CARE HOMES FOR OLDER PEOPLE
Heron House Coronation Close March Cambridgeshire PE15 9PS Lead Inspector
Lesley Richardson Key Unannounced Inspection 3rd May 2006 10:00 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 Heron House DS0000024313.V291913.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. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Heron House Address Coronation Close March Cambridgeshire PE15 9PS 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) 01354 661551 01354 657291 Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Susan Ward Care Home 95 Category(ies) of Dementia (17), Dementia - over 65 years of age registration, with number (42), Old age, not falling within any other of places category (36), Physical disability (17), Physical disability over 65 years of age (36) Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. A maximum of 36 places to provide nursing care under category OP. Up to 17 places to provide nursing care to category DE. DE service users to be accommodated in Wendreda unit only. A maximum of 18 places to provide nursing care to category DE(E). Physical Disability (PD) PD(E)) only in association with Dementia (DE DE(E)). Condition 4 to be reviewed when the home has a registered manager. Date of last inspection 23rd November 2005 Brief Description of the Service: Heron House is a purpose built home situated off a main road in a residential area of the market town of March. It is owned by Four Seasons Homes No 4 Ltd and provides care and support for up to 59 service users over the age of 65 years, including up to 17 service users with dementia. Fees for the home range between £480 and £600. The home has 53 single rooms and 3 double rooms, 53 of which have en suite facilities. Resident accommodation is on one level. There are a variety of communal areas available to service users and the home provides bathing and additional toilet facilities with aids and equipment to enable the needs of service users to be met. Service users have easy access to the gardens and courtyards throughout the home. An extension has recently been built and the original building is being refurbished. An application has been made to the Commission for Social Care Inspection for an increase to the total number of places available at the home. The home is situated approximately 1 mile away from the centre of March, where there is a range of shops, pubs and a post-office. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 11 hours and was carried out as an unannounced inspection on 3rd May 2006 and 5th May 2006. It was a key inspection. 7 hours were spent with staff members, service users and undertaking a tour of the home. Not all conversations with service users can be included in this report, due to the level of dementia suffered by some people who live there. Both inspection days were conducted with the manager present. The home returned a pre-inspection questionnaire to the Commission before the inspection took place. No comment cards from relatives and visitors, or service users have been returned, although these were distributed prior to the inspection. A themed inspection looking a falls in the home was also completed and is included in this report. Eight requirements and four recommendations have been made as a result of this inspection. Some of these requirements have been carried over from the last inspection as they have not been met. Failure to comply with requirements may lead to legal action being taken against the home. What the service does well:
The home provides personal and nursing care for older people and people, both under and over 65 years of age, with dementia in a clean and pleasant environment. People who live at the home said the food is good and they are happy with the choices of meals available. Training is provided for staff members to make sure they understand how to care for the people who live at the home properly. This was shown, particularly in the area for older people with dementia, in the way the care staff work with people and considers the information they obtain from records. Analysing the records brought about changes to the way people who fall in the unit are looked after and the number of people falling has dropped significantly. There are some areas where training should improve and this is discussed in the section ‘what they could do better’. Records are kept of the results of health and safety checks completed at the home, as are records of financial transactions undertaken on behalf of people who live there. This makes sure any money going into and out of accounts can be traced. Health and safety checks must be completed to make sure people who live at the home and staff who work there are as safe as possible. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The home must improve the way it finds out what the people who live there think of the home and how they are cared for. This has an impact on many other issues that arise and if it is done well it can have an extremely positive effect on the care provided. Not every person who lives at the home is able to say how they would like to be cared for and a few people who can, said they didn’t feel their concerns would be listened to if they did complain, or that some of the care staff considered their feelings. One person said, “carers just come in, bang the door and you’re awake whether you want to be or not”. There is some dissatisfaction about the choice some people have in the way they are cared for. For example, they would like a bath or shower on a day other than the one allocated, but don’t feel they are able to ask. Protecting people who live at the home is extremely important, and although the home makes sure it refers all concerns about possible abuse to the local protection of vulnerable adults (PoVA) team quickly, it needs to make sure people feel safe in divulging this information first. They also need to make sure all the checks and information that are required to be obtained before employing a new staff member are obtained, and that they are all satisfactory. People going to live at the home have their abilities and needs assessed first. This makes sure the home is able to provide all the care they need before they live there. A copy of the assessment must be available for care staff to refer back to when completing care records. The home must improve it storage and recording of controlled drugs to make sure these dangerous drugs are not misused. People who live in the dementia unit have not had a suitable garden
Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 7 area for a number of years. This must be rectified to make sure everyone at the home has the opportunity to go outside if they wish. 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. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 8 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 Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 9 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 and 6 The outcome for these standards is adequate. Copies of pre-admission assessments must be available to ensure the home is able to meet service user’s needs. EVIDENCE: Pre-admission assessments: Pre-admission assessments are completed to ensure new service users needs are properly assessed and planned for. Assessments of need are also obtained from healthcare professionals and social service departments. This gathers as much information as possible about each person before they enter the home and ensures their needs can be met. However, a pre-admission assessment was not available for one service user admitted at the end of 2005. The manager said this was because the service user had been resident at the home before being transferred to hospital. Further assessment must take place of service users needs if they have had extended hospital admission. This is to ensure the home is still able to meet their needs. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 10 Two places are available for intermediate care at the home, although this is not in a dedicated unit. Admission is through referral via the district nurse to prevent admission to hospital or to continue rehabilitation after discharge from hospital for a maximum of six weeks. Healthcare professionals, such as physiotherapists and occupational therapists, visit service users at the home and leave written guidance for staff to follow. However, staff members at the home do not have specific training for this service user group. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 11 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 The outcome for these standards is adequate. Improvements have been made to ensure that the personal and health care needs of service users are identified and met. Continued improvement is needed to make sure these shortfalls do not place service users at risk. EVIDENCE: Individual care plans are available and some progress has been made on the previous requirement to ensure that all aspects of the personal and social care needs are identified and planned for. Plans give general guidance to staff members about how to meet needs but do not give guidance that is specific enough to each person’s individual need. Plans are reviewed on a monthly basis, but have not always been changed to show updated information. Significant events are not always recorded in care plans, although entries in daily records are made, but there is no cross-reference to show the effect the event had. This was particularly evident for one service user who had suffered a number of falls, which had been recorded in the progress notes but not in the care plan for a medical condition causing dizziness or the moving and handling assessment, and suffered a mild head injury on the day of inspection. Care
Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 12 plans are kept in service users rooms and they can be looked at, at any time. One person confirmed she reads and agrees with what is written in her plan. Referrals are made to healthcare professionals and this was evident from discussions with staff members. However, not all interactions with these professionals are documented in care records. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having all of their healthcare needs met if informal systems break down. The home makes a basic analysis of information collected in accident records written after service users have fallen. This, with advice from the falls co-ordinator, has resulted in the home purchasing sensor equipment and ensuring a staff member is present in the lounge of the dementia unit. The equipment alerts staff when service users, who are at high risk of falling, get up from chairs or out of bed. Although the equipment does not restrain the service user, it has had the effect of ensuring immediate attention for them and reducing the number of falls at the home significantly. Medication is administered by registered nurses and senior care staff to service users who are unable to or do not wish to administer their own medication. The home uses a system of Medication Administration Records (MAR) and blister packs for medication administration. MAR sheets are completed appropriately and an alphabetical letter depicting the reason for not giving medication is also used. There is one letter, however, that requires definition, and this is not always available. Controlled drugs in the home are stored correctly and administered using recommended recording procedures. However, controlled drugs for one person were found outside of the locked storage cupboard but in the locked clinical preparation room. There was mixed opinion amongst service users about the staff who work at the home. While some service users felt the more physically dependent they were on care staff to meet their needs, the less polite the care staff were. Other service users said they had different experiences and did not have any problems with how the care staff approached them. Observation of care staff showed they were polite, asked service users what they would like rather than telling them what they could have, and knocked on doors before entering. However, two service users were specific in their comments and said care staff either did not knock or didn’t wait for an answer before entering their rooms. One service user said, “carers just come in, bang the door and you’re awake whether you want to be or not”. There was general agreement at a discussion with service users living in one part of the home that being there enabled them to continue a lifestyle they may not be able to maintain on their own. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The outcome for these standards is adequate. There has been an improvement in the available social activities, which provide increased stimulation and interest for people living in the home. EVIDENCE: An activities co-ordinator is employed and a programme of activities has been developed for all areas in the home. The co-ordinator has had no training to enable him to perform the job or specifically to provide activities for those service users with dementia. Training has been scheduled for the next few weeks. There was also little evidence to show service users life histories and social interests had any influence on the activities provided. Service users said the home organises something every day, which they can attend if they wish. Although service users said they could choose to attend particular events, there was mixed opinion about whether they were able to make decisions about their everyday lives. Some service users felt they were not enabled to make decisions. For example, being asked how they would like their personal hygiene completed each day, whether they would like a bath or shower on any other day than the scheduled ‘bath day’, or being asked if they would like to see their GP if they didn’t feel well. Other service users felt they were able to ask for things if they wanted a change to their usual daily routine.
Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 14 The home has an open visiting policy and service users said they are able to see family and friends whenever they want. They are also able to visit in private. A main meal took place during the inspection; food served contained a variety of food groups and looked appetising, and there were a range of alternatives available. Service users were happy with the choice available and that vegetables were already on plates prior to serving, although they had not been consulted about this. The dining room in the dementia unit for older people was calm and quiet, which enabled conversation between service users, but also ensured there were few distractions and meals could be eaten undisturbed. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The outcome for these standard is adequate. Improvement must be made to ensure service users feel their concerns are listened to and acted upon. EVIDENCE: Information obtained prior to the inspection shows the home has had no formal complaints in the last twelve months and this was confirmed with the manager. However, concerns had been raised but these were not recorded. The home is developing a system for logging all concerns, which will enable reflective practice and action to taken to ensure service users are happy. There was a general consensus amongst service users that there was not much point in complaining, as it was not always possible to do anything about the issues. Two service users felt there was no point in complaining because nothing would be done and this was discussed with the manager. There have been two Protection of Vulnerable Adults (PoVA) issues since the last inspection, which have been dealt with promptly and referred to the PoVA team immediately. The home has developed links with the local PoVA team and has had training from the lead practitioner. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The outcome for these standards is good. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. EVIDENCE: The home is well decorated and maintained and all areas are accessible and safe for people who live there, with large open communal spaces. It was clean, tidy and all areas were free from offensive odours. The laundry is placed well away from the kitchen and dining areas, which minimises the risk of spread of infection. The garden and patio area is pleasant and well maintained. The garden outside the dementia unit lounge is still overgrown with weeds. Although there are plans for its improvement, staff say this has been hampered by a limited budget and bad weather. This means service users in the dementia unit for older people have been without a safe and pleasant outside area for some considerable time. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 17 During the first part of the inspection there were two ramped areas that were identified as possible hazards to service users safety. The indoor ramp had been secured and had a non-slip surface applied by the second part of the inspection. Arrangements had also been made for rails to be placed at either side of a ramp to the garden in the dementia unit. Therefore a requirement about this will not be made. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The outcome for these standards is adequate. Although vetting and recruitment practices have improved they still do not ensure that all appropriate checks are being carried out, which potentially leaves service users at risk. EVIDENCE: Staff rotas show that staffing numbers in the home are at acceptable levels and above those identified as being required using the Department of Health Residential Forum tool. There is a registered nurse on duty in each of the three different areas during the day and a registered nurse on duty in the nursing and dementia unit at night. The dementia unit for older people was calm and most people showed signs of well-being, for example, eye contact, initiating conversation and appearing content, with purposeful movement. There were a few people who were asleep and may have withdrawn through inactivity, but on the whole the atmosphere was positive with no underlying tensions. This shows staff members in this area have worked hard to understand service users communication and care needs. However, some service users in another part of the home said they often had to wait for assistance and they felt this had not improved in the last few months. This was discussed with the manager. Information obtained prior to the inspection shows staff members have had a variety of training covering the use of equipment, health and safety, and service user specific information, such as dementia, diabetes and falls
Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 19 prevention training. Observation of staff interaction within the dementia unit shows they have a greater understanding of dementia care, and this is having a positive effect on service users. As described in the Health and Personal Care section training from the falls co-ordinator and staff analysis of data collected about falls has resulted in a significant reduction in the number of falls service users are having. However, only 28 of care staff have a NVQ qualification in care at level 2 or above, which means that not enough staff members have a qualification matched to their job role. The staff files were seen for three of the home’s most recently employed staff members. Employment histories in two files had been written in months and years or years only and nothing could be found in either file to show gaps in employment had been explored. A full employment history, together with a satisfactory written explanation of any gaps in employment must be obtained. Although all three files contained two satisfactory written references, one reference was from a work colleague and another was from a person not given as a referee. There was no information to show the home had explored this and decided these were acceptable references. Photographs of the applicant were also not available in two of the files. One staff member’s file was checked to confirm CRB and PoVA checks had been carried out on staff members from overseas and this had been carried out. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The outcome for these standards is adequate. Records are kept to a standard that ensure service users welfare, health and safety. EVIDENCE: The home now has a new manager, who has been registered with the Commission for Social Care Inspection. She has completed a management qualification. There has been no formal quality assurance survey conducted since the last inspection, although in roads have been made into developing a questionnaire for service users. Staff and residents meetings are conducted to enable discussion of common issues. However, these meetings have not taken place for several months, thereby limiting the opportunities service users have to share their views. Comments made by service users about the difficulty in making their views known are included in other sections of this report.
Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 21 However, it is also acknowledged not all service users were of the same opinion and felt they were able to give their views of the home. The home operates a ‘pooled’ money account for service users, which is monitored electronically and manually, to ensure accounts are kept separate. The majority of service users have relatives who help them to manage their finances, although a number of residents look after their own financial affairs. The home employs an administrator who acts as appointee for one service user. Checks are completed to ensure the health and safety of service users and the results of these are recorded. The fire safety policy and procedure is comprehensive and contains information on fire drills, fire prevention, escape routes, equipment testing and what to do in the event of a fire. Records were seen for fire safety and hot water temperatures. These were all recorded as acceptable. Information received prior to the inspection shows health and safety maintenance and service checks have been completed within the last year. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 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 X X 2 X X 2 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 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 3 Heron House DS0000024313.V291913.R01.S.doc Version 5.1 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 OP3 Regulation 14(1)(b) Requirement Timescale for action 15/07/06 2 OP7 15(1), (2)(b) 3 OP9 13(2) 4 OP12 16(2)(m), (n) The registered person must not provide accommodation to a service user at the care home unless the registered person has obtained a copy of the assessment. The registered person must 31/07/06 prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person must keep the service user’s plan under review. (Previous timescales of 18/04/05 and 15/01/06 have not been met.) The registered person must 15/07/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must 31/07/06 consult service users about their social interests. The registered person must consult service users about the programme of activities arranged by or on behalf of the care home.
DS0000024313.V291913.R01.S.doc Version 5.1 Heron House Page 24 5 OP14 12(2), (3) 6 OP19 23(2)(o) 7 OP29 19(1)(b) (i) 8 OP33 24(1), (3) (Previous timescale of 31/01/06 has not been met.) The registered person must enable service users to make decisions with respect to the care they are to receive and their health and welfare. The registered person must ascertain and take into account their wishes and feelings. (Previous timescales of 15/05/05 and 15/01/06 have not been met) The registered person must ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained. A plan of improvement must be made available. The registered person must not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. (Previous timescale of 15/01/06 has not been met) The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The system referred to in Paragraph 1 must provide for consultation with service users and their representatives. (Previous timescale of 28/02/06 has not been met) 15/07/06 31/07/06 15/07/06 31/07/06 Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP8 OP10 OP27 OP28 Good Practice Recommendations Information and advice obtained from healthcare professionals should be documented in service users records. Service users views should be obtained to ensure their wishes are respected regarding privacy and dignity. The manager should review the deployment and working practice of care staff to ensure there is adequate cover and care given is appropriate. 50 of care staff should have or be working towards gaining a NVQ level 2 qualification appropriate to their job role. Heron House DS0000024313.V291913.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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