CARE HOMES FOR OLDER PEOPLE
Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL Lead Inspector
Carol Mitchell Unannounced Inspection 22nd November 2006 09:50 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 Meppershall Nursing Home DS0000015039.V320322.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. Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Meppershall Nursing Home Address 79 Shefford Road Meppershall Bedfordshire SG17 5LL 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) 01462 811224 01462 812027 gacontracts@btinternet.com G A Projects Ltd Mrs Julie Sumner Care Home 57 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (10) of places Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to four (4) service users under the age of 65 years may be admitted to the home. 20th December 2005 Date of last inspection Brief Description of the Service: Meppershall is a purpose built care home with nursing on the outskirts of Bedfordshire in the village of Meppershall. The service is registered to provide residential and nursing care for fifty-seven service users. Ten of these places are for younger adults with physical disabilities and the remainder are for older people. The accommodation is distributed over two floors accessed by shaft lifts. The communal accommodation and facilities are spacious including wide corridors and access routes to the grounds. The building also provides a day care facility not included in the registered facilities used on commission by Social Services. The building is surrounded by large grounds and parking spaces for staff and visitors are provided. The rural setting means that there are views of the countryside from the home. The home has links with the local community and shares transport for service users with its sister home. Information about this home can be obtained by phoning and visiting, and there is also an internet website address for the company. The following information about fees was obtained on 22/11/06:• • • • Lowest fee, residential care £480; Lowest fee , nursing care £580; Highest fee, residential care £580; Highest fee nursing care £600. Items not covered by the fee:• • • • Hairdressing (starts at £4, Perm £16); Newspapers; Toiletries/tissues; Staff escorts provided at £5 per hour. Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report takes account of information received by the Commission since the last key inspection report of 20th December 2005, and as a result of an inspection visit. Information available before the inspection visit included two feedback cards from residents, and one from a relative. The unannounced inspection visit took place over four hours and forty five minutes on the morning and early afternoon of 22nd November. During the visit the inspector spoke to residents, staff, the manager and a director. Some records were checked and the inspector looked around some parts of the building. The inspector would like to take this opportunity to thank all those who helped with the inspection visit. What the service does well:
The atmosphere in the home is friendly and calm. The manager and staff are helpful and friendly, and people living at the home feel well looked after. The manager checks that only people who can be properly cared for at the home actually move in, and she gives out lots of information about the home. Residents said, “There is a good, humorous relationship with staff”; “Staff are always polite, they know how to look after you.” People living at the home with health needs feel well looked after. “The nursing care is excellent”, one resident said. Different members of the community health care team visit the home, and the medicines are organised. The manager listens to people living at the home. Residents’ meetings are held, and a resident said that he speaks up about anything worrying him. If she has something to complain about another resident said that she “would talk to the staff, all of them”. The manager looks into any complaints properly, and makes sure that all the right checks are made before anyone is allowed to work at the home. Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 6 The staff are supported at the home, and they receive training. Meetings are held for staff, and they like working at the home. A staff member said, “Colleagues are very good, and easy to get along with”. The home tries to help people to carry on with their usual lives. A resident said that he goes out a lot, “I keep busy, I manage to make my own amusement.” Some letters from relatives in the home’s “Complements Book” showed their satisfaction with the care given at the home:“….looked after efficiently by your staff”; “…..always well looked after and comfortable”; “You do a wonderful job”. What has improved since the last inspection? What they could do better:
The manager is thinking about the meals given to people living at the home. Residents should be very involved with this, and the manager is considering how she can make sure this happens in the best way. Residents should also be involved in ideas to make the bathrooms as attractive as possible. The manager has a way of checking that staff have important training, and she needs to improve how she does this to make sure that no one can accidentally miss out.
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 7 At the time of the inspection visit there were a few signs around the home advising staff about things they should, or should not do. The manager is going to remove these because they get in the way of her aim to make the home a very “homely” place to be. The manager and the directors should think about whether the manager would be helped by having some extra training or support to do with personnel and employment matters at the home. The carpet in the Livingstone lounge area was smelling from a spillage of milk. The manager was to arrange repeat cleaning of the carpet on the day of the inspection visit, and she will be checking that the smell is eradicated. Copies of the complaints procedure on display should include the contact details of the Commission. 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. Meppershall Nursing Home DS0000015039.V320322.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 Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that she knows about the needs of people who want to live at the home, and that they get the right information before they move in. Therefore residents can be sure their needs will be met. EVIDENCE: There is a pack with pictures and information about the home and this is given out on request. The Commission’s most recent report is included in the copy held by the home’s office, and this is shown to anyone visiting. Manager and her deputy carry out full assessments before anyone moves into the home to make sure that they can be looked after there. Assessments usually take place in the prospective resident’s home.
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 10 Prospective residents and/or family members go and look around and often stay for a trial period before deciding on a permanent move into the home. Someone was being shown around the home on day of the inspection visit. The home offers “intermediate care” for one person. The home has the support of the intermediate care team including occupational therapists and physiotherapists. They visit the person at the home, have a large input into care planning, and provide any necessary equipment. At the time of the inspection visit the neurological rehabilitation team was supporting a resident following a stroke. Contracts for residents at the home are issued from head office. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that residents get the support they need from health care professionals, and care plans are written so the staff know how to look after and support residents. Therefore people living at the home can be sure their health needs will be met. EVIDENCE: The residents spoken to said that they are very well looked after. Residents looked well looked after, and equipment such as pressure relieving mattresses was in use. Frail residents looked comfortable and cared for, and were helped to eat and drink in a sensitive manner by gentle and calm staff. The home has weekly input from a local family doctor, and district nurses visit regularly. Arrangements are in place for dentistry and the services of an optician and chiropodist. Other members of the health care team are also visitors to the home and these include the tissue viability nurse, continence
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 12 adviser, and dietician. On the day of the inspection visit a resident was out at an appointment with the speech and language therapist. Care plans are being rewritten to make sure that they are well organised, as suggested during the last inspection visit. The care plans seen were detailed and individual. Care plans should be checked to make sure that all the care is recorded. For example, early waking is a problem for a resident, and although staff are very familiar with the required support, this was not fully recorded. Residents are asked to check their care plans and they sign them if at all possible. Risks had been considered and assessed in an individual way. Two residents had sores at the time of the inspection visit. Both residents are under the care of the community tissue viability nurse who is satisfied with their progress. Some aspects of medicines management were considered briefly during the inspection visit, although medicines management was not checked in detail on this occasion. Residents reported that their medicines are given to them correctly. Medicines are organised by the deputy manager, and are inspected by the supplying pharmacist twice a year. Registered nurses administer the medicines. The registered nurse on duty was able to describe what she would do in the event of an error being made. One resident was self-medicating at the time of the inspection visit. The registered nurse spoken to discussed how she keeps up to date, and listed clinical training courses she had attended. On the day of the visit one registered nurse was attending a course about bowel management. The staff seen during the visit were kind, calm and gentle with residents, and personal care was carried out with due regard for privacy. Residents can have keys to their rooms if they wish. (Two currently choose to hold keys.) The recent death of a resident was discussed with the manager. The gentleman had expressed wishes about his care, and these had been adhered to. A Macmillan nurse had visited, and pain levels, and eating and drinking had been monitored. Family members had been closely involved in the gentleman’s care. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to be as independent as possible, and are supported to enjoy life at the home. The manager listens to what residents say they want. People at the home can therefore be sure that expectations about living there will be met. EVIDENCE: On Mondays and Tuesdays someone is employed to run activities such as arts and crafts. Some residents go out, for example to attend church. Regular religious services are held at the home for those who wish to attend, and one was in progress during the inspection visit. Efforts have been made since the last inspection visit to improve the activities for any residents who find group based activities difficult or inappropriate. Time is sometimes spent talking or reading on and individual basis, and some
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 14 special equipment such as special mobiles/lights has been bought or is being considered for use in some situations. A resident described enjoying very much having her things around her and being able to read books and watch television in her room. Another resident also had lots of personal belongings, and gets out and about by use of a mobility scooter and enjoys the independence this brings. There are hard paved areas outside giving access to the garden. There is a separate room on the ground floor for the use of smokers. In the dining room residents were enjoying their lunch and in general spoke positively about the food at the home. However, one resident who chose to eat in his room on that day, explained that mashed potato is on the menu far too frequently for him, and another said that too often there are sandwiches for tea. At tea time soup is also available as are cakes. Twice a week there is a hot option for tea such as scrambled eggs, or beans on toast. The manager had already begun to review the menus at the time of inspection, and she will involve the residents in deciding what changes should be made. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager finds out what residents think about things. She is going to make sure that she keeps a very careful check on the essential training that all staff should do. The proper checks are made before someone works at the home, and if there is an occasion when a resident says they have not been spoken to in the way they would wish, this is looked into properly and the matter dealt with. Therefore people living at the home can be sure that they will be listened to, and protected from harm. EVIDENCE: Residents said that they feel happy to raise concerns with the staff or manager, one also said that she would talk to her daughter if she ever has a problem. Another resident said that he raises any issues during residents’ meetings. During the inspection visit residents were calm and relaxed in the presence of staff. A complaints procedure on display in the Livingstone Wing did not include the contact details of the Commission. Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 16 Two complaints have been received since the last inspection, and the manager was able to show that both had been looked into thoroughly. The views of residents had been sought and followed after the receipt of a complaint about the combination lock access to the home, and the other complaint was not fully concluded at the time of the inspection visit. There has been one referral to the Protection of Vulnerable Adults (POVA) team about the way a resident may have been spoken to by a staff member. The manager had obtained guidance about this and made sure that residents were protected. Training concerning the abuse of vulnerable adults is provided, and when questioned staff were able to say what they would do should they witness anything which they find worrying. There is a system at the home for making sure that essential training is undertaken by all staff. However this needs very careful attention to make sure that no staff member misses out on vital training as has happened in one instance since the last inspection. The correct checks are made before anyone is employed to work at the home. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The owners and manager buy new equipment to make sure that residents can be well looked after, and they keep the home decorated and maintained. The manager tries to make the atmosphere as homely as possible, and sorts out problems when they arise. Residents can therefore be sure that they will be living in a well maintained and comfortable home. EVIDENCE: During the inspection visit residents said that they are happy with their rooms. The bedrooms seen had lots of residents’ personal possessions, including occasional items of furniture. The home has a comfortable and relaxed atmosphere. The homely atmosphere would be further enhanced if occasional signs reminding staff
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 18 about required actions were removed. The manager agreed with this and said that she will remove any signs. A large bathroom was seen on the first floor. The bathroom has been pleasantly decorated and it may be improved further by the addition of decorative mirror/pictures, and blinds/curtains to dress the obscured glass window. The manager will consider this with the residents. There is an ongoing redecoration programme and since the last inspection visit some bedrooms have been decorated, and painting work has been undertaken on the first floor. Some new profiling beds, nursing chairs, a garden arbour and some furniture for the home have been bought and donated. Any maintenance jobs are recorded in a book and then attended to. One of the bedroom carpets is due to be replaced, and the new carpet had been ordered at the time of the inspection visit. In general the parts of the building seen were clean and without unpleasant odours. However in the Livingstone lounge area an old spillage of milk could be smelt. The carpet had been shampooed once but repeat treatment was indicated, and the manager undertook to address this on the day of the inspection visit. A recent environmental health inspection of the kitchen resulted in a very good rating of 4 stars being awarded. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that the right checks are made before people work at the home, and she provides training and support for staff. Therefore people living at the home can be sure that their needs will be met by an effective staff team. EVIDENCE: At the time of the inspection visit there were 46 residents at the home. Care and nursing numbers are currently 9 for mornings, 9 for afternoons and evenings, and 5 at night. The manager, deputy manager, registered nurse, and care assistant independently stated that staffing numbers are sufficient for the current needs of residents. Two residents and a registered nurse commented that it is very busy during peak activity periods in the mornings and evenings. Call bells are answered but sometimes there is a delay whilst another resident is being attended to. The manager adjusts staffing levels according to need, and at the time of inspection was considering the impact on staffing of an increased number of residents who require help with eating. The manager keeps staffing levels under review and will continue to discuss this issue at meetings.
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 20 The staff seen during the inspection visit were gentle and attentive to residents’ needs. Residents spoke about staff very positively. Staff spoken to were able to discuss the needs of individual residents, and they confirmed that the home provides training. Registered nurses have opportunities for their professional development. A registered nurse questioned listed the training received by her, and spoke positively about the team working at the home. The care assistant spoken to was undergoing induction training at the time of the inspection visit, and was able to describe being supervised when she started working at the home. The care assistant said that the manager and registered nurses had been very helpful and friendly towards her. Staff meetings are held regularly and those spoken to said that they are able to speak with the manager freely about any concerns or ideas they may have. A sample of staff files and discussion with the manager confirmed that proper procedures are followed when recruiting staff. Meppershall Nursing Home DS0000015039.V320322.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is approachable, listens to residents, and wants to put things right when there are problems. Therefore people living there can be sure that the home is run with their best interests at heart. EVIDENCE: A director and the manager were present during the inspection visit, and both were friendly and approachable in their dealings with residents, staff, and visitors to the home.
Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 22 Residents’ meetings are held at the home, the most recent one during late October. Opinions of residents are actively sought informally and during the meetings, and the manager and a resident were able to talk about examples of this such as comments about the food, and use of the combination lock fitted to the front door. The home issues questionnaires to residents and family members periodically, and these were due for distribution at the time of the inspection visit. Staff said that they feel well supported by the manager, saying that she is helpful and friendly. They receive supervision sessions regularly, and staff meetings are held. A registered nurse and a care assistant spoke about good team work, and friendly relationships within the team. Staff feel able to raise concerns or ideas with the manager. The staff spoken to were pleased with the training opportunities offered to them. The manager has a deputy, and administrative support from one of the directors, and runs the home in an organised way. For example she makes sure that there are procedures for reporting any maintenance jobs requiring attention, and for the checking of any monies held on residents’ behalf. The procedure in place regarding the tracking of essential training needs to be reviewed to make sure that all staff members receive this on schedule, or that any omissions are quickly identified and dealt with. The manager had realised that this is an area requiring improvement at the time of the inspection visit. The manager sometimes has to deal with complex issues to do with personnel management, and she and a director use the Advisory, Conciliation and Arbitration Service (ACAS) as a source of nationally available helpful advice regarding the development of policies and on matters of procedure. The inspector and the manager discussed whether there may be a need for additional training or support for the manager in the field of human resources management and employment law. The manager agreed that she and the directors will give this further consideration. Meppershall Nursing Home DS0000015039.V320322.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 3 x 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 24 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 2 Refer to Standard OP15 Good Practice Recommendations It is recommended that the comprehensive review of meals provided at the home is continued with the full and high profile involvement of residents. The system for the monitoring of the tracking tool in place for mandatory training should be reviewed to ensure that inadvertent omissions are always quickly identified. (Subsequent monitoring of the tool should be audited to check that it is robust.) The directors and manager should give consideration as to whether the manager would benefit from additional training or support in the areas of human resources and employment law. OP18 3 OP31 Meppershall Nursing Home DS0000015039.V320322.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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
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