Inspection on 02/07/07 for Leeming Garth

This inspection was carried out on 2nd July 2007.

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

Leeming Garth 24/06/08

Leeming Garth 04/07/06

Leeming Garth 22/11/05

Leeming Garth 08/06/05

Leeming Garth 30/12/04

Leeming Garth 01/07/04

Leeming Garth 02/03/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

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The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT Lead Inspector Jo Bell Key Unannounced Inspection 09:00 2nd July 2007 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 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leeming Garth Address Leeming Bar Northallerton North Yorkshire DL7 9RT 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) 01677 424014 01677 425121 leeminggarth@schealthcare.co.uk Southern Cross Home Properties Limited vacant post Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (53), Physical disability (2) of places Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 2 Named Service Users in category (PD) to receive nursing care and this condition shall cease when the specific arrangements end. One specific service user over the age of 55 in the category PD, named on variation dated 23rd October 2006, may reside at the home. 4th July 2006 Date of last inspection Brief Description of the Service: Leeming Garth Care Centre provides general nursing care for up to 53 older people and for two people with physical disabilities. The home is situated in the village of Leeming Bar with close access to the A1. The accommodation is spread over two floors and there is stair lift and a passenger lift, giving access to the upper floor, there are two areas of the home, the manor and the court. The home is set in extensive grounds and there is ample car parking facilities for visitors and staff. Southern Cross Home Properties Limited owns the home. Fees range - between£329 and £631 per week. Information is available regarding the service through inspection reports, statement of purpose and service user’s guide. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Monday 2nd July 2007. Prior to the site visit a pre-inspection questionnaire was completed and ten relatives and ten service user surveys were sent out. A total of ten were returned (seven people using the service, and three relatives) along with two surveys from doctors. One inspector spent six hours at the home. During this time people using the service discussed their experience of living in the home, observation of care practices took place. The lunchtime meal was examined and aspects of the environment were inspected. The manager talked about the care planning and medication system, and three people were case tracked where their details were inspected in detail. Staffing issues including recruitment and training were discussed and health and safety was examined. Overall, people are cared for in a pleasant and homely environment. Though aspects of care giving, training and the management of the home need improving to progress the service forward. What the service does well: What has improved since the last inspection? Medication audits and care plan audits are taking place, this identifies areas for improvements which ensures needs are being met. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. Needs are assessed prior to admission for permanent residency and for intermediate care. We have made this judgment using a range of evidence, including a visit to this service EVIDENCE: The manager of the home carries out initial assessments prior to a person entering the service. This is for both care managed people and people who are privately funded. Three of these were examined and they all contained detailed information regarding health and personal care. The manager is aware of the type of health and social needs which the home can meet. One person confirmed that an assessment had taken place. The home offers intermediate care, this is where a person is admitted to the home for a short period of rehabilitation before being discharged back into the community. The intermediate care team assess people and liaise with the home as to how needs can be met. For example a physiotherapist or speech therapist may be needed, or specialised moving and handling equipment may be required. The manager had a good understanding of this process and was aware of the input needed form the staff group. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience adequate quality outcomes in this area. Personal and healthcare needs are not consistently met, this includes aspects of privacy and dignity. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People receive an adequate standard of care, however observations showed that cleanliness of hair, clothes, glasses, nails and teeth could be improved on. Many people have a wash on a morning and the home have a ‘bath list’ which determines which day of the week each person will be bathed on. The rationale for this is because of the shortfall in the number of baths or showers. On the upstairs floor eighteen people needed personal care and only one assisted bath was available in close proximity. This makes it difficult for staff to give people a choice about their preference for a wash, bath or shower each day. This issue has been highlighted previously and needs addressing as a priority. (see also Standard 21). Five people in the downstairs lounge were spoken with, mixed comments were made regarding the staff and the care received. This was also evident in the surveys returned. For example ‘do you receive the care you need?’, one person commented always, and two commented usually. Three care plans were examined in detail and the three people they related to Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 10 discussed the care, staff, the environment and generally what life is like living at the home. Risk assessments relating to nutrition, falls, moving and handling, prevention of pressure sores and the use of bed rails were all in place and completed correctly. Whilst the initial assessments were good, on one occasion no care plans had been formulated from the initial assessment. This needs acting on to ensure staff are aware of the person’s individual needs. The person it related to had some difficulty communicating and was unable to confirm if staff had tried to obtain information for the care plan. Care plan audits do take place (See Standard 33) however there are some blanks in the care plans that need updating, for example the date a plan was reviewed or evaluated. On one occasion a person was being moved with one carer when two people were needed, the second carer came as the manoeuvre was almost complete. People confirmed that they can access a doctor when needed, the chiropodist was spoken to who was complimentary about the service and felt the level of care received was good. Evidence of involvement from the continence advisor, and specialist wound care nurse was available and staff had a good understanding of how to meet nutritional needs, with referrals to the dietician in place. It would be beneficial if another set of scales were available. Currently there is only one set of sit-on scales for forty five people. People generally have their medication administered, stored and disposed of correctly. A procedure is in place and staff have received medication training from the local pharmacist. Three medication charts were checked and these were found to be completed correctly. Stock balances take place on a weekly basis and controlled drugs are recorded and stored in line with the home’s medication procedure. The manager is aware of how to dispose of controlled drugs and strict records are kept to ensure there is a clear audit trail. Fridge temperatures are taken and recorded daily, and drug trolleys are stored securely in the medication room. The manager has started to completed medication audits and no errors have been reported. One concern raised was that eye drops were on occasions been administered when they had expired. The manager was made aware of this and took action to prevent this happening again. Privacy and dignity was observed and discussed with staff and people using the service. Staff addressed people in a pleasant manner, and staff were observed knocking on doors prior to entering, and signs were available stating where the bathrooms were located. One visitor said that ‘staff always take people into a private room when a healthcare professional comes’. It was evident that staff were talking about other people when attending to people using the service. For example at lunchtime one carer discussed ‘feeding’ three other people and included their names whilst the carer listening was attending to people at the dining table. On another occasion a member of staff discussed her personal life in front of people with another carer. This was done in a loud voice and not relevant to the client group. The manager was made aware of this. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience adequate quality outcomes in this area. There is a lack of activities in the home and people are not given enough choice regarding their daily life. Though people enjoy the food and drink provided. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People do not have access to enough activities. Whilst there is an activities organiser, this is only four afternoons a week and there are three different areas in the home and currently forty five people. Details of activities are available on the notice board which include dominoes, crafts, and entertainers. The home do not have their own minibus for trips out but one can be hired. However, this is sometimes difficult as there needs to be enough staff to supervise individuals, and as many clients need two people to assist them this type of activity happens rarely. Observations during the day showed people sat in the downstairs lounge for long periods of time, the television was on extremely loud, and speaking with people it was evident that only one person in the lounge was interested in watching a programme. In the afternoon until 3pm people remained in the same position with little stimulation. Three staff confirmed that more activities were needed, and some staff felt the activities Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 12 did not encourage independence. People did confirm that visitors were welcomed into the home at any time, and the visitor’s book confirmed this. A church service is regularly offered and people can access the pleasant grounds. The lunchtime meal was observed in the upstairs area. People are given a choice of two meals and staff record this information. However it would be useful having a menu on the table or in the dining room so people are aware of the food about to be served. Home-cooked food is provided and fresh vegetables and homemade puddings are generally available. The portion sizes are suitable and plate guards are available. Material table cloths and napkins were in place and flowers on the table helped make the dining experience pleasant. Three people commented that the food was lovely, enjoyable, and tasty. The chef communicates well with the staff and ensures that people who are underweight have their food fortified. A new system is due to be introduced where the nutritional value of food is calculated. This will mean staff know exactly the calorific value of food and what action to take to enhance the food. The chef is aware of how to puree food and present this in a dignified manner. On one occasion a member of staff put three drinks on the table without any explanation as to their content. The drink was hot tea and people should have been made aware of this to prevent any scalding from the hot liquid. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience adequate quality outcomes in this area. People have their complaints listened to, although improvements in the staff’s understanding of abuse is needed to minimize the risk of harm to people. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure in place, and the manager is aware of how to investigate any concerns or complaints. People spoken with confirmed that they would be happy to speak to a member of staff if they had any issues. No complaints have been received by the Commission for Social Care Inspection, and the home is not dealing with any formal complaints. Eight surveys confirmed that people know how to complain (residents and relatives). People said they felt safe in the home, and the manager was aware of the different types of abuse which this client group may be exposed to. The vulnerable adults procedure from the local authority and department of health is accessible and this include the no-secrets document and whistle blowing. It was evident that staff need abuse awareness training. This was highlighted at the previous site visit almost twelve months ago and no action has been taken. Staff spoken with confirmed that they were unaware of the action to take if an allegation of abuse is made. This puts people at risk. The manager needs to be more familiar with the action to take when someone gives her information regarding an incident. This relates to the role of social services. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 & 26 People who use the service experience poor quality outcomes in this area. People live in a homely environment though there are insufficient bathing facilities and areas of the home smell of urine. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People live in a homely environment in pleasant surroundings. Many areas of the home are nicely decorated with suitable furniture evident in the communal areas. Three people’s rooms were inspected and whilst there are no en-suite rooms, those inspected were a good size and people confirmed that they liked spending time in their room and all had good views of the surrounding area. In two areas (room 33, and the area next to the stairs) smelt of urine. This is unpleasant for people using these areas. Staff need to receive infection control training to ensure they are aware of the correct procedures to prevent crosscontamination. The laundry area had sufficient washing machines and tumble driers, though this area was untidy. People’s clothes did not look very clean or well ironed, this needs addressing. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 15 The main concern raised was the lack of bathing facilities, currently there are three baths and one shower for forty five people. This is not sufficient and people are not been offered a choice because of this unresolved issue. It was evident that the home was unsure how to work within the no smoking ban regulations (which came into force 1st July). At the back entrance of the home where the fire exit is residents were able to smoke inside the building, though another sign said no smoking. The manager needs to clarify the situation. It was evident that the home was unsure how to work within the no smoking ban regulations (which came into force 1st July). At the back entrance of the home where the fire exit is residents were able to smoke inside the building, though another sign said no smoking. The manager needs to clarify the situation. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience adequate quality outcomes in this area. People are recruited effectively, though a review of the staffing levels needs to take place and training needs to improve to ensure people are cared for by competent staff. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The staffing levels in the home need to be reviewed. Whilst the staffing levels are generally adequate, the number of people that need two carers to assist them is increasing. Currently there is no deputy and agency staff are being used. At the site visit in the upstairs area four carers and one agency nurse were working, this was for eighteen people. However problems with the hoists were identified where it is becoming increasingly difficult to manoeuvre them on the carpets which slows staff down when trying to assist people. Some staff have undertaken an NVQ Level 2 or 3 (55 ) and this has been beneficial to ensure a basis standard of care is given. One member of staff confirmed she has completed induction training but no records were available to back this up. Some individual training files have been implemented but these are not up to date. The induction process is equivalent to Skills for Care (set of standards to practice with) and once implemented is suitable in helping staff meet individual needs. The recruitment process was examined and discussed with the manager. Three staff files had two references, criminal records bureau checks and for registered nurses the personal identification number was verified through the Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 17 nurses and midwifery council. This all helps to protect people from harm. The manager is aware that files need to be updated, however she does not have time to do this as she usually works with the other staff (see management outcome). Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,15 & 38 People who use the service experience adequate quality outcomes in this area. People have their financial needs protected, though the management of the home needs improving as currently people are not sharing their views and opinions regarding the service, and aspects of health and safety are not being met. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager of the home is a registered general nurse who is in the process of completing her NVQ Level 4 in management. She has experience in caring for older people and has worked in the home for six years. The manager has been in post for 12 months but is not currently registered with the Commission for Social Care Inspection, this needs to be addressed. The manager is unable to fulfil her management responsibilities which are having an effect on people using the service and other staff members. This is because she is currently having to work as a ‘hands on’ member of the team and has no supernumerary Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 19 time to complete her role. The home has been without a deputy for 12 months, and there is no permanent administrator. The quality assurance system whilst in place has not been fully implemented. For example no surveys have been sent out to people using the service or their relatives to ascertain their views or opinions. Audits of individual care plans have taken place but no follow up action has been taken when issues arise, for example areas for improvement were noted on one occasion in February but no check has been made to identify if these have been carried out. The audit form has not been completed, signed or dated for any further action over the past 12 months. The manager does not have the time to complete all the audits. This was also evident regarding staff training. Some staff have not completed moving and handling training, infection control or basis food hygiene. Individual training records are not completed and whilst a matrix is available it is difficult to evidence which training has taken place. Staff spoken with did confirm which training has taken place but all mandatory areas need completing to ensure people are being cared for by competent staff. These areas have been previously identified which the manager is aware of. The home does not deal with people’s finances directly. A personal allowance account is available and records for this were available. The pre-inspection questionnaire confirmed that no service users are subject to power of attorney or subject to Guardianship. Aspects of health and safety were examined, some radiator guards were missing and window restrictors need to be correctly fitted. The manager confirmed that she is waiting for the electrical wiring certificate and no issues are outstanding. Water temperatures are checked monthly and three were tested on the day and found to be satisfactory. A fire risk assessment has been completed and weekly fire tests take place, one of these is done randomly. Emergency lighting is in operation and door closures are available if people wish to keep their room door open. The nurse call bell system is fully operational and moving and handling equipment was last checked in March 2007. No issues regarding health and safety were raised by people using the service. Though staff felt that more equipment was needed as some of the hoists are difficult to move on the carpets. Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x 1 x x x x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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 15 Requirement All people using the service must have care plans in place (this relates to the one individual identified at the site visit). This will assist the staff in understanding the person’s needs. People must only have eye drops administered which are in date. This prevents any harm which may occur as a result of having out of date medication. Timescale for action 12/07/07 2. OP9 13 02/07/07 3. OP10 18 People must be treated in a 02/07/07 dignified manner with their privacy respected. Staff must not discuss the care of residents infront of other residents. Safeguarding adults training for all staff needs to take place. This will make staff more aware of the different types of abuse and the action to take if an allegation occurs. 02/08/07 4. OP18 18 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 22 5. OP21 23(j) The registered person is required to provide sufficient usable bathing facilities for the number of service users accommodated. (This requirement remains outstanding from the previous three inspections.) 02/09/07 6. OP26 13 The strong smell of urine in room 12/07/07 33 must be eradicated. The smell of urine at the bottom of the stairs must be eradicated. This will make the environment more pleasant for people using the service. A review of the staffing levels must take place, especially when people require assistance from two staff at once. The quality assurance system must be fully implemented. This includes seeking views and opinions through surveys, and acting on the results from the care plan audits. Staff must complete mandatory training including moving and handling, infection control and basic food hygiene. This will ensure staff care for people correctly. Evidence of training must be completed for each individual staff. 02/08/07 7. OP27 18 8. OP33 24 02/08/07 9. OP38 19 02/09/07 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 23 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 OP12 Good Practice Recommendations The manager should appoint an activities organiser as soon as possible so that organised activities could take place. Consideration of the no smoking ban needs to take place. The manager needs to apply to become registered with The Commission for Social Care Inspection as soon as possible. The manager must have time to carry out her management duties, to ensure the home is run in the best interests of people. 2. 3. OP26 OP31 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Leeming Garth DS0000028033.V335900.R01.S.doc Version 5.2 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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