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Inspection on 28/06/07 for Milverton Nursing Home

Also see our care home review for Milverton Nursing Home for more information

This inspection was carried out on 28th June 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Comments from people who use the service included "I wouldn`t move anywhere else", "they look after me too well sometimes" and "very pleasant". A relative or friend of a person living at the home said "The general nursing care is well done". People living at the home enjoy the food provided. Individuals spoken to reported that staff were friendly and polite. Staff records are well kept and include all the important checks to help protect people living at the home. A good programme of training is made available to care staff.

What has improved since the last inspection?

Extensive building work has started to extend and improve the environment for people living there. Some good work has been done to obtain better information about individuals in `getting to know you` assessments. Some very good work has been done around person centred care and training has been given to staff around this important area.

What the care home could do better:

Procedures for managing medication need to be further improved. A challenge for the home is how to develop the care provided to be more person centred and individualised. Mealtimes in particular could be a muchmore positive occasion for all involved. The service needs to think creatively as to how this can be done. Everyone living at the home needs to have a social care plan in place. Care staff need to see the provision of social care and occupation as a very important part of their role. Care staff on each shift would benefit from having someone leading them to role model and support them in good person centred care practice.

CARE HOMES FOR OLDER PEOPLE Milverton Nursing Home 99 Ditton Road Surbiton Surrey KT6 6RJ Lead Inspector Jon Fry Key Unannounced Inspection 28th June and 11th July 2007 1.20pm 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 Milverton Nursing Home DS0000026253.V347174.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. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milverton Nursing Home Address 99 Ditton Road Surbiton Surrey KT6 6RJ 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) 020 8399 4663 F/P 020 8399 4663 milvertonhome@btconnect.com Surbiton Care Home Limited Margaret Mary Rea Care Home 23 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Physical disability over 65 years of age (0) Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide nursing care and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category (Category OP) (no more than 23 persons) Service users with a physical disability who are over 65 years of age (Category PD(E)) (no more than 23 persons) Service users with dementia who are over 65 years of age (Category DE(E)) (no more than 10 persons) The maximum number of service users who can be accommodated is 23 22nd May 2006 2. Date of last inspection Brief Description of the Service: Milverton provides nursing care for up to twenty-three older people, ten of whom may have dementia. The home is in a residential area of Surbiton near to shops and public transport links. Accommodation is provided within a mixture of single and shared rooms on the ground and first floor. There is a passenger and stair lift in use within the home. At the time of this inspection, weekly fees range from £630.00 - £787.50 per week. Additional charges are made for hairdressing, chiropody and newspapers. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector who spent nine hours in the home over two separate visits. The inspector talked individually with six people living at the home. Four relatives or friends of individuals were also spoken with during the inspection. A number of records were examined and discussions took place with the manager and four staff members. Completed surveys were received from three people living at the service, four relatives or friends of individuals and seven care staff. What the service does well: What has improved since the last inspection? What they could do better: Procedures for managing medication need to be further improved. A challenge for the home is how to develop the care provided to be more person centred and individualised. Mealtimes in particular could be a much Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 6 more positive occasion for all involved. The service needs to think creatively as to how this can be done. Everyone living at the home needs to have a social care plan in place. Care staff need to see the provision of social care and occupation as a very important part of their role. Care staff on each shift would benefit from having someone leading them to role model and support them in good person centred care practice. 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. Milverton Nursing Home DS0000026253.V347174.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 Milverton Nursing Home DS0000026253.V347174.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 3. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Good information is made available about the home. Assessments are completed before people move in to make sure that their individual needs can be met. EVIDENCE: “This is a good home”, “the best I could of found” and “very pleasant” were some comments from people living at the home. Relatives and friends comments included “we are reasonably happy” and “the nursing care is excellent”. A user guide is available which contains information about the service provided. The manager told us that this could be made available in large print Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 9 if requested. We recommend that other formats are looked at for the guide such as tape or pictures to make sure that it can be used by as many people as possible. The guide gives the current fees and any additional charges. People moving in have a trial period of four weeks to see if they like it and to make sure that the service can meet their needs. We saw that there is an admissions procedure and that assessments are completed prior to anybody moving in. Once an individual comes to live there, a care plan is written based on these assessments. Some excellent information about individuals and their background had been gathered in the ‘getting to know you better’ questionnaire in use. The home should look at how this information can be put into care plans, as this was not happening consistently when we visited. The information can then be used by care staff to engage with individuals. This is particularly important for people with dementia. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans could be more person centred and better address the health, personal and social care needs of individuals. Arrangements for the handling, storage and administration of medication could be improved. EVIDENCE: Two of the four relatives or friends of people who completed a survey said that the home ‘always’ met the needs of their family member. One person said ‘usually’ and another individual said ‘sometimes’. We looked at the care plans for three people and the information provided covered areas such as mobility, diet and personal care. Each care plan contains pre-printed information about potential care needs, this sometimes makes the information presented too general. Staff do add additional information to each document but need to make sure that each plan is specific Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 11 to the person. One example of this is where the care plan for one person around personal care contained printed instructions such as ‘staff will offer daily mouth, eye, feet and hair washing to the resident each day’. This information needs to be personalised to each individual. A social care plan was in place for one person. This gave very good information about what the person liked to do and this needs to be recorded for everyone living at the home. Risk assessments are completed around areas such as falls, pressure areas and nutrition. We saw that these were generally well completed but more consistency is needed about when they are reviewed. It is important that assessments are looked at regularly particularly following and accidents or incidents. Full individual assessments should also be put in place for the use of cot sides. Daily notes kept by staff should also be looked at. We saw that some of these were very repetitive and general statements such as ‘all care needs met’. Notes kept by staff need to contain good information which can then be used to evaluate and review the care being provided. Medication procedures need further improvement. We saw that items were stored correctly and that records were generally kept well. There were however eight instances where the record of administration had not been signed by staff after a medication had been given. One issue was highlighted where staff were signing for a medication as being given when it was not actually in stock. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home offers an adequate range of activities. There is scope to improve this by making sure there is a full social care plan for each person and involving all staff in delivering this care. Improvements need to be made to make sure that mealtimes are a positive occasion for everybody involved. EVIDENCE: People spoken with said that they enjoyed the food offered with comments including “the food is good”, “very good”, “its cooked well” and “quite good”. The service needs to look at how mealtimes can be made a more positive occasion and an opportunity for people to talk and interact. Staff need to review when and how the meals are served particularly when people need assistance to eat. We saw three instances of staff standing up when Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 13 supporting individuals to eat and a staff member helping two people at the same time. Sometimes staff were also too quick in giving assistance and ‘outpaced’ people. This led to an impression of the mealtime being a task to have to get done rather than a pleasant social occasion. We have made some recommendations around mealtimes for the service to consider. We also recommend that the menus in use be presented in more user-friendly ways such as large print or pictures. Activities are provided by staff who visit the home three times a week. One of these people visits on a Monday for one hour to do exercises or a quiz. Another hour of activities is provided on Wednesday and Friday with records showing that these sessions included singalongs, reminiscence and games. Comments included “ok”, “I’ would like a few more activities” and “more outings”. One relative or friend said “needs more stimulus”. Work to build a large extension is going on in the garden of the home and a number of people spoke about this. Two people who live at the home said they were enjoying watching this but three relatives or friends each commented about the loss of an outside area for people to enjoy. Comments included “my relative needs more fresh air” and “residents will remain indoors this summer of 2007”. Care staff spoken to said that they did not routinely provide activities and that this was not really their role. Feedback included “there are not enough activities” and “residents should have activities everyday”. A programme of activities is displayed but the record of activities kept did not always reflect this. All individuals need to have a social care plan in place and care staff should be involved in providing this important care. It is strongly recommended that increased hours be provided for activities coordinators who could then be more involved in organising and supporting staff to deliver activities. This is particularly important for those people who spend a lot of time in their rooms and for individuals with dementia. One visitor said they are made to feel welcome and can visit at any time. Individuals spoken to said that they were able to have friends and family visit when they liked. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals are aware of how to make a complaint. Training in Abuse Awareness supports staff in protecting people living at the home. EVIDENCE: There are suitable procedures in place for dealing with complaints. The complaints policy and procedure is part of the guide for the people living there. We have recommended that this procedure be displayed in a large print or picture format. The manager said that there had been no complaints since the last inspection. The service has internal policies and procedures for the Protection of Vulnerable Adults (POVA) and a copy of the local procedures was also seen to be available. There have been no recent allegations of abuse. Staff have training in abuse awareness. The Local Authority provided an inhouse course for care staff in February 2007. Milverton Nursing Home DS0000026253.V347174.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home generally enjoy a satisfactory and clean living environment. There is currently extensive building work going on at the home which makes it difficult to properly assess these Standards. EVIDENCE: As stated previously, it was difficult to properly assess the environment with the large amount of building work going on. Individuals spoken to were satisfied that the renovations were being managed satisfactorily although the noise from building works was very loud at times. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 16 People spoken to were generally happy with the environment. Comments from individuals included “I like my room”, “good” and “ok”. A relative or friend of one person said the room was “satisfactory” but that there was very limited space for a hoist to be used. One ground floor bathroom near the lounge was also seen to have limited room for wheelchairs and other equipment. We saw that the lounge area became quite congested at times and we saw two instances where staff had trouble helping people to move in wheelchairs due to the limited space available. The manager reported that the interior of the home was to be extensively re-modelled as part of the current building works. One person raised concerns about the equipment they were provided. Their relative or friend also said that they felt the environment and equipment provided could be better adapted for the individual concerned. This was discussed with the manager at the time of inspection and a referral should be made via the GP to an Occupational Therapist as necessary. Milverton Nursing Home DS0000026253.V347174.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are generally enough staff on duty to meet the needs of people using the service but this needs to be kept under close review. People living at the home are protected well by the recruitment procedures. There is a good staff training and development programme in place. EVIDENCE: Feedback about the way the staff carried out their duties was generally positive. Comments included “very good”, “the staff are very good”, “nice staff” and “very good”. One relatives or friend said “they seem to have caring and understanding nursing staff”. One person living at the home said that they thought there should be more staff on duty as they sometimes did not get the support they needed. Five out of the seven staff who returned surveys also reported that they thought there should be more staff on duty. Comments included “we need an extra carer in the morning” and “not enough cover for staff sickness”. Care staff spoken with individually talked about the needs of people living at the home increasing so that more intensive support was now required from them. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 18 We looked at the recruitment records for three members of staff. These were very well maintained and contained all the necessary checks including Criminal Records Bureau (CRB) checks. Staff are offered a good level of training in a number of topics such as manual handling, Fire Safety, the Mental Capacity Act and Protection of Vulnerable Adults. There had been some very good work done by a student social worker around person centred approaches and this included training for care staff. This work needs to continue as some staff appeared to still be very task based in their approach and centred mainly on physical care. Milverton Nursing Home DS0000026253.V347174.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Day to day management arrangements require further review to make sure that care staff receive the leadership and support they need. There are generally good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: The manager has knowledge and experience of running a care service for older people. Areas for future improvement for the manager to look at include improving mealtimes, medication procedures and care planning. Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 20 The manager demonstrated a good knowledge of person centred care but this area still needs work to turn these ideas in to actual practice. It is recommended that the service looks at who is leading the staff on each shift and making sure that this person is role modelling good person centred practice for others to follow. As stated previously, care staff need to see social and emotional care as an important part of their work. A number of issues around leadership and support were raised consistently by care staff in surveys. These were referred to the owner following the inspection as they were clearly management issues which were affecting morale within the staff team. A system for regular individual staff supervision is in place but needs development to make sure that all full time staff receive this at least six times per year. People living at the home and their relatives or representatives are sent questionnaires as part of the quality assurance process. The most recent survey was in 2007 and the results of this are displayed in the ground floor hallway. The minutes of a meeting for people living in the service were seen for May 2007 and issues discussed included catering, activities and spiritual care. Health and Safety checks take place to make sure people are kept safe and good records are kept of these. One issue was highlighted where the service needs to make sure that the hot water temperatures of baths and showers are checked each week. Milverton Nursing Home DS0000026253.V347174.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 2 X 3 Milverton Nursing Home DS0000026253.V347174.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. 1. Standard OP7 Regulation 16 (2) (m) (n) 15 (1) Requirement Each person living at the home must have a care plan in place addressing their individual social needs and how these are to be met. This will help to make sure that their social and recreational needs are being met by the service. In order to protect the welfare of people living at the home, risk assessments must be subject to a regular documented review process. Full individual risk assessments must be put in place for the use of cot sides. It is particularly important that individual risk assessments in place be reviewed following any incident or accident. In order to fully protect the health and welfare of people living at the home, medication records must be correctly maintained at all times. DS0000026253.V347174.R01.S.doc Timescale for action 01/11/07 2. OP8 13 (4) 01/09/07 3. OP9 13 (2) 01/09/07 Milverton Nursing Home Version 5.2 Page 23 4. OP15 12 (4) 5. OP36 18 (2) Medication must be given as prescribed with full and accurate records kept at all times. In order to respect the dignity of people living at the home, staff must sit down when assisting individuals with their meals. All full time care staff must receive supervision with their line manager at least six times per year (pro-rata for part time staff). This will help to make sure that good quality care is being delivered to people living at the home. In order to fully protect the safety of people living at the home, weekly recorded checks must be made of the hot water temperatures at all bath and shower outlets. 01/09/07 01/11/07 6. OP38 13 (4) 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The user guide to the home should be made available in a variety of formats such as audiotape or pictures. The ‘getting to know you’ assessment format should be consistently used to make sure that good quality person centred information is captured. This should then be used to inform the care plan from when the individual moves in. The home should look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person orientated and less task based. Care plans need to give specific information about how the person likes the care and support to be delivered. Daily notes need to be reviewed to make sure that good DS0000026253.V347174.R01.S.doc Version 5.2 Page 24 3. OP7 4. OP7 Milverton Nursing Home 5. OP12 quality useful information is being recorded. The organisation should seriously consider increasing the hours of the activities co-ordinators in the home. All care staff should be responsible for the provision of social activities. The job of the activities co-ordinator could be changed to be more of an organisational / supporting role for care staff. The frequency of trips outside the home could be increased particularly if the garden area is out of use for an extended period. Menus should be presented in user-friendly formats such as pictures or large print. Large whiteboards could also be used to present information and any changes. Mealtimes should be made a more positive occasion and an opportunity for people to interact. Practices such as protected mealtimes, varying numbers of mealtimes, and staff eating with people who live there should be considered seriously by the home. Referrals should be made as required to an Occupational Therapist to make sure that both the environment and equipment provided for individuals is suitable for their needs. Staffing levels should be kept under constant review to make sure that suitable numbers of staff are provided to meet individual needs. It is strongly recommended that all staff continue to receive training in person centred care and caring for people with dementia. This should cover person centred approaches, effective communication and the use of activities. The home should look at the day-to-day management arrangements within the home. This is to make sure that staff on each shift receive the leadership, guidance and support they need to do their jobs well. The person in charge of each shift needs to role model good practice for other staff to follow. 6. OP15 7. OP22 8. 9. OP27 OP30 10. OP32 Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milverton Nursing Home DS0000026253.V347174.R01.S.doc Version 5.2 Page 26 - 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. 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