Inspection on 08/06/05 for Middletown Grange

This inspection was carried out on 8th June 2005.

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

Middletown Grange 11/08/08

Middletown Grange 14/08/07

Middletown Grange 26/04/06

Middletown Grange 08/11/05

Middletown Grange 26/01/05

Middletown Grange 06/09/04

Middletown Grange 09/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Middletown Grange Middletown Hailey Witney OX29 9UB Lead Inspector Annette Miller Unannounced 8 June 2005 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 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. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Middletown Grange Address Middletown, Hailey, Witney, OX29 9UB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01993 700396 01993 775704 Barchester Healthcare Homes Limited Elizabeth Mouratsing (Acting) Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (1) Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Of the 40 places in the home, up to 30 places may be used for service users with nursing needs being met by the nursing staff in the home. The individuals with nursing needs must fall within the OP category, as the nursing facilities are not providing a specialist service for any other category of care. The 10 non-nursing residents in the home may fall within the following categories: OP, DE(E) and PD(E). The home must be staffed to at least the minimum levels within the agreed staffing statement for the home. A maximum of 5 beds may be used for intermediate care (N) within a designated area of the home as agreed with CSCI. Service users to be accommodated in intermediate care beds must be aged over 65 years. Date of last inspection 26 January 2005 Brief Description of the Service: Middletown Grange is owned by Barchester Healthcare Homes Ltd. The home is registered to provide care for up to 40 residents aged from 65 years. Thirty of the beds are registered for nursing care. There are two spacious lounges, a conservatory and a separate dining room on the ground floor. Bedroom accommodation is situated on the ground and first floors and is available mostly in single rooms. Recreational and social activities are provided daily, with occasional trips being arranged to places of interest whenever possible. The home is purpose-built with a large and attractive landscaped garden at the front. A keypad lock is fitted to the front gate to prevent service users wandering onto the road that is nearby. The home is situated in a village location not far from the market town of Witney, where there are shops and local amenities. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors over a period of seven hours. The inspection focused on talking to residents and staff to obtain their opinions of the home. The availability of training was discussed with staff and a tour of the building and inspection of documents took place. The acting manager was away from the home due to illness and the company had arranged for a manager from one of its other homes to provide temporary cover. This arrangement started on the day of inspection. A regional operations director joined the inspection during the afternoon. What the service does well: What has improved since the last inspection? What they could do better: Written information provided to residents must be reviewed and updated to ensure that the information provided is accurate. It is essential that prospective residents have a pre-admission assessment to determine whether or not the home can meet their needs. Record keeping continues to be poor in most areas, particularly regarding the planning of residents’ care. Care planning must improve to ensure that care needs are appropriately met and that evidence of the care provided is stated. It is unacceptable for residents to be dressed in clothes belonging to other people, which was the situation for at least one resident on the day of inspection. Staff should take greater care when sorting laundered clothing to ensure that it is returned to its rightful owner. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 6 It is crucial that support is given to the new manager to ensure that the difficulties currently being experienced as a result of frequent management changes are resolved for the benefit of all residents and staff. Five members of staff were spoken to and two did not feel very well supported, with three not commenting on their feelings. One member of staff felt undervalued and one said, “This is not a nice place to work”. The impression gained from this last comment was that this was due to a succession of managers and general lack of leadership. Induction training must be improved in order to meet national training organisation standards for new workers. There has been no improvement in implementing training records and the home was again unable to provide written evidence of the training, if any, that has been undertaken. 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. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 4. The home’s Statement of Purpose and Service Users’ Guide do not provide residents and prospective residents with up-to-date information for them to be clear about the services the home provides to meet their needs. Pre-admission assessments are not routinely carried out and residents cannot be certain that their needs can be met in the home. EVIDENCE: Registered care homes are required to have a Statement of Purpose and a Service Users’ Guide that provide a range of information to residents and prospective residents. At the last inspection these documents did not contain the information required and a requirement was made that they be reviewed and updated. The Statement of Purpose currently available provides out of date information and is not the updated edition sent to the Commission for Social Care Inspection (CSCI) in January 2005. The document on display gave the name of a manager who left the home in March 2004 as the person to send complaints to. There is also reference to admitting people with a diagnosis of Alzheimer’s disease, whereas the thirty nursing beds are not registered to Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 9 provide this type of care. The home is only permitted to admit residents with mild dementia into the ten residential beds. The home should be displaying the latest published inspection report, which is the January 2005 report. The report available in reception was the September 2004 report. Neither the temporary manager nor the nurse-in-charge could find copies of pre-admission assessments for residents admitted recently. The purpose of these assessments is to assess residents prior to admission to determine whether or not their care needs can be met. These assessments are required by the Care Homes Regulations 2001 (Regulation 14). Training records are not kept for staff and these must be started to provide evidence of the training undertaken. There were numerous training dates marked in the 2005 diary but no indication of how many staff attended, or whether the training actually took place. The training recorded in the diary between January and June 2005 consisted of: • • • • • • • wound care x 2 sessions. dementia training x 1 session. medicine training x 1 session. handling and moving x 6 sessions. first aid. care planning. control of substances hazardous to health (COSHH) Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet or safeguard service users’ health and social care needs. Personal support to help residents wear their own clothes is not consistently offered. EVIDENCE: Three sets of care records were randomly selected for inspection and in each case the standard of record keeping was poor. Assessment sheets that should have been completed on admission had not been filled in. The records for two residents did not contain care plans, even though each resident had complex care needs. An entry in the daily diary for one resident said, “care continues”, yet there was no information to indicate what this care comprised of. When this was discussed with the nurse in charge she said there was a previous set of records, but information had not been transferred across, or updated, when new records were started. Entries in the old notes had stopped in December 2004. The pre-admission assessment for a newly admitted resident could not be found and the temporary manager concluded that it had not been carried out. The assessment section that should have been completed on admission was Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 11 blank. This resident had complex care needs, yet no care plans had been completed. There was an entry on the 26th May 2005 in the daily report that said, “Needs to be assisted with feeding, seems to be loosing weight”. There was no record of what action was taken. One set of records contained care plans, but staff were not recording their actions. For example, a care plan stated that the resident must be weighed monthly but there was no record of this being done. When this was discussed with the nurse in charge it was found that residents are weighed monthly but the weights are recorded on an A4 sheet of paper kept in the nursing office, rather than being recorded in the care records. Some very low weights had been recorded in May 2005, eg 31.3 kgs and 32.2 kgs, but there was no record of residents being referred to their doctor or a dietician, or of any ongoing monitoring by the home’s staff. It was also noted that a new resident had lost 4.5 kgs in two months, but there was no record of what was being done about this. This was discussed with the nurse in charge and it appeared that no action had been taken. There is open visiting and an inspector spoke with one relative. The visitor took the opportunity to report that their relative, who was confused, frequently wore clothing that was not his own. Whilst the visitor recognised the difficulties in keeping track of her relative’s clothing, it was clear that this situation caused distress to her and compromised the dignity of the resident. It is recommended that a review of the procedure for separating residents’ laundry is carried out to ensure that clothing is returned to the correct owner. A collection of communal clothing was observed in the laundry, and whilst it is recognised that there may be times where spare clothing is needed, the use of communal clothing should be kept to a minimum in order to preserve the dignity of residents. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Activities are well planned and good opportunities are provided for residents to maintain their interests and socialise with other residents. The activities organiser is commended for his commitment to improving the day-to-day life of residents. The lunchtime meal was well organised. However, in order to promote an unhurried and relaxed mealtime for residents who need help to eat, staff should sit down next to the resident whilst providing one-to-one assistance. EVIDENCE: The activities organiser was organising artwork in the garden for seven residents when the inspectors arrived. It was apparent that residents enjoyed being outside and that the activities organiser had a good rapport with them. One of the residents said the activities organiser was “very good”, and another liked following him around. A good range of activities is provided and trips out are arranged whenever possible. Activities take place during weekdays starting at 9am through to 2.30pm with breaks for coffee and lunch. Staff should ensure that residents who enjoy the activities are brought to the lounge in good time. One resident who had been helped to wash and dress before 8.00am was not escorted to the lounge by her carer until 10.15am. The activities organiser is involved in serving coffee to residents mid-morning and takes this opportunity to check on residents who have chosen to stay in their rooms. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 13 The home’s dining room is spacious and provides a pleasant dining area with views across the garden. Classical music was playing quietly on the radio and the atmosphere in the dining room was calm and relaxed. Three staff were providing assistance and gave discreet assistance and were seen talking to residents. Two residents were being spoon-fed by one member of staff who was moving between them. This is poor practice and is not conducive to residents’ comfort, or to a relaxed and unhurried mealtime. Other members of staff were seen to assist residents more appropriately, sitting next to them and talking with them. Staff in the dining room had omitted to notice that two residents needed help to cut up their food until this was drawn to their attention by an inspector. Staff must ensure that all residents are observed to ensure their needs are met. Cold drinks were being offered and residents who needed help to drink were assisted. The activities organiser arranged for a group of service users to have lunch in the garden under a gazebo and they very much enjoyed this event. The garden is a lovely area with many flowering plants and is enjoyed by residents and their relatives during good weather. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home’s complaints procedure must be reviewed and updated to ensure that accurate information is available. Complaints should be dealt with in line with the complaints procedure so that complainants feel their complaints are listened to and acted upon. EVIDENCE: The complaints procedure in reception contained some inaccurate information about whom a complainant should contact. Clearly the procedure had not been updated for some time as the name of a manager who had left the home in March 2004 was still shown as the person to contact. Also, the name of the company representative to contact if a complainant remained dissatisfied was different in two complaints policies displayed in the same area. The home’s complaints file was examined and the last complaint was dated April 2004, yet CSCI is aware of two complaints made in May and June 2005 about the standard of care provided in this home. The manager should ensure that a record is kept of all complaints made and that the record includes details of the investigation and any action taken. One of these complaints was not dealt with within the 28-day timescale set by the company and the person dealing with the complaint did not keep the complainant informed of the reason for the delay. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 standard(s) 20 and 26. The standard of the environment within this home is good providing service users with an attractive and homely place to live. The poor standard of laundry facilities that are sited in an outhouse to the side of the building affects the provision of a good laundry service. EVIDENCE: There is an ongoing programme of refurbishment and redecoration to ensure that décor and furnishings are in good condition. The garden at the front of the home provides excellent outdoor facilities and a group of residents were sitting in the garden with the activities organiser taking advantage of the good weather. The gate into the front garden is kept locked for the safety of residents. Visitors enter the home by putting a security code into the keypad that is fixed to the front gate. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 16 Normally there are two cleaners on duty, but on the day of inspection there was only one. This is a large home for only one cleaner and there should be sufficient domestic staff employed to provide adequate cover. Surface cleanliness was good, but greater attention could be paid to areas where dust accumulates, such as along skirting boards and in corners. The atmosphere was fresh smelling in all communal rooms, but in one bedroom there was a smell of urine because a commode had not been emptied. This was mentioned to the temporary manager who immediately arranged for it to be emptied. The home’s laundry is inadequate to cope with the amount of laundry generated by the number of residents accommodated. It is situated in an outhouse and has only one washer and one dryer for up to 40 residents. It has been the company’s intention to extend the home since 2002 and planning permission has been obtained, but there is still no date to start this work. Whilst it was acceptable to manage with the existing laundry facilities temporarily, this situation is no longer satisfactory and the company must plan to update the present laundry facilities in the near future. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. High staff turnover has had the effect of depleting the level of experience in the staff team and this situation is having a detrimental impact on the standard and consistency of care offered within the home. EVIDENCE: The total number of registered nurses and carers employed is low for the size of the home. This means that many staff work overtime and regularly work 12-hour shifts. The staffing rota for the week beginning 6th June 2005 showed that the nurse in charge was working seven days in a row to provide cover for vacant shifts. There are only four nurses and twelve carers currently employed for day and night duty. The staff on duty consisted of: • • • 8am – 2 pm: two registered nurses and five carers. 2pm – 8 pm: two registered nurses and three carers. 8pm – 8 am: one registered nurse and three carers. One cleaner and one laundry assistant were on duty. The maintenance man, who has a basic food hygiene certificate, was covering for the cook who was off sick. The temporary manager, who is a registered nurse, was on duty. Whilst this number of staff meets the requirements of the home’s staffing statement agreed with CSCI, the inspector has concerns that the high staff turnover has depleted the amount of experience, knowledge and skills available within the current workforce. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 18 A review of the skill mix of staff must be carried out to ensure that the staff team has the necessary knowledge and skills to meet residents’ health and welfare needs. Five members of staff were spoken to and two indicated that they did not feel well supported, with three not commenting on their feelings. One member of staff said that they felt undervalued and another said, “This is not a nice place to work”. One member of staff expressed concerns about the standard of care provided. One member of staff was pleased with the training opportunities provided. Induction training was discussed with a carer who had been in post for one month. The carer was not included in the duty rota for the first four days and worked with a senior carer for two days to gain an understanding of what was required, as this new member of staff had not previously worked as a carer. Handling and moving training and an introduction to fire safety was provided before the carer was included in the workforce. Training records had not been kept and this is unsatisfactory. It is good practice for new workers to be allocated to a senior member of staff throughout their period of induction lasting for up to six weeks. Also, that a workbook is issued that shows a comprehensive list of training to be undertaken. The new worker and assessor should sign the workbook each time an element of learning has been satisfactorily achieved. The carer said a workbook had not been issued and was unclear about the identity of the supervisor. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 32. The lack of management continuity since the company purchased the home in 2002 has resulted in poor leadership of staff. Since the last inspection there has been no improvement in staff morale and this situation is detrimental to achieving positive outcomes for residents. EVIDENCE: When Barchester Healthcare purchased the home in December 2002 a temporary manager was provided until a permanent manager was appointed. An appointment was made in June 2003 and this manager stayed until March 2004. Her successor started in May 2004 and left in October 2004 and the next manager started in April 2005, but was off sick at the time of the inspection. There has been a succession of temporary managers between these appointments and this, together with the changes in permanent managers, has had a detrimental effect on staff morale and the amount of supervision and support staff have received. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 20 The new manager has submitted an application to the CSCI to become the registered manager and this application is being processed. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 1 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 1 x x x x x x Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6 Requirement The Statement of Purpose and Service Users Guide must be reviewed and updated and a copy of each document sent to the CSCI inspector. Residents must not move into the home without having had his/her needs assessed and been assured that these will be met. Residents care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Residents care plans must be kept under review. Review and update the complaints procedure to ensure that it specifies how complaints may be made and who will deal with them, with an assurance that they will be responded to within a maximum of 28 days. The responsible person for the company must submit an action plan to the CSCI inspector outlining how the company intends to provide adequate laundry facilities. Timescale for action 18.07.05 2. 3 14 3. 7 15 With immediate effect from 08.06.05 With immediate effect from 08.06.05 4. 16 22 18.07.05 5. 26 16(2)(e) 18.07.05 Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 23 6. 27 18(1) 7. 30 18(1) 8. 36 18(2) The manager must review the 18.07.05 skill mix of staff to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. The manager must ensure that 18.07.05 all members of staff receive training appropriate to the work they are to perform, including sructured induction training. Records of training must be kept. The manager must ensure that 18.07.05 persons working at the care home are appropriately supervised on a day-to-day basis and receive formal supervision at least 6 times a year. 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 10 15 Good Practice Recommendations Residents should wear their own clothes at all times. Staff training should include instruction to staff about sitting down to help residents to eat and not assisting more than one person at a time. Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Middletown Grange H57-H08 S40174 Middletown Grange V231429 080605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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