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Inspection on 08/06/06 for Herewards House

Also see our care home review for Herewards House for more information

This inspection was carried out on 8th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff were welcoming and there was a relaxed atmosphere in the house. Staff worked well together and service users spoke well of their care.

What has improved since the last inspection?

There has been new carpet in the communal areas and new furniture purchased. A new stairlift has been installed.

What the care home could do better:

The house needs improvement both decorating and making safe the garden. The temperature in the conservatory needs monitoring once the ceiling fans have been put in place. The dining room needs better crockery, cutlery and glasses. An OT assessment is necessary to make sure that the house has sufficient lifting aids and adaptations. Care plans must be in place for all service users and reviewed regularly. Recruitment must be safe and include two references and CRB checks. Staff training in manual handling is needed now. Checking training for all staff is important and ensuring that NVQ training increases. Staff supervision needs to improve. Quality assurance needs to include relatives etc. and the annual development plan is available.

CARE HOMES FOR OLDER PEOPLE Herewards House 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP Lead Inspector Unannounced Inspection 8th June 2006 10:50 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 Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Herewards House Address 15 Ray Park Avenue Maidenhead Berkshire SL6 8DP 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) 01628 629038 Mr Bedanan Guru Seegoolam Mrs Dhanwantee Seegoolam, Mrs Sangeeta Rukunny, Mr Bolah Rukunny Mr Bolah Rukunny Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Herewards House is situated in a quiet residential area of Maidenhead. There is a parade of shops in walking distance with the River Thames close by. The building has been converted and extended to provide residential accommodation for 27 elderly persons. The home has a conservatory with access to the garden, a dining room and separate lounge. Some bedrooms have en-suite facilities. Since July 2004 the home has been under new ownership, and is managed by the proprietors who are jointly registered with CSCI and job share the Registered Managers post. The current scale of charges is £400-450 per week. Additional items include sweets, cigarettes, hairdresser, chiropody and newspapers. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been prepared using a pre-inspection questionnaire prepared by the manager, 6 questionnaires completed by service users with the Manager, inspection records and a site visit that took place on 8th June for a total of 5.5 inspector hours. Included in the site visit was discussion with the manager and senior staff, conversation with service users and discussion with care and household staff. Some records were seen and the inspector had lunch with service users. What the service does well: What has improved since the last inspection? 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. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 6 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 Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 7 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): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The statement of purpose and service user guide are available and provide sufficient information. Contracts are given to all service users. The manager is admitting service users out of registration category. One of the last admissions had a noted diagnosis of dementia. The home is not registered to provide this care. The inspector was advised that this was incorrect. Written confirmation of this was received. The manager must ensure that care plans include accurate information. EVIDENCE: The statement of purpose and service user guide are available and contain sufficient information for prospective service users and relatives. Contracts are given to all service users; this was confirmed in the questionnaires and in individual service users files. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 8 The last four admissions to the home were seen as part of case tracking. All of these contained assessments completed prior to admission. Of these admissions one service user admitted had a diagnosis of dementia and this was a main part of the care needs. The home is not registered to admit people with dementia. The providers and managers must not admit out of category. The providers recognised this. Further information was provided by the care manager that there was no diagnosis of dementia for this service user. Therefore the requirement has been removed. Intermediate care is not given in this home. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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 adequate. This judgement has been made using available evidence including a visit to the service. Care plans are available. One service user did not have a completed care plan. Daily records were kept. Care plans were reviewed approximately three monthly. Medication administration by care staff was seen to be safe. The manager must ensure that all care staff administering medication are safe and administer according to the home’s policy and procedure. EVIDENCE: Care plans of four service users were case tracked. These showed that all service users had their care needs assessed prior to admission. An initial care plan was prepared but this did not include details of how physical care would be given. For one service user an initial care plan had not been prepared. Care plans showed that care was considered. Care plans are reviewed up to three monthly and the National Minimum Standards recommend monthly. This helps to make sure that changing needs are noted and care changed as necessary. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 10 GP’s provide the medical service. Records are kept of visits. Referrals are made for other services as necessary. One service user has been referred to medical specialists following increased agitation and confusion. This has affected other service users causing some anxiety. Staff have not had dementia training or challenging behaviour training and this should be considered to assist with anxious behaviour. Medication administration is by care staff. Medication storage is in the conservatory. The room is hot and staff are planning to move the medication in case it is too hot. In the meantime the temperature in the cupboard must be checked daily. The medication store is ordered and medication brought in and disposed of records are kept. Medication training took place last year. There is a medication procedure for use by staff. There is no record of initial training and any subsequent check to ensure that medication is administered according to the home’s procedure. The managers need to ensure that checks are in place. A Service user said, “ I can stay in my room or come out to the lounge”. The inspector saw service users views being respected by staff. Staff encouraged service users to make full use of the home, assisting to move into the garden or around the house. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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 the service. Activities are limited. To ensure that activities take place and are publicised. Relatives and friends are relaxed during their visits. Better crockery, cutlery and glasses could improve the meal service. The meals were straightforward and generally satisfactory to service users. EVIDENCE: There are some outside entertainers brought in. Each day a member of staff is allocated to do some activities and a general record is kept of this. No training has been given and the activities did not always take place. Only a few service users were involved in these. There is no daily planned activity schedule publicised to give service users choice to attend or not. Visits by outside entertainers are displayed. No activities took place during the visit. It is important to provide social activities for people to enjoy as part of their quality of life. Service users spoke of wanting more occupation. Activities need to be reviewed with service users. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 12 Service users have easy contact with relatives and friends. The inspector met visitors who were happy with care, one visitor spoke very well of the care given. Visitors are encouraged. Choice and control of service users is present but could be improved e.g. choice of meals, choice of activities. The meal service in the dining room was freshly prepared and enjoyed by service users. There was discussion with the chef about when preparing soft food that each part of the meal is kept separate. The inspector was advised that one service user preferred food minced together. It was agreed that the chef would try to separate the food for both other service users. One service user said, “ The food was satisfactory”. Service users can eat in the dining room or in their own rooms. Another service user said, “There is a choice of where to eat”. The menu has an alternative but no choice is offered to service users; anyone who doesn’t like the main course is given the alternative. It would be good practice to offer options for the main meal to service users each morning. There would then be a real choice for all service users. This is recommended. The dessert was served with cream and no choice was given. The chef agreed to use a jug and offer choice in the future. The plates, cutlery and glasses used on the dining tables were of poor quality and unmatching. The inspector was given a cracked plastic glass that leaked onto the table. It is important for service users dignity and respect that the presentation of the tables is good and to prevent infection that cracked crockery is not used. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Complaints are investigated as necessary and people know who to take concerns to. POVA issues are taken seriously. EVIDENCE: The complaints record was seen and included all complaints being investigated in a timely fashion. There is a complaints procedure available and service users noted in questionnaires and in conversation that they knew who to complain to. The manager has obtained the multi-agency guidelines for investigating suspected abuse of vulnerable adults. During the visit one service user was noted as having unexplained bruising. Following this staff training has taken place to ensure that all staff know how to report unexplained injuries and a reporting format has been introduced. Some staff will also be completing the POVA course locally. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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, 22 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The house has had some improvements made, there are still more to be done. The high temperature in the conservatory is a concern for service users and storage of medication. There is one hoist in the home and limited lifting and handling equipment. A review of the home by an OT is necessary to ensure sufficient equipment is in place. Household staff work hard to keep the house clean and tidy. The security of the garden should be improved. EVIDENCE: The house is large and spread over three floors. There have been some new carpets on the ground floor and in bedrooms and the back garden has been Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 15 cleared. A new stairlift has been put in and some new furniture has been purchased. The front drive has been resurfaced. There is still a lot of work to be completed. There is an outstanding recommendation to redecorate the large bathroom; this has not been completed. All of the bathrooms on the first and second floor have peeling paper and poor paintwork and need to be redecorated to prevent cross-infection. The house generally has a homely feel with a lot of decorative items around. One of the main lounges is a conservatory and provides a light and bright lounge. Unfortunately the lounge is very hot in the summer. The manager agreed that the temperature was hot and advised CSCI in writing that two ceiling fans would be put in place within a week. Because of the discomfort of the service users in this room it is important to advise when the fans are in place and to monitor the temperature daily e.g. during the middle of the day, to make sure that the temperature has dropped sufficiently. There is one hoist left in a service users room. To use this hoist in other parts of the building staff have to lift the hoist up a step. In discussion with the manager there was no copy of an Occupational Therapy report to make sure that the home has sufficient disability equipment and environmental supports. There are two service users in wheelchairs with very restricted mobility plus other service users with mobility difficulties. In view of the limited handling equipment available it is required to have an OT review of the building. The household staff work hard to maintain a clean environment. During the visit when touring the home 2 rooms needed carpet cleaning. The manager confirmed that these carpets would be cleaned in a few days. There were a few places in corridors were the carpet had become wrinkled. The manager confirmed following the visit that the carpets would be refitted on 15th June. The garden surrounds the home. There has been a recent incident when a service user went out in the evening to the front of the house and was returned by a member of the public. In the evening without staff support it is not safe for service users to be in front of the house. The care plan has been reviewed but no physical change has been made in the house to prevent a reoccurrence. Staff are unable to constantly monitor this service user in the evening. Therefore the manager must make provision to ensure the safety. Options include improving the fencing so the front of the house cannot be accessed from the side or back or an alternative monitoring system. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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 poor. This judgement has been made using available evidence including a visit to the service. Sufficient staff are on duty. Recruitment records are very poor and put service users at risk. Staff training in manual handling is not up to date and will also put service users at risk. NVQ training needs to expand. EVIDENCE: The staff rota demonstrates that sufficient staff are employed, there are more staff in the morning to ensure physical care is given. The staff group includes women and men and with a variety of ages. Service users were positive about the staff; comments made included “ the staff are very good” “ satisfied with the care, staff are very friendly”. There are a number of staff that have worked in the home for years and spoke of the group being supportive. Four staff recruitment records were seen. Within these four the following deficits were found. Each file contained an application form and correspondence. 1. One member of staff had a CRB from another home and from a few months earlier. All staff need a fresh CRB to assure the manager that no offences have been committed. Also that the CRB is genuine. 2. One member of staff had a work permit that expired in February 06. 3. Three members of staff had only one reference and of these two references were To whom it may concern and the originator of the reference had not been contacted. Two references as a minimum are Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 17 recommended and general open references must be checked back to the writer for safety. 4. No record was kept of staff induction. In discussion with staff they confirmed induction took place but the content was not all remembered. 5. Three staff had no contract. All were appointed as relief staff but had been working in the home every week. Staff contracts are part of employment legislation. 6. There is no record kept of interviews. This is good practice. NVQ training is taking place. There was a previous recommendation that NVQ training be increased to achieve 50 of staff. The preinspection record showed 12 staff having NVQ 2 but the inspector was advised that some of these staff have left. There is presently 8 staff out of 18 carers with NVQ 2. Therefore the home has not achieved the 50 minimum recommended. Staff training records show that are weaknesses in the essential training. Manual handling training last took place in 2004 and is now overdue. The inspector was advised that 4 staff are doing first aid training in July and that 10 staff are booked on POVA training this year. No staff have had dementia training. Health and Safety training was completed for 5 staff last year. There is no central training record that provides a valuable management tool to know when training is needed. This is required plus manual handling and dementia care training for all staff. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. One of the Managers is now working full time in the home and this is positive. The managers have care qualification and experience but no management training. This is required. Quality assurance is limited, not involving relatives, involved professionals plus staff and not publicising the results / annual development plan arising from this. Service users money is well managed. Staff individual supervision and support should improve. There is an awareness of health and safety issues. EVIDENCE: This home has two managers; one of these is now full time in the home to provide support and management to staff. Both have nursing qualifications and care experience, neither have NVQ 4 in management and the registered Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 19 managers award. Both have been registered since July 2004 and should have already obtained the qualification. Mr B Rukunny has started the course, the joint manager Mr B Seegoolam has not. Quality assurance in the home is limited. The manager completes a questionnaire with service users approximately 3 monthly. There is no involvement of relatives or involved professionals e.g. care managers, doctors plus home staff. Expanding the people asked about the service is important. This is a requirement from the previous inspection and the requirement is repeated. No annual development plan was noted in the preinspection information. The manager advised that there is an annual development plan but not in the home. A requirement is made for a copy of this. The manager does not keep Service users finance. Any money owed e.g. hairdressing and chiropody is added to the monthly invoice. Two service users have their allowance obtained for them and given to them. Both of the managers have had other employment and been present in the home for limited time. Individual supervision of staff has taken place for only a few people. Nine records of supervision were seen for this year. Staff meetings take place monthly this covers discussion of general practice and information. Additionally some individual time should be given to all staff. Annual appraisal of staff is also considered good practice. There is an awareness or health and safety. Maintenance and safety checks of the house are maintained as confirmed by the preinspection questionnaire. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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 3 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 23(L) Requirement The registered manager is required to ensure: That the temperature in the medication cupboard be checked daily while the store cupboard is in the conservatory. The registered manager is required to ensure: That all staff administering medication receive in house training initially and subsequently and a record is kept of this. The registered manager is required to ensure: That care plans should be prepared initially and that all service users have a care plan reviewed monthly. The registered manager is required to ensure: That an activities plan be prepared and publicised. This plan to include groups and individual service users. The registered manager is required to ensure: That new crockery, cutlery and glasses are obtained for the dining room. The registered manager is required to ensure:That safety of DS0000060965.V292825.R01.S.doc Timescale for action 01/07/06 2. OP9 18(C) 01/09/06 3. OP7 15(2) 01/07/06 4. OP12 16(M) 01/07/06 5. OP15 16(G) 01/08/06 6. OP19 23(B) 01/09/06 Herewards House Version 5.1 Page 22 7. OP19 23(2)(G) 8. 9. OP21 OP22 23(2)(J) 23(2)(N) 10. OP28 18(C) 11. OP29 19(C) 12. OP30 18(I) 13. OP30 13(5) 14. OP31 9(2)(I) 15. OP33 24 (1) residents in the evening is improved. The registered manager is required to ensure:That confirmation is sent that the ceiling fans are put in place in the lounge and that the temperature is being monitored daily in the hottest part of the day. The registered manager is required to ensure: That the bathrooms are redecorated. The registered manager is required to ensure:That there is a review of the home including lifting equipment and environmental support by the OT. The registered manager is required to ensure:That NVQ training is promoted to achieve a minimum of 50 care staff with NVQ 2. The registered manager is required to ensure:That recruitment practice includes 2 references, a record of interview, a written contract, CRB check, current work permit if applicable and induction training record. The registered manager is required to ensure:That staff training records are maintained to evidence that all staff have a minimum of three-paid training days a year. The registered manager is required to ensure:That staff training in manual handling techniques take place. The registered manager is required to ensure:That both managers should have an NVQ 4 in management. The registered manager is required to ensure:That registered person/s actively seek DS0000060965.V292825.R01.S.doc 01/07/06 01/10/06 01/12/06 01/12/06 01/07/06 01/08/06 01/12/06 01/07/06 01/09/06 Herewards House Version 5.1 Page 23 and record feedback from residents and their representatives, this information is to be available for inspection. Repeated requirement. 16. OP33 24(1) The registered manager is required to ensure:That a copy of the annual development plan is sent to CSCI. The registered manager is required to ensure:That individual supervision is given to all staff. 01/07/06 17. OP36 18(2) 01/09/06 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 OP15 Good Practice Recommendations That service users are offered an active choice of meal. Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Herewards House DS0000060965.V292825.R01.S.doc Version 5.1 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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