Inspection on 20/09/06 for Middleton Manor Care Centre

This inspection was carried out on 20th September 2006.

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

The inspector 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

Middleton Manor Care Centre 11/09/07

Middleton Manor Care Centre 02/02/06

Middleton Manor Care Centre 27/10/05

Middleton Manor Care Centre 14/01/05

Middleton Manor Care Centre 21/06/04

Middleton Manor Care Centre 22/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Middleton Manor Care Centre Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ Lead Inspector A Thompson Unannounced Inspection 20th September 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Middleton Manor Care Centre DS0000017886.V312869.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. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middleton Manor Care Centre Address Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ 01621 856464 01621 851535 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Susan Elizabeth Freeman Care Home 41 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (41) of places Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 41 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 16 persons) The total number of service users to be accommodated in the home must not exceed 41 persons 2nd February 2006 Date of last inspection Brief Description of the Service: Middleton Manor is a large three-storey property adjoining other properties in a residential area close to the centre of Maldon. The home is owned by Ashbourne (Eton) Limited, which is a subsidiary of Southern Cross. Residents’ bedrooms are located on all three floors of the home and comprise of 31 single rooms and 5 shared rooms. On the ground floor of the home there are two communal lounge/dining rooms and two communal lounges. On the first floor there are also two small conservatory type lounges available for residents, although one of these is often used for staff training, and the position of both does not lead to general usage by residents other than those with private rooms directly adjacent. Two passenger shaft lifts provide access between all floors. The home provides 24-hour personal care and support to residents with varying dependency levels, including some places for those diagnosed with dementia. The home is well decorated and furnished throughout. Visitor car parking is provided to the side of the property. At the rear there is a patio style garden that is fully enclosed, and has been subject to extensive improvements over recent years. Information from the home states that weekly fees range from £365.15 to £560. Past inspection reports are available from the home, and from the CSCI internet website. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Wednesday 20th September 2006. The content of this report reflects the inspector’s findings on the day of the inspection along with information provided by the service and feedback by service users, relatives, staff and other parties. Practice and procedures occurring after this inspection will be reported on in future inspection reports. Discussions took place with ten service users, the care manager, administrator, three members of staff and three visitors. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All residents spoken to expressed satisfaction with the care and accommodation they received, but not all were satisfied with the quality of the food offered. Visitors spoken with were complimentary of the care and support provided to residents by the staff and management team. Questionnaires were left at the home so that relatives not spoken with on the day had the opportunity to make their views on the service known to the Commission. Staff confirmed they received support from management. They also confirmed that they had been offered training appropriate for there roles. Twenty-six standards were inspected with twenty-two met and four almost met. What the service does well: Staff appeared kind and attentive to residents needs. In-house training covered all the main areas for ensuring staff were equipped with the knowledge and skills for their role. Relatives and visitors are made welcome, and residents considered that management and staff had done everything possible to ensure that their relationships were maintained. The home was considered comfortable, clean and safe. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s assessment format and process ensured that initial perceived needs were identified upon admission. EVIDENCE: Two members of staff including either the manager or care manager visits prospective new residents to undertake an assessment of need. Evidence of this process was seen in care plan files for residents admitted since the last inspection. Assessment headings covered included: communication, mobility, personal hygiene, nutrition, vision, continence, behaviour, manual handling, hearing, medication, foot & oral care, falls social & risks. A care plan is commenced leading up to admission, with completion as soon as possible after. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health, personal and social care needs of residents were adequately detailed in individual plans of care. Health care needs of residents were met and residents felt they were treated with respect. EVIDENCE: Four care plans were inspected. Included was background information, personal details, and next of kin contacts. The residents’ needs/action sheet included the ‘aim of care’ taking account of the headings assessed when carrying out the initial assessment, and further sections added after admission. These were a physical & social assessment, a social profile, pressure care risks and a dependency assessment. Care plans seen included records of residents’ weight, consultations, had been regularly reviewed and included review and evaluation record sheets. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 10 District Nursing services support the home in pressure sore assessment and will also supply appropriate aids and treatment. Continence issues are supported by the community continence nurse and hearing needs are provided for by GP referral to a local hospital. A dentist visits the home, as does a chiropodist and an optician. Some residents continue to see their dentist in the community. The GP holds a weekly surgery in the home and will visit at other times on request. The homes medication policy and procedure covered ordering, receipt, storage, administration, homely remedies and returns of unused stocks. Staff training on medication issues had been provided by the pharmacist. Certificates of attendance were seen and staff spoken with said they had received training on the system used. There is one good practice recommendation noted under medication which is that before staff are permitted to take on the role of administering medication, they are subject to an in-house written competency assessment. Medication administration records were inspected no shortfalls were noted. Discussions with individual residents indicated that they were treated with respect by staff, as did observation of staff going about their duties and interactions with residents. Staff on duty were seen to be courteous, caring and professional in their dealings with residents, and residents spoken with said staff were helpful and considerate. Visitors spoken with were also complimentary regarding staff attitudes and the care provided. Some residents said they had their own private telephone, others use either the home’s payphone or may receive calls of the portable office phone. Treatments and consultations are provided in private, residents’ also confirmed that they wear their own clothes and that staff use their preferred term of address. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle experienced within the home matched the expectations of residents. They were able to maintain contact with family, friends and participate in the local community. Residents were offered a varied balanced diet but some were not always satisfied with the quality of ingredients. Residents were supported to exercise choice in their daily lives. EVIDENCE: Residents meetings had taken place, minutes of issues discussed and decisions made were seen displayed around the home. Also seen were minutes displayed in the entrance lobby of a meeting that had taken place for relatives. The home had a weekly activities programme, which was displayed, around the home. Included sessions were: reminiscence, sing-a-longs, cards, manicures facials, massage, games, puzzles, 1-1 talks, bingo, hairdresser visits and trips to the local high street shops. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 12 Daily activities are led by a designated activities coordinator who had received training for this role. Records had been kept of activities taken part in by individual residents. A church minister visits the home fortnightly to hold a communion service. Residents spoken with confirmed they were satisfied with the choices and options made available to them regarding daily routines and leisure interests on offer. Visitors spoken with said they were always made welcome by staff. Some personal allowance monies are held for safekeeping and records of transactions and receipts are kept. The administrator advised that the home does not act as appointee for any of the residents. Advocacy support is available locally however no evidence was seen that information is displayed/provided to residents and relatives on how to contact an independent advocate. There is a recommendation on this point. Inspection of private rooms confirmed that residents had been permitted to bring their own personal items with them on admission. There was also confirmation of this direct from residents, who told the inspector of the furniture and personal items they had been permitted to bring in with them. Nutrition records and menus evidenced choice and variety. The main daily meal is lunch with two choices, there is also a choice at tea. All residents spoken with said they got enough to eat and two said it was good and that there was always a choice, however two others said they did not always enjoy their lunches as sometimes the food did not taste good. Since the last inspection catering provision has moved away from being provided by contractors to the full control of the management team. National Minimum Standards state that appealing meals are provided and there is a recommendation that every effort is made to ensure that residents are offered meals that are appealing, as well as wholesome and nutritious. Meals may be taken in private rooms or communal lounges if preferred, evidence of this practice taking place was seen. Minutes of residents meetings were seen to include discussion on meals. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents knew how to complaint and the home’s complaints procedure allowed for residents and relatives to formally raise any concerns or areas of dissatisfaction with the service. The home’s adult protection policies, procedures and practices were aimed at ensuring residents welfare. EVIDENCE: The home’s complaints procedure contains guidance on how to make a complaint and who to complain to. Also included were timescales for responses from the home. Evidence was seen to confirm that records are maintained in the home, of complaints received and of any investigation and resulting outcomes. Residents spoken with said they knew who to speak to in the home if they any concerns, and that in the past management had responded positively to any queries/issues they had raised. The manager is an in-house trainer on adult protection matters. She has provided training to staff which included clarifying types of abuse, recognising signs and required actions if abuse suspected. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 14 The homes policy on adult protection was inspected, there was written guidance for staff on recognising and reporting abuse and action to be taken by staff and the person in charge if abuse is suspected. The home was provided (by CSCI) a copy of the latest POVA guidelines. Already on site were the Essex Vulnerable Adults Protection Committee guidance booklets on abuse, which the care manager said are provided to all staff. Induction and NVQ training also includes adult protection issues. The home also had a ‘whistle blowing’ policy which provided guidance to staff on their responsibilities to report any concerns to management. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Furnishings in the home looked comfortable and areas of the premises seen were acceptably maintained. Private accommodation was comfortable and suited to needs and preferences. The home appeared safe, accessible, clean and was considered to be hygienic. EVIDENCE: The home was fully accessible to residents’ currently accommodated and was adequately maintained externally and internally. The patio style rear garden was well laid out accessible. Individual private accommodation and facilities are all considered to be of a good standard. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 16 Lighting in communal rooms was considered domestic in character and sufficiently bright. The furnishings of communal rooms were mainly domestic in character, of adequate quality and appropriate to the range of needs of residents. Twenty five private bedrooms benefit from en-suite facilities or designated private toilet facilities in the corridor immediately opposite the bedroom. Communal wcs are located in the bathrooms, and next to the shower room. It is understood that the only other communal wcs for residents are the two close by the main lounge/dining room on the ground floor. Staff call systems were located in all private rooms and communal rooms seen. The home is equipped with two shaft passenger lifts to provide access between floors. Private rooms were well decorated, comfortable and evidenced individual taste. During discussion with residents all said their rooms were comfortable. Door locks and keys are provided according to individual choice and risk assessment. All rooms seen were naturally ventilated with windows and all were centrally heated. There are only two bathrooms in the home, both are quipped with fixed hoists but the home does not meet the recommended ratio of one assisted bath to eight residents. There is a recommendation in this report that the registered provider considers improving this ratio. There was a shower room on the top floor which could be developed to provide a ‘walk-in’ shower, but this was a designated private en-suite facility. Hot water supply in the home is regularly tested by staff and records were seen to confirm this. All radiators in the home that were seen were guarded, and lighting in residents’ rooms was considered domestic in character and fully appropriate for individuals requirements/needs. On the day of the inspection the premises were considered to be clean and hygienic. Policies and procedures were available for inspection confirming that working practices are in place to control the spread of infection. The laundry room were inspected and were equipped an appropriate washing machines (with sluice cycle programme) and tumble drier. The laundry room was considered small for the size of the home. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels appeared to meet the needs of residents. Staff had been provided in-house training opportunities to equip them with the skills for their role. Staff recruitment procedures aimed at the protection of residents had been followed EVIDENCE: The home’s staffing rota was inspected and confirmed that staffing levels are being maintained at six care staff on duty on morning shifts until 1330 hours then three on until 1500 hours then five on until 2130. Night staffing is three on waking duties. The manager post is sumernumery. Separate and additional rostered staff were employed to undertake cooking, kitchen assistant, administrative, activities and domestic duties. Maintenance is undertaken as and when needed by company contractors. Discussion with staff and records confirmed that regular staff meetings are held. Staff records and discussion with staff evidenced that application forms had been completed, interviews held (with notes kept), written references obtained, written terms & conditions issued and criminal records checks undertaken. Copies of proof of ID and photographs were also on file. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 18 The manager reported that the home had 60 carers holding NVQ 2 or equivalent. Evidence of pass certificates were seen. New staff undergo the home’s induction programme. Records of this were seen, and staff spoken with who had employed since the last inspection confirmed they had received induction training. The induction package had been expanded and included modules on the principles of care, resident care, role of the worker, health & safety, effects of the setting on service provision and safety. At the next inspection records will be checked to ensure that this package is used for all new employees. The manager and care manager were qualified in-house trainers on: food hygiene, manual handling, health & safety, fire awareness and POVA. Training records and discussion with staff confirmed that staff had been provided training on all these subjects by the manager. Staff had been provided training on first aid by a company qualified trainer from outside the home. Again evidence of pass certificates were seen and staff confirmed they had received this training. External training provided had included NVQ, activities, continence, dementia and medication. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had been run and managed efficiently and effectively. Procedures for gaining the views of residents and relatives were in place and had been implemented. Records required by regulation were in place. Financial practices in the home appeared to have been competently managed. The health and safety of residents and staff appeared to have been assured. Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 20 EVIDENCE: There is a registered manager in post who was on leave on the day of the inspection and therefore standard 31 could not be fully covered. The inspection process was dealt with by the care manager and the administrator. An annual quality assurance questionnaire exercise takes place. The last survey had taken place this year and responses received were inspected. Questions included asked residents and relatives their views on health & wellbeing, privacy, security, daily life, complaints, physical environment and for any suggestions. Residents forms included the managers recorded actions resulting from feedback, where required. Some residents personal allowance monies were held for safe keeping by the home. Records of transactions, receipts and balances held were kept and were inspected with no errors noted. The home had COSHH data sheets for cleaning substances used. There were premises risk assessments in place but needed reviewing. There is a recommendation on this point. Random samples of records required to be kept were inspected. These included: complaints, assessments, care plans, staff rotas, staff recruitment, accident records, visitors book, fire drills, regulation 37 notices, regulation 26 reports, menus, medication, background info’ and next of kin details, cash held for safekeeping and fire procedures. All seen were satisfactory. Discussions with staff, management and inspection of records confirmed that training is provided to staff in moving and handling, fire safety, food hygiene, first aid and basic training in infection control. Certificates and service records were available for inspection to confirm that the home’s fire equipment, passenger lift, hoists, call alarms, emergency lights, gas supply, portable electrical appliances and electrical installation supply had all been tested/serviced within recommended timescales. The electrical installation supply appeared due for retesting in October 2006 (5 year timescale). Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X 3 3 3 3 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 X 3 2 Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 22 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 OP9 Good Practice Recommendations The registered manager should ensure that that home’s medication training for staff includes a recorded assessment of competency for undertaking the role of administering medication. The registered manager should ensure that residents and their relatives know how to contact external advocacy services. The registered provider should ensure that residents are provided an appealing diet. 2 OP14 3 OP15 Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 23 4 5 OP21 OP38 The registered provider should consider increasing the number of assisted bathing facilities in the home. The registered manager should ensure that the home’s premises risk assessments are reviewed/updated annually Middleton Manor Care Centre DS0000017886.V312869.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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