Inspection on 17/01/08 for Chilterns Manor

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chilterns Manor 16/01/09

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

CARE HOMES FOR OLDER PEOPLE Chilterns Manor Northern Heights Bourne End Buckinghamshire SL8 5LE Lead Inspector Yvonne Souden Unannounced Inspection 10:00 17 January 2008 th 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 Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilterns Manor Address Northern Heights Bourne End Buckinghamshire SL8 5LE 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) 01628 528 676 01628 527 735 chilternsmanor@aol.com Centurion Health Care Ltd Ms Marion Randolph Care Home 22 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) - maximum number of places 2. 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 22. Date of last inspection Not Applicable – New Service Brief Description of the Service: Chiltern Manor provides residential care and accommodation for 22 older people. The registered provider is Centurion Health Care Ltd. The home is traditionally furnished and decorated to a high specification set in its own landscaped grounds, and has car parking facilities for approximately twelve to fifteen vehicles. There are 18 single bedrooms, and 2 double rooms over three floors, that can be accessed by stair lifts, most rooms have en-suite facilities, and those that don’t have a wash hand basin; double rooms are single or kin share only. The home is situated at the end of a private road, adjacent to open farmland. Chiltern Manor has a Statement of Purpose and Service Users Guide available on application to the home. Email chilternsmanor@aol.com Information CSCI received 18/01/08/ confirms that weekly fees start from £375 to £850. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. On the 6th September 2007 the service had a change of provider and this is the provider’s first inspection by the Commission for Social Care Inspection. The provider completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided by the commission. The AQAA was used by the provider to review their service and inform the commission of their findings. We have referred to the AQAA as the provider’s review in this report. The review was used as part of the evidence to inform the report. Other evidence used to inform the report includes an 8-hour site visit to the service by the inspector. This enabled the inspector to observe care practice and speak to people who use the service, staff and management of the home. The Commission for Social Care Inspection received completed surveys that had been sent to people who use the service, their relatives, staff and health professionals, their views of the service provided have been used to inform the report. Other evidence used to inform this report was documentation viewed by the inspector at the site visit. From the evidence seen by the Inspector and comments received, the Inspector considers that the home would be able to provide a service to meet the needs of individuals of various religion, race, or culture. The home follows the organisation’s policy and guidelines to manage issues relating to equality and diversity. What the service does well: The service provides a warm and welcoming atmosphere within an environment that has furnishings and décor of a high standard. Staff are aware of the needs of the residents and treat them with dignity and respect, and staff have received health and safety training to promote the safety and well being of the residents. Residents are provided with a nutritionally balanced diet and have recreational activities provided, and entertainment from external entertainers. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 6 The provider demonstrates knowledge of improvements needed to promote choice, safety and well-being of the residents and has commenced plans to improve residents care plans’, choice of menu and activities. 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. The summary of this inspection report can be made available in other formats on request. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is made available for people who want to and use the service. People who use the service have their needs assessed before an agreement is reached for them to come and live in the home. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated to reflect the name of the new provider. The provider has said that they plan to look to simplify the statement of purpose that was inherited. 90 of surveys received from people who use the service said that they received enough information about the home before they moved in. Health and social care needs assessments were viewed; the provider confirmed plans to implement a new ‘Needs Assessment’ and a sample was seen. The needs assessment would ensure the health and social care needs of prospective residents continue to be sought prior to admission. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of the people who live in the home are met, but their needs and how to meet those needs are not clearly documented within their plan of care. EVIDENCE: Surveys identified that residents feel their needs are met and that staff are always or usually informed of the residents changing needs. Residents spoken to at the site visit were complementary of the service provided and said, “the staff are always very kind and helpful”. Documentation viewed identifies that staff make daily observation records of the residents, but records are limited, for example ‘had a good day’ ‘slept well’. Staff were observed at the handover meeting to be aware of the needs of the residents, as they reported information to the afternoon staff mainly from memory. The care plans used by the home have been inherited by the provider and do not address the primary care needs of the residents. The handwriting of the Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 10 care plan was not easy to read, and the care plan does not offer a person centred approach to promote choice, independence and well-being. For example a care plan said, ‘needs help with bathing and ‘think needs nebulisers’, but did not say how to meet those needs; risk assessments were reviewed and detailed the number of staff and equipment used to transfer, but did not give details to minimise risk whilst assisting the resident in bathing. The care plan had been reviewed since the takeover of the new provider, but changes had not been made to reflect identified needs and how to meet those needs. The provider confirmed in their review sent to the commission prior to the site visit that ‘we plan to improve care plans’. Staff spoke of the impending plan to change the format of care plans, and two staff confirmed that they are scheduled to attend external care planning training 18/01/08. The provider showed the inspector a sample of the new care plan, confirming plans to implement as soon as staff have received training. Residents said their health care needs are met, as quoted by residents’, “Not been well, G.Ps visited home and prescribed medication”, “we are taken to the opticians, and if you need a doctor they will get someone”, “the district nurse visits regularly”. Two residents said in agreement, “they get the doctor for us they keep an eye on you”, “staff very good, they get you everything you need”. Medication cabinets were secure. Controlled drugs were within a locked medication cabinet, but were not stored separately; the new provider was unaware that this is a legislative requirement. The provider has made improvements on the safe handling of medication by implementing a monitored dosage system; records matched stock kept. Medication policies and procedures are in place and staff receive medication training. Staff were observed to treat residents with dignity and respect, assisting residents were needed whilst promoting their independence. 100 of the residents surveys received said staff listen to them and act on what they say. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are enabled to participate in community events, but one to one and group activities are limited particularly for those people who have memory loss or dementia. People who use the service receive a nutritional balanced diet. EVIDENCE: 50 of those residents who responded to the commissions survey said there was always activities arranged that they could take part. One survey said “ there are some activities, but I am 88 years of age, so do not want too much activity”. Residents spoke of entertainers visiting the home, spoke of their visitors and of going out, as quoted, “there is no public transport, so I need someone to take me places”, “very nice helpers – we go out with the helpers” and “my son visits regularly”. In their review the provider spoke of plans to improve menu choice and activities. Plans are in place to recruit an activities coordinator for one to one and group activities. A relative said within a survey, when asked, how could Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 12 the home improve? “Perhaps more entertainment, also group activities for the more able residents”. The improvements planned by the provider would be viewed as good practice, and a recommendation particularly for those people who have memory loss or dementia and need more valued one to one activity sessions in their lives. Care plans should be developed to incorporate social recreational activities for all – with training provided for the co-ordinator to deliver activities that would be suitable for older people and people who have memory loss or dementia. The residents were complementary of the food provided and two residents said in agreement “very good food”, “no choice at lunch time”, “sweet, we can choose” and “never hungry always plenty of food”. In their review the provider spoke of introducing more choice at meal times particularly around teatime. Kitchen staff also confirmed this as they spoke of plans in place to improve menu choice. Records confirm that a new cook has been recruited. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service know who to go to if they have a concern or complaint and are protected from abuse. Restraint has been used inadvertently to meet the needs of one service user. EVIDENCE: The home has a complaint procedure and people who use the service feel listened to and say within surveys received that they know how to make a complaint. The Commission for Social Care Inspection and the home has received no formal complaints about the service provided since the new provider took over the service on the 6th September 2007, and date of this Key Inspection visit. The home has a copy of Buckinghamshire County Council Multi-Agency Safeguarding Adult policy and procedure dated January 2006. Staff training records identify that all staff have received safeguarding adults training. The provider review states no incidents of restraint have been used, and no safeguarding adult referrals have been made within the last twelve months. Staff were observed to treat residents with dignity and respect assisting residents where needed whilst promoting their independence. Residents spoke of staff with fondness and said they felt safe and happy within the environment they live. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 14 A resident who spent the day upstairs in their room was unable to move from the chair, as a side table was wedged in front by the legs of the chair that the resident was sat on, which could be construed as restraint. Records confirm that the resident has a history of falls and has dementia. Care plans did not identify the needs of the resident, and risk assessments did not detail that a form of restraint was used as the only means of securing the residents welfare. The resident’s needs had not been reassessed at the time of the inspection to reflect their current care needs, however the provider confirmed that this has since been done. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable, safe, homely and clean environment. EVIDENCE: A relative of a resident said in a survey “they provide a very caring environment for residents. The home is always very clean and beautifully furnished. In the summer the garden is delightful and is very pleasant to use when the weather is good”. The home was observed to be comfortably furnished, clean and homely. A large flat screen television is provided in the lounge, with furnishings arranged to meet the needs of the residents. Residents had personalised their rooms to their individual taste. The home has a main stairway with electric chair; there are other stairways used by staff and a further stairway to the lower ground floor that has a stair lift. One of the stairways that lead from the first floor hall to the kitchen is Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 16 narrow and steep. A piece of drop down hand rail is in place at the top of the stairs to minimise risk of falls, but it leaves a height of roughly 3 to 4 feet between the floor and handrail, and the hall at the top of the stairway is narrow. A risk of a resident falling is very real from records of falls seen; some residents on the first floor use a stick or walking frame to mobilise. The homes environmental risk assessment on stairs dated November 2007 details who is at risk and existing control measures i.e. residents supervised at all times when using stairs, carpet checked, restrictor bars on back stairs. The provider confirmed a review of the environmental risk assessment on stairs would take place to minimise the risk of residents falling down the stairs. Fire logbooks detail regular weekly safety checks, and training records confirm that staff attend fire and health and safety training. The laundry is fully adapted to meet the laundering needs of the residents with infection control policies and procedures in place and evidently followed. Colour coded laundry bags were observed as was protective clothing and hand washing facilities. Staff have received infection control training. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient staff numbers put people who use the service at risk of not having their needs fully met. People who use the service have their needs met by staff who are trained and qualified and are protected by the services recruitment procedure. EVIDENCE: Staff were observed to be attentive in meeting the needs of the residents, but some staff were concerned that those needs were not being fully met and felt this was due to insufficient staff numbers. As quoted from a staff survey “there are three carers on in the morning which is fine, but in the afternoon there are only two. I think it is best to have three because when two go upstairs to change one of the residents there is no one down stairs to keep an eye on the rest, so if someone had a fall the carers would not know until they come down the stairs”. The staff rota identifies that three cares are on shift from 8:00 to 14:00, and two carers on shift between 14:00 to 20:00 to meet the needs of eighteen residents, six of those have either dementia or memory loss, and two require two staff to assist with personal care and moving and handling. The provider has reviewed staff numbers, and plans to recruit an activities coordinator. The team leader confirmed an advert out 17/01/08 to recruit a Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 18 senior carer and a new cook has been employed. Kitchen and house keeping staff were observed to be in sufficient numbers to meet good housekeeping for the residents. Over 50 of staff have a National Vocational Qualification in care at level 2 or above. A relative said in a survey “the staff have always been extremely professional at Chiltern Manor. There have been some staff changes recently due to new management”. The provider has implemented individual training records to monitor staff training. Records identify that staff receive regular mandatory health and safety training and receive other specialist training for example dementia care. Records show that staff are scheduled to attend care-planning training. Staff inductions viewed detail staff shadowing other staff in their first week and attending mandatory training. The induction addresses the services policies and procedures. The provider is looking at the Skills for Care induction programme. Staff have received a copy of the General Social Councils code of practice. Recruitment files of three new staff were viewed. Records identify that all safety checks are maintained in the recruitment of staff to safeguard the residents. Improvements should be made in the application form to ensure the applicants record of employment states the full date as opposed to the year. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance systems are in place to ensure people who use the service are safe and are afforded choice in their lives, but this is at risk due to staff uncertainty over management lines of accountability. There are no formal communication systems for the people who use the service to enable them to be part of the decision making within the management of the home. EVIDENCE: The previous provider and manager continue to be the registered manager. The new provider confirmed with the Commission on registration that the manager had agreed to continue managing the service in the interim until a new manager is found. The provider confirmed at the site visit that the manager visits the home once or twice a week and that the provider is in the home most days. The provider also confirmed that the manager’s post has not been advertised. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 20 Staff are confused about who is managing the service, evident from comments made in returned staff surveys as follows; “we don’t have a manager at the moment”, “we may not meet with the manager, but we have a very good team leader who we can go to and who gives us lots of support”, “the new manager has not discussed with me how I am working or given any support yet”, “The change over from old management to new management has been hard and we have lost staff, but I think things are on the change and we will be a very good working team”, “despite the uncertainty of being under new ownership, the owner and managers have been supportive and helpful. I enjoy my job”. Records identify that staff meetings do take place, and staff said at the site visit that they feel supported by the new provider and now feel more settled with changes that have taken place. The most recent supervision records of staff could not be located at the time of the site visit. 20 of staff that responded to the commissions survey said they often receive supervision and support, 40 said they regularly do and 40 said they sometimes do. The provider confirmed plans to ensure all staff receive regular supervision. The provider said they have had several informal individual meeting with residents and their representatives, but has not held a formal meeting to ensure the residents and their representatives are kept informed and are involved with changes made within the home. Systems are in place that monitors Health & Safety, and policies and procedures were reviewed 2007. Staff receive health and safety training within their induction, and receive further training to update their skills. The provider completed an Annual Quality Review Assessment that informed the Commission for Social Care Inspection of the service provided, which has been referred to in the report as the providers review. The provider spoke of plans to improve their quality assurance systems to improve the outcomes for people who use the service. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 3 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 3 2 3 X X 2 X 3 Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Not applicable as new service 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 OP9 Regulation 13. (2) Requirement The registered provider must ensure a controlled drugs cupboard, which complies with the misuse of Drugs (safe custody) Regulation 1973 is provided for the secure storage of any Controlled Drugs, which are prescribed for people who use the service. The registered person must arrange training for staff to improve staff awareness of the home’s Physical Intervention Restraint policy and procedure, Department of Health Guidelines on restraint and the Mental Capacity Act. The registered person must ensure people who use the service are not subject to restraint unless this is the only means of securing their welfare and there are exceptional circumstances. In the case of a person that lacks capacity the provider must meet the conditions of section 6 of the 2005 Mental Capacity Act. Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 23 Timescale for action 17/04/08 2 OP18 13. (6) 13. (7)(a) (b) 13. (8) 18. (1)(c) (i)(ii) 17/02/08 The registered person must on any occasion that a service user is subject to physical or cultural restraint record the circumstances, including the nature of the restraint. 5 OP27 18. (1)(a) The registered person must review and ensure there are at all times sufficient and qualified care staff to meet the health and social care needs of the people who use the service. 27/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The providers should continue with their plan to implement new care plans that should be reviewed and signed in agreement by the owner of the care plan, and/or their representative. The care plans should be developed to incorporate social recreational activities for all, and training should be provided for the activities co-ordinator to deliver activities that would be suitable for older people and people who have memory loss or dementia. The registered provider should ensure staff are informed of change to have a clear sense of direction and leadership. The registered provider should ensure staff receives regular supervision to achieve this aim. The registered provider should improve communication systems in place and improve opportunity for people who use the service to share their views and opinion of the service provided. This could be achieved by introducing residents meetings and questionnaires that can be used to improve the quality assurance monitoring of the service. DS0000070364.V357459.R01.S.doc Version 5.2 Page 24 2 OP12 3 OP32 4 OP38 Chilterns Manor Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Chilterns Manor DS0000070364.V357459.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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