Inspection on 17/08/05 for Greenacres

This inspection was carried out on 17th August 2005.

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

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

Other inspections for this house

Greenacres 07/07/07

Greenacres 15/06/06

Greenacres 22/02/06

Greenacres 18/09/04

Greenacres 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Greenacres Green Lane Standish Wigan WN6 0TS Lead Inspector Lindsey Withers Unannounced 17 August 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Greenacres, Address Green Lane, Standish, Wigan, WN6 0TS 01257 421860 01257 472133 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CLS Care Services Limited Mrs Joy Hogarth Care Home 40 Category(ies) of Older People 40, Physical Disability (elderly) 8 registration, with number of places Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum numbers registered there can be up to 40 OP, and up to 8 PD(E) 2. The service should at all times employ a suitably qualified and experienced Manager who is registered by the NCSC. Date of last inspection 18th September 2004 Brief Description of the Service: Greenacres Care Home (part of the CLS Group) is registered to provide accommodation and personal care and support for up to 40 individuals over the age of 65. Within the total number of 40, up to 8 residents can be accommodated who have a physical disability. All rooms are offered on a single occupancy basis - only four bedrooms have en suite facilities. At the time of this inspection, the home was keeping its total number of residents to 30. Greenacres is situated in a residential area, close to Standish centre and the amenities of supermarket, shops, restaurants and community services. Car parking at Greenacres is limited, but street parking can be found close by. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven hours on one day and was unannounced. Part of the time was spent in the office talking to the Manager, looking at five care plans (that is, the records used to show the plan for caring for a resident), and other papers used to manage the home. The remainder of the time was spent in the lounges, dining area, and private rooms talking at length to nine residents, and in a meeting with a Care Team Leader. Other residents and staff were spoken to over the course of the inspection. A number of monitoring visits had been made to Greenacres since April 2005, specifically to ensure that the standard of recording in care plans was improved. What the service does well: What has improved since the last inspection? The garden at the front of the reception area has been redeveloped over the summer, and a large patio area has been built. Garden furniture, with a variety of styles of seating, together with occasional tables, have been purchased. Planting is bright and colourful, and residents have been seen to make good use of it during the good weather. The standard of presentation of the home is getting better, with some redecoration being done inside. The dining areas look better, with tables set with tablecloths, napkins, and matching crockery, so creating an inviting place in which to eat. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 6 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. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 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 standard(s) 3, 4, and 5 Residents move into Greenacres only after assessment. Wherever possible, residents visit the Home prior to admission, that they can decide whether or not Greenacres is suitable for them and that their needs will be met. This is not the case for those accessing respite care, where residents’ needs may not be met as their admission process is not thorough. EVIDENCE: A sample of five residents’ files were looked at during this inspection. Four files contained a pre-admission assessment document that had been completed with assistance from the resident or their supporter, and there was enough information from which to form a plan of care. On the fifth file, for a person seeking respite care, there was no pre-admission assessment. For this person, therefore, there was nothing on which to form a plan of care. Respite care is deemed to be a specialised service under Standard 4.2 of the National Minimum Standards and so should be delivered using current good practice guidelines. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 9 None of the files contained information in relation to the person’s social interests or hobbies. While the Manager said there was no CLS documentation on which to record this information – which is vital to personcentred care - there was nothing to stop the Manager introducing a form of her own or by incorporating such information into care plan 9 – Work and Leisure. All files showed that, where specialised services from external sources had become necessary, access had been arranged for the residents, or continued where the arrangement was in place at the time of admission. These included mental health assessments, physiotherapy, and occupational therapy services. Greenacres is not registered to provide day care services. People requiring this type of service must be referred to relevant providers of day care. Residents spoke about how they had come to be living at Greenacres. Usually this had been as a result of a deterioration in their physical health. Residents had had the opportunity to visit the home prior to making a decision to move in, first of all on a temporary basis, and then, following review after a minimum of one month, on a permanent basis. Wherever possible, emergency admissions are avoided. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 10, and 11. The poor standard of recording in care plans is unacceptable. Files cannot demonstrate that a person’s health, personal and social care needs have been identified and can be met by the home. Neither can files confirm that the health and well-being of residents is promoted and maintained. However, residents themselves said they were satisfied with the level of care that they received. Residents can be assured that they will be treated with respect and dignity at all stages of their lives at Greenacres. EVIDENCE: Care plans had been the subject of a requirement at the last inspection. Several monitoring visits had been made, four since April 2005. At the last monitoring visit the Manager had given a written assurance that files would be in order by the end of July. Different samples have been looked at during the visits. In the sample looked at during this inspection, improvements were not sufficient to show that the needs and expectations of residents are identified, monitored, and reviewed in a thorough and measurable way. This lead to an immediate requirement being served by the Inspector, and a final monitoring visit scheduled for 25th August 2005 on the understanding that, if the Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 11 documentation was not up to standard at this visit, the CSCI would have to consider whether it would be appropriate to begin enforcement action against the registered person. There were errors and omissions on all of the five files that were looked at, some more significant than others, but all impacting on the quality of care being provided. On three files, an audit of the document had taken place on 19th July 2005 when shortcomings were identified, yet no remedial action had been taken. This situation is made more disappointing because staff were able to speak about the training that had taken place, and were aware of their obligations to keep care plans complete, correct, and up to date. Examples of errors included: incorrect relationship to the service user of the next of kin; progress record referring to care plan elements, when these had not been written. Examples of omissions included: healthcare results not followed up on; observations of a person’s physical condition recorded but not reported for action; risk assessments not completed; care plans not completed; a person’s health deteriorating but no referral for re-assessment recorded. The findings made during this inspection were discussed fully with the Care Team Leader and, separately, with the Manager of the home, both of whom gave assurances that the care plans would be brought up to standard by 25th August. Speaking with residents, all echoed the same opinion that they were satisfied with the way they were looked after by staff at Greenacres. One person was spending 3-4 weeks at the home on respite care, and said that while he wanted to get back to his own home, he did not mind spending time at Greenacres. This was an indication of the level of comfort he felt. Residents said their right to privacy was upheld. For example, two residents said they bathed and dressed with the minimum of involvement from staff. Staff may ask did they need help but, other than that, the two residents said they were left to themselves. The telephone is located in an alcove on a quiet corridor. For more privacy, residents could use the phone in one of the offices. Staff were respectful when speaking to residents, using terms of address from informal “pet” names, to the more formal Mr. or Mrs., according to the wish of the resident. Staff were careful not to be over-familiar with residents. One minor privacy issue was identified during the hoisting of a resident, when the resident’s back and underwear became exposed. The matter was identified to the Manager by the Inspector, who reminded the two members of staff about the need to ensure the modesty of residents during hoisting and transfer. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 12 The records showed that good information had been collected in relation to what a resident wanted from the home at the end of life. The care plan for one person who had recently died showed the extent to which the home had involved health professionals and the family to ensure that everything that could be done had been done. The files showed that special or specific wishes had been made recorded, for example, organ donation, favourite hymns or pieces of music. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, and 15 Residents are able to spend their time doing as they would wish, with help from staff as and when it is needed. Residents are able to make choices in all aspects of daily living. Residents receive regular visitors to the home, and are able to join in activities outside of the home, with assistance if needed. Food is good, well-cooked, and nicely presented at times suitable to residents. EVIDENCE: At this inspection, residents were seen to be reading, doing word puzzles, listening to music, or knitting. Others took the opportunity get out and about outside of the home. All the communal space at the home is used, and residents were free to sit where they wanted, either with other residents or in the quiet spaces that can be found around the home. Those who prefer their own company went back to their rooms after meals where they followed their own interests. During the course of this inspection, a church service was held, which those residents who attended said they looked forward to. Residents said they had enjoyed a singsong and a glass of wine. One or two mentioned having been to Martin Mere. The records showed that a quiz had been much enjoyed by residents, and that there had been a game of quoits. Residents said that they occasionally residents watched one of the many videos that were on display in the main lounge. The library service calls on a weekly basis but only one person makes good use of it. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 14 During the summer some residents had been involved with the redesign of the garden, and a good number now enjoyed sitting out in the better weather. There appears to be sufficient going on to satisfy most residents. One resident described his lifestyle as “boring” but added that the situation was probably of his own making because he had lost interest in his hobbies. It was evident that people had formed friendships during their stay at Greenacres. Some residents knew others because they had lived locally before moving to the home. There is a good number of visitors to the home, but not all are signing in the Visitors’ Book on arrival. From a safety point of view, this should be encouraged. Resident choice is a prime focus for the staff at Greenacres. Staff do not assume what a resident might want, but make efforts to seek out the resident’s view. Independence is encouraged, and assistance is provided where it is needed. Residents spoke highly of the food provided for them. Three gentlemen agreed that there was always “plenty to eat” and “good choice”. The meals served are a substantial breakfast of choice, a light lunch, and another substantial meal at tea-time. Supper is served from a choice of light snacks. Drinks are readily available all day. A water dispenser is located in the dining room. Residents said if they wanted something to eat or drink through the night, staff were happy to oblige. Assistance is on hand for those residents who need some help with eating. Over the course of breakfast, staff were seen to be checking and re-checking with residents to make sure they were eating enough. The two dining areas were nicely presented with linen, serviettes, and cruet sets. At meal-times, residents were served with tea and coffee in individual pots, or juice is available, if preferred. One or two residents like to remain in an easy chair to eat their meals and small tables are provided. Some residents took breakfast in their rooms, in which case the meal was presented on trays with hot food being covered to retain heat. Attention is paid to ensuring residents who require special diets are catered for, such as low sugar, high fibre, etc. For those residents who are finding it difficult to eat a meal, supplement drinks, such as Ensure, are obtained on prescription from the GP. One resident recommended the braised steak which he said was “beautiful”. The chicken casserole also was a hit with residents. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This section was not assessed on this occasion. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23, 24, and 26. The home is clean and there is good attention to hygiene standards. The standard of maintenance and presentation of the home and garden is improving but further work is still needed. Residents make good use of communal areas and liked their bedrooms. Specialist equipment is provided or arranged to assist residents to remain independent. EVIDENCE: Effort is being made to improve the standard of decor and maintenance both inside and outside of the home. The reception area is welcoming and a number of residents like to use this central space. The communal areas are comfortable and domestic in style and are well-used by residents who move from one area to another as they wish. There is a separate smoking lounge which keeps other areas smoke-free. Residents were very complimentary about the garden, which has been transformed over the summer. A very pleasant patio area is now available to residents beside the main reception door. A variety of garden furniture has been purchased, which residents take advantage of during the better weather. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 17 Work on the outside of the building itself has yet to be completed. This work is now well outside of the original timescale that was set and this programme must now be scheduled and completed. Visiting one gentleman in his room, he said he had everything that he needed and that it was comfortable and clean. He said his bed was comfortable and the bathroom was just across the corridor. A resident accessing respite care said he had been pleased with his bedroom and had been surprised to find it so comfortable. Staff had “fixed things up” for him, so he could watch TV in the evening if he wished. Residents had taken the opportunity to bring in personal items to help make their bedroom their own. Residents may have a key to their bedroom door, but when asked if they had a key, residents said they just closed the door when they wanted to – there was no need to lock it. Residents had a number of aids and adaptations available to them including assisted toilets and bathrooms, hoists, grab rails, hand-rails, wheelchairs and zimmers. One gentleman had some tools supplied by the occupational therapist so that he could still dress himself independently. There is a passenger lift to the upper floor, and ramps have been installed to aid access for those in wheelchairs and who have mobility problems. A nurse call system is in place, and residents were able to demonstrate how they would call for attention. Lighting in communal and individual areas was good. A variety of lighting was available throughout the home. On the day of the inspection, the weather was very warm, yet ventilation through the home was generally good and residents were comfortable. At this inspection, the home was clean throughout and there were no unpleasant odours. As they went about their work, staff were seen to be complying with good practice guidelines in relation to infection control. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staff at Greenacres have a good approach to their work, providing support, reassurance and companionship to residents. The staffing level is generally good, and staff are effectively employed. Training and development of staff is improving so staff are becoming better at doing the work they are employed to do. However, the effectiveness of training needs to be monitored so that competence is assured. EVIDENCE: The home is maintaining its total number of residents to 30 at the current time. There were sufficient staff on duty at the time of this inspection to meet the needs of residents. This included capacity to allow a member of staff to escort a resident to hospital following a fall. The practice of retaining two members of staff on duty overnight continues. However, staff were able to confirm that extra staff are brought on duty if the dependency level of residents is higher than normal. Care Team Leaders have an hour’s overlap between shifts so they are able to provide a good handover. Staff were heard to be checking on information given at handover so they were clear on the status of residents at the beginning of their shift. CLS is developing strategies for staffing its homes as it progresses through the Investors in People programme. Staff at Greenacres have been formed into three teams, made up of care and ancillary staff, with a Care Team Leader being responsible for each team. Team meetings have begun, the aim of which is to develop a cohesive approach to work, where each member of staff understands the role of everyone else. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 19 A staff training and development plan is currently being devised for staff at Greenacres that will run through to the end of 2006, and members of staff are being asked to suggest particular areas of training that they feel would be relevant to the care of older people. Future planned training includes supporting people with dementia, moving and handling, fire safety awareness, health and safety, and life long living, and staff have suggested training in areas such as foot awareness which they would like to be delivered by the chiropody service. All members of staff are being encouraged to attend all courses. Training for staff in relation to care planning had not been successful, given the poor standard of care planning seen at this inspection. The content and delivery will need to be reflected upon before any further training sessions are scheduled. Development opportunities are being provided for staff. For example, one care assistant has received training so she can undertake administrative duties in the main office at Greenacres, and a kitchen assistant has been given additional support so that she can undertake duties as Cook. Residents were appreciative of staff, describing them as “helpful” and “considerate”. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: This section was not assessed on this occasion. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 3 4 7 Regulation 14 12 15 Requirement Pre-admission assessments must be carried out for all prospective residents. Respite care services must be no less rigorous than the service provided for permanent care. Care planning must be completed for each residents, and reviewed and updated on a regular basis. Risk assessments must be completed for all residents, and reviewed and updated on a regular basis. Healthcare results must be followed-up. Assessments must be arranged for residents health or mental well-being is deteriorating. A record of all visitors to the home must be maintained. External redecoration to the premises must be scheduled and completed. The training programme for care planning must be reviewed for its effectiveness. Timescale for action 5th September 2005 5th September 2005 Immediate and ongoing Immediate and ongoing Immediate and ongoing Immediate and ongoing 5th September 2005 31st March 2005 16th September 2005 4. 7 13 5. 6. 7. 8. 9. 8 8 13 19 30 12 12 17 23 18 Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 23 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. 4. Refer to Standard 4 19 27 30 Good Practice Recommendations Day Care services should be referred to appropriate providers. The programme of refurbishment and redecoration should continue. Additional staff should be employed at any time when the dependency levels of residents dictate. Training should be assessed following delivery to ensure staff competence. Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton, BL6 6HG 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 Greenacres F06 F56 S5736 Greenacres V229868 17.08.05 Stage 4.doc Version 1.30 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. 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