Inspection on 29/10/08 for Lyndhurst

This inspection was carried out on 29th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lyndhurst 01/05/08

Lyndhurst 04/12/07

Lyndhurst 10/08/06

Lyndhurst 16/05/06

Lyndhurst 19/12/05

Lyndhurst 21/06/05

Lyndhurst 12/10/04

Lyndhurst 24/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Lyndhurst 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ Lead Inspector Sally Hall Unannounced Inspection 29th October 2008 09:30 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 Lyndhurst DS0000013707.V372972.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. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Address 67 Byfleet Road New Haw Weybridge Surrey KT15 3JZ 01932 842730 01932 842730 lyndhurstchome@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered managers/owners (if applicable) Type of registration No. of places registered (if applicable) Mr Aboo Bakar Seeparsand Mrs Zehra Bibi Seeparsand Mr Aboo Bakar Seeparsand Mrs Zehra Bibi Seeparsand Care Home 16 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (16), of places Physical disability over 65 years of age (3) Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 65 YEARS AND OVER One named indivivual DE(E) Dementia - 0ver 65 to be added to the registration for the duration of their stay at the home. 1st May 2008 Date of last inspection Brief Description of the Service: Lyndhurst is a large detached house in a residential road within walking distance of local shops and New Haw and Byfleet railway station. The building is Tudor style with car parking facilities to the front of the house and an enclosed mature garden to the rear. The home can provide care for sixteen older people, up to ten of whom may also be diagnosed with dementia currently. Bedroom accommodation is single with the exception of one double bedroom. Nine of the bedrooms have en-suite facilities. There is a large combined lounge and dining area and a conservatory overlooking the garden. There is a kitchen and separate utility room. The managers/owners stated fees range from 365 to 480 pounds per week. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Inspector agreed and explained the inspection process with the Registered Managers/owners at the start of the inspection. The focus of the inspection was to assess Lyndhurst in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The Inspector used a varied method of gathering evidence to complete this inspection, pre-inspection information such as the previous report and discussion and correspondence with the registered provider including and improvement plan sent to us by them following the last inspection was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. Documentation and records were read. Time was spent reading written policies and procedures, reviewing care plans and records kept within the home. Other area’s viewed included risk assessments, pre-admission assessments, training records and recruitment records. The Inspector identified four people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to the care provision for them. In addition the Inspector met with the other People who use the service, and a regular visitor which gave her a good opportunity to observe the quality of care being provided by the home and understand the impact the care provision has on their quality of life. During the day the inspector undertook a SOFI, Short Observational Framework for Inspection, it has been designed for inspectors to experience sitting beside people in the communal part of the home, allowing them to get an insight in the general mood state of the people observed and an insight into how staff interact with service users and the difference that makes. It provides a snap shot observation and lasted for just over two hours and was part of the overall inspection process. These observations were recorded, it remains anonymous and the information is put on a spreadsheet, which gives an overall assessment of how good the outcomes are for the service users living there. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The managers/owners have worked hard to improve the standards and meet the requirements from the last two inspections, they now need to show that they can sustain these improvements in order for this to be reflected in there quality rating in the future. A comprehensive assessment tool is now used by the home to ensure all information is used to ensure that if a service users is offered a place the home can meet their needs. The plans of care are being rewritten when there is a change to the service users circumstances and the care provision changes, it would however be clearer if old plans of care are archived so it is easy to show what remains current. All staff have now had updated moving and handling training and staff observed were seen to now being moving people appropriately using the equipment correctly. As part of the new assessment process more information is being recorded about each person who uses the service background, likes and wishes around hobbies and activities. The first aid box kept in the home is now checked regularly with items missing being replaced, staff have also all now undergone first aid training. Staff are now only wearing protective gloves when it is appropriate. Medication audit evidenced that the storage, administration, recording and disposal of medication was correct. Medication has been reviewed since the last inspection and service users appeared less drowsy. The environment continues to improve with rooms being redecorated; there was new furniture in a number of the bedrooms seen. The managers/owners Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 7 stated that new bed linen had been ordered; it was evidence that all the plastic has now been removed from the beds and replaced with a mattress protection that is far more comfortable for the service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lyndhurst DS0000013707.V372972.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 Lyndhurst DS0000013707.V372972.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): 3 People who use the service experience good outcomes This judgement has been made using available evidence including a visit to this service. Service users can be confident that if they are offered a place at the home then there assessed needs can be met. EVIDENCE: Four service users files were sampled and included two of the most recent service users to be admitted to the home following the last inspection. The registered managers/owners confirmed assessments as far as possible take place in the service users own home or in hospital if that’s were they are at the time of referral. The managers/owners are using a new assessment tool, called PAL, once completed fully it details all the information needed, giving staff a good indication the needs the service users may have once admitted to the home on a trail basis. It covers all aspects of the person’s physical, physiological and social needs. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 10 This home does not offer intermediate care service. Lyndhurst DS0000013707.V372972.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, 10. People who use the service experience adequate outcomes This judgement has been made using available evidence including a visit to this service. Service users benefit from detailed care plans and are supported by staff that treat them dignity and respect. Service users benefit from their health care needs being monitored, however their protection would be enhanced if comprehensive risk assessments were used. EVIDENCE: Four service users files were sampled, the care plans were well written and crossed referenced well with the assessments seen. Evidence was seen of monthly reviews of the plan of care, which looks at the events during the preceding months and makes provision for any changes in the individual’s condition and needs whether temporary or permanent. These were detailed and specifically looked at each item recorded in the plan of care. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 12 The risk assessments however were not detailed although there was there an in depth moving and handling assessment available for each service user and a falls assessment. The registered managers/owners and all staff had undertaken moving and handling refresher training since the last inspection. Although other risks had been recognised there was no comprehensive formal risk assessment/management form available to document and review these risks. The daily notes are kept, recording information of events and some of the care provision pertaining to individual service users. However the information recorded little personal care in many cases and no times are given to indicate when care and events happen. It is strongly recommended that staff record the time when things happen, along with a brief description of the care and contact provided as this would give a fuller picture of the service users day. The health issues and follow up measures taken and the outcomes are good but these are not being recorded in the daily notes in detail, rather they have been documented in the plan of care, leading to confusion. The home uses a monitored dosage system supplied by the local pharmacy. A medication audit was undertaken, checking the stock against the Mar (Medication Administration Record) sheet. Medication was audited at random on five different Mar sheets and concluded that medication is being given out and recorded correctly. This is an improvement on the findings of the previous inspection. The medication storage arrangements are adequate and there is correct storage for controlled medication. There was a medication fridge available and the temperature is checked on a daily basis. The managers/owners confirmed that service users medication had been reviewed by the GP since the last inspection as at that time service users were seen to be very drowsy, this was not the case during this visit. During the inspection the inspector undertook a SOFI (Short Observation framework for inspection) and saw service users were seen making choices about their lives and were seen to be part of the decision process. A relaxed atmosphere was noted with the resident’s interacting with staff. It is evident through observing members of staff at Lyndhurst that the emotional health of the resident’s is of a high priority and that staff are proactive in maintaining and supporting service users with their emotional needs in order to maintain their quality of life. However this could be further improved if staff were more confident about communicating with those who find it difficult to articulate their needs verbally. The managers/owners have recognised this and explained that he has arranged further training for staff in the form of videos. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 13 Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, People who use the service experience adequate outcomes This judgement has been made using available evidence including a visit to this service. Current service users enjoy an overall comfortable lifestyle. Relatives are actively encouraged to maintain contact with their relatives. Activities are available however the range and amount could be extended. The service users benefit on the whole from appetising meals and balanced diet offered at the home. However opportunities to improve choice and menu planning are recommended. EVIDENCE: Two service users spoken with confirmed they were happy with the lifestyle at Lyndhurst, however during the SOFI observation it was noted that along with some good staff interaction with service users there were also missed opportunities to engage on a one to one level with service users. Activities could be increased, there is an activity person who comes in to the home two to three afternoons per week, records are kept of what the activity takes place. These included a balloon game and the use of a ball for exercises, bingo and Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 15 reminiscence for example. However these seem to be all group activities, little was recorded on a one to one basis. The managers/owners confirmed that arrangements have already been made for the Christmas party to take place and other celebrations are also organised. The managers/owners talked about the visitors form the local community that come into the home, and this included the opportunity for service users to take communion if they wished on a regular basis. However community involvement could be extended, currently occasionally service users may walk if able to the local shop weather allowing. One visitor spoken with confirmed that they are always made to feel welcome and know they can visit the home at any time. The design of the lounge/dining and conservatory provides seating areas within it where service users can entertain their visitors, in addition to the privacy of their own room. Service users spoken with confirmed they are given choices how and where they spend the time during the day. These choices about their lives were seen being given during the SOFI observation. Evidence was seen that service users can bring in personal items for their rooms and the managers/owners confirmed this was encouraged. The general feeling amongst service users spoken to was that the food was good, however little evidence was seen that a real choice is being offered particularly at dinner time. Staff confirmed that service users are offered a choice if they did not like what was cooked for them. There was a menu board in the lounge area this did not mention the choice. The food was sampled and was very tasty and well presented. Staff who assisted service users to eat sat beside them and helped at a pace the service users felt comfortable with, this was evidenced at breakfast and dinnertime. The menu looked well balanced and staff are aware of the service users who have highlighted issues around nutrition. Staff had recorded what service users eat each day most of the time, and the amount that service users had managed to eat was recorded in the daily notes of those highlighted with health issues. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use the service experience good outcomes This judgement has been made using available evidence including a visit to this service. Service users and or there families are aware of their rights with regard to making a complaint and to whom to complain. Service users are also protected from the risk of abuse by the home’s Adult Protection policy and procedures. EVIDENCE: The home has a complaints procedure which details the times scales for action. A copy of this was seen in all service users bedrooms, no complaints had been received since the last inspection the managers/owners confirmed. A visitor spoken with confirmed that they know how to complain and although they had never had to do so felt that if they did it would be taken seriously. The CSCI has not received any complaints since the previous site visit. The home had a policy on protection of vulnerable adults and a copy of the local authority (Surrey County Council) procedures on safeguarding adults. Further evidence confirmed that the home had a whistle blowing policy. Evidence was seen in the staff file sampled that staff have attended adult protection training recently the managers/owners confirmed this is the case for all staff at the home. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 17 Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 18 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): 19,26 People who use the service experience good outcomes This judgement has been made using available evidence including a visit to this service. The people who use the service can feel confident that the home will be clean and free from odour, although there are areas within the home that would still benefit from further redecoration and new furniture most of the work has now been completed and gives a pleasant and homely place to live in. EVIDENCE: During the last six months it was evident that the home has worked hard to improve the standards of the environment with in the home. On a tour of the building, bedrooms had been decorated and new furniture purchased for most of them. The bed protectors are now of an acceptable standard and comfortable for the service user. New bed linen has been ordered and expected with in 14 days of this inspection, this will complete the transformation of these rooms which are currently spoiled by thin washed out Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 19 bedding. There are areas on the ground floor that will be improved by redecoration but that is planned, generally the home has a homely feel is kept clean and free from offensive odours. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use the service experience good outcomes This judgement has been made using available evidence including a visit to this service. Service users care, social and emotional needs are promoted by on the whole well trained care staff in sufficient numbers to meet their needs and are protected by the recruitment procedures within the home. EVIDENCE: Although the home only has 9 service users currently the staffing at the home has not changed there are still three care staff are on duty through the day with a registered managers/owners supervising and working with staff. There is a domestic member of staff on duty daily, plus the cook. At night there is a member of staff who sleeps on the premises in case of emergencies and a member of staff who stays awake to look after the people who use the service. The managers/owners have arranged a number of training courses since the last inspection to ensure that staff have the required courses and they are in date. The training records seen for staff did evidence that training has taken place. It is important that these courses are refreshed at the recommended intervals. Staff have also done some more specialised courses to ensure they have the skills required to meet the needs of the people who use the service Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 21 within the home. At the last inspection the managers/owners confirmed that there were 70 of the staff currently undertaking an National Vocational Qualification level 2 or 3 in care. At least four staff has now completed level 2 and has the opportunity to go on to do a level 3 the managers/owners confirmed. The home does arrange for it’s new staff to have induction training which meets the standards required. The staff have booklets which they must get signed off when they are competent at and procedure or task. Staff files were sampled regarding recruitment they contained all the required information. They contained application forms, detailing all previous work history and copies of qualification certificates, two written references requested, and contracts. The staff also have a CRB (Criminal Record Bureau) check, and proof of the staff member identity is being retained on file. Where staff have been employed form abroad then police checks from those countries have been received, however once they have been working at the home for six months the manager/owner has applied for a CRB for them also. Evidence was seen in files sampled. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 22 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, 38. The people who use the service experience adequate out comes in this area. Through the training and policies and procedures the home ensures that people who use the service and staff remain as safe as is reasonably practicable. People who use the service can be fairly confident the their views will be listen to and used to improve the service provided. The improved standards now reached at the home will need to be maintained in the long term to ensure service users wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The managers, who are also the registered providers, have the relevant qualifications and experience to manage the home. There were a large number of requirements from previous reports that had not been met, Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 23 however the managers/owners produced an action plan which they have followed to improve the standards within the home. They now need to show they can sustain these standards, react in a timely way to changes in legislation and look to further improve the service they provide. Training has taken place to ensure that all health and safety related training has been undertaken by most of the staff. Importantly moving and handling techniques have now been perfected by staff that have all been retrained since the last inspection. Staff have all had first aid training and the first aid boxes have been replenished the managers/owners confirmed. Policies and procedures have now been reviewed to reflect the changes in legislation. The home does not handle service users monies rather it pays any bills as they occur for example hair dressing, chiropody and then invoices the family member or person responsible giving them the receipts once paid. There was evidence at the last inspection that the home had surveyed people who use the service for their opinions about the home and the service they provide. So far this covers the activities and the catering within the home. However the managers/owners had stated that they intended to review the form used and include families and visitors in the survey this has not yet taken place and it strongly recommended that this be undertaken to ensure the surveys are conducted annually at least. Visitor spoken to said that they felt that the home puts the service users first, that they are very much able to do what they want to do when they want to do it. That was also born out during the SOFI observation. Visitor said that staff are always checking that they are happy with the way there relative is being cared for. The fire logbook was seen and all tests are being undertaken and recorded in a timely way. The certificates were also seen for Gas, electrical testing, hoist etc. they were all in date, and periodic servicing is being carried out as is required. Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? no 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. Standard Regulation Requirement Timescale for action 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 OP8 Good Practice Recommendations Ensure that risks assessments that indicate a medium to high risk are documented with the risk management detailing what is needed to reduce that risk individually so staff can access them easily and are aware of them. The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. Ensure stimulation and activities are provided at other times than when the activity person comes in and particularly on a one to one basis, so that all service users have input when they don’t find it easy to do things in groups. 2 OP15 3 OP12 Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lyndhurst DS0000013707.V372972.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!