Inspection on 15/11/05 for Holme Lodge Care Home

This inspection was carried out on 15th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holme Lodge Care Home 21/10/08

Holme Lodge Care Home 24/10/07

Holme Lodge Care Home 24/05/07

Holme Lodge Care Home 26/04/06

Holme Lodge Care Home 12/07/05

Holme Lodge Care Home 13/10/04

Holme Lodge Care Home 14/06/04

Holme Lodge Care Home 11/02/04

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

CARE HOME ADULTS 18-65 Holme Lodge Care Home 1 Julian Road West Bridgford Nottingham NG2 5AQ Lead Inspector Joanna Carrington Unannounced Inspection 15th November 2005 09:30 Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 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 Holme Lodge Care Home DS0000008697.V261941.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 Adults 18-65. 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. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holme Lodge Care Home Address 1 Julian Road West Bridgford Nottingham NG2 5AQ 0115 9822545 0115 9825441 j.allenshaw@east-leonard-cheshire.org.uk 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) Leonard Cheshire Joanne Louise Ollerenshaw Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be within category PD Date of last inspection 12/07/05 Brief Description of the Service: Holme Lodge is a care home providing care and support for up to twenty adults with a physical disability. There are residents living at Holme Lodge that may have a learning disability or a mental health difficulty in addition to their physical disability. All of the bedrooms are single; none are ensuite. The home is situated in Lady Bay, a residential area that is part of West Bridgford. There is a pub, local shop and bus stop very close by and the amenties of West Bridgford and the city centre are only a short bus ride away. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over seven and a half hours on the 15th November 2005. This was the home’s second statutory unannounced visit for this inspection / financial year. The focus of the inspection was to follow up requirements and recommendations from the previous inspection and to inspect the remaining key standards. Therefore, this report needs to be read in conjunction with the previous report. The main method of inspection was called ‘case tracking’ which involved selecting three residents and tracking the care and support they receive through the checking of their records, discussion with them, the care staff and observation of care practices. There was also a partial tour of the premises in order to inspect the environment. Altogether, three residents, three visitors and a member of staff were spoken with. The manager was available for discussion and feedback throughout the inspection. What the service does well: Residents are encouraged to make their own decisions and be in control of their lives. Advocacy services are available to residents when needed. Residents can retain their own care plans in their bedrooms and gender preference and consent to sharing information is obtained from residents. Contact with friends and family is promoted. When appropriate the services of specialist healthcare professionals such as dieticians, district nurses and psychiatric nurses are called upon. There are thorough procedures in place that are followed correctly, for responding to complaints and adult protection. The home is clean and recruitment practices protect residents as all necessary checks are undertaken before staff commence employment. There is an excellent system in place for the training of staff. The organisation Leonard Cheshire does well at carrying out its own monthly inspection visits, in accordance with Regulation 26 of the Care Home Regulations 2001. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 6 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. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X None of these standards were assessed on this occasion. EVIDENCE: Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Residents’ are supported to make decisions about their lives, know their assessed needs and can choose to have possession of their own care plans, however reviewing of these care plans is required. No progress has been made with developing individual risk assessments, important for promoting both safety and independence. Some information kept in the home is not being held handled confidentially . EVIDENCE: Care plans (known as Individual Support Plans) are written in the first person and residents can choose to retain their own care plans in their bedrooms. It was recommended at the last inspection that residents sign to evidence when the plans have been reviewed, as well as when they are initially written. At this inspection, however, there was no evidence on files that reviews have been taking place. Where there have been amendments and additions to care plans these are not dated, which is not helpful in terms of periodic reviewing. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 10 One resident spoken with explained how he votes by post and he has had some support by an independent advocate when he moved to the home. Advocacy services are available to residents if and when required. When residents do not manage their own money this needs to be documented along with the arrangements in place to enable each resident to access and spend their own money etc. Leonard Cheshire have a pro forma titled ‘Risk taking by service users’ which provides a good risk assessment tool. For the four residents that were case tracked none of them had these risk assessments on their files. This was identified at the last inspection, with particular reference to one resident, who is unable to go out to the local shops unescorted. A large complaints file was looked at as part of the inspection and found in this file were documents and correspondence concerning residents and staff of a very sensitive nature. In accordance with data protection this information must be recorded on respective residents and staff files securely. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16 and 17 Residents’ contact with family and friends is promoted and there are opportunities to take part in activities although access to local amenities is currently limited. Residents’ right to privacy is not being respected if staff continue to enter residents’ bedrooms without gaining permission first. Nutritious meals are provided but progress made at the last inspection with accommodating residents’ choices has since diminished. EVIDENCE: During the inspection there were a number of relatives and friends seen visiting the home. Three visitors were spoken with and confirmed that they are always made to feel welcome. There are residents that attend day centre, go to college and one resident is involved in a local theatre group. There are activities provided at the home such as arts and crafts and computers for those that prefer this. Residents spoken with explained how trips out have been Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 12 restricted as there has been no available driver for their mini bus. Two residents spoken with said that they don’t get to go out with staff very much, and would like to go out shopping or even just to the local pub more. All residents now have their own lockable facility and their own post box and any responsibilities for household tasks and developing independent living skills are incorporated in individuals’ care plans, all of which is important for promoting the rights and responsibilities of residents. The manager also reported that all residents have the right to a key to their bedroom although it seems one resident is unaware of this as when asked he said he did not have one because that is just the way it is. It is recommended, therefore, that residents are reminded of their rights and are offered a key. If this is declined then this needs to be recorded in their care plan. During the inspection when talking with a resident and their relative in the privacy of their own room a member of staff just walked straight in, without knocking. This was a different staff member to the staff member that did exactly the same thing at the last inspection. The diary states what meals are to be cooked each day. This showed that there are nutritious balanced meals provided. It was recommended two inspections ago that residents be informed of the day’s options that morning, which residents spoken with at the last inspection confirmed was happening. At this inspection residents stated that they are not always told and there are not always choices. During this inspection so many meals of either lamb or smoked fish were prepared, with both meals attractively presented, but without obtaining the choices off residents beforehand this number may have been wrong. There was no detailed record of what each resident has eaten each day, which is required. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The personal support needs of residents are met although more attention to individuals’ preferences is required. Improvements to care planning and the monitoring of individuals’ weight, which was identified at the last inspection is necessary for ensuring that the healthcare needs of residents are met. Limited progress has been made on ensuring that the medication system is safe. EVIDENCE: There are forms on each residents files identifying gender preference with personal care and also a consent form for sharing sensitive information about an individuals’ care. This is good practice. For personal support plans there are step-by-step instructions for personal care routines such as washing in the morning and dressing. One resident spoken with reported that staff get round to providing his assistance when they can; he did not think his preference of getting up at 9am would be of importance. We checked his care plan to see if this preference had been documented, which it had not. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 14 There was evidence on the three resident’s files seen that residents have regular health checks and chiropody appointments. Residents receive support from specialist health care professionals such as dieticians, community psychiatrists and psychologists when necessary. One resident case tracked has pressure sores and district nurse involvement. There are district nurse records in the home but currently no care plan outlining what treatment is being given and action required of staff over a twenty four period. This is required. At the last inspection it was identified how, despite concerns being raised by dieticians and other health care professionals about individuals’ weight, regular monitoring of weight was not being undertaken. This was still the case at this inspection. All three residents case tracked have not been weighed regularly and two of those residents’ have complex health needs. ‘When required’ medication is now clearly identified as so on the Medication Administration Records and so is the level of dose administered. The instructions on the MAR for one resident’s medication need to be updated so that it states ‘up to’ six times per day, rather than take six times per day. This is following GP instructions and amendment to the script. At the last inspection it was explained by a senior member of staff how one resident continually deceives staff by taking their medication but will then later spit it out. There was no care plan on this resident’s file outlining an appropriate and consistent approach to be taken in managing this situation, which was set as a requirement. The deputy manager explained how the GP has faxed information requesting that the he is informed if after three days the resident has continued to refuse the medication. A copy of this fax was not on file but more importantly there is still no specific care plan, where this information needs to be transferred. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 There is an appropriate complaints procedure, which assures residents that, their concerns and complaints are listened to and acted on. Staff are aware of and adhere to the local Adult Protection Policy and Procedures. EVIDENCE: The complaints file was seen during the inspection and showed that complaints are taken very seriously and acted upon appropriately. All residents and relatives spoken with are aware of the complaints procedure and how to access it. It is recommended that only a summary of the complaint and any subsequent action taken be held on this file, cross referencing it to relevant correspondence and reports, which are then stored in the relevant staff / resident file. (Please refer to Standard 10) There have been two disclosures / allegations by residents since the last inspection that have been dealt with correctly using the Nottinghamshire Protection of Vulnerable Adults Policy and Procedures, notifying both the Adult Protection Unit (APU) and the Commission for Social Care Inspection. The manager was reminded, that, in accordance with the procedure and for monitoring purposes ‘outcome forms’ also need to be completed and sent on to the APU and Commission, once an investigation has been completed and action (if any) has been taken. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Residents’ live in a clean environment, however, the environment would benefit from some immediate attention to its décor, prior to the home’s planned refurbishment. EVIDENCE: There had been no planned refurbishment or redecoration at the care home due to the imminent re-provisioning of the service to a new site. However, the manager reported that since the last inspection there has still been no success in finding suitable land. The décor throughout the building is looking tired and outdated and as priority the manager is looking at redecorating those bedrooms in most need and also updating one of the track ceiling hoists. On a partial tour of the premises it was evident that the home is kept clean and hygienic. There are adequate sluicing facilities and there is a good-sized laundry room, sited away from where food is stored or prepared. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 and 36 The training needs of staff are now being addressed, although supervision sessions are still required for all staff, which will support in this process. Residents are supported by the home’s recruitment practice, but problems with recruiting are having a detrimental impact on morale and meeting needs of residents. EVIDENCE: A computer database is used to monitor training needs of staff, which was shown by the training co-ordinator. This is an excellent system that will ensure staff receive all training that is required to meet the needs of residents. It highlights when mandatory courses such as food hygiene and first aid are due and other training courses that staff are attending include sexuality and relationships, disability awareness and as recommended at a previous inspection, managing challenging behaviour. Staff files showed that supervision sessions are still not taking place for staff, which is particularly important for a staff team that currently has low morale. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 18 The manager has addressed staffing problems identified at the last inspection by increasing staffing levels from three to four in the evenings. The problem, however, is recruiting to vacant posts and covering the hours. Even though hours are being covered by either permanent staff or agency workers (regulars where possible), staff morale is low and this is impacting on required work and responsibilities such as key working and care plans, essential tasks for meeting the needs of residents. This is why trying to recruit to vacancies is vital. On all four of the staff files looked there was evidence of Criminal Record Bureau checks carried out and two references obtained before staff commence employment. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 There are systems in place for monitoring and reviewing the quality of care but more involvement from residents should be promoted. Better recording in the kitchen and in the fire log is required in order to promote and protect the health and safety of residents. EVIDENCE: There are various audits and quality checks that Leonard Cheshire carries out on the home. There has recently been a health and safety audit and there are Registered Provider visits, in accordance with Regulation 26 of the Care Home Regulations, which involves interviewing residents and staff and inspecting the premises. It is recommended that residents meetings are more structured and take place more regularly and participation on the ‘Leonard Cheshire Consultation Group’ is encouraged, as these are ways for residents to be involved. The current Leonard Cheshire Service User Satisfaction Survey, which asks one question then for any other relevant comments, is not Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 20 adequate as a means to consulting residents over ways that the quality of the service can be improved. The servicing of equipment and electrical and gas systems are all up to date and there are adequate measures in place for the prevention of Legionella, all of which is important for promoting the health and safety of both residents and staff. Requirements made following Leonard Cheshire’s Health and Safety Audit are being addressed, including risk assessments for the use of bed rails, seen on residents files. There is a fire risk assessment for the home and weekly fire alarm tests are being undertaken. In accordance with Fire Precautions Legislation outcomes of door releases and emergency lighting must also be recorded weekly. Fridge and freezer temperatures are not being recorded daily, which is essential for ensuring food is stored at a safe temperature to avoid food poisoning and illness. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 X 1 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score x 3 2 3 4 1 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holme Lodge Care Home Score 2 1 1 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x DS0000008697.V261941.R01.S.doc Version 5.0 Page 22 yes 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. 2. Standard YA6 YA9 Regulation 15 13, 14 Requirement Ensure care plans are reviewed (at least every six months). Ensure that activities in which service users participate in are free from avoidable risks and that there are risk management strategies / assessments attached to care plans that are reviewed. (This is an outstanding requirement from the last inspection, original timescale 30/09/05 not met.) Ensure that all information regarding service users is held securely. Ensure that all staff conduct themselves in a manner that respects the privacy and dignity of service users at all times. In accordance with Schedule 4 (13) ensure that a record of food provided for each service user is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. In accordance with Schedule 3(3)(n) maintain in respect of each service user, a record of incidence of pressure sores and DS0000008697.V261941.R01.S.doc Timescale for action 31/01/06 31/01/06 3. 4. YA10 YA16 17 12 30/11/05 30/11/05 5. YA17 16 30/11/05 6. YA19 15(2) 17(1)(a) 30/11/05 Holme Lodge Care Home Version 5.0 Page 23 7. YA19 12 8. YA20 15 9. YA20 13 10. YA24 23 11. YA33 18 12. YA36 18 13. 14. YA42 YA42 23 12 of treatment provided to the service user, including all action required by staff. To promote the health of service users ensure that service users weight is monitored and recorded according to their individual needs and current health. (This is an outstanding requirement, initial timescale 31/08/05 not met) Ensure that advice is sought from the CPN on an appropriate and consistent approach necessary for staff to take in supporting one resident who refuses to take their medication. This is to then be recorded in detail on a care plan. (This is an outstanding requirement, initial timescale 31/08/05 not met.) For safe administration ensure that instructions on the MAR reflect exactly GP instruction, as what should be on the script. Carry out intention to reprovision the physical environment over the next 3-5 years Continue recruiting more permanent staff to ensure the needs of residents are met and continuity of care. This is ongoing. Ensure all staff are appropriately supervised. (This is now an outstanding requirement, initial timescale 31/08/05 not met.) Ensure that all fire safety tests are undertaken, in accordance with Fire Precautions Legislation. Ensure for protecting the health of service users that fridge and freezer temeratures are recorded daily as a necessary measure for the prevention of food poisoning and illness. DS0000008697.V261941.R01.S.doc 30/11/05 30/11/05 30/11/05 01/04/07 31/01/05 28/02/06 30/11/05 30/11/05 Holme Lodge Care Home Version 5.0 Page 24 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. 5. 6. Refer to Standard YA7 YA13 YA16 YA17 YA22 YA39 Good Practice Recommendations Document on care plans when residents do not manage their own money or what support they have in order to do this. Review with residents their expectations and wishes regarding activities and support accessing the community. Remind residents of their right to have a key to their room, and if declined then record in care plan. Residents are at least offered an alternative at every meal, and options are presented to residents each morning, in advance. Include only a summary of complaint and subsequent action on complaint file, cross-referencing to more detailed records. Encourage more feedback from residents and their family, friends and other visiting professionals about the quality of care and services provided. Holme Lodge Care Home DS0000008697.V261941.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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