Inspection on 13/12/05 for Humfrey Lodge

This inspection was carried out on 13th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Humfrey Lodge 18/03/09

Humfrey Lodge 08/01/08

Humfrey Lodge 26/02/07

Humfrey Lodge 13/07/05

Humfrey Lodge 02/03/05

Humfrey Lodge 21/07/04

Humfrey Lodge 22/03/04

Humfrey Lodge 13/01/04

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Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Humfrey Lodge Rochelle Close Thaxted Dunmow Essex CM6 2PX Lead Inspector Diana Green Unannounced Inspection 13th December 2005 09:00 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 Humfrey Lodge DS0000017855.V273858.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. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Humfrey Lodge Address Rochelle Close Thaxted Dunmow Essex CM6 2PX 01371 830878 01371 831187 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) Runwood Homes Plc Manager post vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (48) of places Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 48 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 24 persons) The total number of service users accommodated in the home must not exceed 48 persons Staffing levels will be monitored over the first six months and will be reviewed with the inspectors six months after the date of registration The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 Training on therapeutic activities in dementia care to be provided within three months of registration 13th July 2005 Date of last inspection Brief Description of the Service: Humfrey Lodge is a care home for older people over the age of 65 years. The home is registered to care for 48 individuals, up to 24 of who may have dementia. The home is owned by a private organisation named Runwood Care Homes Limited. Humfrey Lodge is a single storey building that was purpose built and has recently been extended. There are 48 single bedrooms, including 12 single en-suite rooms. The home has a large dining/lounge and two small dining/lounges. There are two enclosed paved gardens that are accessible by ramps. The home is located in the village of Thaxted, in a residential area close to the centre of the village. The home is accessible by car. Parking is available for staff and visitors in the small car park located to the front of the home. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 13/12/05, lasting 6 hours. The inspection process included: discussions with the operational manager, acting manager, five staff, five service users, two relatives and feedback from health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas and the laundry; and inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Eighteen standards were covered, and eighteen requirements made including one repeat, one second and two third repeat requirements. The acting manager and staff were welcoming and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 6 An annual audit of the home has been undertaken and an action plan developed detailing the action required to address shortfalls. The operational manager attends the home regularly to provide advice and support to the acting manager and a quality development facilitator has commenced working with care team managers to develop skills in care planning. The acting manager and some staff have attended training in protection of vulnerable adults provided in-house. The upgrading and refurbishment of the home was nearing completion and the décor improved. What they could do better: There is a lack of management and leadership in the home. The acting manager, a care team manager had been seconded into the post and has been working under difficult circumstances since the former manager left, with several staff vacancies, care planning and other issues and a major refurbishment. Requirements and recommendations made previously by the CSCI have not been addressed. Staffing levels have not been increased as agreed with the commission and there is a high use of agency staff. Whilst the regular staff are caring and work hard, the current low staffing levels have impacted on their ability to adequately meet residents’ personal care needs. One resident said, “I can’t speak too highly of the night care staff. It is the relief staff that are a problem.” Residents spoken with said they had not been offered a bath for two to three weeks and frequently had to wait to receive assistance with personal care. Several residents said they were not given an early morning cup of tea and some were observed not having a drink or breakfast until 11:00 hours. Medication prescribed to be given at 09:00hours was not given until 11:00hours and sometimes later. Administrative support is provided for only three days, which places further pressure on the manager and care staff to answer telephone calls and deal with other administrative tasks. There have been a large number of falls, particularly during the evening and night, indicating that staffing levels are also too low during those hours. Recruitment of staff is not sufficiently robust to protect residents from harm. Two satisfactory references had not been obtained prior to the appointment of staff recruited since the last inspection and induction had not been provided for new staff as required. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 7 There is no planned programme of social activities in place. No entertainment had been provided in the last year. Residents have little social stimulation and some residents complained that no exercise sessions are provided. There are still no therapeutic activities provided for residents with dementia. The standard of cleaning in some areas of the home (kitchen areas in communal rooms) was not adequate. 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. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 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 Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 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, 6 The admission procedure ensures all residents are assessed on admission but this did not include an assessment of social interests. Without this there is no assurance these care needs can be met. The home does not provide intermediate care. EVIDENCE: The manager and/or care team manager undertake assessment of all prospective residents prior to admission, and information on the person’s needs is recorded. Evidence of pre-admission assessments was present on all three files inspected. However there was no record of social interests or hobbies on those inspected. The home does not provide intermediate care. Humfrey Lodge DS0000017855.V273858.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): 7,8,9 The care planning process provides good information for care staff to satisfactorily meet residents’ personal care needs but there is little evidence that social care needs are met. Residents health and personal care needs are not consistently met due to low staffing levels and high use of agency staff. This places residents at risk of injury that is evidenced by the current high percentage of falls. Medicines are not administered at times they for which they are prescribed, potentially compromising residents’ health and wellbeing. Action has been slow to address the shortfalls in medicines storage. Until this is addressed the safety of medicines cannot be assured. EVIDENCE: Four care files were inspected. These contained care plans that covered the majority of key needs with the exception of social interests and foot care. All four care plans agreed with the resident and/or their relative as evidenced by signature. However one resident had received treatment for a fractured femur, Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 11 but the care plan had not been reviewed to reflect changing needs. Another had no evidence of recent agreement of the care plan. Assessments for moving and handling/mobility, risk of falls, pressure areas and continence needs were recorded in all of the files inspected. Feedback received from relatives indicated they were not always aware of the care plan. Training had been implemented on development of care planning and it was evident from one of the care plans that this was beginning to improve staff’s understanding and competence. The home was well supported by the local GP practice and district nursing service. There was evidence that service users had access to health care services. There had been a large number of falls in recent months and evidenced from the accident records. There were 28 falls recorded for October, 32 falls for November and 7 in the last week. The majority of falls occurred during the night indicating that staffing levels were not adequate at that time. No risk assessments of the environment had been made following the falls to evidence how the risk was minimised. There were no residents who were self-medicating. Medicines were stored in three separate locked cupboards in each of the units. Medication was stored in three units of the home in wall cupboards. The storage temperature was above that recommended as safe. The temperature of one storage facility was 27 degrees centigrade. Air conditioning had been installed in the clinical room where a recently purchased medication trolley was to be stored. The home was to transfer to a monitored dosage system for supply of medication and there were plans to provide additional storage and to purchase an additional trolley if it was established this was necessary. Residents spoken with said there was a problem with them receiving recently prescribed medication and a meeting was to be arranged with the supplying pharmacist to resolve the issue. Care staff were observed administering medication at 10:45 hrs. although it had been prescribed for 09:00hrs. The inspector was informed that the medication round sometimes takes from 08:30 to 11:30am. This was clearly compounded by low staffing levels and a lack of staff that had received training to assist with medication administration. Humfrey Lodge DS0000017855.V273858.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, 15 Humfrey Lodge does not provide residents with a stimulating and varied daily life. The meals in the home are varied and wholesome but choice is limited and problems with supply result in basic items sometimes being unavailable. The fluid/nutritional needs of residents are not consistently met due to low staffing levels. EVIDENCE: The home had an activities coordinator who worked 3 days per week. The hours had not been increased as required at the previous inspection. There was no information on activities circulated and no evidence of any social/therapeutic stimulation provided. There had been no entertainment provided during the last year. Residents spoken with indicated they were bored with life at the home and many were observed sleeping or watching television throughout the day. No residents attended day care, although one relative said they had specifically requested this. There had been no residents’ meetings held recently and several residents spoken with complained at the lack of consultation with them regarding the refurbishment. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 13 The menus observed appeared nourishing and the lunchtime meal was eaten well by residents. However some residents said there had been problems in the supply of food with basic items such as tea and sugar running out. There were also problems with choice of food availability as no soup was available, they were unable to have muesli and there was too little fresh fruit. No snacks were offered in the evening and there was no early morning cup of tea provided. The inspector observed some residents not having breakfast until 10:30 and 11:00, not from choice but through availability of staff. Humfrey Lodge DS0000017855.V273858.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 The management and handling of complaints is not sufficiently robust to assure residents and their relatives that their complaints will be listened to and acted upon. EVIDENCE: The home had a complaints procedure on display in one area of the home but this detailed the name of the previous manager. Feedback received from some relatives indicated they were not aware of the complaints procedure and did not know who to complain to. The home had a record of complaints that had been made on issues regarding food, lack of early morning cup of tea, no food provided until 10:00hrs, medication, staffing and delays in answering call bells. Clearly action had not been taken to address these complaints satisfactorily as several residents and their relatives raised similar issues with the inspector. The home had an adult protection policy in place. A copy of the Essex Guidelines for Protection of Vulnerable Adults from Abuse was available and records confirmed that staff had attended training on protection of vulnerable adults. From discussion with the manager it was evident that she was well informed on the required action to be taken in the event of an allegation of abuse. The staff terms and conditions precluded staff involvement in the making or benefiting of service user wills. A whistle blowing procedure was available for staff guidance. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 15 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): 26 Humfrey Lodge is generally clean but standards of hygiene in the small kitchen areas require attention to ensure there is no risk of infection. EVIDENCE: The home had been undergoing a refurbishment that was nearing completion and had evidently been disruptive to the home. However, taking that into account, the standard of cleaning was inadequate, particularly in the kitchen areas of the communal rooms. Fridges were not adequately cleaned either externally or internally and some required defrosting. The door handle of one fridge was broken. Sinks, dishwasher doors and some cupboard interiors were dirty. The dining room in one unit had not been cleaned following breakfast and food debris was present on the floor. Standards of cleaning in the main kitchen were satisfactory. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 The staffing levels at the home are not adequate to appropriately meet the personal care needs of residents, resulting in the health and welfare of residents being compromised and a de-motivated workforce. The recruitment processes are not sufficiently robust to protect service users. EVIDENCE: The care staffing levels were not adequate to meet the dependency needs of residents and ancillary staff support did not meet the needs of the home. Residents were observed having to wait to receive personal care for some considerable time. One resident reported having to wait 45 minutes for the call bell to be answered and another said they had not received a bath for two to three weeks. Residents reported that the regular care staff were friendly, caring and worked hard, but there were not enough of them. However they said they found the attitude of some agency not acceptable. One resident said they were reprimanded by an agency care worker for pressing the call bell when they had previously told them not to. Administrative support was provided for three days per week and this placed pressure on the manager and care staff to answer telephone calls, further reducing the time available for personal care. The activity coordinator hours had not been increased as agreed with the CSCI and there was no one providing activities on the day of inspection. There was one cook on duty with no cover provided for the kitchen assistant who was on leave. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 17 Two new staff files were inspected. One had only one satisfactory reference and the second had one reference that was unacceptable. Neither had records of induction having been undertaken. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37, 38 Humfrey Lodge has had several years without effective leadership and management. Urgent action is now required to employ an experienced manager with the knowledge, skills and competence to manage the home. A lack of training and monitoring of standards places the health and safety of residents and staff at risk. EVIDENCE: The home has had several managers over recent years that have left employment with the inevitable disruption for residents and staff. A care team manager had been providing support as acting manager since the previous manager left in July 2005. The manager had assumed responsibility at a very difficult time with the extended premises and major refurbishment programme. This had clearly impacted on her ability to manage the home efficiently and provide the appropriate staff support. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 19 A service user questionnaire had been circulated and the response used to produce a report on how the home is achieving the key values of the organisation. The annual development plan had been produced from the report and a copy forwarded to the CSCI. This laid down the action required by the manager and staff to address any shortfalls at the home. Monthly visits on behalf of the responsible individual had been made and reported to the CSCI as required. The systems for handling of service users’ monies were inspected. The records for five residents were sampled. All five had accurate records maintained; receipts and amounts held were confirmed as accurate. Residents care records were observed unsupervised, lying on a table in a communal room that was also accessed by residents and visitors. The home had a health and safety policy and appropriate procedures in place and in the main these were adhered to. However the following issues were identified: • Accident records were recorded but no risk assessment of the environment was made following falls. • Fire training had not been provided as required; some staff had not received fire training since October 2004. • Several fire extinguishers were not secured as required. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 x x x x x x x 2 STAFFING Standard No Score 27 1 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 2 Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1) Requirement The registered person must ensure that the care plans include details of the residents’ social care needs and plans for addressing these. This is a third repeat requirement The registered person must ensure that residents who fall have a risk assessment of the environment. The registered person must ensure that medication is given at times prescribed. The registered person must ensure that medication is stored below 25°Centigrade. This is a third repeat requirement The registered person must ensure that social care activities are provided to meet the needs of residents including those with dementia. This is a second repeat requirement The registered person must ensure that the activities’ coordinator hours are increased DS0000017855.V273858.R01.S.doc Timescale for action 31/03/06 2 OP38OP8 13(4) 31/01/06 3 4 OP9 OP9 13(2) & 13(6) 13(2) 31/01/06 31/01/06 5 OP12 12(4) 28/02/06 6 OP12 18(1) 31/03/06 Humfrey Lodge Version 5.0 Page 22 7 OP14 18(1)(a) 8 OP15 16(2)(i) 9 OP15 16(2)(i) 10 OP16 22(3) 11 12 OP26 OP27 13(3) 18(1)(a) 13 OP29 19 (4)(c) Schedule 2 18(1)(c) 9 & 10 17(1)(b) 14 15 16 OP30 OP31 OP37 17 18 OP38 OP38 13(4) & 13(6) 13(4) as agreed with the CSCI The registered person must ensure that residents are enabled a choice in time of having breakfast and are not compromised by staffing levels. The registered person must ensure that food supplies including fresh fruit are available to meet residents’ needs. The registered person must ensure that snacks and drinks are provided in the evening and the interval between this and breakfast is no more than 12 hours. The registered person must ensure that complaints are thoroughly investigated and action is taken to satisfactorily address the identified issues. The registered person must ensure that the communal kitchen areas are kept clean. The registered person must ensure that staffing levels are increased to meet the dependency needs of residents at all times. The registered person must ensure that two satisfactory references are obtained prior to appointment of new staff. The registered person must ensure that all new staff receive a structured induction. The registered person must ensure that a manager is recruited to the home. The registered person must ensure that residents’ records are stored securely at all times. This is a repeat requirement The registered person must ensure that all staff receive fire safety training as required. The registered person must DS0000017855.V273858.R01.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 31/01/06 30/04/06 31/01/06 31/01/06 31/01/06 Page 23 Humfrey Lodge Version 5.0 ensure that fire extinguishers are secured as required. 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 OP3 OP15 OP15 OP27 Good Practice Recommendations The registered person should include foot-care and social care interests and hobbies in residents’ care plans. The registered person should ensure residents have an early morning cup of tea. The registered person should ensure that liquefied food is presented attractively with meat and vegetables served separately. The registered person should review ancillary staffing levels in line with the increased number and needs of residents. Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Humfrey Lodge DS0000017855.V273858.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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