Inspection on 21/11/05 for Hill Ash House

This inspection was carried out on 21st November 2005.

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

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

Other inspections for this house

Hill Ash House 04/06/09

Hill Ash House 08/01/09

Hill Ash House 14/12/07

Hill Ash House 25/09/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hill Ash House Hill Ash House Ledbury Road Dymock Glos GL18 2DB Lead Inspector Mrs Janice Patrick Announced Inspection 21st November 2005 10:25 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 Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hill Ash House Address Hill Ash House Ledbury Road Dymock Glos GL18 2DB 01531 890317 01531 892135 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) European Healthcare Operations Ltd Mrs Alison Margaret Cooke Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2005 Brief Description of the Service: Hill Ash House is an extended Grade 2 building, set in its own extensive grounds. It offers both residential and nursing care to the elderly person. There are ample communal rooms and bedrooms are single with ensuite facilities. A shaft lift offers access to the upper floors. Specialised equipment is provided to meet differing needs and external health care professionals such as the GP, Dentist Chiropodist are contacted as required. The Home has a qualified nurse on duty at all times and ample staff to meet the needs of those that live at the Home. There are extensive grounds that can be enjoyed by the residents in the milder weather. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors over a span of seven and a half hours (10:25am-5:50pm). Both the Registered Manager and Deputy Manager were present throughout and were welcoming and helpful. Additional representatives of the company joined the inspectors later in the day for feedback on the inspection findings. A tour of the building was carried out along with various maintenance records being inspected. Other documentation inspected included care records, staff recruitment files, training records, the Complaints File, Menu’s and staffing rosters. Several staff were spoken to including residents and visitors during this inspection. What the service does well: What has improved since the last inspection? The Home has been externally refurbished and decorated making it attractive and well maintained. The immediate gardens and further land is well tended. Extensive work has been carried out on the Fire detection system, the call bell system and the regulating of hot water and heating systems. Internal decoration has begun with completion of the back lounge and several bedrooms. Many other jobs have been completed outside of the areas that residents have access to but which were necessary to make the Home safe and in order to meet with Care Home Regulations and Health and Safety Regulations. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 6 The food provided has improved for those that were nutritionally at risk. A Quality Assurance System has been devised. NVQ training in care has recommenced. The Registered Manager now has administrative support in the Home during the week. Security of the premises has been improved upon. 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. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 The assessment process used ensures that a residents needs are identified prior to admission and therefore able to be met on admission. The residents’ social interaction is encouraged and extended by the Homes open visiting policy and its active involvement of relatives and friends. EVIDENCE: One visitor confirmed that the Registered Manager had visited mother in their home before admission and that an extensive range of questions were asked about the care her mother required. Another resident remembers being seen by the Registered Manager before coming to the Home. She said, she was very nice but she could not remember the questions asked at that time. Residents said that their family and friends are able to visit them as they choose. Three visitors spoken to during the inspection said they were always made welcome by the staff and that they were able to visit as they wished and take their loved ones out as they chose. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 9 Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 In most cases the care planning system enables the residents’ health and care needs to be identified and gives clear direction on how these are to be met. Personal care and health care needs are met in such a way that preserves the residents’ privacy and dignity. EVIDENCE: The care records of four residents were inspected in detail. These were organised and in the case of three, well updated. One set was behind in review dates and was lacking care plans to key identified needs. This was pointed out to the Manager and did not seem to be a pattern in other care plans that were read. The documentation showed that residents were receiving visits from external health care practitioners such as, the Optician, Chiropodist and the Community Psychiatric Nurse. One set of records showed that a resident had been admitted with identified mental health problems. The Home is not registered to care for these very specific needs although there are procedures that enable a Home to apply to Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 11 the CSCI for a variation to their registration. This was not done in this case. This person had been receiving the support of the CPN on a regular basis prior to admission. Another resident’s main needs derive from her dementia. The Manager was requested to consider whether a variation should be applied for, in this person’s case. Staff were seen to be talking to residents in a polite and appropriate way. One resident felt her privacy and dignity was upheld, another felt some staff were better than others at doing this. One carer was observed feeding a resident in the dining room, standing up. This does not allow for this task to be done in a manner that preserves the persons dignity or in a manner that would feel unhurried for the resident. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The ability to make choices and have ones preferences met in the Home is possible, although this does not always apply to the food. EVIDENCE: Residents said that they could choose how to spend their day. One prefers to spend most of her time in her bedroom and is quite happy with this arrangement. Another resident said she was able to choose what time she goes to bed and the time she gets up. One resident said she could go out with friends and family as she chooses. The general consensus from the residents seemed to be that, although the staff try to provide activities, there were either not many happening or many were not meeting the needs of the residents. Comments about the food were generally poor. They ranged from ‘no choice’ ‘not edible’ and ‘not warm’ to ‘it has no taste’ and ‘unable to recognise the food’. The Registered Manager, who has studied food and nutrition to an advanced educational level, is reassured now that those that are nutritionally more at risk are now receiving nutritional puddings and other additional calorie filled foods. Staff said that puddings were limited for those for example that were diabetic and were generally not impressed, although they were aware that the Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 13 new company who owns the Home and the Registered Manager were endeavouring to sort the problem out. A record of what is being eaten is not kept. Menus were seen, but dated back to 2002 and are not being adhered to so are a poor guideline to what is being provided. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Arrangements are in place to ensure that a complaint can be made and that appropriate action is taken in the case of one being made. Staffs’ awareness and knowledge on Abuse and Protection of the Vulnerable Adult issues is not adequate to ensure this protection is afforded to the residents at all times. EVIDENCE: The Complaints File was inspected and a recent complaint discussed. This was regarding the loss of telephone connection in residents’ bedrooms. This was caused during the fitting of other telephone lines to the main Care Home. The owners are fully aware of the situation but it is proving difficult to remedy quickly. Alternative arrangements have been made for residents to be able to make and receive a call and the complaint was dealt with appropriately and within set timescales. Although some staff have an understanding of abuse issues from studying their NVQ Award in Care, others were unaware of basic issues. Staff were not aware of Gloucestershire’s protocol as laid out in the ‘Alerters Guide’ on this subject and the purpose of the Protection Of Vulnerable Adults (POVA) list. Some staff did not have an understanding of the Home’s Whistle Blowing Policy. It was commented on by staff that they have lost the faith to be able to raise a concern with the management and have it treated confidentially. Reassurance in this system needs to be reinstated as soon as possible, as some staff may not feel able to evoke the Whistle Blowing Procedure when Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 15 needed. Others spoken to informed the Inspector of an appropriate person they felt they would be able to talk to and they knew how to make contact with them. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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, 22, 24, 25 & 26 Improvements are being made to the Home, which are ensuring that residents are living in an environment that is safe, well maintained and clean. EVIDENCE: The new owners of the Home have an extensive rolling programme of maintenance and refurbishment, which has been shared with the Commission for Social Care Inspection (CSCI), along with relevant risk assessments as the works have progressed. Tasks are being addressed in priority order and are referenced throughout this report under the appropriate standards. One of the main priorities was to make safe the electrical system, call bell system and replace standard lighting in areas to include emergency lighting. These have all been completed. Decoration and refurbishment of the building externally has taken place. Some windows are to be replaced commencing in 2006. Window restrictors are in place. One of the bedroom windows remains ill fitting. The Inspector has been told this is a listed window and will take time to replace. It did not appear to be Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 17 making the room cold and there are heavy curtains at the window space, although it could pose a risk to security. Internally, the back lounge has been redecorated and new furnishings have been purchased. Once the leak in the roof has been attended to, the front lounge will be the next to be decorated. Several bedrooms had been decorated before the sale of the Home earlier this year, so the rolling programme of bedroom decoration will carry on as and when required. The bedrooms seen during this inspection had been personalised by the resident and/or their families and looked welcoming. The Home appeared clean and residents spoken to confirmed that their bedrooms were cleaned on a regular basis. The laundry was inspected and was organised, with appropriate equipment in place to meet the Homes needs. The yellow bags used for clinical waste were sitting on the floor in several bathrooms. The Manager was informed that the correct frame with a pedal lid should be purchased to support good infection control practice. This action was agreed on during the feedback session. The carpet in the upstairs bathroom must be changed to a more suitable, washable flooring to promote good infection control. It was noted that oxygen was in use on the premises without the correct Health and Safety sign. It was agreed that this would be sourced immediately following this inspection. It was also recommended that where there are steps along a corridor, that a sign be put at an appropriate height to warn the elderly person of this. All recommendations from the Fire Officer, except one door closure, have been completed. This closure will be fitted soon. A requirement made in the last inspection report to ensure hot water is regulated at 43 Celsius via outlets used by residents, is not complete, although the huge task has started on a risk assessed basis. An additional requirement made in the same report to ensure risks against Legionella are reduced, has also been started but cannot be completed until other urgent work has been finished on the main tanks. These requirements therefore remain, but the Inspector is aware of the huge amount of progress made so far. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 & 30 Sufficient skilled staff are on duty to meet the residents needs. The Home has good recruitment processes in place to help protect the vulnerable resident. EVIDENCE: The Manager confirmed there are enough staff on each shift to meet the residents’ needs. This was also confirmed by residents who commented that staff were always available to help and were very attentive. The Home does have vacancies however, which for the overall smooth running of the Home need to be filled. Staff have undertaken mandatory trainings such as Fire Awareness, Moving and Handling, Food Hygiene and Infection control. Some certificates were seen to verify these trainings including staff confirming that they had received these trainings. Some had also attended various day courses. The management team have identified that there needs to be further organisation in how training is provided and are at present looking at various options. Some care staff have undertaken the NVQ Award in Care. The Home were experiencing difficulty in getting an assessor to come to the Home from the College, but the Manager hopes this has been resolved and currently six staff have either commenced or recommenced their NVQ Award. A selection of current recruitment files were seen. These individuals were at various stages of recruitment. All were being required to submit two Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 19 references and to meet various other requirements laid down in the Care Home Regulations 2001. Clearance with the Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) was being sought before their commencement of employment. The requirement for all qualified staff to be clinically updated was not inspected in detail during this inspection. One member of this team said she did this independently of the Home. It is recommended that any updates that are being carried out by staff, outside of the Home, be recognised within their staff file in order for the Home to demonstrate that staff have the required updated skills relevant to their work. This would also help the Manager identify any shortfalls in training. Another staff member’s file was inspected; this showed evidence of updates in mandatory training, but nothing to show that any training or updates had been done in skills relevant to the post she currently holds. Some recommendations were made at the time of this inspection with regard to this. This is one of the areas that is dependant on the recruitment of enough staff, thus allowing the management of the Home time to acquire appropriate skills and to concentrate on the task of managing the Home. The Inspector is aware that the above issue is being looked at and that how training is provided overall is being reviewed. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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, 32, 33, 36 & 38 Both the Manager and the company management team have clear ideas of how they wish the Home to run and the standards they wish to achieve for the residents. However, communication between this group and staff generally, and the time required by the Registered Manager to manage the Home effectively will require improvement to maintain and build on the good work that has already been achieved. Although the Home and Company have regularly reviewed aspects of their performance so far, the commencement of a structured system that allows for self-review, consultation with residents, relatives and visitors and a good process of auditing will enable the service to improve. Although less experienced staff are always supervised in practice, the staff supervision system is not structured and therefore adequate to enable staff to be guided and reflect on their practice and ultimately develop. Improved systems and further planned maintenance are now providing a safe environment for residents to live in and staff to work in. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 21 EVIDENCE: The Registered Manager has been in post for over three years. She has experienced many problems in trying to manage the Home over this period of time and is now experiencing changes and improvements that have come with the new owners. Many management systems and physical improvements to the environment have needed to be prioritised to ensure the Home was safe and met with the Care Home Regulations 2001. The Manager has a Deputy and more recently a part time administrator to support her. The Company has various heads of departments such as a Human Resource Manager, Estates Manager and General Line Manager who also support her. As roles within the Company become more clearly defined with time, it will be necessary for the Manager to set up her own ‘in house’ management structure. At the present time she does not hold regular meetings with senior staff and her role as the Registered Manager needs to be established and clear leadership is required. The last staff meeting was held in September of this year and staff recently requested a meeting in order to discuss various care issues. This took place a week ago. Although some qualified staff wished to meet this had to cancelled due to a lack of staff cover. The Registered Manager explained that she had not taken her supernumerary hours recently and instead covered four night duties recently in one week. Although these require cover, this is not helping her effectively manage the Home. An external consultant has devised a Quality Assurance System for the Company. This is due to commence at Hill Ash House soon and progress with this will be inspected during the next inspection. The Manager does however, audit accident reports and her Deputy audits the care planning system. An audit of falls is not generally undertaken at present, but several individual residents ‘at risk’ in this area have been reviewed. Any guidance required by less experienced staff is being provided by the more experienced care staff and the qualified members of the team. However, not everyone is receiving adequate supervision to be able to reflect on his or her practice and develop. This requirement must be met to prevent further action being taken by the CSCI. The Estate Manager was present at the time of this inspection. He has kept in regular contact with the Commission for Social Care Inspection (CSCI) since June of this year, when the new Company took over the Home. Many major works were required at this point just to make the Home safe and these have been carried out on a health and safety, risk assessed bases. Both the Environmental Health Officer and Fire Officer have offered advice and support. One Inspector was shown all records and certificates of works carried out and of ongoing monitoring processes. This has resulted in completion of many of the requirements made in the inspection of May 2005. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x x 3 x 3 1 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 x x 1 x 3 Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The Registered Manager must ensure that each identified need has a written care plan showing how this is to met. The Registered Manager must ensure that adequate quantities of suitable, wholesome, nutritious and varied food is properly prepared and made available at such times required by the resident. (Timescale of the 31/8/05 not met). The Registered Manager must ensure records of foods provided for residents are kept in sufficient detail to enable any person inspecting the Home to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of special diets prepared for individual residents. The Registered Manager shall make arrangements, by training staff or by other means to prevent residents being harmed or from suffering abuse or being placed at harm. (Timescale of 30/9/05 not met). DS0000064284.V256801.R01.S.doc Timescale for action 28/02/06 2 OP15 16 (2)(i) 28/02/06 3 OP15 17 Sched 4 (13) 28/02/06 4 OP18 13 (6) 28/02/06 Hill Ash House Version 5.0 Page 24 5 OP25 13 (4)(c) 6 7 OP25 OP26 13 (4)(c) 13 (3) 8 OP27 18 (1) 9 OP30 18 (1)(c)(i) 24 (1a&b) 10 OP33 The Registered Person must reduce the risks of scalding by regulating all hot water outlets used by residents to 43 Celsius. The Registered Person must reduce the risks of Legionella. The Registered Manager must alter the floor covering to a washable type in the upstairs bathroom in order to promote good infection control. The Registered Person must taking into account the size, layout, numbers and needs of the Care Home ensure an appropriate number of qualified and competent staff are employed to meet the needs of the residents and facilitate the smooth running of the Home. The Registered Manager must ensure that staff receive training appropriate to the task they are to perform in the Home. A Quality Assurance System must be commenced in order for the quality of care to be reviewed, taking into account the views of residents, relatives and visitors. 31/07/06 31/07/06 13/03/06 28/02/06 13/03/06 28/02/06 11 OP33 24 (2&3) 12 OP36 18 (2) A report on the findings of the 31/07/06 quality assurance system as far as the stated date in this requirement must be forwarded to the CSCI and made available to the residents/representatives. The Registered Manager shall 28/02/06 ensure that all staff working at the Care Home are adequately and appropriately supervised and that this can be demonstrated through records kept. (Timescale of 30/6/04, 4/4/05 & 30/9/05 not met). Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 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 Refer to Standard OP19 Good Practice Recommendations Signs should be placed in appropriate places to give warning of steps ahead in the corridors. Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Hill Ash House DS0000064284.V256801.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!