Inspection on 11/01/07 for Littledale Nursing Home

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Littledale Nursing Home 02/12/08

Littledale Nursing Home 15/11/05

Littledale Nursing Home 07/07/05

Littledale Nursing Home 24/08/04

Littledale Nursing Home 25/05/04

Littledale Nursing Home 23/03/04

Similar services:

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Abbey The

Snydale Care Home

Hawkhills

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

CARE HOMES FOR OLDER PEOPLE Littledale Nursing Home 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES Lead Inspector Janice Griffin Key Unannounced Inspection 11th January 2007 08:50 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 Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Littledale Nursing Home Address 669 Prince Of Wales Road Sheffield South Yorkshire S9 4ES 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) 0114 261 1644 0114 261 9095 none Dr Abdul Majid Khan Mrs Tahir Majid Khan Mrs Janet Cooper Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Littledale is a 37-bed nursing home on two sites. The main building is a large detached property, which has 30 beds. The other 7 beds are situated in a semidetached property across the road from the main building. The 7-bed unit is currently closed. The main house is a spacious property; it has one lounge, one dining room and a conservatory. Only one bedroom has an en-suite. Both properties are situated on a main road and accessible to community facilities such as shops, pubs, parks and a post office. Both buildings have small gardens and a car park. Copies of the last Commission For Social care inspection report were available for service users and their families to read. The weekly fees are £428 per week. This information was provided on the 3rd November 2006. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place from 08:50am to 15:20 pm. As part of the inspection process the inspector spoke to, nine service users, six staff and the manager. The inspector would like to thank the service users, the staff and the manager for their openness and for their commitment to the inspection process. The inspector was pleased to note that all the service users spoke highly of the ongoing support provided by the staff. Observations confirmed that service users were extremely comfortable and at ease in the company of the manager and staff who were approachable, supportive and appeared sensitive to their needs and feelings of the service users. One service user described the service as ”great”. A number of records were examined which included, the managers preinspection questionnaire, medication records, three service users care plans, three weeks menus and three weeks staff rotas. Records relating to staff recruitment, service users finances, staff training and the homes quality assurance systems were also checked. Several areas of the building were also inspected. Since the last inspection The Commission for Social Care Inspection has received one concern about this home. The concern was from a Social Worker about the staffs moving and handling procedures and the nutritional care of one service user. The inspector checked out the concerns at this inspection and the concerns about the staffs moving and handling procedures were partially upheld but the concerns about the nutritional care of service users was not upheld. The home has a system for displaying information and bringing attention to community events and activities. Feedback on the inspection was given to the manager. What the service does well: All the service users spoken to said they were well cared for by the staff. One service user described the staff as being “great” and very hard working. Service users were able to visit the home for trial periods. The staff said that the manager considers carefully the needs of each prospective service user before agreeing to their admission to the home. Service users were only admitted once it had been determined that the home could meet their needs. Most service users attended a variety of social and leisure activities and these were based very much on the personal preferences of each individual. Feedback was being sought on a regular basis from service users and their families. Staff interacted well with each service user and it was obvious from discussions with them that staff had developed positive relationships with them. The cook Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 6 was familiar with the dietary needs of service users. The inspector observed the lunch offered to service users the food provided was of good quality, well presented and a good choice of food was offered. Documentation and discussion with six staff showed that they have had training in the specialist area of work that they work in. 97 of the staff team were qualified to NVQ level 2 and the manager is qualified to NVQ level 4. Records were in the main well ordered securely stored and up to date, the manager was keen to ensure that any issues found were addressed. What has improved since the last inspection? What they could do better: The information in the homes statement of purpose and contracts/terms and conditions, fees and extra charges was out of date. Some service user had been admitted to the home without a written full needs assessment. Some service users had not seen the dentist for over two years this was because the manager was finding it difficult to get a dentist to visit the home. The medication systems checked by the inspector were satisfactory. Some areas of the home still had damaged decoration, carpets and furniture (easy chairs). One of the new baths did not have an emergency alarm and one bedroom did not have a lockable facility. The inspector observed one member of the staff team lifting service users inappropriately and some staff were pushing service users around the home in wheelchairs with no footplates. One staff file only had one reference. Staff interviewed said the on some occasions the staffing levels were not adequate this was when staff went off sick at short notice, however it was better recently because the staff had only 24 service users to care for and not 30. The registered person was visiting the home regularly but he was not writing a report about the conduct of the home following his visits. The manager managed money on behalf of some service users but an outside auditor had not audited the accounts. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 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 Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussion with nine service users, six staff, the manager and a visit to the home. Some service users have moved into the home without having their needs assessed, this does not ensure that individual care needs can be met. Service users were able to have informal introductory visits to the home at the time of their admission, service users confirmed that this helped them to get to know everyone at the home, which made them feel less anxious. They had been provided with a contract containing the relevant information, however it was noted that some of the information was out of date. Intermediate care is not provided at this home. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home had a statement of purpose but it had not been reviewed for over four years. Detailed full needs assessments had not been completed by the referring social workers for all service users admitted to the home. Service users spoken to said at the time of their admission they were able to have informal introductory visits to the home. Service users had been provided with a contract/statement of terms and conditions and signed copies were retained on individual files. These clearly detailed the fees, including any extra charges, and the services and facilities provided by the home. However some of the information was out of date. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussion with nine service users, six staff and a visit to the home. Service users were encouraged and supported by staff to make decisions. This protects the rights and well being of service users. Information in care plans was satisfactory; it gave the staff knowledge of the service users physical, social, religious and cultural needs. Risk assessments had been reviewed on a regular basis. This protects the service users from harm. There was evidence in the care plans to show that some service users families are involved with the care planning production and the review. This allows the families to have a say in how their relatives care needs will be met. The procedures in place to ensure the safe management of medication are satisfactory. The policies and procedures protect the service users from harm. A pharmacist had checked the home’s medication systems in May 2006 and some minor issues of change were recommended. The manager said the recommendations have been actioned. This is good practice. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 12 EVIDENCE: Staff were observed knocking on bedroom doors and they waited to be invited in before entering. Three service users plans of care were checked. Each set out individual service users needs and the action required and taken by staff to ensure those needs were met. Discussion with six staff identified that a range of health professionals visited the home to assist in maintaining health care needs. Service users weight was being checked on a regular basis. A range of aids to assist service users with mobility problems was provided; these included lifting hoists, assisted baths, walking frames and wheelchairs. The risk assessments in care plans had been reviewed on regular basis. The care plans did not state when the service users last saw a Dentist, the manager said this was because she was finding it difficult to get a Dentist to visit the home. Service users and their relatives have been invited to take part with production of the care plans and their reviews. Systems were in place to ensure the safe storage, administration and disposal of medication. Records were kept of medication received, and disposed of. A pharmacist had checked the home’s medication systems in May 2006; and some minor recommendations had been made following the visit. The manager said the recommendations had been actioned. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussions with nine service users, six staff and a visit to the home. Service users had access to a range of leisure activities based on their individual choices and preferences. Service users confirmed that the routines of daily living were flexible and suited their individual preferences. Service users were supported with maintaining and developing contact with their family and friends, whom they said were always welcome at the home. This creates a home that people want to visit. A good choice of food was offered to service users at lunchtime. Eight service users were being offered special diets on a regular basis. This promotes the rights of service users. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 14 EVIDENCE: The aims and objectives of this home reinforced the importance of treating service users with respect. Service users confirmed that staff were extremely supportive and always encouraged them to become integrated into the local community, when they felt able to do this and with the appropriate staff support provided. Staff confirmed that they were encouraged to support service users with discovering how to enjoy social situations and activities. The cook was familiar with the dietary needs of service users. The inspector observed lunch being offered to service users the food provided was of good quality, well presented and a good choice of food was offered. Eight service users were receiving special diets. Special cutlery and crockery was provided for those service users who had difficulty using knives and forks. One service user was being peg-fed and a dietician was giving support and advises the staff about nutrition on a regular basis. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussions with nine service users six staff and a visit to the home. The homes complaints procedure was clear, accessible and contained the necessary information. This protects the rights of service users. Service users were protected from abuse by the awareness of staff through training and the homes procedures. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 16 EVIDENCE: The complaints procedure was available for visitor, relatives and staff. The manager confirmed that this would be available in alternative formats and languages should this be requested. Service users spoken to said that they knew that they could complain if they were not happy about anything and that they felt able to discuss any issues or concerns that they may have with the manager and staff. They also said that staff were always available and that they were encouraged to talk about anything that troubled them or caused them anxiety. Since the last inspection one concern has been made about this home. The concern was about safe moving and handling procedures and the nutritional care provided to one service user. Observations made by the inspector did identify some issues in relation to safe moving and handling procedures (see section 38). The inspector was satisfied that the nutritional needs of the service users were being well managed. The staff had received training on recognising and dealing with abuse. Staff had been made aware of the action to take in dealing with third party information. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25 and 26. Quality in this outcome area is: adequate. This judgement has been made after discussion with nine service users and using available evidence including a visit to the home. On the day of the inspection the home was clean. Some areas had damaged decoration, carpets and furniture (easy chairs). This made the home look shabby in parts. The bedroom doors were fitted with locks but lockable facilities were not provided in all rooms. One service user had not been provided with a key to her bedroom door. This does not promote the privacy of service users. One bath did not have an emergency alarm. This could affect the health and safety of service users. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 18 EVIDENCE: Service users said that the home was always clean. Some rooms had damaged decoration, carpets and furniture. Bedroom doors were fitted with suitable door locks but lockable facilities were not provided in all the bedrooms. Each floor had a number of toilets and bathrooms, assisted baths and showers were provided for those service users with mobility problems. One bath did not have an emergency alarm. Toilets were easily accessible as they were close to lounge and dining areas. All the toilets had been adapted for service users with physical disabilities and a good supply of equipment was also available for those service users. The home had a proactive infection control policy and they work closely with external specialists, e.g. the Health Authority, Environmental Health and their own staff to ensure infections are minimised. Clinical waste is properly managed and stored. Staff confirmed that they were provided with protective clothing if they needed it and that all the equipment was in good working order and that it had been serviced as required. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is: good. This judgement has been made after discussion with nine service users, six staff and using available evidence including a visit to the home. Care staff had a range of skills and experience, which effectively supported the service users. This will ultimately benefit the health and welfare of the service users. The homes recruitment procedures were not in the main satisfactory, as they did not meet the required standards. The home had a training and development plan and all staff had completed a range of training relevant to their role. This allows the staff to ensure they meet the individual assessed needs of service users. 97 of the staff is trained to NVQ level 2. This shows the managers and providers commitment to staff development Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 20 EVIDENCE: The service users said that the staff worked very hard and described them as “very caring, kind and understanding”. Staff were approachable and sensitive to the needs of service users and were able to communicate effectively with each person. Staff expressed concern about the staffing levels dropping when staff telephone in sick at short notice. They said that they were coping at the present time as the occupancies levels were down to 24. Three staff files were checked; the files demonstrated that a satisfactory recruitment processes had not been followed as required by the Care Homes Regulations. Criminal record checks had been done for all three staff, two references had been obtained for two of the staff files checked but only one reference was available in the third file checked. No gaps were noted in staff’s employment history. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. Staff files checked and discussions with six staff and the manager confirmed that all staff had completed detailed induction training. 97 of the staff team were qualified to NVQ level 2. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. Quality in these outcome areas is: good. This judgement has been made after discussion with the manager, nine service users, six staff and using available written evidence including a visit to the home. The service users and six staff spoken to said the manager was approachable and very professional. Service users and relative’s surveys are completed annually, which ensures that the home is run in the best interest of service users. Records were in the main up to date and well ordered to ensure the best interests of service users. The homes policies and procedures met the required standards. A safe environment was not provided in all parts of the home. This does not protect the health and welfare of the service users. Staff were not being formally supervised at the frequency required. This does not ensure individual staff development and the monitoring of care practices Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager had a job description that clearly defined her roles and responsibilities and staff were aware of her role. Staff said she was committed to ensuring that the home provides a high standards of care, she completes regular internal audits on all aspects of the service provided by the home. She completed her NVQ level 4 training this year. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. There was a quality assurance system, which sought the views of service users and relatives. One member of staff was observed to be lifting a service users alone and other staff were noted to be pushing service users around the home in wheelchairs with no foot plates. The responsible individual visit the home on a regular basis but a report is not written following the visits. Staff were not being formally supervised at the frequency required. No fire exits were blocked and hazardous substances were securely stored. The manager handles money on behalf of some service users, account sheets are kept, receipts were available for all transactions and a second individual witnessed all transactions. An outside auditor has not audited the accounts annually. All records were available for inspection up to date and securely stored. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 23 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 2 X 3 X X 2 2 3 STAFFING Standard No Score 27 2 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 24 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. 2. 3. 4. Standard OP1 OP2 OP3 OP8 OP19 Regulation 6 14 13 23 Requirement The homes statement of purpose and contract of care must be reviewed. Service users must only be admitted to the home on the basis of a full needs assessment. Service users must have access to dentists at regular intervals. The stained damaged furniture (easy chairs); carpets and decoration must be replaced. Those service users, who are capable of using a key, must be offered a key to their bedroom door. All bedrooms must have a lockable facility. All bathrooms must have an emergency alarm near to the bath. The manager must keep the staffing levels under review particularly when the home is full. Timescale for action 01/06/07 01/04/07 01/06/07 01/07/07 5. OP24 16 01/04/07 6. 7. 8. OP24 23 23 18 01/04/07 01/04/07 01/02/07 OP25 OP27 Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 25 9. 10 11. 12. 13. OP29 OP33 OP36 OP38 OP38 19 26 18 12 12 Prospective staff must only be appointed after the receipt of two references. The provider must complete a report on the conduct of the home after his monthly visit. Staff must have regular supervision. Staff must never lift service users alone. Footplates must be fitted to wheelchairs that are used to transport service users around the home in. 01/02/07 01/03/07 01/04/07 11/01/07 11/01/07 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 OP8 OP35 Good Practice Recommendations The manager should speak to her local PCT manager regarding the difficulty she is having getting a dentist to visit the home. An outside auditor should be asked to check the service users accounts at least annually. Littledale Nursing Home DS0000021793.V318527.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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