Inspection on 09/06/08 for Greengarth

This inspection was carried out on 9th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Greengarth 23/05/07

Greengarth 11/10/06

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 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Greengarth Bridge Lane Penrith Cumbria CA11 8HY Lead Inspector Diane Jinks Unannounced Inspection 09:30 9th June 2008 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.V361905.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.V361905.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 39 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (39) of places Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 39 service users to include: up to 39 service users in the category of OP (Old age, not falling within any other category) up to 10 service users in category DE(E) (Dementia over 65 years of age) 23rd May 2007 Date of last inspection Brief Description of the Service: Greengarth is registered to provide accommodation and care for up to 39 older people, of whom 10 have dementia. 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. Accommodation 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 large communal lounge that is used for special events, and a pleasant conservatory/garden room. There is a small day centre in the home, which operates Monday to Friday for people who live locally. This is managed separately and therefore not included in this inspection. There is a passenger lift and a range of mobility equipment to assist people in their daily lives. Outside there are garden areas and two pleasant easily accessible internal courtyards. 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 £326.00 - £434.00 per week (June 2008), subject to the assessment. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The assessment of this service took place over several weeks and included a visit to the home. A random inspection visit was also made to the home in November 2007. People using this service, staff, visitors and relatives were asked for their views and opinions about the home, either during the visit or by completing questionnaires. The provider completed an Annual Quality Assurance Assessment (AQAA), which provided extra information to verify some areas of the inspection process. What the service does well: What has improved since the last inspection? Improvements have been made to some of the decorations and furnishings at the home. This helps to ensure that the home is maintained to a good standard and provides a comfortable and safe environment for the people that live there. Improvements to the care needs assessment and care planning process have also been made, although there are still some areas that need to improve further. Some improvements have also been made to the social and leisure activities provided for the people that live at Greengarth. Comments on surveys show that some people enjoy these activities and ‘wish there were more’, whilst others are content to entertain themselves. People can choose whether or not they join in with these activities. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 6 The service is required to tell us about certain accidents and incidents that occur at the home, particularly where it affects the well-being of a resident. Improvements have been made to ensure that senior staff are aware of this reporting process. 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. The summary of this inspection report can be made available in other formats on request. Greengarth DS0000036484.V361905.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.V361905.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service have their health and social care needs assessed prior to moving into the home. This helps to ensure that the home will be able to meet their needs and expectations appropriately. EVIDENCE: Most of the people that participated in this assessment of the service say that they received enough information to help them make a decision about moving into the home. Some people said that they were able to visit the home before they made their decision. The home produces a Statement of Purpose and a guide. These documents provide information about the home and the type of services it can provide. We looked at a sample of care records during our visit to the home. They show that people are given a copy of their terms and conditions of residency. This helps to make sure know what is included in their fees and the type of service they may expect. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 9 The files also contain care needs assessments. These have been carried out by a social worker or the manager at the home. Care needs assessments help to make sure that the home will be able to meet the needs and expectations of the prospective resident. The organisation has recently introduced new ways of recording pre-admission information. This will help the manager and staff at the home to develop a more person centred and individual care plan for people who use this service. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some gaps in the care planning process, which means that people using this service may not always consistently receive the service and support they need. EVIDENCE: The sample of care files that we looked at contain care plans and information about the level of care and support each person requires. They include information regarding risk assessment, nutritional assessment and details of medication needs. The care plans are generally up to date and reflect the current level of care and support required, providing details of how these needs will be met. Although they have been reviewed monthly there are some areas where changes to care needs and risks have not always been updated. Staff are able to give verbal updates and people using this service say that they receive the care and support they need. One person, receiving respite care, does not have a formal plan of their care needs or of how their needs would be met. Their care plan is starting to be developed. The manager has consulted the person about their needs and Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 11 requirements, recording these in the assessment document. Further information to help with the development of the care plan, has been obtained from the day care centre, within the home, which this person attends. Care plans and daily notes show that people have access to healthcare professionals such as doctors, community nurses, opticians and dentists. Most of the people taking part in the assessment of this service say that the staff at the home are very attentive. They say that their needs are always catered for and that when summoned, staff arrive promptly. One relative was particularly pleased with the care her mother receives. She said ‘nothing is too much trouble for the staff. If we paid £1000 a week, our mother could not receive any better care’. There are medication policies and procedures in place to help ensure that medication is managed and administered safely. Staff records show that training has been undertaken to help them carry out this task safely. Medication is mostly supplied in colour-coded blister packs and there are photographs of residents kept in the medication records. These measures help with identification and help ensure that the correct medicine is given to the correct person at the correct time. Two members of staff undertake the administration of medication. One is directly responsible for the administration and a second person checks the record chart and that it is being given to the correct resident. Both workers then sign the record. A sample of the medication records was looked at. They were found to be up to date and accurately completed. Medicines have been signed for and where medication has been refused or not required the records have been completed appropriately. An audit of medication that is liable to misuse was carried out. The home has an appropriate record book and clear records are kept of the times the medication is given and when a new supply comes into the home. The records for this type of medication are also signed for by two members of staff. Medication is generally stored securely and there is a designated fridge at the home for medication that requires cold storage. This is also secure with appropriate records maintained. There are procedures in place for checking medication into the home and for medication that needs to be returned to the pharmacy. Supervisors are given dedicated time for the responsibility of checking and recording medication to help ensure that this is done thoroughly and accurately. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are provided with opportunities to participate in some social and leisure activities if they choose. EVIDENCE: The manager told us that there is a range of interesting and achievable activities provided throughout the week or people to join in if they wish. Details of daily activities are displayed on notice boards throughout the home. Future events are discussed at residents meetings. A church service is held weekly at the home and people using this service choose whether they attend or not. The home has links with the local community and voluntary organisations. For example, children from local schools organise tea parties and entertainment. Local drama groups visit and perform in the home. Voluntary groups provide coffee mornings/evenings. People using this service, their friends and families are encouraged to support and participate if they choose. A League of Friends group is established and meets regularly in the home and a representative from this group attend residents meetings. They help with fundraising for extra activities, outings and to offer general social and cultural Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 13 assistance. Some of the people that use this service told us that there are activities and opportunities for social stimulation in the home. Some people choose not to participate in these activities, whilst others ‘wish there were more.’ People confirm that residents meetings are held and a variety of subjects are covered on the agenda. People living at the home are encouraged to attend and have their say. There are proposals to re-locate and modernise the home in the future. Consultation meetings have taken place with residents, staff, families and friends. Where necessary an advocacy service has been obtained to ensure that all residents are clear about the proposals and are able to express their views and opinions about them. There is written information about the proposals available at the home. The meals at the home are freshly prepared by the cook. Meals include fresh fruit and vegetables and home baking. The people we spoke to indicate that they are satisfied with the food. They say that there is always plenty of variety, choice and food. There are always two choices at lunch and teatime. Some people say that if there is something on the menu that they don’t like, then they are always offered an alternative. One person said that they had tea and biscuits in bed first thing in the morning, which they enjoy. They added; ‘there is always enough to eat at meal times and you can have more if you want it’. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are safeguarded and protected from harm or abuse by the rigorous policies and procedures that are in place at the home. EVIDENCE: There is a complaint process in place at the home. A copy of this is on display on the main notice board. There is also information about the organisations complaint process, which would be through the local authority. Most of the people living at the home say that they know about the complaint process and who to address their complaints to if necessary. No one that we spoke to had needed to make a complaint and the home has not received any since our visit to the service last year. However, a significant number of people using this service did indicate that they did not know how to raise a concern. This was discussed with the manager as a possible topic for the residents meeting agenda. This would help clarify the process and inform people of whom they needed to speak to if they did have a concern or complaint to raise. The manager has a process in place for recording information about complaints, including their outcome. This helps to ensure that complaints will be dealt with properly. Monitoring complaints is good practice; it helps the manager to identify where further improvements may need to be made to the service. There are also procedures in place at the home to help protect people from harm or abuse. Some of the staff we spoke to said that they have received training on this subject and that it helped to raise their awareness of what to Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 15 do if they suspect an adult in their care has been abused. Staff training records confirm that training and refresher training takes place. The home also has copies of the local authority’s guidance on reporting and responding to safeguarding matters. This further helps to make sure that people are protected from the risk of abuse. The manager also ensures that people living at the home have access to advocates and other professionals if they choose or if they are needed. This encourages people to voice their opinions and raise any queries or concerns they may have. People completing surveys as part of this inspection process indicate that staff listen and act upon what they say. Comments from staff and from the surveys we sent them indicate that they are aware of the safeguarding process and of the complaint process. Most of them say that they are able to approach their supervisor if they are concerned about the welfare of anyone living at the home. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 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 warm, clean and pleasant environment for the people that live there. There are some areas that would benefit from further improvements. EVIDENCE: The home consists of four units including one unit allocated to people who have dementia illnesses. Each unit has a communal lounge and dining area together with a small kitchenette. Breakfasts are served from here and throughout the day there are facilities for hot and cold drinks and snacks. There is a large lounge area and two conservatories, one of which is located in the Wainwright unit. The home has a designated room for those residents who wish to smoke. The room needs to be reviewed to ensure that it fully complies with the smoking laws. These areas are maintained in a clean and tidy manner and people living at the home say that it is always clean and fresh. Each unit also has communal bathrooms, shower rooms and toilets. There is a reGreengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 17 decoration and general maintenance programme in place at the home. Many of the communal areas and private rooms of the people that live at the home have been improved and redecorated to a good standard. People are able to personalise their own rooms. Many have their own televisions, radios, ornaments, pictures and photographs in their rooms. The majority of bathrooms and toilets require some work. Wallpaper is peeling, there are some water-damaged areas and the handling equipment used to help people access these facilities has damaged some baths. We have previously highlighted these areas as needing some refurbishment to help ensure that people may bathe in a comfortable, safe and relaxing environment. Refurbishment in bathrooms and toilets would also help to reduce any risk of cross infection. The home is equipped with various aids and adaptations to help people using this service with their mobility and to maintain as much of their independence as possible. Facilities include grab rails, raised seating, handling equipment and a passenger lift to the first floor. Care staff have some responsibility for some domestic tasks, but there are housekeepers employed too. During this visit to the home we looked at the laundry. It was kept in a clean, tidy and well-organised condition. Staff working in the laundry are provided with gloves, aprons and special laundry bags are used for some of the laundry. This helps to manage and control the risk of cross infection. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are recruited safely and are provided with training. This helps to ensure that people using this service are supported by suitable care workers, who understand their needs and requirements. EVIDENCE: We looked at samples of staff recruitment and training files during our visit to Greengarth. There are robust recruitment and selection procedures in place and staff are not allowed to commence employment at the home until the organisation has undertaken all the necessary checks. These measures help to safeguard the people that live in this home from unsuitable care workers. Staff training records show that the home provides induction training and further training for all staff. Various training courses are undertaken including basic training such as manual handling, health and safety, food hygiene, infection control, fire procedures and the administration of medication. Some specialised training is also provided to help staff understand the needs of the people they care for. Examples of this training includes dementia awareness, catheter care, bereavement and National Vocational Qualifications (NVQ). The manager says that over half of the staff that work at Greengarth have gained or are working towards an NVQ in Care. At the time of our visit, there appeared to be a sufficient number of staff on duty at the home. Both staff and people living at the home who returned surveys to us indicate that there are usually enough staff on duty at the home. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 19 The home generally has a low turn over of staff and this helps to build and maintain good relationships, understanding and consistency between staff and residents. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed by a qualified and experienced manager. This helps to ensure that the home operates to promote and protect the best interests of people who use this service. EVIDENCE: The Manager of Greengarth has 19 years experience working in a range of older adults residential care settings. She has achieved qualifications in management and in health and social care, as well as the registered managers award. She is supported by a team of supervisors and the operations manager visits the home regularly. Residents meetings are held and the manager states that from time to time people using this service are asked about their views and opinions on a variety Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 21 of their experiences of living at Greengarth. These meetings are particularly important at this time as the home falls into Cumbria Care’s modernisation programme. This means that the home has been recommended for replacement by a new and up to date building. People living at the home indicate that they are being consulted and kept up to date on these developments. People living at the home have been consulted on their views and where necessary they have been supported by advocates to help ensure that their views and best interests are properly represented. Staff records and surveys confirm that they receive regular supervision from either the manager or a supervisor. Supervision helps to make sure that staff are working safely and keep up to date with their training and good practice techniques. Annual appraisals also take place. Information obtained from supervision and appraisals helps the manager to produce a training and development plan for the staff and the home. Some people using this service take advantage of the secure facilities at the home for the safekeeping of some of their money. We looked at a sample of the records kept in relation to resident’s personal monies. There is a clear process for recording monies in and out of their ‘accounts’. Two signatures are required for all transactions and where staff purchase goods on behalf of the resident, receipts are obtained and kept. The manager carries out random audits of the accounts. These measures help ensure that resident finances are protected from mis-use and handled safely. We looked at a selection of maintenance and service records for the home. Fire fighting equipment is regularly checked, as are electrical appliances and manual handling equipment such as hoists. We looked at the records of accidents, incidents and notifications that the manager is required to tell us about. The home has a copy of the latest guidance regarding notifications and there are clear written instructions for staff with the responsibility of completing these documents. The manager makes sure that accident forms are completed, when appropriate, for both staff and resident injuries, accidents or near misses. Care files contain risk assessments in relation to manual handling and assisting people with their personal care regimes. These documents do not always contain sufficient information for staff to follow, particularly where people may have behaviour that challenges or may be susceptible to pressure sores or falling. Gaps in risk assessments may at times compromise the health and well being of some of the people who use this service. Additionally, these documents are not always signed and dated. This makes it difficult to assess whether the information is up to date and current. There are areas of health and safety, which demonstrate good practice. Staff are provided with health and safety training, safe handling techniques and infection control. Where bathing equipment has limited use, risk assessments have been undertaken and are available for staff to consult. Greengarth DS0000036484.V361905.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 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 12 Requirement The risk assessment process in place at the home must include the provision for assessing people at particular risk from falling. Strategies must be recorded to assist staff to minimise the risks to people using this service. Where necessary, expert advice must be sought to ensure that strategies are appropriate and any specialist needs are not overlooked. (Previous timescale of 30/06/07 and 31/12/07 not met). Timescale for action 14/07/08 2. OP7 15 Where changes in care needs are 14/07/08 identified, these must be recorded without delay. Care plans must accurately reflect the care and support required by each individual. This will help ensure that people using this service receive the care and support they need. There must be a detailed plan, including timescales, in place at the home to ensure that the bathrooms, shower rooms and DS0000036484.V361905.R01.S.doc 3. OP19 23 31/08/08 Greengarth Version 5.2 Page 24 toilets at the home are maintained in a safe and satisfactory condition. This will help ensure that people using this service live in a safe and comfortable home. 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 OP38 Good Practice Recommendations It is recommended that the manager review the smoking policies and the designated smoking room at the home to ensure that the arrangements in place are sufficient to meet the smoking legislation introduced from 1st July 2007. Greengarth DS0000036484.V361905.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Greengarth DS0000036484.V361905.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. 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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