Inspection on 24/04/06 for Limes Residential Care Home

This inspection was carried out on 24th April 2006.

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

Limes Residential Care Home 04/12/07

Limes Residential Care Home 14/08/06

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

CARE HOMES FOR OLDER PEOPLE Limes Residential Care Home 11a Station Cresent Ashford Middlesex TW15 3JJ Lead Inspector Pauline Long Unannounced Inspection 24th April 2006 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 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 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. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Limes Residential Care Home Address 11a Station Cresent Ashford Middlesex TW15 3JJ 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) 0208 9091110 Elmbank Residential Care Home Ltd Mrs Alena Vivian Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The named service users (as detailed in letter dated 6th March 2006) currently accommodated in the home who fall within the category of `dementia - over 65 years of age` may only continue to remain in the home subject to a full care management review and re-assessment of their individual care needs. No further admissions may take place in respect of that category. Date of last inspection Brief Description of the Service: The Limes is a care home for older people, which is located in a residential area in Ashford. The property is a detached older style dwelling, which has been sympathetically extended to provide accommodation for up to 16 residents. Rooms are arranged over two floors, the first floor having stair lift access. There is an adapted bathroom and a walk in shower. Individual rooms are of varying sizes and each one is fitted with a wash hand basin. There is a well-kept garden to the back of the property, where residents can sit out in the warmer months. The home is situated close to the town centre and has good road links: Ashford railway station is within walking distance. There is limited parking to the front of the property. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of the key inspection of the CSCI year 2006-2007 and was unannounced. The inspection was carried out by one inspector and lasted for seven hours. The ownership of the home has changed since the last inspection and a new manager had been in post for two days. Discussions were had with the residents, provider, manager and staff. Documents sampled included, residents files and care plans, staff files, daily observation notes, and health and safety records. CSCI would like to thank the residents, manager, provider and staff for their hospitality and co-operation during the inspection. What the service does well: What has improved since the last inspection? All of the residents now have a contract of care service provided. The home has successfully recruited a new manager, a full time cook and care staff. Medication policies, procedures and administration are much improved. All medication record sheets now contain an up to-date photograph of a resident indicating that a new member could easily identify a resident minimising the risks in the administration of medication. Staffing levels have been increased in order to ensure residents care needs are met and to improve the catering arrangements. Risk assessments are now routinely carried out, which enable staff to identify risks which could impact on the health and safety of the residents. However care staff still require further training in this respect. All care staff have been enrolled on a six month dementia care training course, which aims to provide them with the skills to understand and manage challenging behaviours. Other statutory training has been undertaken. Staff are now receiving the required one to one supervision meetings with a line manager. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 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 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 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 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Files sampled, evidenced that arrangements were not in place to ensure a full needs assessment takes place before any new admission. The home does not provide for intermediate care. EVIDENCE: The home has undergone changes in ownership and management. It was identified that the previous owners had implemented a needs assessment format. Whilst this assessment covered activities of daily living and is “tick box” document, which does not give in-depth detail in to a residents needs. The assessment format will need to be developed further in order to provide a comprehensive overview of a residents needs. The home accepts referrals from both local authority and privately funded individuals. The files sampled evidenced that community care needs assessments were not always obtained by the home prior to a resident being admitted. However no new residents have been admitted to the home since the last inspection. The manager was advised that the home must obtain a Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 10 community care needs assessment for any new residents referred by local authorities, and that a comprehensive pre-admission needs assessment must be carried out on any privately funded prospective residents prior to admission to the home. The home does not provide for intermediate care. A requirement has been made in respect of this standard. Please refer to pages 23 and 24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 11 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff had a good understanding of the resident’s health and personal care needs, which were met on the day. However the care planning skills of staff need to be improved. Resident’s commented that they are treated respectfully. Medication policies and procedures are in place and are adhered to. EVIDENCE: The home has recently introduced a new care plan format. It was positive to note that the care staff had transferred all of the individual resident’s details from the old care plan format. The new format allows for a much more detailed and holistic view of a residents needs and appeared to be less cumbersome. The care plan covers all activities of daily living needs and incorporates a risk assessment related to each activity. On reading the document it became apparent that the care staff did not have a complete understanding of how it should be completed. The staff commented that they had received some training in this area, however they were aware of their shortcomings and were confident that further training in this area would improve their understanding. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 12 Resident’s healthcare needs were documented and there were records to demonstrate visits from general practitioners and community nurses. A requirement was made at an earlier visit that the home must ensure, all of the residents had a review from both general practitioner’s and care management teams. It was not clear from the records as to when and if these reviews had been carried out. This was discussed with both the care staff and managers, who stated that the reviews had taken place. Records in respect of food and fluid intake and weight charts were kept on identified residents. It was positive to note that, the care plans sampled had been reviewed on the 24/04/06. Daily records are kept in a daily log book. These records were well documented across the 24 hour day and provided a holistic view of a residents day. Medication procedures and practices were discussed with the deputy manager who is responsible for overseeing the homes medications. It was evident that the homes medication systems were improved and well managed. All of the medication record sheets were in good order and no gaps in the recording were noted. The day-to-day medication is stored in a wheeled medication trolley, which in turn is stored in a locked cupboard. The trolley was well maintained and clean. All of the medications were up to-date and blister packs had the appropriate medications removed. Controlled drugs were kept in a separate locked cupboard and good records kept. The home carries out a monthly audit of medication and those medications not used are returned to the pharmacy and records kept. The new manager commented that a new medication audit was being considered, and would be discussed with the staff. Staff were observed providing support to residents in various aspects of personal care. Bedroom and bathroom doors were not left open, staff were observed to knock on doors before entering. One resident commented that the staff were always respectful and would never enter a room before knocking. Requirements have been made in respect of these standards. Please refer to pages 23 and24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home enables the residents to maintain fulfilling lifestyles in the home. The meals in the home are good, offering some limited choice. The home promotes contact with family, friends and the local community EVIDENCE: On the day the inspection started at 9.00am and it was pleasing to note that some residents were still in the process of getting up. Other residents were up and enjoying their breakfast. One resident was observed eating breakfast in his bedroom, the television was on and he was enjoying watching the news. He commented that he preferred to spend the day in his bedroom and likes watching his selection of DVD’s. Residents were observed being supported into the garden for a walk, others were reading and humming along to the music on the radio. There is no pre-planned programme of activities at the home, however the minutes of the residents last meeting held on 14/03/06 recorded that the residents agreed, they enjoyed playing bingo, going to the shops and joining in with sing-a-longs. The need for the home to develop an activity programme was discussed with the manager and provider, who stated that this would be on the list of things for the new manager to discuss with the residents and staff. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 14 When the new owners took over the running of the home there was a concern around the changes they made to the quality and quantity of food. The inspector spent some time observing the kitchen management and food hygiene practices. The menus covered a five week period and were varied, however there was no documented evidence to indicate that there was more than one choice of main meal. On the day the lunch time menu consisted of mince pastry pie, with mixed vegetables and potatoes, and mandarin oranges and cream for pudding. The chef commented, that one resident had requested fish instead of pie, and other residents had requested strawberries for desert. Both these choices had been provided. The chef was observed blending food for resident’s specialist dietary needs. Discussions were had with the chef around the need for food to look appealing and appetizing. Food storage was checked, fridge, freezers and cupboards were well stocked. The chef served the meal from a trolley brought from the kitchen to the dining room. There was a concern that as the trolley was not a heated one, as there was a risk the food temperatures could not be maintained. However the residents commented that the food was “nice and hot” The chef demonstrated a good understanding of residents likes and dislikes in respect of the amount of food. He was observed chatting to the residents about the food. All of the residents appeared to be enjoying their meal, commenting “ how nice it was”. The chef was advised to record the resident’s comments as part of the homes quality audit. Lunch time at the home was unhurried with residents given sufficient time to eat their food. Staff were observed supporting those residents who required assistance, this support was offered in a respectful manner. A recommendation was made in respect of kitchen equipment. Please refer to pages 23 and 24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory policies and procedures and training in place for dealing with the protection of the residents, and for addressing concerns and complaints. EVIDENCE: The CSCI have received one complaint about the home since the last announced inspection. The complaint related to reduced staffing levels and the quality and quantity of food provided by the new providers. As a result of this complaint a CSCI investigation was carried out and subsequently a referral was made under the local authority safeguarding adult procedures. The complaint has been satisfactorily resolved. It is positive to note that the new providers have worked with, and continue to work in collaboration with the CSCI and the local authorities social care management teams to ensure the health safety and wellbeing of the residents. Some of the care staff have yet to undergo training in respect of safeguarding adults. It became apparent that one member of staff had been employed prior to having a (POVA) First check carried out. Discussions with staff demonstrated that they had a good understanding of what constitutes abuse and what they would do if faced with an abusive situation. Requirements have been made in respect of these standards. Please refer to pages 23 and 24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good, and meets the needs of the residents, providing a clean, attractive and homely place to live. EVIDENCE: On the day the home was found to be clean and maintained to a satisfactory standard throughout. The fabric and decoration of the communal areas was satisfactory, domestic in design and reflected that of any busy household. A malodour was noted in one room. This was discussed with the manager and provider, who provided a satisfactory explanation as to the reason for the malodour. It was also noted that one of the hall carpets was badly stained and it became apparent that there was a water leak under the floor. The provider stated that a plumber had been called in this respect. Staff are issued with protective clothing for example: uniforms, gloves and aprons. Clinical waste bins are also provided. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 17 Resident’s bedrooms were clean, tidy, pleasant and personalised to ensure comfort. One resident commented that he “liked spending time in his bedroom it made him feel like he was at home”. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing arrangements in place on the day of inspection were sufficient to meet the needs of the service users. Recruitment practices were poor. Staff training in the home has improved. EVIDENCE: Following the recent adult protection issue at the home staffing levels were increased and have been maintained. On the day the staffing numbers were observed as being adequate for the dependency levels of the residents. The staff team consisted of a manager, a deputy manager, three care assistants, one chef and one cleaner. One new member of staff has been recruited since the last inspection, and this file was sampled. Some of the required documentation was in place to include 2 references, a photograph and a contract. However not all of the checks required had been carried out prior to employment: for example a POVA First check had not been completed. This was discussed with the provider, and she was advised that staff should not be employed at the home until all POVA checks are completed. Several staff training days have been introduced for example: Safeguarding Adults, fire training, malnutrition screening, dementia care, first aid, medication administration, care planning and manual handling. As discussed earlier in this report further training in care planning and risk assessment must be arranged. It is positive to note that the dementia care course is an Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 19 accredited college course and that the provider is also undertaking this course. It must be noted however, that not all of the staff have undergone the Safeguarding Adults training course. Requirements were made in respect of these standards, one was an immediate requirement in respect of POVA First checks. Please refer to pages 23 and 24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are aware of their responsibilities to ensure residents receive consistent quality of care and that the health, safety and welfare of the residents is promoted. The systems in place for recording residents financial interests was unclear. Arrangements were in place to supervise staff EVIDENCE: As discussed earlier in this report the home has undergone major changes. A new manager has been recruited and had been in post for two days. He is a qualified enrolled nurse and has worked in a large care home as the care manager of a dementia unit. He has recently undertaken National Vocational Qualification (NVQ 4) and the registered manager award. An application has yet to be submitted to the CSCI office in respect of his registration. Discussions were had with the staff group, who commented that they had concerns around the changes and were feeling somewhat vulnerable and unsupported. This was brought to the attention of both the manager and Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 21 provider, who stated they would meet with the staff as a matter of urgency to discuss their concerns. It was positive to note that this meeting took place on the day. There was evidence to demonstrate that the provider has implemented a formal staff supervision process and staff commented that they had received a one to one supervision meeting with the provider. Staff meetings are also being held. The provider has spent a considerable amount of time at the home in the past few months. Meetings have been held with both residents and staff enabling them to express their views. Service user surveys have yet to be developed, however minutes of meetings demonstrated that residents views had been sought in respect of food and daily activities. Discussions were had around the need to develop and implement service user surveys. The provider commented that the home is not responsible for resident’s personal monies. However she also commented that during the period of change, when they took ownership of the home it was not clear as to how resident’s paid for hairdressing and chiropody services. Until this could be established the provider set up a personal account for each resident whereby resident’s would have access to these services until arrangements were made with next of kin. It was unclear from the records kept as to how this was managed. Health and safety checks are carried out at the home and records kept in respect of this. A fire risk assessment has recently been carried out and various recommendations made as a result for example: the home must review its fire evacuation policy. It was noted that as part of this assessment all the fire doors were checked and found to be closing satisfactorily, however the inspector found that some of the fire doors were closing very quickly and could have the potential to knock down a frail resident. This was discussed with the manager and provider and they were advised to have the doors rechecked. Fire alarm systems are checked weekly. Accidents and incidents are recorded and reported as required. Kitchen practices were checked. Records in respect of food hygiene regulations were kept and were up to date. However some food storage practices were poor, potatoes were being stored outside the kitchen door and were not being stored appropriately. Requirements were made in these areas. Please refer to pages 23 and 24 of this report. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 2 X 3 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 1(a(b(c(d 12(1)(a) Requirement Timescale for action 26/05/06 2. OP30 3. OP4 4. OP12 5. OP15 The registered person(s) must ensure that all residents admitted to the home have a comprehensive assessment of their care needs prior to being admitted to the home. 12(1)(a) The registered person(s) must 18(1)(c ) ensure that all staff undergo training appropriate to the work they are to perform. Comprehensive care planning and risk assessment training must be provided. 12(1)(a) The registered person(s) must 14(2)(a(b ensure that a resident who has been assessed as requiring nursing care is suitably placed in order that their care needs can be met. The Social Services Care Management team must be contacted urgently regarding this matter. 16(2)(m(n The registered person(s) must ensure that an activity programme is developed and implemented in conjunction with resident’s choices. 12(1)(a) The registered person(s) must 16(2)(i) ensure that two choices of main DS0000066830.V289100.R01.S.doc 26/06/06 26/05/06 26/06/06 03/05/06 Limes Residential Care Home Version 5.1 Page 24 7. OP29 19 8. OP35 12(1)(a) Schedule 4(9) 9. OP8 12(1)(a) 13(1)(a(b 10. OP30 18(1(a(b (C 12(1)(a) 13(6) 18(1)(c ) 12(1)(a) 13(4)(a(b (c 12(1)(a) 13(4)(c ) 11. 12. OP18 OP38 13. OP38 14 OP33 24(1)(a(b (2)(3) meal must be offered to the residents. The registered person(s) must ensure that all staff employed to work at the home have all of the required checks. POVA first checks must be carried out prior to a member of staff starting work. The registered person(s) must ensure that a robust system is in place to protect and safeguard resident’s monies and to record petty cash transactions. Adequate records must be kept. The registered person(s) must supply the CSCI with evidence that resident’s General Practitioner and Care Management reviews have taken place. The registered person(s) must provide the CSCI with a staff training and development programme. The registered person(s) must ensure that all of the staff have training in safeguarding adults. The registered person(s) must ensure that all of the fire doors in the home are working appropriately. The registered person(s) must ensure that foodstuffs are not stored outside the kitchen door, unless they are stored in an appropriate container. The registered person(s) must ensure that a service user survey is developed and circulated to all residents and service users. 26/04/06 26/05/06 03/05/06 26/05/06 26/06/06 27/04/06 25/04/06 27/07/06 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations The registered person(s) should consider providing a heated trolley in order that the chef can safely continue to to serve the residents meals at their tables. Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Limes Residential Care Home DS0000066830.V289100.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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