Inspection on 11/10/05 for Lindisfarne Nursing Home

This inspection was carried out on 11th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Lindisfarne Nursing Home 20/06/07

Lindisfarne Nursing Home 07/08/06

Lindisfarne Nursing Home 13/04/05

Lindisfarne Nursing Home 30/11/04

Lindisfarne Nursing Home 17/05/04

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

CARE HOMES FOR OLDER PEOPLE Lindisfarne Nursing Home Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS Lead Inspector Mrs P A Worley Announced Inspection 11th October 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lindisfarne Nursing Home Address Kepier Chare Crawcrook Ryton Tyne & Wear NE40 4TS 0191 413 7081 0191 413 7308 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) Gainford Care Homes Limited Eileen Bellas Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (54) Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Lindisfarne Nursing Home is a two-storey purpose built home providing nursing care and personal care to people suffering from mental illness and dementia. The home is situated in the centre of Crawcrook and close to local shops, park and other facilities, and is on a main bus route. All bedrooms are single and the majority are en-suite, and all the necessary services and facilities are provided including an emergency call system and bathrooms and toilets that are suitable for physically frail or disabled people. There is a passenger lift to take service users and visitors between floors. A choice of lounges is also available. Easy access into and around the Home is available and corridors and doors widths are wide to allow access for wheelchair users. The home has extensive and pleasant gardens and a safe area for service users to sit outside. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 1 day and was carried out by two inspectors. Time was spent with service users, families, staff and people who visited on the day. Inspection of a sample of records was undertaken including assessments, care plans and resident’s finance records of personal allowances and staff files. Time was also spent looking around the building to check the facilities and equipment available for service users and the general maintenance of the property. A meal was shared with service users on both floors to sample the food and get a feeling of what the mealtime experience is like for people living at the home. Some service users were unable to make verbal comments to the inspectors about the quality of the service provided because of their level of dementia. However, time was spent with service users during the day and picking up on non-verbal cues to show their views, and some visiting relatives were also spoken with. What the service does well: What has improved since the last inspection? Care plans have shown signs of improvement and social histories are currently being completed to give a broader a picture of who the person is, which helps to plan effective care using a more person centred approach. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 6 Many of the requirements outlined in the last inspection report have been addressed and the Manager and staff have worked hard to achieve this. New colour coded laundry skips have been bought to help improve the organisation of dirty laundry and seems to be effective. Door guards are now in place so that service users, who need to have their bedroom doors open to make access easier, are now able to do so. The ventilation system has also been repaired and is now effective and no longer noisy. Mealtime arrangements have been changed to improve the menus, and individual choices and preferences are better catered for. The rooms are now less crowded and a more relaxed atmosphere is present. Training for staff has increased and includes areas covering protection of vulnerable people and conditions relevant to those people who live in the Home. 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. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 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 Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): .3 & 4. The Home does not provide Intermediate Care (standard 6). Comprehensive assessments are undertaken on admission, which inform the care planning process. Families are aware of the pre-admission assessment processes and are given information about the service offered by the home prior to admission. EVIDENCE: Care Manager’s assessments are in place in the files and link into the homes initial assessment of need undertaken on admission. Subsequent assessments are up to date and provide useful information about a variety of needs, including falls assessments, continence assessments and moving and handling assessments. This information should help to inform how care is planned with the individual and monitor a persons’ level of independence/dependence. However, they don’t always link fully into the care plan. For example using the ‘Crichton’ behaviour rating scale to identify how the person’s dementia or mental health need affects their behaviour and impacts on their quality of life. One assessment refers to a person as ‘anxious’ but this is not considered within the care plan. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 9 A number of visiting relatives spoke of the needs being met of their relatives living in the Home. One relative said, “ staff are friendly and caring and her mother was brighter than she’d been in a long time”. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Social histories are being developed and care plans have made some good progress. However, behavioural and psychological aspects of care are not detailed enough to provide sufficient guidance to staff and ensure a consistent approach is adopted. The systems in place for dealing with medicines are satisfactory and the arrangements ensure that resident’s medication needs are met. Personal care and support by staff is offered to residents in a way that respects, promotes and protects their privacy and dignity. EVIDENCE: Care planning generally has improved and more recent plans have a better structure and are written in an easier to read style. However, they still focus largely on physical aspects of care. Whilst the evaluation sections of the plans are completed and up to date, they tend to contain information that demonstrates the plans are only monitored. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 11 Evaluations do not review how effective the care plan is for that particular area of need and do not show where this evaluation has highlighted the need for a change in how care is planned. Entries are often uninformative and lack detail for example ‘remains wandersome’, ‘xxx remains physically and verbally aggressive’, ‘skin remains intact’ or ‘care plan still relevant, to be continued’. Behavioural strategies are not in sufficient detail to help maintain a consistent approach by staff or provide sufficient guidance in difficult situations. For example one entry stated ‘keep xxx calm and maintain a hazardous free environment’ but didn’t explain how this should be done. However, care plans completed more recently show evidence that clearer detail is now being recorded when plans are reviewed. For example one plan looking specifically at someone’s diet clearly outlines which food to avoid and another plan looking at aggressive behaviour explains to staff ‘don’t argue with her’. Care staff and nursing staff were both knowledgeable about the care planning process and able to demonstrate verbally, the care provided in great detail. This knowledge needs to be recorded in the plans to ensure a consistency of approach to care and dealing with and preventing situations. Regular contact with GP’s, dietician, optician, chiropodist, psychiatrists and other professionals is well documented and shows that service users physical health care needs are fully met. During the inspection visit a Nutritionist visited the Home to discuss with the Manager in-house training she was to give to staff regarding balanced and nutritious diets and meals for residents. The arrangements for the ordering, storage, administration of medicines remains satisfactory. In line with recent legislation regarding the disposal of medicines from nursing homes, the Manager has a contract with an appropriate provider for the safe disposal of medicines. New flooring has been laid in the medicines room. This flooring is more appropriate in a clinical area where medicines are stored and enables effective cleaning to be carried out. Staff were observed to treat residents with respect in their approach to them, and upheld their dignity when dealing with personal care issues. All residents appeared well cared for and appropriately dressed, and one relative said, “ Staff are smashing, the residents are always clean, wearing their own clothes and well turned out”. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15. Daily routines are flexible around individual needs and preferences. The activities co-ordinator is working hard to provide a range of activities to people with wide varying levels of need. Service users are given choice at meal times and encouraged by staff to maintain independence where possible. Food is freshly cooked, nutritious and well presented. EVIDENCE: Meal times were more relaxed and service users didn’t have to wait a long time for their meal. Staff were helpful and encouraging to service user’s who needed some help. Tables were set with cloths, place mats and condiments on the first floor but no tablecloths, only placemats on the ground floor. Following a review of the mealtime arrangements, the dining rooms were less crowded. Service users were offered choice about where they wanted to have for their lunchtime meal and appropriate plates were used for those who needed assistance to maintain independence with eating. Second helpings and drinks were offered to residents and cold drinks were provided and available in the lounges for residents throughout the day. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 13 The activities co-ordinator is enthusiastic and tries hard to motivate service users to take part in activities, and has spent time establishing individuals’ likes, dislikes and preferences. She has established resident’s meetings and encourages them and relatives to participate, and is gathering ‘life history’ information from residents and families in order to better understand the social interests of individuals. Both she and the care staff recognise the need to arrange both group and individual activities. The activities co-ordinator arranges activities and accesses information about local events, involving the local community etc, and care staff support this role. This has helped to widen the opportunity for service users to access the local community and engage in one to one activities such as ‘hand massage’ or group activities such as ‘gentle exercise’. A programme of daily activities is displayed in the Home and on the ground floor a white board gives notice of forthcoming monthly events to ‘look forward too’. However, some relatives stated “there is still not enough for them to do” and “it’s difficult to get people with dementia involved”. Most staff, including the activities co-ordinator, have taken part in a 12-week course about dementia and generally showed a good understanding of dementia type illnesses. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The Home has a satisfactory complaints procedure, which ensures that complaints are handled in a timely and objective way. Satisfactory arrangements are in place for the Protection of Vulnerable Adults. All staff have now received formal and up to date training in this matter to ensure that they are able to protect vulnerable people from abuse. EVIDENCE: A complaints procedure is displayed in the Home and is also available in the Service Users Guide, which gives information about how to and whom complaints can be made to. Those residents who were able to express their views, and relatives who were spoken with, were confident about who they could make complaints to and that they would be dealt with appropriately. The Home’s policy and procedure on Protection of Vulnerable Adults remains in place and arrangements were made following the last inspection for the training of staff in this area. The Manager advised that the majority of staff had attended training provided through the Local Authority Social Services Adult Protection Co-ordinator and the remainder were to attend this week. In discussions with staff they confirmed that they had had training were able to describe what actions to take on witnessing, or suspicion of abuse. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 & 26. The standard of cleanliness has improved but décor was beginning to show signs of wear and tear, and does not give clues to orientation for service users. Sufficient aids and adaptations are provided to assist people with moving and handling needs, however, the positioning height of some equipment is not suitable for people using wheelchairs. EVIDENCE: Service users bedrooms are decorated to a good standard however, some parts of the home are beginning to show signs of wear and tear, where wheelchairs make scuffmarks. And, despite the needs of the service user group, little thought has been given to developing clues to orientation around the home for people with dementia. The building is aesthetically pleasing as everything matches but there is little in the way of tonal contrast around doorframes, or use of colour, pictures or other clues to help confused people find their way around. Photographs are put on service user’s bedroom doors Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 16 but these are pictures of the person in the present day, which many people with dementia may not recognise. Sufficient aids and adaptations are available to help people such as lifting equipment, raised toilet seats, grab rails, special mattresses and beds, where they are needed. This enables staff to help people safely. However, mirrors, hand towel dispensers etc and other equipment in toilets are not positioned to take account of people with a physical disability, and should be reviewed prior to admission for the individual, and moved if needed, for that person. The home was clean and odour free and issues from the last inspection concerning cleanliness and infection control have been dealt with and were observed to be satisfactory. Colour coded linen bags with lids have been provided to enable dirty and foul linen to be appropriately stored until going to the laundry, and this has also reduced the odour that was apparent previously. The extractor/ventilation systems in bathrooms have been repaired and are now effective and less noisy. A large extractor fan has been wall mounted in the corner of a small dining room on the first floor. Although the room was empty when this was observed, the fan was switched on and was very noisy, blowing very strong cool air, and had no controls in order to reduce this. Staff said it was switched on between mealtimes to keep the room comfortably cool and not whilst residents were having meals. Elsewhere on the first floor the temperatures were felt to be quite high and the Manager stated that two air conditioning units had been purchased, one per floor, to control this. It was suggested that wall thermometers be placed around the Home in order to monitor temperatures throughout the building. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 17 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 & 30. Staffing levels and skill mix are provided in numbers to meet the needs of service users living in the Home, but are not always consistent and effective in their allocation. Staff receive appropriate training in areas relevant to the care needs of service users and to enable them to competently do their jobs. EVIDENCE: Appropriate numbers and skill mix of staff are planned to ensure enough staff are provided to meet residents needs, but a recent complaint made about staffing numbers highlighted that on occasions, the relocation of staff to cover staff absences had resulted in inappropriate allocations of staff numbers in parts of the Home. The Manager has acknowledged this and taken steps to ensure that adequate and appropriate staffing is provided to meet residents needs. Inspection of staffing rotas indicated that this is achieved at most times. Residents spoken to and who were able to express their views said that the staff at the Home were friendly and caring. Some visiting relatives said, “the staff are smashing”, and “there’s always staff around to help and assist residents”. Observations throughout the day indicated that staff were courteous and sensitive towards residents, and were prompt and attentive to their needs. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 18 There has been a high turnover of staff since the last inspection; many having left for personal reasons, and a number of those staff had achieved NVQ qualifications. This has resulted in drop in the percentage of care staff now with NVQ qualifications but the figure is still above the minimum standard needed. More effective staff training to ensure residents’ needs are met, has taken place, and training opportunities for staff have improved. Staff confirmed they had received training in areas such as dementia awareness, diabetic awareness, care planning, communications skills and infection control, in addition to statutory training requirements such as moving and handling, fire safety, food safety and first aid and the protection of vulnerable adults. Safe handling of medicines, and other areas of clinical training in appropriate subjects, has also been provided for nursing staff and include influenza vaccine update training, cardiac resuscitation and treatment for anaphylaxis. Staff appeared more positive in their approach to their work and indicated that they felt more confident having received the training to allow them to care for residents more effectively. Some staff spoken with confirmed that they were now able to spend more time with individual residents and because of the Dementia training they had recently attended, understood better, the needs of people with dementia and how to meet them. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 & 38. The Manager is qualified and experienced to run the Home and has taken steps to provide more effective leadership to staff, and a more effective management approach. Appropriate systems are in place and function well, to safeguard service user’s personal allowances. Records are clear and well documented. Staff follow appropriate safe working practices to promote and protect service users’ health, welfare and safety, and the moving and handling of service users is guided by up to date risk assessments. EVIDENCE: From recommendations made at the last inspection the Manager has reviewed the management of the Home and the support and guidance to staff, and the monitoring of staff performance. Some of the management workload and Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 20 responsibilities are now shared between the Manager and the Deputy Manager with some areas and responsibilities delegated to nursing staff. A more structured and organised management style was observed at this visit and staff and residents where able, and relatives, spoke of the caring, approachability and support of the Manager. She has almost completed the Registered Managers Award training and it is planned that the Deputy Manager is also to undertake this training and qualification. The petty cash and personal allowance monies of some service users are the only accounts that are dealt with at the home, by the administrator. These records are well maintained and show that only small amounts of cash are held or handled by the home and are backed up by receipts. Although two people initial entries, there is no log identifying whose initials have been used. This may make it difficult to check back who has made an entry where there have been staff changes over time, therefore keeping a signature and initial specimen list, is recommended. Where service users lack capacity because of their dementia, relatives or Social Services have power of attorney to manage their finances on their behalf. This protects service users against financial mismanagement and financial abuse. The company have financial procedures to guide staff dealing with service user finances and this was made available for examination following the inspection. Case files also highlighted that an inventory of valuables and other possessions is made when a person is admitted to the home. However, this is not updated to reflect for example where clothing has been replaced or discarded, in order to keep an up to date log. Discussions with staff, and records confirmed that they have received training in health and safety matters, including moving and handling, food safety, fire safety, infection control and the safe handling of medicines. Self-closure door guards are now in place where fire doors need to be kept open, foot rests were in place on wheelchairs and appropriate moving and handling practices with residents, by staff, were observed. Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 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 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 x x 3 x x 3 Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 22 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 Care plans must continue to be developed to include more details about the psychological and behavioural care. Evaluations must review the effectiveness of the care given. A programme to indicate the necessary refurbishment and decoration of the Home, where required, must be provided and made available to the Commission. Staffing numbers must be maintained at levels to meet service users needs at all times. Timescale for action 31/01/06 2. OP19 19 31/12/05 3. OP27 18 11/10/05 Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 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. 2. Refer to Standard OP12 OP22 Good Practice Recommendations The Home should pursue the development of activities for service users to meet their capabilities and preferences. The height positions of mirrors, paper hand towel dispensers etc, should be reviewed to ensure they are accessible to people using wheelchairs. The provision of colour coding, signs and pictures should be considered to assist people with dementias to recognise places and help them with orientation. Room thermometers should be provided to monitor the heating levels in the communal areas. The Manager should complete the Registered Managers Award and NVQ 4 training in order to gain the required qualifications required for managers. 3. 4. OP25 OP31 Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Lindisfarne Nursing Home DS0000018174.V250805.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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