Inspection on 11/10/06 for Greengarth

This inspection was carried out on 11th October 2006.

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

Greengarth 09/06/08

Greengarth 23/05/07

Greengarth 18/01/06

Greengarth 29/06/05

Greengarth 03/11/04

Greengarth 23/06/04

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

CARE HOMES FOR OLDER PEOPLE Greengarth Bridge Lane Penrith Cumbria CA11 8HY Lead Inspector D Jinks Unannounced Inspection 09:10 11 and 13 October 2006 th th 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 Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengarth Address Bridge Lane Penrith Cumbria CA11 8HY 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) 01768 242040 www.cumbriacare.org.uk Cumbria Care Mrs Susan Jane Tweddle Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (40) of places Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. A maximum of forty older people (OP40) may be accommodated. Ten of whom may have dementia (DE(E)10). 18th January 2006 Date of last inspection Brief Description of the Service: Greengarth is currently registered to provide accommodation and care for up to 40 older people, of whom 10 have dementia. However, the home has recently changed one of the smaller bedrooms into a designated smoking area for residents. The number of service users the home can now accommodate is 39. The home is operated by Cumbria Care, which is an internal business unit of Cumbria County Council. Greengarth is situated close to the centre of Penrith and is on a bus route. The accommodation for the residents is provided in four separate living units, each with a lounge/dining room and kitchen area, communal bathrooms and toilets. Bedrooms are close by. There is also a communal large lounge that is used for special events, and a conservatory situated near to the unit, which accommodates people with dementia. There is a small day centre in the home, which operates Monday to Friday for people who live locally, but this is managed separately and therefore was not included in this inspection. There is a passenger lift and a range of equipment to assist people in their daily lives. Outside there are garden areas and two pleasant easily accessible internal courtyards for residents to sit out in good weather. There is a small car park for staff and visitors. The home produces a guide to the services and facilities provided and this is available on request from the manager. The scale of charges range from £363.00 - £422.00 per week (October 2006), subject to the assessment. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home, which took place over a day and a half. During the visits all the key standards of the National Minimum Standards were assessed. The visits included discussions with the manager and staff at the home as well as meeting and talking to some of the residents and their visitors. Questionnaires were also sent out to health care professionals, residents and their relatives or representatives. These helped to obtain personal views of the services provided by the home from people with varied backgrounds and experiences. There was a poor response to the questionnaires with very few being returned. The registered manager had completed a pre-inspection questionnaire prior to this visit. This assisted in verifying information throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home has a procedure in place for dealing with complaints, this document would benefit from a review to ensure that people using this service fully understand the process and what they might expect if they do raise concerns. Most residents have their own written plan of care and support. These plans do not consistently record all of the relevant and necessary information to ensure that residents personal, social and healthcare needs will be met appropriately. Some of the entries made in these records and some of the practices at the home do not indicate that residents are always treated with respect and dignity. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 6 Risk assessments are also undertaken but again they do not always contain sufficient detail and information. People living at the home said that there are ‘sometimes’ activities available that they can join in if they wish. The activities available would benefit from a review, to include the views and interests of residents. This would help to ensure that leisure and social interests of everyone living at the home are considered and included in a structured activities programme. Service users should be consulted about the meals and menus that are provided. Where service users require a special diet, the advice of dieticians should be sought. This will help to ensure that each resident is provided with a balanced and nutritious diet. 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. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home obtains care needs assessments prior to admitting residents to the home. This helps to ensure that the home is suitable and will be able to meet their needs appropriately. EVIDENCE: A sample of residents care files were looked at. These residents had moved into the home during the last six months. Each person had received an assessment of their care needs prior to their admission. The assessments had been undertaken either by the social service department or the hospital. The details recorded in the assessments did not consistently provide the same level of information. Some of the assessments had been reviewed by the resident’s social worker. Some of the resident’s relatives were spoken to during the visit. They said that social services had helped them with the choice of home, ensuring that they were provided with sufficient and relevant information about the home. They were also able to visit the home prior to admission and felt that any questions they might have were answered to their satisfaction. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 9 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, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not consistently record sufficient information regarding resident’s needs. EVIDENCE: Most residents had a care plan, although one resident with extensive care needs had lived at the home for several months and did not have a care plan. In most cases care plans included basic information, which included a risk assessment element. The plans did not consistently provide sufficient information about the individual care needs of each resident. Where assessments and care plans identified that service users had problems with eating, drinking or had special dietary needs, nutritional assessments and monitoring had not been carried out. Risk assessments were generally carried out but these were inconsistent and there were gaps – particularly where service users may suffer from some conditions such as dementia, poor eyesight or may be prone to falling. Where incidents had occurred reviews and amendments to care plans and risk assessments had not always taken place. There is evidence to indicate that care provision is not properly thought through and linked to the needs of service users. For example, a service user Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 10 at the home was described as having a ‘poor appetite’ and ‘loose fitting dentures’ but a referral to a dentist had not been made to check whether the dentures contributed to the cause of the poor appetite. Comments written in care plans did not indicate that service users were always treated with respect and dignity. During a visit to this home one resident was seen on the toilet with the door open. The toilet was on the ground floor and very near to the main entrance area and manager’s office Daily notes kept by the home recorded significant events in the daily lives of people living at the home and there was evidence to indicate that residents had access to their doctor, district nurses, chiropodists and hospital appointments. There had been several instances of medication errors at the home over the last 12 months. The medication policy and procedure at the home have recently been reviewed. Supervisors at the home were responsible for the administration of medication and had received training. A second member of staff accompanied the supervisor on the medication round and acted as a ‘checker’. These measures helped to ensure that the incidence of further errors were minimised. Samples of medication records looked at during the visit had been accurately completed. Each medication round can take up to two hours to complete. This may mean that any recommended times between doses are not always adhered to. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The food and menus available in the home did not indicate that service users received a nutritionally balanced diet based on good practice, guidance and advice from dieticians. EVIDENCE: Residents at the home had some access to social and leisure activities. Some of the care plans recorded their hobbies and interests. Activities that were said to take place included games such as dominoes, cards, gentle exercises, television and music. Occasionally outside entertainers visited the home including pupils from a local school. Weekly church services take place at the home and residents are given the opportunity to attend if they wish. Some of the people spoken to during the visit said that staff tried to put on activities but said this was not always easy for them to do due to the limited ability and concentration of some residents and also due to the lack of staff. Another person said that they were generally satisfied with the care provided at the home but there is a ‘lack of stimulation both verbal and physical’. Residents meetings take place every three months and residents; their relatives and staff are able to attend. Issues that affect the home and future activities are discussed at these meetings. Minutes are kept of the meetings and are circulated. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 12 People living at the home were able to see their visitors in the privacy of their own room or in one of the communal areas as they wish. District nurses and relatives participating in the inspection confirmed that this was the case. Service users may also choose to have their meals in their own room or in their dining area. The sample of menus seen at the home did not provide sufficient information to confirm that residents are always offered a nutritionally balanced diet. Service users are offered a choice of food and vegetables are included with the meals. However, nutritional assessments have not been completed for service users who may have special dietary needs or who may be at risk of becoming under nourished. A discussion with some of the residents and the cook indicated that the advice of dieticians was not actively sought for residents who may need special diets such as low fat, vegetarian or soft foods. The cook confirmed that soft diets would be pureed together. The home has a large food processor that is too big to puree individual items of food. This was discussed with the cook and the manager, it was suggested that the home buy a small hand blender or similar gadget to help ensure that meals are presented in an attractive and appealing manner. A poor attitude and limited knowledge towards the special dietary needs of service users was demonstrated. A tour of the kitchen and food storage areas confirmed that a selection of fruit and vegetables were available. On the day of the visit the cook was making fruit pies, using some of the gifts that the home had received from local Harvest festivals. The manager is aware of the recent guidance on nutrition and this subject was discussed with her as needing attention. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had policies, procedures and staff training in place to help ensure the protection and wellbeing of people living at Greengarth. EVIDENCE: The home had a comments and complaints process. This was made available to residents and their relatives. The procedure would benefit from a review to ensure that the process is clearly described, includes the stages and timescales for dealing with complaints and is updated to ensure that name of the Commission for Social Care Inspection, together with accurate details of the address and telephone number are included. The manager indicated that she had not received any complaints during the last 12 months. Most of the service users and their relatives, participating in the inspection indicated that the manager or staff would listen and deal with any complaints that they might have. There was a process at the home to help ensure the protection and safety of vulnerable adults. The home also had a copy of the local authority’s multi-disciplinary procedures for the protection of vulnerable adults. Staff are provided with training and updates to help them recognise, prevent and report any suspicions they may have regarding the mis-treatment of adults. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 14 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home generally provides a clean, safe and homely environment for residents. EVIDENCE: The home was reasonably well maintained and provided a homely environment for residents. There were some areas of the home that need to be redecorated and carpeted, in particular the lounge area in Wordsworth unit, where the ceiling and the carpet required some attention. The fire door at the top of the main staircase was also in need of some attention to ensure that it closed properly. The manager confirmed that no redecoration or refurbishment had been undertaken at the home since the last inspection in January 2006. Service users each had their own room, which although small, had been personalised with some of their own possessions such as pictures, ornaments and small items of furniture. The home was ‘divided’ into four units. Each unit had it’s own lounge, dining and kitchenette area. There were bathrooms, shower rooms and toilets sited throughout the home. Bathrooms and toilets were fitted with equipment such as hoists, bath seats, raised seats and hand Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 15 rails to help maximise the independence and safety of residents. Each room had an emergency call bell so that residents may summon assistance from staff if required. A former bedroom, which was particularly small, had been designated as the smoking area. There was a conservatory and a large communal day room that service users may also choose to use. Generally, the home was clean, fresh and maintained to a reasonable standard. Although on the day of this visit there was a slight odour near the toilet and bathroom area by the day centre. This was discussed with the manager as requiring some attention. The home had experienced long term problems with domestic staff and agency staff have been covering these tasks. The manager tried to ensure that the agency send the same member of staff, which helps with continuity and maintaining standards. There was a fully equipped laundry at the home. This area was maintained in a clean and tidy condition. Protective clothing was available for staff to use and laundry items were kept separately with special laundry bags available to help prevent the spread of any infection. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 16 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, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels may not always be appropriate to meet the needs of people living at the home. EVIDENCE: There was a staff rota kept at the home, which showed the numbers of staff on duty at any given time. This indicated that there were sufficient staff on duty at peak times, for example, getting up in the morning, to help ensure that the needs of people living at the home were met. There were several staff vacancies at the home and staffing levels had been supplemented with the use of agency staff on some occasions. The home employed care staff, including relief, support workers and supervisors, cooks and domestic assistants. Sufficient numbers of staff were on duty on the day of the visit and resident’s needs were generally being met appropriately. The manager was confident that sufficient numbers of staff were on duty at all times, including during the night. At the time of this visit there were several residents at the home requiring two members of staff to attend to their care needs at night and had high dependency needs. The size and layout of the home could potentially pose problems for staff in ensuring that service users needs are met appropriately and timely. During a visit to this home it was noted that a ‘call bell’ in the home remained unanswered for over five minutes. Some of the staff, residents and relatives participating in the inspection said that the home appeared to be short of staff on occasions. Each member of staff had a personal development record. This recorded the various training courses that they may have undertaken, including training in Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 17 the principles of care, manual handling, emergency action, adult protection, medication awareness, dementia awareness and National Vocational Qualifications (NVQ). It is a number of years since some of the staff at the home participated in some of these training courses and it would be beneficial for them to receive updated training. Some comments regarding staff training were received from visiting professionals. They felt that staff would benefit from further education relating to use of continence pads, pressure area care and prevention of pressure sores. The training files of two members of the night staff team were looked at. The records available did not indicate that night workers consistently receive suitable training and updates as required and this was discussed with the manager during the inspection. The home had a robust process for recruiting new members of staff. Samples of employment records were looked at during this visit. They contained details and records to confirm that all the necessary checks and information was obtained prior to employing staff at the home. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 18 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): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a qualified and experienced manager at the home. However, the home may not always be run in the best interests of service users. EVIDENCE: The registered manager had completed relevant managerial training to help her in carrying out this role competently. Generally, residents and visitors to the home were satisfied with the service they received and commented that the staff were very good, caring and competent. Most people also generally felt that the manager was approachable. As part of the inspection process, questionnaires were sent out to a random selection of people living at the home, their relatives or representatives and staff working at the home. On this occasion there had been a poor response to the questionnaires and the manager was asked to encourage service users and staff to complete and return them. This information helps to inform the inspection process. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 19 There were arrangements in place at the home for quality assurance checks to be carried out. The results of these checks were included in the annual development plan for the service. Service users were encouraged to be responsible for their own finances, sometimes with the help of their relatives. There were facilities available at the home for the safe keeping of resident’s valuables. Records relating to residents, staff and the running of the home were kept. These were not always up to date and accurate. Care plans and risk assessments were missing, staff training records did not consistently record up to date information and therefore there is room for some improvements in these areas. The manager was responsible for ensuring the health, safety and welfare of residents and staff at the home. Fire records had been kept, staff fire training had been maintained up to date and the manager was aware of changes in respect of fire safety and risk assessment. The home’s existing fire risk assessment was in place until Cumbria Care’s health and safety officer has undertaken appropriate training in order to carry out an up dated fire risk assessment for the home. In general food preparation and storage areas were clean and tidy. Opened packets of food had been resealed, covered and labelled with dates. The cook was seen to be wearing nail polish on one of the visits to the home and had also wedged open the fire door to the kitchen from the home. These health and safety matters were discussed with the manager for her attention. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15, 17 Requirement The registered person must ensure that each service user has an up to date care plan, which sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the service user’s needs are met. Each care plan must be reviewed at least once per month. The registered person must ensure that service users have access to specialist services, which including dental and optical services. The registered person must ensure that service users rights to privacy, respect and dignity are upheld at all times. The registered persons must ensure that service users receive a varied, appealing, wholesome and nutritious diet. The menu plans must also take into consideration the views of service users. Timescale for action 01/12/06 2 OP8 13 01/12/06 3 OP10 12 14/11/06 4 OP15 16 01/12/06 Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 22 5 OP15 16 6 OP16 22 7 OP30 18, 19 8 OP38 12, 13 The registered persons must ensure that food, including pureed meals, is presented in an attractive and appealing manner The registered person must ensure that there is a simple, clear and accessible complaints procedure, which includes the stages and timescales for the process. The registered person must ensure that all members of staff receive appropriate training, including refresher training; appropriate to the work they are to perform. The registered person must ensure that the home and staff working at the home comply fully with all aspects of health and safety legislation. 14/11/06 01/12/06 31/01/07 14/11/06 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 Refer to Standard OP8 Good Practice Recommendations It is recommended that the registered persons undertake a full and detailed nutritional assessment in respect of each resident upon admission to the home and subsequently on a periodic basis. Significant factors such as levels of mobility and oral health should also be considered and recorded. It is recommended that the registered person review the system for the administration of medicines, to ensure that the correct amount of time between doses is allowed and service users receive their medication within the appropriate timescales and as prescribed. It is recommended that where staff administering medication are unable to wash their hands in between service users, the use of alcohol hand cleanser be used in preference to ‘baby wipes’. DS0000036484.V308623.R01.S.doc Version 5.2 Page 23 2 OP9 3 OP9 Greengarth 4 OP12 5 OP19 6 OP27 7 OP31 It is recommended that the arrangements for leisure, social and recreational activities are reviewed and updated to suit the needs, preferences and capacities of the people living at the home. It is recommended that the registered persons review and update the renewal and maintenance plan for the home to ensure that all areas of the home, which require attention, are included in the plan. It is recommended that the registered persons review the staffing levels in line with the identified needs of people living at the home to ensure that their care needs will be appropriately met in a safe and timely manner. This should include the numbers of staff on duty at night and an action plan for outbreaks of illness, which may affect both staff and service users. It is recommended that the registered persons ensure that the records kept at the home are maintained accurately, kept up to date and reflect current good practice guidance. Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Greengarth DS0000036484.V308623.R01.S.doc Version 5.2 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!