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Inspection on 22/10/05 for Downshaw Lodge Nursing Home

Also see our care home review for Downshaw Lodge Nursing Home for more information

This inspection was carried out on 22nd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Examination of a number of residents` care files showed that pre-admission assessments were detailed and provided lots of information about what care each resident needed. Relatives said that staff worked hard and treated the residents well. Staff were seen to be polite and patient with residents even when the residents were sometimes uncooperative and verbally aggressive.

What has improved since the last inspection?

Unfortunately since the last inspection few improvements have been made and in many areas a big deterioration in standards was noted. The regional manager agreed with this assessment and had a clear insight into the changes that need to be made to start to improve conditions for residents in the home. A small number of communal rooms have been redecorated which has resulted in brighter and cleaner areas for residents to sit in.

What the care home could do better:

Care plans did not fully address the needs of the residents and evidence was lacking that actions stated were carried out. Care plans and risk assessments were inaccurate and had not been reviewed regularly. Residents` health care needs were not monitored properly such as their weight. The inspector could not be assured that residents were being cared for properly. Residents did not get a choice of food at meal times and residents that were nutritionally at risk were not adequately catered for. The chef was not aware that a number of residents had diabetes and one resident had other dietary requirements. Provision of the food needs to improve so that residents are offered a choice of appetising, well-presented meals. There were not enough staff to meet the needs of the residents. Residents were left for long periods with no mental or social stimulation. Staff had had minimal training this year in topics that are relevant to the care they need to provide to the residents.

CARE HOMES FOR OLDER PEOPLE Downshaw Lodge Nursing Home Downshaw Road Ashton-under-Lyne Tameside OL7 9QL Lead Inspector Mrs Fiona Bryan Unannounced Inspection 22nd October 2005 09:30 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 Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 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. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Downshaw Lodge Nursing Home Address Downshaw Road Ashton-under-Lyne Tameside OL7 9QL 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) 0161 330 7059 0161 339 4112 Exceler Health Care Group Plc Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (45) of places Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 45 Dementia No services user under the age of 55 years to be admiited to the establishment. 2 registered nurses on duty 24 hours; The Home Manager shall be a First Level Registered Mental Nurse and be supernumerary to the stated staffing levels for 37.5 hours per week. 19/4/05 Date of last inspection Brief Description of the Service: Downshaw Lodge is a purpose built, two-storey building that accommodates up to 45 service users from the age of 55 years with dementia who require nursing care. The home is owned by Exceler Health Care Group plc, which is a subsidiary company of Ashbourne Health Care, and is under the control of a general manager who is also a qualified nurse. Service users are accommodated in single rooms, 26 of the rooms having ensuite facilities. Rooms without en-suite facilities are provided with vanity units incorporating washbasins. Within the home there are six communal rooms offering a variety of settings for service users to socialise, entertain family or friends and participate in activities. A pleasant garden is designed to ensure that service users can enjoy being outdoors whilst maintaining their safety and security. The home has access to a mini-bus and service users who are able to, are taken for trips out to a number of local destinations. The home is located on the main Oldham Road with good access by public transport. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Saturday 22nd October 2005 when the inspector spent time talking with visitors and staff and observing how the residents spent their day and how staff looked after them. A selection of documents was examined including care files, staff duty rotas, and menus. This was the second full inspection of the year but a monitoring visit was also carried out in September 2005 as the home has had no manager since the last inspection and the CSCI has received several telephone calls from care managers, relatives and staff at the home expressing concern about staffing levels and the care provided to residents. A number of areas of concern were identified during that visit as areas that were seen as needing improvement at the first inspection in April 2005 had not improved and some aspects of the service had deteriorated further. A number of requirements were made at the visit to the home in September 2005 and these were reassessed at this inspection, together with other areas that were examined in April 2005. Comments cards for residents and visitors were left at the home. Three relatives returned cards, all of whom felt there were insufficient staff on duty at times, one commenting “improvements in staffing levels would directly improve the standard of care”. At the time of the inspection there were no senior personnel on duty at the home, although the company has been providing temporary managers to oversee the home until the appointment of a new manager. The inspector returned to the home on 4th November 2005 to provide feedback on the inspection to the regional manager. What the service does well: What has improved since the last inspection? Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 6 Unfortunately since the last inspection few improvements have been made and in many areas a big deterioration in standards was noted. The regional manager agreed with this assessment and had a clear insight into the changes that need to be made to start to improve conditions for residents in the home. A small number of communal rooms have been redecorated which has resulted in brighter and cleaner areas for residents to sit in. 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. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 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 Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Residents are assessed before moving into the home. Residents and their representatives are not confident that the home can meet their needs. EVIDENCE: Examination of four residents’ care files indicated that detailed assessments had been undertaken for all residents prior to their admission. Residents’ preferred routines and likes and dislikes were included which gave the reader a good idea of how to care for each resident on a day-to-day basis. In most cases detailed life histories had been completed, sometimes by the resident’s family and these were helpful in understanding each resident as an individual. However, the information gained from the pre-admission assessments was not always reflected in the care plans and from the appearance of many residents, the lack of stimulation and the noisy and at times stressful environment, the numbers of staff available to care for the residents and the level of supervision and support being provided to them, it was apparent that many of the residents’ needs were not being met. These observations were also reinforced Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 9 by comments from visitors regarding the staffing levels and the care provided to residents. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Care plans do not fully identify the needs of the residents and lack of implementation and adequate monitoring and evaluation places residents at risk. Residents are treated kindly and their privacy is upheld but poor standards in maintaining residents’ hygiene and personal appearance reduces their dignity and self-esteem. EVIDENCE: Information gained during residents’ pre-admission assessments was not always used to develop care plans. Four care files were examined in detail of which none had had risk assessments and care plans reviewed appropriately. Outcomes of risk assessments had not been used to plan care and proper interventions and strategies were not in place to reduce identified risks. Examples of shortfalls included the following: Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 11 • • • • • One resident had not had a risk assessment for falls reviewed although they had been found on the floor six times within a short period of time. Interventions to reduce the risk of further falls were inadequate. Several residents had care plans regarding weight loss. There was no evidence that the actions stated had been carried out and their weight had not been monitored as planned. Several residents whose risk assessments identified them as being at risk nutritionally did not have care plans implemented to address this. The risk assessment for pressure sores had not been reviewed for one resident since August 2005, although they had since developed a pressure sore. The wound care plan lacked detail and there was no information as to the progress or deterioration of the wound. The moving and handling assessment for one resident indicated that he was independent. A subsequent care plan stated that the resident needed to be moved using the hoist. Appropriate access to other health care professionals had not always been organised. A care review held on 14/10/05, for one resident, which was attended by the resident’s representative, staff from the home and the residents care manager from social services, highlighted that the home was not meeting the resident’s nutritional needs. Actions agreed at the review had not been carried out at the time of the inspection on 22/10/05. Many residents appeared unkempt with soiled clothing, uncombed hair, dirty teeth and long nails. Many of the men were unshaven and none of the ladies wore make up. One visitor commented that she had brought toothpaste in for her relative, which had hardly been used. This visitor had also brought in a new electric razor, which was lost and then found broken. She had then brought in disposable razors but it was noted that the shaving brush was still in its box in the resident’s bathroom and had never been used. Staff were observed to treat the residents very kindly, with courtesy, respect and patience. Visitors were complimentary about the staff and stated that they were “lovely but rushed off their feet”. Staff took residents into the privacy of their own rooms or the bathrooms to carry out personal care, however residents’ dignity was not always being maintained when their appearance was not maintained to an acceptable standard. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home does not satisfy residents’ social and recreational needs. Contact with residents’ friends and relatives is encouraged. Residents are not able to make choices about their lives. The home does not provide a satisfactory diet for all residents which puts them at risk nutritionally. EVIDENCE: Staff reported that the home’s activity organiser was taking maternity leave. No formal provision had been made for social events and leisure pursuits to be arranged in her absence. Residents were observed sitting for long periods of time with no mental or social stimulation. Although residents’ care files contained detailed life histories, information that could help the staff to provide meaningful activities for individual residents had not been considered and therefore the opportunity was wasted. For example one care file explained that the resident enjoyed and was good at singing and had also been interested in painting, drawing and pottery. A carer was asked if paper and crayons or pencils could be provided but she was unable to locate Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 13 any. An activities room is provided on the ground floor but this seemed to be used to store equipment and furniture and residents do not use it very often. A number of visitors were seen in the home and they confirmed that they were made welcome by staff and were able to visit as often as they wished. A cooked breakfast is provided at weekends. On the day of the inspection residents were having either cereal and toast or sausages and tinned spaghetti. The chef visited both floors in the morning and provided a menu list for staff to use when asking residents about their choices for meals that day. However, staff said they did not have time to complete them and they were not returned to the kitchen. Lunch was vegetable soup, scrambled eggs and tinned tomatoes, which looked very unappetising. Residents who could feed themselves with finger foods were given sandwiches. Dessert was sponge and custard. The sponge for residents on the first floor was burnt. One visitor said sponge was served for dessert nearly every day. The main meal of the day is served at teatime and was steak pie. On the first floor one tray of pie was provided for 19 residents. Staff had to be careful in serving portions, as they were concerned they would run out. No food was left over to offer residents second helpings and no choice was offered to residents at either meal although these were the recommended courses of action for some residents who had been identified as being nutritionally at risk. Dessert was ice cream. As stated elsewhere in this report the home was not meeting some residents’ nutritional needs and one resident was having meals brought in by relatives. Meal times especially on the first floor were noisy, chaotic and unpleasant for staff and residents. There were insufficient tables and chairs for all the residents to be properly seated and one resident was seen balancing her plate on the arm of her chair to eat as there was no place at the table for her to sit. A chef who had worked at the home on a number of occasions previously was on duty as it was the regular chef’s day off. The chef was not aware that there were a number of residents with diabetes in the home and one resident required a gluten free diet. Staff said this resident had a very limited variety of desserts (bananas or yoghurt) offered to him. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff need support, supervision and ongoing training to ensure that residents are protected from abuse. EVIDENCE: The majority of staff have undertaken training in respect of “Resident’s welfare” which includes the recognition of abuse and how to report it. However lack of supervision and adequate management structures over the past few months have put residents at risk of abuse. Senior managers within the company have acknowledged this during feedback of the inspection and were able to outline the measures they have started to put in place to ensure that staff receive adequate training and supervision and are appropriately managed. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 The home is safe and a fair standard of hygiene is maintained but residents lack choice and access to all the communal rooms, which leads to overcrowding and a less pleasant environment for residents to live in. EVIDENCE: Since the last inspection a small lounge on the first floor and the dining room on the ground floor had been redecorated and both looked cleaner and brighter. It was reported that another communal room was also being redecorated in the near future. The garden was very well maintained. Keypad locks on each of the floors ensure that residents are safe to move independently if able, around the units. Several communal rooms within the home are not utilised as much as they could be, as residents are routinely brought to sit in one lounge on the ground Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 16 floor. The main lounge on the first floor was overcrowded and too warm – a wall thermometer registered the temperature of the room as 26° C. The home was generally clean and tidy. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Insufficient numbers of staff are provided to meet the needs of the residents. Staff do not receive the correct training to be able to do their job. EVIDENCE: On the day of the inspection nineteen residents were in occupancy on the ground floor, with one nurse and three carers to look after them. Twenty-three residents were in occupancy on the first floor, who also had one nurse and three carers to look after them. The staffing level on the first floor fell below the minimum staffing levels laid down by the previous registering authority and was also not sufficient when taking into account the dependency of the residents. A number of the residents across both floors presented management challenges to the staff and several residents needed three members of staff to assist them, as they were resistant to personal care interventions. As stated elsewhere in this report, mealtimes were especially problematic. A large number of residents required assistance to eat or supervision and prompting. On the first floor at teatime, whilst the nurse was administering medication, one carer was putting the food on to plates, one carer was serving the meals to residents and one carer was helping residents to eat. Staff were forced to try to attend to residents as quickly as possible so that they could move on to help other residents. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 18 Several visitors commented that they did not feel there was always enough staff on duty and reported instances where food had been placed in front of residents and left to get cold as there was no staff to prompt the resident to eat it, or another resident would take it off the plate. Staff stated that they had not received any training since the last inspection. The training records were not available. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The home is not run in the best interests of the residents. EVIDENCE: The inspector was unable to assess Standard 31, as the home has not had a manager since the last inspection. Although a unit manager from another home within the group was placed at the home to provide some managerial support, care practices, record keeping and the level of staff training and supervision have deteriorated significantly over the last six months. Senior managers from within the company are aware of this and are currently putting strategies in place to address many of the issues identified in this report. Several staff meetings have taken place over the last few months. The inspector could not evidence other quality assurance measures that have been implemented, as at the time of the inspection there was no access to the records. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 2 x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x x x Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4OP7 Regulation 15 Requirement Timescale for action 31/12/05 2 OP7OP8 3 OP7 4 OP4OP8 The registered person must ensure that care plans are reflective of pre-admission assessments and set out in detail the action which needs to be taken to ensure that all aspects of the health, personal and social care needs of the residents are met. (Timescale of 15/10/05 not met). 13 The registered person must 31/12/05 ensure that adequate risk management processes are in place in relation to pressure area care, falls and nutrition for all service users where appropriate. 15 The registered person must 31/12/05 ensure that the residents’ care plans are reviewed at least once a month and updated to reflect the changing needs and the current objectives for health and personal care are actioned. 12, 13, 16 The registered person must 31/12/05 ensure that all assessments undertaken are accurate, are reflective of service user’s needs and where appropriate a corresponding plan of care is in DS0000025432.V263822.R01.S.doc Version 5.0 Downshaw Lodge Nursing Home Page 22 5 OP8 12 6 OP8 12, 13 7 OP10 12 8 OP12 12, 16 9 OP12OP14 12, 16 10 OP15 16 11 OP15 13 12 13 OP15 OP18 12 13 14 OP20 23 place. The registered person must ensure that the personal hygiene of all residents is maintained. (Timescale of 30/9/05 not met) The registered person must ensure that residents have appropriate access to other healthcare professionals. The registered person must ensure that the dignity of residents is maintained at all times. (Timescale of 30/9/05 not met). The registered person must ensure all service users accommodated at the home have a social care plan with recorded interventions that are person centred. The registered person must review the home’s care practices to ensure that service users are provided with choices in the areas they can influence. The registered person must ensure that adequate quantities of food, which is suitable, wholesome and nutritious is provided which is varied and properly prepared. The registered person must ensure that special therapeutic diets are provided when advised by healthcare and dietetic staff. (Previous timescale of 31/5/05 not met) The registered person must ensure that residents are offered a choice of food. The registered person must ensure that staff receive the training, supervision and support to prevent residents being placed at risk of harm or abuse. The registered person must ensure that the temperature of the home is suitable for the DS0000025432.V263822.R01.S.doc 30/11/05 30/11/05 30/11/05 31/12/05 31/12/05 30/09/05 30/11/05 30/11/05 31/12/05 30/11/05 Downshaw Lodge Nursing Home Version 5.0 Page 23 15 OP27 18 16 OP30 18 17 OP33 24 residents. The registered person must 30/11/05 ensure that sufficient staff are on duty to meet the needs of the residents and promote independence and choice. The registered person must 31/03/06 ensure that staff receive training appropriate to the work they are to perform. The registered person must 31/01/06 ensure that a system is established for reviewing and improving the quality of care provided at the home and for obtaining the views of the residents and their representatives. 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 Refer to Standard OP15 OP20 Good Practice Recommendations The registered person should ensure that meals are taken in a congenial and pleasant setting. The registered person should ensure that the physical design and layout of the communal rooms are suitable for the residents’ needs. Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Downshaw Lodge Nursing Home DS0000025432.V263822.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!