Inspection on 11/12/05 for Leonard Cheshire Of Gloucestershire

This inspection was carried out on 11th 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 no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Leonard Cheshire Of... 12/09/07

Leonard Cheshire Of... 15/05/06

Leonard Cheshire Of... 11/05/05

Leonard Cheshire Of... 25/11/04

Leonard Cheshire Of... 18/06/04

Leonard Cheshire Of... 07/01/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOME ADULTS 18-65 Leonard Cheshire Of Gloucestershire Charlton Lane Leckhampton Cheltenham Glos GL53 9HD Lead Inspector Ms Lynne Bennett Unannounced Inspection 11th December 2005 9.00 Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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 Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Leonard Cheshire Of Gloucestershire Address Charlton Lane Leckhampton Cheltenham Glos GL53 9HD 01242 512569 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 Mr Gareth Jones Care Home 36 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (2), Physical disability of places (36) Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user (under a Learning Disability Category) until they leave the home. 11/05/05 Date of last inspection Brief Description of the Service: Leonard Cheshire of Gloucestershire provides residential and nursing care for people with a physical disability. The home is owned and managed by The Leonard Cheshire Foundation. The home is located in Leckhampton, not far from Cheltenham town centre, and close to local facilities and amenities. The home was purpose built some 13 years ago, providing a main building divided into five lodges for six people, communal spaces, offices and a hydrotherapy pool, a sensory room and a physiotherapy room. There are six bungalows that enable service users to have greater independence but also retain some support from staff. The home has four mini buses and a car; service users also use local taxis and the community transport system. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on Sunday 11th December and lasted over four hours. The visit was carried out by two inspectors, Tanya Harding and Sharon Hayward-Wright. Several of the lodges were visited and several service users and staff were spoken with. A number of records were examined including care guidance and staff rotas. The registered manager came in for part of the inspection and has provided additional documentation since the visit. The purpose of this inspection was to assess progress with meeting the requirements made in the last report. There was evidence that progress has been made in some areas. Since the last inspection there have been two additional visits to the home which focused more specifically on nutrition and care planning. Outstanding requirements from the last inspection and from the additional visit are incorporated into this report. Some service users felt that although staff try hard to do a good job, they struggle to provide the level of support required by each individual. People understood the issues about staffing levels and funding implications and felt compromised by this and guilty about raising these issues. What the service does well: What has improved since the last inspection? What they could do better: Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 6 It is important for the home to take on board the wants and wishes of the service users by responding to their requests with positive actions. Service users voiced their concerns about lack of opportunities to go out at weekends. They felt this was due to the lack of staff and drivers. Better staffing levels would enable the service users to take part in activities of daily living and support their aim towards greater independence. Security of the front doors needs to be reviewed to protect the service users from unwelcome intruders. The use of kitchens and dining rooms in individual lodges should be promoted and supported to increase opportunities for the residents to prepare own meals and enjoy these in a more homely setting. Concerns about availability of adequate staff during nights must be resolved. 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. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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 Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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): Not assessed. EVIDENCE: A variation to home’s registration has been approved to accommodate a named service user with learning disabilities. The updated registration certificate was displayed. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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 and 9 Service users are involved in making decisions about their care. Improvements to risk assessments would ensure better protection for the service users. EVIDENCE: Service users spoken with confirmed that they are consulted about their support needs. Progress has been made towards meeting the requirements made in the last inspection report and subsequent visits to improve care plans. The timescale for completing these requirements has been extended to allow the home to review the whole care planning process in detail. Risk assessments were examined for several service users. Those seen were generic and talked mainly about the health and safety aspects of the environment not the individual service user themselves. The information in the risk assessments was very limited. For example a risk assessment for shower/ bathing under the heading ‘hazards’ stated ‘none’. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 10 The National Minimum Standards for younger adults talk about people taking risks as part of an independent lifestyle. It is felt that current risk assessments do not reflect this ethos. Individual risk assessments need to identify with the person those areas which may make the service user feel more vulnerable. Consideration should also be given to the duty of care towards that person, ability to consent if this is unclear and any other factors which may influence the person’s ability to take part in any chosen activity safely. There is a risk assessments procedure in place for hazards in the environment. The environment is just one aspect of what needs to be considered when assessing safety of individuals and further information on how this can be done effectively must be sought. Staff responsible for carrying out individual risk assessments must receive the relevant training. A risk assessment has been implemented for a service user who smokes in their room. This allows the person to smoke only in the presence of staff. There was evidence that on occasion the person requests to smoke, but are asked to wait until staff are freed up. This can be upsetting for the service user. Also this practice exposes staff to passive smoking. Further consideration needs to be given to the appropriateness of this risk assessment. Records seen provided evidence of reviews taking place for risk assessments. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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): 13, 15, 16 and 17 Opportunities for service users to access the community at weekends and evenings are limited due to transport and staffing issues. Relationships with family and friends are supported. Further improvements are needed to the quality of meals in the home and to enable the service users to have the opportunity to prepare own meals. EVIDENCE: Service users felt that opportunities to access the community are very limited especially at weekends. This is mainly due to availability of staff support and transport. One service user said that this makes them cross. Concerns about difficulties in supporting service users to access the community have featured in inspection reports since January 2004 and these shortfalls must be addressed. Daily records are maintained for each service user. Those seen were brief in contents. For example one record said that the service user was ‘up and is fine’. Records of service users attending activities are kept. There was Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 12 evidence of people going swimming, to colleges and shopping in town. There was no reference to any evening activities outside of the home. Social events are arranged for service users in-house. The day before the inspection a Christmas Fayre was held to which relatives and friends were invited. People spoken with said they can have visitors in the home and go out to visit or stay with their families. Service users were observed to be able to access all areas of the home. A number of daily routines for service users were looked at. These provided evidence of service users being encouraged to be as independent as possible in daily living tasks. For one person a care plan was seen which looked at enabling the service user to learn about money. The last report presents concerns about availability of wholesome and nutritious meals in the home. All of the cooked meals are prepared and served in the large canteen-type dining area. Each of the lodges now has a fitted kitchen and dining area, which are homely in size and appearance. The kitchens were installed with aim to offer the service users opportunities for preparing their meals. However, this has not been achieved and people living at the home voiced their disappointment. The service users and staff felt that this is because there are insufficient staffing levels to enable people to go out shopping for their food. People stated that staff were ‘rushed off their feet’, trying to do their best and working a lot of extra hours. Service users spoken with stated that there has been little improvement in the quality of the food. They said that the vegetables were not always fresh and lots of meals included chips. Several service users said the variety of meals could also be improved so that the same meals are not repeated quite as often. The inspectors observed the lunchtime meal on the day of the visit. A Sunday roast was being served and people commented that this tasted nice. Due to the comments received from the service users about the quality of the meals, it has been recommended that the management team should taste the meals on at least on weekly basis. There were plans for people to have Christmas dinner in the lodges and service users said they were looking forward to this. Staff spoken with confirmed that reheating of meals is still continuing. This practice potentially places the service users at risk of food poisoning and must stop. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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): Service users may not always be given the opportunity to receive their personal care in the way which they prefer. EVIDENCE: There are occasions when service users receive bed-baths as instead of showers or baths in order to save time. There was evidence that given the choice, people would much rather have a shower or a bath. This would be seen as a more ordinary and dignified way of keeping clean. Service users preferences need to be identified in care plans and suitable arrangements must be put in place to provide the required support. One person was seen being transported between the bathroom and the bedroom covered in towels. Consideration should be given to offering the person greater dignity in consultation with them. Information about health related appointments is recorded in daily records. There was evidence that people have access to doctors and other health professionals. The relatives are informed of illnesses where necessary. Self –medication assessments are in place for service users who manage their own health needs and medication. The manager confirmed that the updated homely remedies list is in place. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 14 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): 23 Systems for protecting service users from harm may not be sufficiently robust and put people at unnecessary risks. EVIDENCE: A copy of the policy regarding protection of vulnerable adults from abuse has been provided to the Commission for reference. This is dated 17/08/01 and makes no reference to the CSCI being informed under Regulation 37 of any allegation of abuse or occurrence of abuse. There is a reference to the Registration and Inspection unit being informed at a later stage of the investigation. There is no reference to the local adults at risk procedures. The policy needs to be reviewed and updated in line with the relevant legislation and current guidance (to include local procedures). There is also a policy for managers with regards to POVA legislation and referral to the POVA register. This report provides evidence of concerns expressed by staff and service users about safe staffing levels in the home. See standard 33. The majority of the service users in the home are able to self-advocate and those spoken with said they have raised issues with staff and the home manager in the past. However, there was also feedback from the service users that they feel guilty about bringing up the same issues, such as food, staffing levels and availability of transport. These issues have also been highlighted in past inspection reports and must be addressed. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 15 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 The majority of the decoration and fittings are in a good state of repair with some minor improvements necessary to make the environment more pleasant for the service users. EVIDENCE: One bedroom in B lodge was very odorous and the communal corridor was also affected. This must be addressed to ensure that the environment remains pleasant for all service users in this part of the home. Some of the chairs in the dining room/ kitchen area in B lodge were worn and ripped in places and need to be replaced. Accessible kitchens have been fitted in each lodge although some finishing and repair work is required. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 16 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 Inadequate staffing levels may potentially be putting the service users at risk. EVIDENCE: There was evidence in records that staff have raised concerns about the numbers on duty during the night. The manager advised that a minimum of three staff are required to provide waking cover between hours of 8pm and 7.30am. A twilight nurse provides additional cover between 8.30 – 11.30pm. However, there was evidence that some night shifts were covered by just two staff after the end of twilight shift. The layout of the home and the number of residents with complex physical needs means that two staff may be required to support one person, leaving over 30 other residents without access to staff. If two staff are required in the adjacent building, this will leave the main house unattended and raises additional security issues. This is clearly unacceptable and the manager has agreed to look into why this shortfall in staffing has been allowed to happen, as he was unaware of this situation. A copy of his findings must be send to the CSCI. Some service users spoken with felt that inadequate staff numbers are putting them and other residents at risk. However, some people felt there were sufficient staff and they did not have to wait long for the required support. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 17 The manager advised that there are plans to recruit a qualified nurse. One additional carer was waiting to start employment subject to CRB check. The manager has provided a copy of the night staff job descriptions for trained nursing staff and for care staff as requested in the last inspection report. There is a specific reference to maintaining security of the building at night as well a list of roles and responsibilities relevant to both posts. In response to the requirement made in the last inspection report training has been scheduled for staff in February 2006 to increase their awareness of supporting people with learning disabilities. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 18 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): 37, 40 and 42 The management of this home is satisfactory overall, but there are inconsistent practices in areas of monitoring records and addressing requirements, which could potentially place service users at risk. Security issues and shortfalls in health and safety procedures may be putting the service users at risk. EVIDENCE: The process of managing the home appears open and transparent. There are systems in the home which provide service users with opportunities to get involved in running of the home and to voice their views. However, there are a number of areas which the home has previously agreed to address but the necessary standard has not been achieved. The policy on identifying and reporting of abuse is considerably out of date and must be reviewed, see also standard 23. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 19 Procedures for carrying out risk assessments need to be reviewed to ensure resulting guidance for identifying hazards and reducing risks is detailed and effectively protect the service users. Concerns about the security of the new entrance doors were brought to the attention of the home manager. Improvements must be made to ensure the safety of the service users and staff. The home has a visitors’ book which is usually placed in the main entrance hall. This could not be found on the morning of the inspection, but was later located. The inspectors were made aware that there have been a number of visitors to the home the day before this visit. However, no records of any visitors for the 10th of December 2005 were noted. The last entry in the visitors’ book was for 9th December 2005. Regulation 17 requires for the home to keep such record as an additional protection for the service users in the home as well as for fire safety purposes and this must be adhered to. There is a names board in the hallway which indicates which staff and residents are in. The staff member advised that this board can be taken out in case of a fire drill/ evacuation. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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 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 X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 1 X X X CONDUCT AND MANAGEMENT OF THE HOME 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Leonard Cheshire Of Gloucestershire Score 2 X X X Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X 2 X DS0000016491.V271206.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Timescale for action 14/03/06 2. YA9 13(4)(6) Care plans must be completed for all service users in line with their assessments. These must be individual to each person and provide detailed guidance about people’s support needs. (Within timescales at the time of this visit). Individual risk assessments must 14/03/06 be person centred and provide sufficient detail of which hazards have been considered, the level and the severity of risks identified and actions which must be taken to reduce/ eliminate the assessed risks. Staff responsible for carrying out individual risk assessments must receive the relevant training. Provide sufficient staff and suitable transport to enable the service users to go out more, (to include evenings and weekends). (This is a long-standing requirement which has not been met to a satisfactory standard.) 3. YA13 12 and 16 14/03/06 Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 22 4. YA17 17(2) Sch 4.13 5. 6. YA17 YA18 13(6) 12 A record must be kept of the 14/01/06 food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. (Within timescales at the time of the visit). Practice of reheating food must 31/01/06 stop. Service users preferences with 14/03/06 regards to how personal care is to be provided need to be identified in care plans and suitable arrangements must be put in place to provide the required support. The policy on protecting vulnerable adults from abuse must be reviewed and updated in line with the relevant legislation and current guidance (to include local procedures). Investigate the reasons for the shortfall in night staffing and why this has been allowed to happen. Provide a copy of the findings to the CSCI. 14/03/06 7. YA23 13(6) 8. YA23 13(6) 28/02/06 9. YA24 23 Improvements must be made to the environment as follows: a) Address the odorous bedroom in B lodge. b) Replace worn and torn chairs in B lodge. c) Complete work and decoration in new kitchens. 14/03/06 10. YA33 18 There must be suitably qualified, DS0000016491.V271206.R01.S.doc 31/01/06 Page 23 Leonard Cheshire Of Gloucestershire Version 5.0 11. YA42 23 12. YA42 13(6) competent and experienced staff working in the care home in such numbers as are appropriate for the health and welfare of the service users. Improvements must be made to 31/01/06 the security of the front entrance to ensure the safety of the service users and staff. A record of all visitors to the 31/01/06 home, including names, must be kept. 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 YA17 Good Practice Recommendations The management team should taste the meals on at least on weekly basis and a reference to this should be made in Regulation 26 reports. Regular feedback should also be sought about food provided by the home from the service users. Menus and records of food served should be monitored to check whether there is frequent repetition of meals. 2. 3. YA17 YA18 The use of small kitchens in the lodges should be promoted for all meal times. One person was seen being transported between the bathroom and the bedroom covered in towels. Consideration should be given to offering the person greater dignity in consultation with them. Evidence of this should be recorded in the person’s care plan. Leonard Cheshire Of Gloucestershire DS0000016491.V271206.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leonard Cheshire Of Gloucestershire DS0000016491.V271206.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!