfectant hand wash being available outside most of residents’ rooms. Staff received training for infection control, and a new member of staff already had basic knowledge of when to use gloves and wash hands after only two weeks as a care assistant. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 29 and 30 Staff training programmes and the home’s recruitment process are good, but the indications are that there are occasions when staffing levels may result in residents’ needs not always being met. EVIDENCE: The roster of staff indicated that staffing numbers met, and on some days exceeded, the number of care hours as recommended in the Department of Health Residential Forum. Comments received from a resident, staff, relatives and one health professional, indicated that there can be times when staffing is lower, especially at the weekends. Staff expressed concerns that residents can still be in bed at 10:30am when a carer is off sick. One resident stated, • “I have been left in bed when there aren’t enough staff, …more at the weekends than in the week. If there was more staff I may be able to be taken out more in my wheelchair.” A relative stated, • “Understaffed more at the weekends, probably. Girls (the carers) can be stretched…which is a shame because they are so good.” The office manager stated that carers can ring in sick at short notice and then other members of staff are asked to cover, and if this is not possible then management come in to provide the cover. The home does not use agency staff. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 18 The skill mix was such that a nurse was present on both floors, accompanied by experienced care assistants. Any new employees went through an induction programme with supervision from a more experienced carer. It is noted that care assistants are able to access NVQ training fairly soon after commencing and 50 of the care assistants have NVQ qualifications. Evidence in the preinspection questionnaire demonstrated various training for all staff, both qualified and unqualified. One nurse spoke of attending a recent study day at an acute hospital for palliative care. Recruitment records of two members of staff indicated that the home follows a robust recruitment process. For example no staff member is employed without Criminal Records Bureau checks and two written references. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 33, 36 and 38. The quality assurance process within the home is good indicating that the home is run in the best interests of the residents, however some practices within the home have the potential of putting residents at risk of harm. EVIDENCE: On the day of inspection it was noted that residents sitting in the lounge near reception were left unsupervised for periods of time which was a comment also made by a relative. Staff were noted coming in and out of the lounge but they did not communicate or check on all residents. For example, one resident was at first heard asking for a drink of water and then stated that she felt sick. There was no means for this resident to call for assistance. Other residents stated that they shouted if they needed help. The inspector had to go and find assistance via the office manager. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 20 A carer was observed using equipment safely, to assist a resident to stand. However, a single carer was observed transporting a resident in a hoist along the corridor from the resident’s room to a bathroom. Another resident also described this procedure being used when being taken to the bathroom. This is unsafe practice. Evidence was seen of resident and relatives meetings inviting suggestions in improving the home. The office manager stated that the home provides monthly questionnaires, which are left in the resident’s rooms to be completed. She admitted that this is not always done, but a reminder has been sent out to relatives as to where the questionnaires can be found. Detailed audits are kept on wound care and their progress, which is good practice. Regular supervision was evident for staff with also annual appraisals. The home has recently produced a newsletter to keep both residents and their visitors informed of the activities and news within the home. Staff successes are also displayed in the home. The owners of the home visit monthly to evaluate aspects of the home’s performance. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x 3 x 1 Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 22 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. Standard 7.2 Regulation 15 (1) Requirement The home must ensure that care plans are written to cover all aspects of care including details of any challenging behaviour and all nursing care required, including all aspects of catheter care. The home must ensure that the fridges used for the storage of medication are kept at the correct temperature. The home must ensure that residents feelings and wishes are taken into account especially in choosing times for getting and going to bed. The home must ensure that all staff are aware of adult protection procedures in line with Department of Healths No Secrets document. The home must ensure that all staff are aware of the correct procedures for moving and handling, including safe use of hoists. Timescale for action 17/09/05 2. 9.1 13 (2) 17/09/05 3. 12.2 12 (3) 17/09/05 4. 18.2 13 (6) 17/09/05 5. 38.2 13 (5) Immediate Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7.3 8.4 27.1 38.1 Good Practice Recommendations It is recommended that relevant clinical guidelines are used in the recording and monitoring of residents fluid intake and output. It is recommended that the care plans containing treatment details of wounds are written as per the homes policy. It is strongly recommended that the home reviews its policy for covering staff sickness to ensure that staff numbers are within the Department of Healths guidelines. It is strongly recommended that the home ensures that residents sitting in lounges are regularly monitored. Cedar Court C51 C01 S1933 Cedar Court V235660 220705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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