Inspection on 19/01/07 for Eleri House

This inspection was carried out on 19th January 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Eleri House 29/03/06

Eleri House 20/12/05

Eleri House 18/01/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Eleri House 15 Laburnum Walk Malvern Worcestershire WR14 1HD Lead Inspector Rachel McGorman Unannounced 19th January 2007 9:45 Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 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 Eleri House DS0000061478.V327487.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 Adults 18-65. 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. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eleri House Address 15 Laburnum Walk Malvern Worcestershire WR14 1HD 01684 899176 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) bill@elerihouse.fsnet.co.uk Mr Charles William Cole Mr Charles William Cole Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29/03/06 Brief Description of the Service: Eleri House is registered to provide residential care for up to three adults who have a learning disability. The Registered Provider is Mr Charles William Cole, who is also responsible for the day-to-day running of the home and is also registered as the Care Manager. The home is run as a non-profit making organisation. The premises is a converted town house situated in Malvern, within walking distance of the town centre, and in close proximity to local shops, public transport, and a range of amenities and facilities. The building has been well maintained, and provides suitable and pleasant accommodation for the three people who live there. There is ample communal space, which includes the garden areas that are accessible to service users, and also an adjacent building that provides a facility for activities, and, in addition, contains a Snoozelen. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a half day. This was a key inspection and twenty-two standards were assessed on this occasion. The inspector had discussions with service users and the staff member on duty. Staff interaction with service users was also observed. The registered manager was met and provided the majority of the documentary records examined. One service user provided a guided tour of the home. What the service does well: What has improved since the last inspection? • • • The provider is exploring what quality assurance tools can be used to measure the quality of the service provision. The provider has invested in developing the property by providing a conservatory. The provider has employed a designated staff member who works as an activities worker for four hours per week. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 6 What they could do better: • • • • The provider needs to amend service user’s literature to reflect transparency related to fees and any additional on costs for placements. A formal Quality Assurance System should be introduced. The registered manager should instigate the safe food business manual to strengthen the home’s safety practices. The provider should consider adopting good practice measures to enhance the pre-employment checks as part of the recruitment and selection procedures. The home should consider introducing ‘Person Centre Planning’ (PCP). The provider should consider involvement of advocacy and network with other homes to find out what has and has not worked locally. Risk assessments should be dated and evidence a process of review. The provider is encouraged to familiarise themselves with good practice guidance available through the Commission’s website. • • • 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. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provider is able to assess and ensure the needs of prospective service users are considered. Information about the home is available to enable prospective service users to make an informed decision about their future care needs. The assessment and admission procedures should ensure that suitable placements are made for any prospective service users. EVIDENCE: The provider has available a ‘Service User’s Guide’ and a ‘Statement of Purpose’. This material is available in print form. As identified at the last inspection visit there have been no recent changes in the resident group at the home. Discussions with the manager indicated a planned process for any prospective service user and staff would expect to work closely with the social worker, parent or carer and any other key staff from the previous placement. The provider will need to amend service user’s literature to reflect transparency of fees and any additional on-costs for placements. This is as a result of recent changes to the regulations related to admissions and assessment. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7& 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s plan of care is based on the initial assessment, which identifies their assessed needs, and how these will be met. The individual care plans should represent the day-to-day care practice of the home. Consideration should be given to adopting person centre planning tools. Safety issues and the assessment of risk are considered and do not unnecessarily hamper the principles of providing quality care. Minor improvements with the risk assessment pro forma should be considered. EVIDENCE: As identified at the last inspection report, an individual plan of care is produced for each service user, based on the initial assessment undertaken during the admission process. The plans detail the specific needs of service users and how these are to be met. There was good evidence that the individual plans Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 10 are being monitored through the annual reviews, staff care forum meetings and by keyworkers. Each service user has an allocated keyworker. Discussions with the manager indicated the home had previously considered introducing ‘Person Centre Planning’ (PCP), but found the tools provided as unworkable for the existing service users. It is recommended this area be revisited as the local language and speech therapy department have devised more service user friendly tools. There is an increase in the value placed on adopting a person centred approach. The provider should consider involvement of advocacy and network with other homes to find out what has and has not worked, locally. It was evident through discussion and observation that consideration about was given to involve service users in day-to-day decisions. Staff use informal structures to ascertain the views and opinions of service users. A good practice example was seen during the visit involving one service user who had requested to cook a plum crumble. The service users are active members of their local community and are known by neighbours and the local shops. Records related to the financial management of service user’s accounts follow the home’s policy and procedure. The provider ensures a detailed record of financial transactions of service user’s accounts is maintained. Risk assessments are available for service users. Risk assessments are interrelated to activities based in the home and also within the community at a wider level. The home has two files for recording risk assessments; one file had evidence of a review process. It is recommended that all risk assessment pro formas should be clearly dated and evidence a review. Where risk assessments are identified as remaining static and unchanged this needs to be stated in the risk assessment. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The opportunities made available to service users enable them to live as fulfilling a life as possible. The involvement of each individual in planning their activities, both within and outside the home, means that they are able to choose what they wish to do. The involvement of family and friends is encouraged, and enables supportive relationships to be maintained. The provider demonstrates a positive attitude to diversity, particularly in relation to disability. EVIDENCE: One service user is attending the local social educational centre for one day per week. Feedback given by staff indicated this is experienced positively. None of the service users are involved in any local adult education courses although this has been tried in the past. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 12 The home employs one activity worker who works on a Tuesday morning and organises art and craft based sessions. Staff indicated that service users enjoy this and the home has a separate designated activity room away from the main house. This also contains a white room with a range of visual and sensory equipment. The deputy manager is a trained to provide ‘Indian Head Massages’ and this is regularly provided at the home. The home also has a new conservatory built, which is used as a relaxing space and provides soft beanbags and a music centre. In addition there are good links with local people and this includes using the local shops, pubs, cinema, restaurants and theatre trips. One service user is involved with walking dogs at the local animal rescue centre. In the past service users have played a substantial role in funding raising events, including long distance sponsored walks. This has helped to raise the profile of service users with a disability, being actively engaged with their local community. The contact arrangements with relatives are set out at the initial assessment. Relatives are welcome to visit the home. Also contact is maintained by phone and emails. Service users are encouraged to retain involvement with their family. The daily routines in the household are based on shared group living. There was evidence of service users being involved with cooking and domestic household tasks. Staff show initiative and creative ways of engaging service users on the day to day running of the home. Service users are encouraged to keep their bedroom clean and tidy. Mealtimes were described as sociable occasions and unhurried. There is no set menu and residents are involved in choosing foods from the freezer and fresh food from the fridge. All service users are involved in food shopping. Service users prefer these arrangements in relation to the menu planning. The provider ensures records are maintained of foods that are eaten. The provider should be familiar with the latest CSCI report on meals in care homes. Also with the National Institute for Clinical Excellence (NICE) guidance on nutrition for adults. This information is available on the Commission’s website. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Support and encouragement is provided to each service user, in order to promote independence in respect of their personal and healthcare needs. Procedures are in place for managing the ageing process and possible illness and death of service users, to ensure that dignity and respect is maintained. The arrangements in place for the safe management and control of medications are good. EVIDENCE: As identified at the last inspection, the personal and healthcare needs of service users are closely monitored, and additional specialist support and advice is sought from the primary health care team and other health professionals, when necessary. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 14 A policy relating to ageing, illness and death of service users has been implemented at the home, and discussions held with service users and their families to determine their wishes concerning terminal illness and death. The outcome is recorded on their individual plan of care. All of the service users can manage most of their own personal care needs including hygiene routines. Staff do, on occasions, provide advice and prompts to reinforce certain aspect of their hygiene care. All of the service users are registered with the local health centre and Moor Street dentistry practice. Records are maintained on the service user’s case file related to the outcomes of these visits. The home has the Boots chemist MAR medication system to manage all medications. This system ensures medication errors are kept to a minimum. The storage of medication is appropriate and records indicated no gaps with staff signatures. All staff have completed training in the safe control and administration of medication and this is an accredited course. The registered manager keeps staff competency under review. At this inspection visit the process for administering household remedies and the staff identification signature list was not examined. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is followed at the home, and service users are encouraged and enabled to express their views and opinions. The understanding by the manager and staff of the issues relating to the abuse of vulnerable adults, should ensure the protection of service users. EVIDENCE: As identified at the last inspection visit, a complaints procedure has been developed in a suitable format for service users, and a record is maintained, which includes comments and compliments. During this visit no complaints about the service, or have any comments or compliments had been recorded. Policies and procedures for the protection of service users have been produced, and the care manager has undertaken the relevant training. Training on the Protection of Vulnerable Adults has also been passed to all staff. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are suitable for their purpose. They are well maintained, nicely furnished, clean, and ensure as far as possible that the safety and wellbeing of service users is promoted. The standard of the accommodation is satisfactory, and provides service users with a comfortable and homely place to live, although the need for future consideration to be given to the areas of the home which do not meet the National Minimum Standards is identified. Health and safety matters are being addressed. The manager should consider implementing the safe food for business manual. This will reinforce the existing practices in the home. EVIDENCE: As identified at the last inspection visit, the premises at Eleri house is a large detached, double fronted house, which is maintained to a satisfactory Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 17 standard, and is suitable for its purpose. The communal areas of the home are nicely decorated and comfortably furnished, and the lounge & dining area, which is on two levels, has recently been redecorated to a high standard. Each service user has a single furnished bedrooms that reflect the personality of their occupants. As identified previously, the bedrooms do not all comply with the National Minimum Standards with regard to washbasins and door locks. Consideration will need to be given to these matters in the event of a new service user moving into the home. The provision of toilets, bathing and showering facilities are satisfactory. The service users living at the home do not have the need for any specialist equipment, although a Snoozelen is available for their use. The new addition of the conservatory is compliant with building regulations. Documentary evidence was available to confirm this. The provider should consider professionally cleaning one of the lounge chairs sited in the window bay of the sitting room. The hallway carpet on the landing should be professionally cleaned as there a number of stained areas. The provider has a health and safety policy and the registered manager is responsible for ensuring care practices are kept under review. The registered manager stated that he provides in house training on infection control. In the past the registered manager was supplied with a range of leaflets from environmental health and these are available in the policies and procedures for the home. It is recommended that the registered manager should adopt the ‘Safe food business Training Manual’ to continue to promote good practices in the home. An Environmental health officer visited in November 2006 and there are no significant actions as a result of this visit. The inspector was informed that the registered manager and deputy are due to attend a course on kitchen hygiene in January 2007. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The training arrangements of the home are meeting the professional needs of staff. The recruitment and selection practices should follow the homes own procedures at all stages. The home should adopt further good practice elements to strengthen the recruitment process. EVIDENCE: There are four fulltime members staff of employed at the home and two staff are on duty between the hours of 8:00am – 8:30pm. One sleeping members in staff provides nighttime cover. These arrangements permit a flexible approach for service users to be away from the home for lengthy periods during the day. All of the staff are qualified to NVQ level 2 or 3 in Health and Social Care and this exceeds the standards. There was documentary evidence of core training being reviewed. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 19 The arrangements in place for recruitment and selection were examined. One personal file was examined that involved a recently recruited staff member. The major elements of pre-employment checks were in place including, application form, written references and an application for a CRB check. It is recommended that the take up of references should include at least one phone call to verify the authenticity of one of the referees. A written record should be retained. The provider should ensure three yearly Criminal Records Bureau (CRB) checks should be taking place in line with good practice. The practice of accepting employees for work prior to the return evidence of the necessary pre-employment checks should cease. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements at the home are satisfactory, and staff and service users benefit from the positive leadership they receive. The quality assurance system needs to be fully implemented, and the results of surveys audited, to confirm that the aims and objectives of the home are being met. The policies, procedures and records maintained at the home, comply with legislative requirements and therefore help to safeguard the rights of service users. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 21 EVIDENCE: As identified at the last inspection, the Registered Manager, Mr Bill Cole, has many years experience working with this client group. Initially training as a nurse, he obtained the RNLD qualification. He also holds the Advanced Management in Care Award, and is an NVQ Assessor and Verifier. He has certificates in Youth and Community work, and also in mountain leadership. The deputy has also gained the Registered Manager Award RMA in both care and management. The homes ethos and culture is based on an open atmosphere by creating an environment that is relaxing to live in while, ensuring service users are fully protected. As identified at the previous inspection, monthly visits to the home are undertaken by Mr. H. Casey, the Chairperson of the Management Support Group, and an annual report is produced. The registered manager has not yet addressed what quality assurance tools will be used to measure the home’s success in achieving the stated aims and objectives. The results should be audited and records published annually, and a copy submitted to the Commission. The inspector provided some further good practice models to pursue. The key policies and procedures at Eleri House should be reviewed periodically. The financial viability of the business is sound. The provider has appropriate insurance arrangements in place and certificates are available. All of the domestic installation checks are within the annual timescales. The records connected to fire safety checks were examined. A clear structure was in place for checking equipment and there were organised practice evacuation drills. It is recommended that the evacuation needs of individuals should be recorded in service user’s personal records. To compliment this area the registered person should make sure staff know what these needs are and be trained to evacuate anyone who needs help. Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes. This relates to Standard 39. New timescale set. 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 YA39 Regulation 24 Requirement A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 39. (Previous timescale not met of the 30/09/06) The provider must amend service users literature to reflect transparency of fees and any additional on-costs for placements. This will ensure that information is in line with recent changes to the National Minimum Standard Regulation 5 June 2006. Timescale for action 30/06/07 2. YA2 5 (June, 2006) 30/06/07 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 YA26 YA26 Good Practice Recommendations Future consideration should be given to fitting appropriate locks to the bedroom doors. (Remains) Future consideration should be given to the provision of wash hand basins in all bedrooms. (Remains) DS0000061478.V327487.R01.S.doc Version 5.2 Page 24 Eleri House 3. YA6 4. YA17 The home should introduce ‘Person Centre Planning’ (PCP). The provider should consider involvement of advocacy and network with other homes to find out what has and has not worked locally. 1. The registered manager should instigate the safe food business manual to strengthen the home’s safety practices. 2. The provider should be familiar with the latest CSCI report on meals in care homes. Also with the National Institute for Clinical Excellence (NICE) guidance on nutrition for adults. This information is available on the Commission’s website. The arrangements for chiropodist/podiatrist should be referred to in the health section of service users records. The home should provide clear care practice guidelines about how nail care will be managed at the home. The Commission’s website provides some useful reference points to consider. All risk assessments should be dated and evidence a process of review. Ideally the process of review should be agreed at the point of the initial assessment. Good practice would indicate consideration is given about when and with whom to review the assessment and this will depend on the activity and potential harm posed. The registered manager should instigate the safe food business manual to strengthen the home’s safety practices. The evacuation needs of individuals should be recorded in service user’s personal records. To compliment this area the registered person should make sure staff know what these needs are and be trained to evacuate anyone who needs help. The provider should consider professionally cleaning one of the lounge chairs sited in the window bay of the sitting room. The hallway carpet on the landing should be professionally cleaned as there a number of stained areas. 1. The take up of references should include at least one phone call to verify the authenticity of one of the referees. A written record should be retained. 2. The provider should ensure three yearly Criminal Records Bureau (CRB) checks should be taking place in line with good practice. 3. The practice of accepting employees for work prior to the return evidence of the necessary preemployment checks should cease. 5. YA19 6. YA9 7. 8. YA30 YA42 9. YA24 10. YA34 Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Eleri House DS0000061478.V327487.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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