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Inspection on 18/04/07 for Diamond House Care Home

Also see our care home review for Diamond House Care Home for more information

This inspection was carried out on 18th April 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Diamond House Care Home Bennett Street Downham Market Norfolk PE38 9EJ Lead Inspector Mr Jerry Crehan Unannounced Inspection 18th April 2007 1:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Diamond House Care Home DS0000065214.V336849.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. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Diamond House Care Home Address Bennett Street Downham Market Norfolk PE38 9EJ 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) 01366 385100 01366 385600 diamond.house@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Position Vacant Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22nd May 2006 Brief Description of the Service: Diamond House is a care home providing residential care for up to 42 older people including service users with dementia. It is situated on the edge of the town of Downham Market and is within easy reach of local facilities including shops, pubs and other community facilities. Diamond House is purpose built with accommodation provided on two floors, service users with dementia mainly occupy the first floor. Stairs and passenger shaft lift service floors. There are 38 single rooms and 2 shared rooms. There are patio and garden areas that are visible from a number of service users bedrooms. Diamond House is one of several homes in Norfolk owned by the proprietors. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 7.75 hours on 18th April 2007. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff, deputy manager and the new manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The new manager provided pre-inspection information to the Commission prior to the inspection. This included 7 comment cards from relatives and visitors to the home which gave broadly favourable comments about the service provided by the home, however, a recommendation has been made in this report concerning the absence of any comment cards from people who use the service. Diamond House is one of several homes in Norfolk owned by the proprietors. The range of monthly fees for the home is from £1124 to £2072. What the service does well: • • The individual needs of people using the service are assessed and understood in order that the service can be sure their needs will be met. The principles of privacy, respect and choice for people who use the service are put into practice and supported by the management of the home. People who use the service have access to an effective complaints procedure and are protected from abuse through staff awareness and training in protection. Staff in the home have been trained and are in sufficient numbers to support the needs of people who use the service. Relatives/visitors to the service say that staff have the right skills and experience to look after people properly. • • • What has improved since the last inspection? Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 6 • • • The plans of care for people who use the service set out more clearly the action required by care staff to meet needs, and these are reviewed. There have been adequate numbers of staff available to meet the needs of people who use the service. The new manager has notified the Commission of all significant events at the service. What they could do better: • • People who use the service are limited in what they can do to satisfy their social and recreational needs. People who use the service have access to a good diet, though this should be better promoted to become a greater part of daily life at the home. The homes environment is safe, however some areas of the home are not well maintained and should provide more comfort. Some parts of the home lack a warm and homely feel. The manager should ensure that the views of people who use the service user sought at all opportunities and included when making decisions that effect outcomes for people living at the home. • • • 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. Diamond House Care Home DS0000065214.V336849.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 Diamond House Care Home DS0000065214.V336849.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): Standards 3 & 6 People who may use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs of people using the service are assessed and understood in order that the service can be sure their needs will be met. EVIDENCE: The home has an assessment pro-forma (for pre-admission assessment) used by the manager or deputy when collecting information. The document is well designed to ascertain the level of support required by prospective service users. There was evidence of good assessment of prospective service users. The manager had collected a range of information, some of which was gathered in a visit to the prospective service user and their spouse. The service user had a diagnosis of Alzheimer’s disease and was appropriately placed at the home, as were other service users observed during the inspection visit. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 9 Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive health and personal care that is based on their individual needs. The principles of respect and choice for people as individuals are put into practice. EVIDENCE: Several care files were looked at during the inspection visit. Each contained individual care plans and risk assessments. The files were seen were all well maintained and up to date. Each one had a review date and contained generic and individual risk assessments. The daily reports are brief and record the care pattern for the day in practical and physical terms relating to health aspects and treatments. Though do give some indication as to mood and the general sense of wellbeing of the service user. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 11 The information in the care files records the health care support offered. At the time of the inspection visit there were two service users requiring pressure area care. The plan for one of these service users was seen and was combined with the service users plan for mobility. There was no clear need for these aspects of care to be combined in this way, and a more clear need for them to be separate in order to be clear for care staff as to their responsibility. However, the plans provided the information required by staff. There was evidence of nutritional screening where service users with particular vulnerability are identified. The manager has been proactive in looking at the incidents of falls at the home and in commissioning expert advice and training for staff. Care staff spoken with were aware of this and aware that they were due to receive training. There was evidence of social history information on files seen, in order to support the social care of people who use the service. Care staff spoken with have a good understanding of their role in providing practical care to service users, but also in supporting people’s independence where possible, and in bringing as much of service users own history to them. Observation of staff throughout the visit to the home provided evidence that staff have confidence in their role and an understanding and sensitivity to the needs of service users. Each of the seven comment cards from relatives/visitors received prior to the inspection visit indicate that the care home either always or usually give people who use the service the support they expect or agreed. There were no comment cards received from people who use the service (See Recommendation 1). The manager acknowledged some problems with lost or spoilt clothing, though indicated a labelling service was in use. There are suitable safe storage arrangements for medication on both floors of the home. Appropriate records are kept for the receipt of medication into the home, its administration and any medication returned to the pharmacy. Photographs of service users accompany their MAR charts to assist in safe administration. There are instructions for staff for the administration of PRN medication in most instances, though not all (See Recommendation 2). There was evidence of good practice in meeting the individual needs and preferences in medication administration for a service user with a hearing loss who was communicated with in writing, and a service user who prefers liquid medication from a spoon rather than pot. At times (usually the 9pm medication round) there is one person with the responsibility to administer medication to service users on both the ground and first floor of the home. There is a concern at the length of time this may take to complete. The manager said that she was aware of this and had secured appropriate staffing to ensure that there would be two staff on duty at this time to undertake the administration task in a timely way. Service users spoken with during the inspection visit said they were content with the care and service they receive. Other service users were observed Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 12 being cared for by staff who were acting competently and demonstrated a knowledge and understanding of their needs. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a good diet, though this could be better promoted to become a greater part of daily life at the home. People who use the service are limited in what they can do to satisfy their social and recreational needs. EVIDENCE: There is a published programme of weekly activities at the home. The programme is made available in every service users bedroom, and in communal areas of the home. Mobile library visiting dates and times were also publicised. PAT dogs visit the home regularly. There were photographs of recent activities on display. At the time of the inspection visit the activities programme indicated ‘one to one’ activities with the designated activities coordinator. Service users spoken with gave reasonable responses as to the suitability of activities on offer, one person stating that ‘we had a party here the other day and sometimes we have Bingo’. The relative of a service user commented that they hoped their relative at the home would be able to do more activities. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 14 There is an activities room on the first floor accessible to service users. There are three ‘fiddle boards’ on the corridor walls on the first floor, with themes of the seaside, music and doors. These add interest to the environment. The manager stated that the former dedicated activities coordinator is now the deputy manager for the home, and that the home had been without a dedicated coordinator for several months. The manager also acknowledged a limited budget available for activities of £60 per month for all 42 service users. The activities coordinator is due to undertake training appropriate to their role late this year. Care staff were not observed to be undertaking activities with service users at the time of the inspection visit. The social and leisure needs of service users were generally met though not as comprehensively as at the last inspection of the home. It is recommended that they have access to trained colleagues from other local services owned by the proprietor to increase their knowledge and expertise (See Recommendation 3). It is recommended that care staff play a more significant part in supporting service users to undertake leisure and social interests (See Recommendation 4). Discussion with service users and observation during the visit to the home provided evidence that the home supports their contact with relatives and friends, and that it enables service users to bring and keep their own possessions with them. The rooms seen on the day of the inspection visit are reasonably furnished and equipped to suit the service users daily lifestyle and reflect their personal choices and preferences. However, some bedrooms on the first floor of the home looked sparse and lacked a warm or homely feel. Service users asked about the food during the inspection visit gave favourable responses such as ‘can’t say a bad thing about the food’ and ‘I enjoyed my lunch’. The main meal options seen looked appetising and were served in reasonable quantities. Tea time options available is usually soup or sandwiches, though other options are available and homemade cakes were being prepared by kitchen staff. Service users are provided with a supper option of a choice of drink and biscuits. There was no evidence of the availability of finger foods, and limited availability of fluids to service users, particularly on the first floor of the home accommodating service users with dementia. It is recommended that finger foods and fluids be made more accessible to service users to support their health and wellbeing (See Recommendation 5). Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to an effective complaints procedure and are protected from abuse. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is indicated in the ‘service users guide’. Five of the seven comment cards received from relatives/visitors to the home prior to the inspection visit indicated that they know how to make a complaint about the care provided by the home if they needed to. The manager stated that the home had received three complaints in the last 12 months, each of which had been substantiated. The manager keeps records of complaints all of which are responded to in writing. The home has experience of making appropriate referral under the Norfolk Adult Protection Procedures. Each of the staff spoken with were clear about the action they would take if concerned about the possibility of abuse taking place and were confident that the manager would deal with this appropriately. They were equally aware of the home’s ‘Whistle-blowing’ procedure and its function. Staff have received ‘in –house’ training in the protection of vulnerable adults (POVA). This covers types of abuse, includes group work, a case study and a questionnaire to assess levels of understanding. The manager indicated that further training Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 16 covering adult protection and ‘POVA’ issues is being made available to staff at the end of April, and hopes this will further increase the protection afforded to service users. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment is safe, however some areas of the home are not well maintained and should provide more comfort. EVIDENCE: A tour of the home’s environment was undertaken and there is evidence that refurbishment and redecoration of service users rooms and communal areas is needed, particularly of the first floor of the home to make the interior of the home more attractive. As already indicated some areas lack warmth and a homely feel. This is as a consequence of poor decoration in some areas, of a lack of good quality furniture, of headboards that are not fixed to beds properly, damaged doors (See Requirement 1) and of very worn bedding and ‘clumped’ pillows (See Requirement 2). Other communal areas and bedrooms are decorated to a good standard. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 18 Overall the environment at the home suggests a lower level of care and ‘service’ than is actually provided. The internal and external environment is generally safe and accessible for service users and staff. A keypad has been fitted to the front door for additional security for service users who may wander. Hoists and other equipment were safely stored on this occasion, so as jot to cause any obstruction. The home is clean and tidy. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home have been trained and are in sufficient numbers to support the needs of people who use the service. EVIDENCE: There is a total staff compliment of 28 carers, 6 ancillary staff, the manager and deputy manager. There were 40 service users accommodated at the home at the time of the inspection visit, cared for by 6 care staff during the morning and 5 care staff during the afternoon/evening. Staffing numbers and deployment present a concern regarding medication the round at night, which is often undertaken by one staff member for both floors. The concern is the length of time it may take for one person to undertaken this task, and whether prescribed medication is being given at the appointed time. As indicated above the manager is aware of this and stated that she had secured sufficient funding to address staffing needs at this time. Aside from this service the staff on duty were evidently meeting users needs. Of the seven comment cards received from relatives/visitors of service users prior to the inspection visit, six of these indicate that the care staff always have the right skills and experience to look after people properly, one comment card indicated that this was sometimes the case. Comments in Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 20 comment cards include ‘the carers are very good’ and ‘they work hard and do everything they can for the people in their care to the best of their ability’. The interactions between care staff and service users observed during the inspection visit were good, and reflected an anticipation and understanding of the needs of service users. At the time of the inspection visit there were 36 of care staff working at the home with NVQ 2 or above (See (Repeated) Requirement 3). The manager indicated that eleven care staff were registered to undertake this training. This would see the home comfortably exceed the 50 requirement. Sample staff files provided evidence that service users are protected by good recruitment practices. Staff training records provided evidence of a range of mandatory including dementia training. Staff spoken with stated that this helped them to deal with issues such as dealing with challenging behaviour. At the time of the inspection visit all of the staff working with service users with dementia had undertaken this training. There was evidence in staff files of training in food hygiene, first aid, adult protection (with further training due as indicated above) moving and handling, infection control, health and safety and staff induction training. The manager had undertaken some analysis into the rate of falls experienced by service users at the home. She has been proactive in seeking relevant professional advice and training from the local ‘falls team’ in an effort to improve outcomes for service users in this aspect of their care. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home promotes the privacy, respect and the care of people who use the service, however, quality assurance systems should be further developed to measure success in meeting the aims and objectives of the home. EVIDENCE: The new manager has been in post for 7 months, prior this she was the home’s deputy manager for over three years. She indicated that she has begun the process of applying to the Commission to be registered, and is currently undertaking her ‘Registered Managers Award’ training programme. Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 22 Service users and staff spoken to describe the manager as approachable and that she will address issues brought to her attention. Reports from monitoring visits to the home undertaken by the proprietor are provided monthly, and there are other external audits, including validation audits are undertaken by the proprietor to monitor the practice of the home. There are some processes within home for monitoring the quality of the service it provides, including staff team (or unit) meetings, relatives meetings, monthly care reviews and staff supervision. The manager indicated that quality assurance feedback questionnaires are sent out annually to services users and their relatives. Though it is not clear how these have been used to inform any development or improvements to the service offered by the home, nor whether any results have been published. The change in the management at the home has hampered the implementation of a satisfactory and systematic approach to quality assurance (See Requirement 4). Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(2)(b) Requirement The manager must ensure that all of the people who use the service have access to an environment in a good state of repair. The manager must ensure that all of the people who use the service have bedding and other furnishings that are comfortable and in good repair. The manager must ensure that staff receive NVQ 2 training appropriate to the work they perform. This will ensure that people using the service have their needs met. The manager must ensure that the views of people who use the service user sought and included when making decisions that effect outcomes for people living at the home. Timescale for action 31/07/07 2. OP19 16(2)(c) 30/06/07 3. OP28 18(1)(a) 31/07/07 4. OP33 10(1) & 24(2) 31/12/07 Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 25 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. Refer to Standard OP33 OP9 OP12 Good Practice Recommendations People who use the service should have the opportunity to complete inspection comment cards provided by the Commission. Arrangements for the administration of PRN medication are recorded in the service user care plan. People who use the service have activities programmed and planned by staff with access to trained colleagues from other local services owned by the proprietor to increase their knowledge and expertise. People who use the service should be supported by care staff who play a more significant part in supporting them to undertake leisure and social interests. How finger foods and fluids (to support the health and wellbeing of people who use the service) are made accessible should be reviewed, as choice for some people is limited. 4. 5. OP12 OP15 Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Diamond House Care Home DS0000065214.V336849.R01.S.doc Version 5.2 Page 27 - 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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