Inspection on 14/06/05 for Dale Park

This inspection was carried out on 14th June 2005.

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

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

Other inspections for this house

Dale Park 26/07/07

Dale Park 28/06/06

Dale Park 29/12/05

Dale Park 23/12/04

Dale Park 16/06/04

Similar services:

Chirnside House

Emmaus House

East Croft Grange

Craignair

Croston Park Nursing Home

Conifers Nursing Home

Cloisters

Elmsdene Care Home

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

CARE HOMES FOR OLDER PEOPLE Dale Park 221 Meols Cop Road Southport Merseyside PR8 6JU Lead Inspector Mike Perry Unannounced 14th June 2005 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. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Dale Park Address 221 Meols Cop Road Southport Merseyside PR8 6JU 01704 501780 01704 501782 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) Southern Cross Healthcare Services Limited John Price Care Home 54 Category(ies) of Dementia - 54 registration, with number of places Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 54 DE Date of last inspection 23/12/04 Brief Description of the Service: Dale Park is a purpose built home providing nursing care for 46 oldr residents with mental health needs related to dementia [ the home is registered for 54 but shared rooms are used for single use]. The home is owned privatly by Southern Cross Health Care and the Responsible Person is Mr Phillip Scott. The Registered manager is Mr John Price. The home is situated in Soputhport close to a retail park and with access to a bus route for the town centre. There are shops close by and a pub. Dale Park is divided over 2 floors and 4 units. Each floor has 2 lounges and 2 dining rooms. The first floor is accessible by a passanger lift and stairs. two bedrooms have ensuite facilities. The home is equiped with manual handling aids and grab rails to promote independence . There is a car park to the rear of the home and there is an enclosed garden. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and included a complaint investigation. Brief details of the complaint and findings are included in the section entitled ‘Complaints and Protection’. During the visit, a partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The operations manager, home manager, 6 nursing and care staff members, residents, 3 relatives and 2 visiting professionals were spoken to during the visit. Leaflets were also left in the home to enable residents and others to comment on the service provided. What the service does well: Dale Park provides a good range of information about the services and facilities in the home so that residents and relatives are assisted in making a choice to move in. Senior staff assess residents prior to admission and also following admission to the home. This ensures that care needs can be planned for and met. The plans of care are drawn together with relative involvement to varying degrees and are generally easy to follow and provide a good description of the care. The staff maintain good communications with external health care support such as community nurses and General Practitioners [GP’s]. Referrals are made when required so that residents’ health needs are met. Relatives commented on the caring nature of the staff and how they were supportative and try to personalise the care as much as possible. Relatives commented that they are ‘always made welcome in the home’ and that ‘staff are easy to talk to’. It was possible to observe how staff managed some difficult situations in a calm manner. There are activities planned for residents and the quality of these are good and are now provided on a more 1:1 basis due to the increasing dependency of residents in the home. The meals provided offer good quality and choice. Staff spoken to were knowledgeable about resident care needs. The training offered by the home is good and some of this is specific to dementia care such as the person centred training currently being conducted. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The information guides could be improved by the inclusion of the results of resident satisfaction surveys as well as the summery of inspections by the Commissions. All assessments of residents needs by the nursing staff need to be signed and dated. The needs of the small group of residents in the home with particularly challenging behaviour and acute nursing needs was a feature of the inspection. The home struggles to meet these specialist needs in a consistent manner and examples of this came from a complaint investigation where changing care needs around diet and drink were not met. Another resident who needs regular blood monitoring for diabetes had not had this recorded for a number of days. Weight loss in another resident was not noted. There was discussion with the management about the direction of the home in trying to plan acute care needs for the future. There is an urgent need to review the way that nurses administer medicines and this must be done in a consistent and safe manner to protect residents. Activities in the home can be further developed as people with dementia are particularly in need of mental stimulation. Because of the numbers of residents in the home more staff are needed to plan and get involved. Although standards of accommodation are good the recommendations for garden access and shower facilities remain. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 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. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 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 Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 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) 1 an 3 The information available for residents and relatives is generally appropriate and useful. The guide could be further improved by the inclusion of requirements listed so that an informed choice can be made when choosing the home. The assessments carried out by the home are good and help ensure that the home can meet the needs of residents admitted. EVIDENCE: The home has a useful range of information guides available such as the ‘Service Users Guide’, which describes the facilities and services in the home. These are displayed in the entrance to the home. Relatives spoken to said that they had been given copies of this document which had helped in both choosing the home and also assisted in the settling in period. The requirements from the previous inspection with regard to the inclusion of the results of the resident satisfaction surveys as well as including a copy of the latest inspection report from the Commissions [Inspecting body] have not been carried out. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 10 The manager or senior nurse in the home carry out assessments prior to residents coming into the home so that the home is better able to make a judgment as to whether needs can be met. The assessments seen were comprehensive and included assessments from health and social care professionals also involved with the residents care. Further assessments are carried out once the resident is admitted and from these a care plan is devised. The assessments include all routine daily living activities such personal care as well as more specific assessments covering risk, nutrition, pressure area care, and mental assessments. The social assessments display evidence that relatives are involved in the care. Not all of the assessments seen were filled out in enough detail and some were not signed or dated. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 11 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) 7,8,9,10 Individual care plans are of a general good standard and display evidence of relatives being involved so that routine care is managed effectively. More acute and challenging care needs can be missed and the current care planning system does not respond quickly to meeting these needs. There is good liaison with health care support services so that residents are referred appropriately. The administration of medicines in the home is inconsistent and does not meet good practice guidelines so that residents may be placed at risk. Care staff have a good understanding of the personal care needs of residents and these are met within the confines of some very challenging behaviour. EVIDENCE: Individual care plans were available for each resident. 4 care plans were reviewed and these were very well written and detailed the health and personal care needs of residents in a clear manner. They are reviewed on a regular basis. Relatives spoken to have some involvement with the care plans and, depending on choice, had contributed information and views. The care plans reviewed were for those residents who exhibited more challenging behaviour such as aggression or non-compliance with care. The management plan for these specific needs varied. Although generally appropriate there were the occasional lack of update in the face of acute Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 12 problems. This was highlighted by one resident who developed poor eating and drinking which required further monitoring [see complaints part of the report]. Another resident has lost a lot of weight recently but there was no plan generated to meet this need as the staff reporting process did not immediately pick this up. Another resident with diabetes had not had routine blood monitoring [BM’s] recorded for the previous 4 /5 days. The management of residents with aggression could be assisted by the introduction of behaviour monitoring forms and this was discussed. In discussion with staff it is evident that the bulk of the care planning and recording is left to the 2 senior nurses on each floor and it may be that acute needs are picked up better if the care planning is a more shared responsibility incorporating named nurses. There is also an issue with respect to future planning in the home if such residents are to have there needs addressed more consistently [see complaints]. The staff in the home are careful to refer residents for health care reviews and this was evident from the regular visits by the GP as well as other health care professionals clearly recorded in the care files. 2 visiting community nurses where reviewing residents with diabetes at the time of the inspection. They seemed unaware of the skill level of some of the trained staff with respect to collecting blood samples and this should be communicated to them. The method of administering medicines in the home is inconsistent. One recording sheet reviewed displayed omissions in recording whether medicines had been administered the day previously. Other recording sheets also showed numerous omissions with no explanation recorded. In conversation with a nurse it is evident that good practise guidelines for the administering and recording of medicines are not consistently followed so that residents may be placed at risk. Staff interviewed understood the importance of maintaining the dignity of people who have dementia. Relatives spoke very positively about the caring nature of the staff and that they will always listen. One relative commented that ‘the staff always try to personalise the care’. Generally residents are protected from displays of undignified behaviour although this can be difficult, as day areas cannot be observed at all times. Residents who are non compliant with staff attempts at care also present major challenges [see complaints section]. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 13 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, 15 Activities are provided and continue to be developed in the home. Further development here would assist in providing some quality of life for all residents. Arrangements to involve relatives in the home and in the care of residents are good so that relatives feel supported and in contact with events. Daily choices of meals are always available and nutritious meals and special diets are provided, to ensure residents received a wholesome balanced diet. EVIDENCE: The home employs an activities organiser. She reported that due to the increasing frailty and dependency of residents a lot more of her work is now in a 1:1 basis with activities involving, for example, touch, such as nail painting or hand massage. Some residents’ benefit from local shopping trips on an individual and group basis. A Snozelen [room for relaxing which provides light stimulation] has been created since the last inspection although limited use is currently being made of this and the intention is to develop more regular use. The garden is well appointed and although not immediate accessible is made use of. Social histories of residents are included in the care files and the activities organiser makes entries of individual activities carried out. The quality of this therapy is good but with 46 residents it is spread thinly and there are long periods when residents remain without stimulation. In order to Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 14 provide more consistent input the provision of another person in this role would be extremely beneficial so that quality of life for residents could be improved. Relatives interviewed stated that visiting is open and that they are always made welcome in the Home. They stated that staff were very informative and always kept them up to date with care issues. The activities organiser runs a relative and friends support/social group. There have been contacts made through this group with advocacy groups, the Alzheimer’s disease Society, and age concern. The meals in the home are well planned and offer choice. Given the limited ability of some residents to exercise choice the staff are aware of various likes and dislikes. The menu is open to change and recently full cooked breakfasts have been reintroduced and the main meal of the day has been moved to teatime to meet resident needs. Special diets are provided, particularly liquidised and soft diets for those residents with eating difficulties. Some staff reported that liquidised meals are not sent up in enough quantity. Staff need to ensure that the correct amount of diets are entered on the kitchen ordering list. The meal times observed were highly social events and staff were very patient with assisting residents to feed and skilled with some of the more challenging residents who are difficult to maintain with an adequate diet. The behaviour of some residents can be extreme and disturb meal times for others. A review of this should be part of the general review of care of challenging behaviour recommended elsewhere in this report. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 15 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) 22 There is an effective complaints procedure in the home so that residents and their representatives feel that they are listened to and their concerns are acted on. EVIDENCE: There is a complaints procedure clearly available in the residents’ information guide [service users guide]. A complaints monitoring form was seen and these are collated centrally by Southern Cross who can track any trends. Relatives interviewed felt that staff were approachable and issues were dealt with appropriately. There has been one complaint recorded since the previous inspection and this had been investigated under the local adult protection procedures involving the Commission. The issues involved one member of staff incorrectly lifting a resident. There were requirements made by the Commissions and the home has completed some training in this area. One complaint had been received by the Commission and was investigated as part of the inspection. The complaint was from a care professional. A resident had been admitted to the home following assessment in hospital and had not been managed effectively over a period of 2 weeks prior to being referred back to the hospital. The complainant felt that there had been some neglect of the resident concerned and that there had been some considerable weight loss. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 16 There were 5 separate elements to the complaint and the investigation upheld 3 of these. One element was inconclusive and one element was partly founded. The main concern was that the resident in question did not receive adequate monitoring around diet and drinks as these were not recorded in enough detail. One requirement and one recommendation were issued to the home to improve practice. Although the above complaints are recorded as founded the homes assessment and care planning processes were good initially. Appropriate referrals were also made. The complaint highlights the difficulty faced by the home in managing residents who are presenting with acute of challenging behaviour. The focus of the inspection [of which this complaint was part] was on the management of such individuals and the effect that they have on the rest of the residents in the home. There was detailed discussion with senior management regarding the role of the home and the importance of continuing strong links with support services in health and social services. The management of the home displayed an open and constructive attitude to the complaint. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 17 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) 19,20,21 The home is generally well designed and meets the needs of people who have dementia who live in a safe well-maintained environment. Outdoor facilities have been improved since the last inspection, although residents would further benefit with the provision of easier access. Toilet and washing facilities are good and would further benefit from the provision of shower facilities offering more choice for residents. EVIDENCE: The Home is purpose built to meet the needs of people with dementia and has many good practice facilities such as level access to bedrooms and good day space. There is a rolling programme in place for decorating the home and generally the accommodation is bright and comfortable. Relatives commented on this. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 18 The maintenance person works full time and is also responsible for the upkeep of the external grounds. There is an enclosed garden area that is very useful for this service user group. Unfortunately there is no direct access to the garden as the current access is via the laundry area. This has been highlighted in previous inspections reports and does create a problem for this particular Service User group who could benefit in terms of quality of life with more direct access. The garden itself is pleasant and safe. The maintenance person has worked hard to develop it with the provision of a gazebo and a water feature. Since the last inspection the development of a Snozelen room was noted. There are accessible toilets and bathrooms on each floor. The recommendation for the provision of shower facilities on previous inspection reports has not been met although are being considered. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 19 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) 27,28,30 Staffing is consistent in the home and provides enough minimum numbers to meet resident’s needs satisfactorily. A training programme is provided for staff so that they are equipped to carry out their role and meet general care needs of residents in a safe manner. EVIDENCE: For 46 residents in the home there were 2 trained nurses and 9 care staff on duty and these figures are consistent from reviewing the duty rota. The manager and activities person are additional to these numbers. An improvement from the last inspection has been a decrease in the use of agency staff so that continuity of care is more likely to be provided in meeting residents needs. Extra staff are provided to meet needs; an example being the provision of 1:1 cover for a resident displaying particularly challenging behaviour. The home is continuing to develop the training program, which includes a course over 8 weeks centred around the person with dementia. Staff interviewed felt that this helped them understand the needs of the residents in their care. New staff interviewed had completed an induction course covering care issues and aspects of the running of the home and this is recorded in an individual induction pack. Ongoing foundation training includes the provision of NVQ training and the home are just short of providing 50 of care staff with this qualification. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) not assessed Not assessed. EVIDENCE: Not assessed. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 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 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 x x x x x STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The service users guide must include the results of resident satisfaction surveys as well as a copy [summery sheet] of the latest inspection report by CSCI [ last requirment date 30.6.05 not met] Care plans must reflect the more acute and challanging needs of residents and be updated as required All care needs including acute care needs must be revised at any time when it is necarssary to do so having regard to any change in cicumstances and records must refect accurate recording and monitoring. The administration of medicines must meet good practice so that medicines are administered and recorded on an individulal basis. Timescale for action 1.12.05 2. 7 15 1.12.05 3. 8 14 1.12.05 4. 9 13 immediate and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Dale Park Refer to Good Practice Recommendations F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 23 1. 2. 3. 4. Standard 3 7 8 12 5. 15 6. 7. 15 28 All assessments completed should be signed and dated The care planning in the home should be shared between the nursing staff with an expansion of the named nurse system. The manager shoukd ensure that the diabetic liason nurses are aware of the homes staffs skill / ability in taking bloods. Promotion of quality of life for all residents in the home would greatly benefit from the introduction of more activities and this can only realistically be achieved by another staff member employed to assist with this. Arrangments for the managment of meal times with respect to residents exibiting distubed behavior need to be reviewed in the context of the overall requirment to review the needs of such residents. Care should be taken when ordering special diets so that the correct amount is provided. 50 of care staff should be trained to NVQ level 2. Dale Park F03 F53 Dale Park S17278 V233205 14.06.05 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Knowsley Office 2nd Floor, South Wing, Burlington House Crosby Road North, Waterloo Liverpool L22 0LG 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. 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