Inspection on 28/02/07 for Park House

This inspection was carried out on 28th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Park House 17/10/07

Park House 11/01/06

Park House 08/09/05

Park House 15/02/05

Park House 16/08/04

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

CARE HOMES FOR OLDER PEOPLE Park House 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH Lead Inspector Caroline Johnson Key Unannounced Inspection 10:00 28 February & 6th March 2007 th 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 Park House DS0000021183.V307661.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. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address 1 Walton Park Bexhill-on-sea East Sussex TN39 3NH 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) 01424 211258 phil@brit45.freeserve.co.uk Mrs Jacqueline Brittain Vivienne May Tree Care Home 7 Category(ies) of Dementia (7) registration, with number of places Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That the maximum number of service users to be accommodated will not exceed seven (7). That service users accommodated will be older people aged sixty five (65) or over on admission. That only service users with a dementia type illness will be accommodated. 11th January 2006 Date of last inspection Brief Description of the Service: Park House is a detached property situated approximately one mile from Bexhill town centre. Accommodation is on two floors with a stair lift fitted to assist service users to have access to the first floor accommodation. The home has a large garden, which is shared with the care home next door that is owned by the same proprietor. The home is registered to accommodate up to seven older people who have a dementia type illness and the registered owner is Mrs J Brittain. The fees for the home as of 28 February 2007 range from £368 to £420 per week. However, the proprietor stated that the fees were being reviewed. Additional charges are made for hairdressing, chiropody and dry cleaning. The home ensures that copies of the inspection report are made available upon request and there is always a copy available in the home to refer to. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of the inspection process two site visits were carried out. The first visit was on the 28 February 2007 and this lasted from 10.00am until 3.00pm and the second visit was on 6 March 2007 and lasted from 09.50am until 2.15pm. During the visits there were opportunities to meet with the relatives of three of the residents. Time was spent in the dining room observing an activity and staff interactions with residents. The manager was not on duty on the first site visit but the owner came to the home. Time was spent with both members of care staff and with the manager on the second day of inspection. A wide range of records were also examined including the care plans for two residents and record keeping held in relation to staffing, medication, health and safety and quality assurance. A full tour of the building was undertaken. Prior to the inspection process comment cards were sent to the home for distribution to residents or relatives on their behalf. Overall, feedback received was very positive. Comments included - in relation to staffing, ‘bare minimum but hard working and conscientious’ and ‘would like a female carer on at night as occasionally there is only one male carer’, ‘I have been lucky to receive good care and attention from all the staff and thank Vivien (manager) especially’. What the service does well: What has improved since the last inspection? The activity programme in the home has improved both in relation to the numbers of activities but also the quality of the activities. The home also uses photography to evidence the work undertaken. There are plans to develop the activity programme even further. Training opportunities for staff have also improved greatly ensuring that the staff are skilled and competent to meet the needs of the residents. Quality assurance systems have also improved and more regular audits ensure that record keeping is kept up to date, views of relatives are sought more regularly and improvements have been made to the environment as a result. Relatives are invited to annual care plan meetings giving them a greater say in how their relative’s care is provided. All requirements made at the last inspection have been addressed but further Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 6 clarification is required in relation to one so it has been repeated on this inspection report. 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. Park House DS0000021183.V307661.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 Park House DS0000021183.V307661.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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. With some minor additions to the home’s statement of purpose the document will then provide clear information to prospective residents. EVIDENCE: Since the last inspection the statement of purpose has been amended to make it more individual to the home. However, the document needs to be amended further to include details of the provider and company and to include reference to all areas specified in Schedule one of the Regulations. A pre admission assessment was seen in relation to one recently admitted resident. There was detailed information provided and the family of the resident had been very involved in the assessment process. The owner is also very involved in the assessment and admission process. The home does not cater for intermediate care. Park House DS0000021183.V307661.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): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. The introduction of annual care plan meetings has given relatives greater input into the care provided to their relative in the home. The care to be provided in care plans is detailed but the quality of risk assessments needs to improve so that everyone is clear about what the risks are and how to prevent accidents/incidents occurring. Further training in this area will improve the quality of record keeping in this area. EVIDENCE: Two care plans were examined on this occasion. In relation to one resident ‘s care plan it was noted that the care plan was being reviewed at regular intervals and kept up to date. Risk assessments were in place but the risk and level of risk is not always clearly defined and therefore the action to be taken by staff is also not always clear. For example in relation to one resident there was a risk assessment stating the resident doesn’t communicate as well as they used to. It doesn’t give information about how they communicate or what if any, the identified risk is. As a result it is not clear to staff what they need to record in the daily records in terms of any action taken in relation to this. There was also reference to a resident being aggressive. On the assessment it referred to aggression only on occasions and some information about the Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 10 action to be taken. In the care plan it stated that the resident is rarely aggressive, and that the resident could shout and scream when asked to do something. Daily records referred to regular incidents of aggression but there was no risk assessment in place. The home has introduced care plan meetings for each of the residents to be held annually. Relatives are invited to attend. One relative spoken with stated that she found the meetings very helpful. The previous week she had raised a problem she had noted with her relative’s seating position and the problem had been resolved within days. Staff have had some training on care planning and the owner talked about her commitment to raising standards in this area. Each of the residents’ weights are monitored monthly. Records show that a range of healthcare appointments are arranged to meet the individual needs of the residents. This includes gp appointments, visits from the district nurses, chiropody and opticians. Medication is stored in a monitored dosage system and records seen in relation to medication administered to residents were in order. However, when changes are made to the prescribed medication, the change should be dated and signed and an explanation recorded on the back of the MAR chart. Medication is stored appropriately and a returns book is kept to record all medication returned to the pharmacy. Park House DS0000021183.V307661.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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. The home has worked hard to improve the quality of the activities provided and the use of photography is a good way of demonstrating to relatives the work that they do. Communication with relatives of the residents is good and relatives feel comfortable visiting and spending time in the home. EVIDENCE: On the day of inspection there was a poetry reading activity. All but one of the residents were involved. The owner ran the session and the cleaner and both care staff were also on hand throughout the session. Three of the six residents actively took part in the session and it was apparent that the other residents also enjoyed the session. The session was well run as it encouraged residents to reminisce about poetry they had read in the past and there was lots of social interaction. The home keeps an activity book showing the residents involved in the various activities within the home. Two of the relatives spoken with stated that they enjoyed looking through the book. Staff are also working on putting together life books and have asked relatives to bring in photos of people and places that were importance to the residents. The activity co-ordinator advised that other activities in the home include, painting, flower arranging, bingo, ball games Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 12 and craft sessions. When entertainers are used next door at the sister home the residents are always invited to attend. It was noted that care plans refer to how individual religious needs are to be met and in relation to one resident a lay person from a local church visits them on a weekly basis. It was also noted that the subject had been discussed at a care plan meeting to ensure that the home were complying with the wishes of the family. On the first day of inspection it was noted that there were a lot of visitors to the home. Staff advised that Wednesdays and Sundays are the busiest days for visitors. Three sets of relatives were spoken with and each stated that they enjoyed spending time in the home, staff are very friendly and there is always a good atmosphere. One of the residents has a dog. The dog likes to bark at visitors and has been known to be aggressive at times. There were incidents recorded in the incident book of the dog biting staff. A muzzle had been tried but staff advised that this was unsuccessful. It was reported that the resident is very attached to their dog and it is in their best interest to keep the dog. Following further discussion it was decided to try using the muzzle again and it was recommended that staff advise all visitors to the home not to approach the dog. Arrangements have been made for the dog to have regular walks and time in the garden at various intervals throughout the day. There is a four-week menu in place that is varied and well balanced. Staff advised that they have regular deliveries of fresh fruit and vegetables. On the second day of inspection there was a freshly baked cake made by the manager. Relatives spoken with stated that the food is always presented well. Three of the residents require assistance with eating their meals. Park House DS0000021183.V307661.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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. There are good procedures in place so that anyone wishing to make a complaint could do so. The availability of the manager and the good communication systems in the home may assist in ensuring that any minor grumbles never reach a formal complaint stage. EVIDENCE: There is complaint procedure in place should anyone wish to complain. It was reported that there had been no complaints made since the last inspection. The Commission has not received any complaints about the home since the last inspection. Records showed that half of the staff team have received training on the protection of vulnerable adults and that further training has been arranged by the company to be held in March 2007. There have been no adult protection alerts made by the home since the last inspection. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. The home is well maintained and the recent move to using the small lounge as on office thereby creating additional space for residents and relatives in the dining room should enhance the quality of the environment for the residents. As the laundry is accessed via the kitchen area the home needs to ensure that the procedures in place to prevent infection are clear and detailed. EVIDENCE: The manager advised that the roof in the dining room is due to be replaced in the summer months. The annual development plan for the home refers to how the quality of the environment will be maintained. All areas of the home were seen and it was noted that residents rooms have been personalised. A good practice recommendation was made at the time of the last inspection that the arrangements regarding the office and telephone calls be reviewed to ensure effective communication and confidentiality. This was because the Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 15 office was sited within the dining room. This subject was discussed during the inspection and following the inspection, the manager reported that the office has since been moved to the small sun lounge and a settee has been put into the dining room so that there is now additional space for residents to meet with their relatives in private. The manager advised that feedback from relatives so far has been very positive and that having an office has increased confidentiality and provided a private area for staff supervisions and meetings with relatives. A requirement was made at the last inspection that the home consult with the fire brigade to ascertain if the arrangements for limiting access to the first floor accommodation were safe. Since then the home has arranged for a fire risk assessment to be carried out. The risk assessment report had been received by the proprietor a couple of days prior to the inspection. The proprietor advised that she now needs to put in place an action plan in response to the recommendations made. It was not clear if there was reference in the document to the access to the first floor. The proprietor advised that this would be followed up. During a tour of the building it was noted that the fridge and the cooker were not very clean. There was a stale odour in the lounge and dining room on the first day of inspection. This was not present at the time of the second visit. There was a cleaning rota on the wall within the kitchen and staff advised that agreement had been reached to have a cleaner in the home twice a week for a few hours. The cleaner was due to start working in the home the week of the inspection. It was noted that access to the laundry area is via the kitchen. As six of the seven residents suffer from incontinence this is not an ideal practice. The home was advised to contact Environment Health for advice regarding how to manage this appropriately. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. All staff work hard to meet the needs of the residents. However there are times particularly on the night shift when the safety of residents is compromised and this requires urgent review. Staff training opportunities have increased within the past year and this is already improving the quality of the care provided in the home. EVIDENCE: The manager advised that she has six hours management time each week. The rest of her week is working on shift. Care staff advised that in addition to caring duties, they also have responsibility to clean, do laundry and cook. The manager advised that arrangements have been made to have a cleaner twice a week for a few hours. Three of the residents require assistance with feeding and all but one of the residents requires support with continence. One of the relatives spoken with during the inspection advised that they have concerns about staffing arrangements at night. Throughout the day there are two care staff from 8am until 7pm. There is one night carer that comes on duty at 7pm and works until 8am. Staff spoken with stated that as there are only two staff it is not always possible to have breaks. It was reported that the night carer gets all but one resident up in the morning before the day staff come on shift. As residents are dressed they are taken down stairs and therefore there is no one supervising them until the day staff come on duty. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 17 Training opportunities available to staff have increased this year. The majority of the staff team have received recent training on moving and handling, medication, dementia, food hygiene, care planning, infection control and first aid. Arrangements have been made for staff to receive training on fire safety in April. Some of the staff team have received training on the protection of vulnerable adults, continence, epilepsy and pressure care. It was noted that further training dates had been arranged in March to cover most of the areas mentioned above. One staff member stated that they would like training in the management of challenging behaviour including restraint. They stated that they had highlighted this in a recent staff supervision. Of the six care staff employed two care staff have completed NVQ level two, one of these is currently doing level three and the other is due to commence studying in the near future. Another staff member is currently studying for level two and another staff member will commence training during the course of the year. Two staff recruitment files were examined. In relation to one it was noted that both references were from the last place of work but neither was from the employer. There were gaps in the staff member’s employment history that had not been explored. In relation to the second staff file seen it was noted that the carer had not started their induction to the home. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. Quality assurance systems in the home have vastly improved and this is bringing about improvements to the quality of the environment and the quality of care provided in the home. EVIDENCE: The manager has completed NVQ at both level three and four. Staff spoken with during the inspection stated that the manager is ‘very supportive’. Formal supervision is provided regularly and staff appraisals are carried out annually. The provider advised that an assistant general manager has been appointed by the company to provide advice and support to each of the managers within the company. Initially she will spend at least one day a week in each of the homes. She has completed NVQ level four and is currently studying for the RMA (Registered Manager’s Award). Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 19 Relatives of three of the residents were spoken with during the inspection and feedback was very positive. One relative stated that they had looked at approximately twenty homes before deciding on Park House. The home was chosen because it was `small, homely and had a good atmosphere’. Another relative also stated that they looked at several homes too. Everyone described the manager as very approachable’. One relative stated that the staff are great and that they had been very supportive when her relative was ill. As part of the inspection process comment cards were sent to the home prior to the inspection for completion by residents or their relatives on their behalf. Overall, feedback received was very positive. Comments included in relation to staffing ‘bare minimum but hard working and conscientious’, would like a ‘female carer on at night as occasionally there is only one male carer’, ‘I have been lucky to receive good care and attention from all the staff and thank Vivien especially’. Records were seen in relation to accidents and incidents. Within the incident records there were details of some accidents. Almost half of the accidents recorded occurred at nighttime. As part of the home’s quality review system, satisfaction questionnaires were sent to the relatives of the residents. Information from the returned questionnaires was examined and a response was given to relatives. As a result of the questionnaires the settee in the lounge was replaced with two armchairs and the owner advised that she had carried out a review of staffing arrangements and would employ a carer to work between 7pm – 10pm. The owner advised that they had identified an appropriate worker and were awaiting checks before offering the position. Regular audits have been introduced to be carried out on a regular basis. Room checks are done on a daily basis and periodic audits are then carried out to monitor this work. Audits of daily activities and care plans are carried out monthly, quarterly audits are carried out in relation to medication and individual risk assessments and staff personnel files are also audited. Health and safety checks are carried out monthly. There is an annual development plan in place highlighting the specific areas that the company will be seeking to develop during the year. Incidents affecting the wellbeing of the residents are now routinely reported to the Commission. Hot water temperatures tested on the day of inspection were within agreed safety limits. Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 20 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 2 X 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4(1c) Sch 1. Requirement The statement of purpose must be amended to include reference to all areas specified in Schedule one of the Regulations. Timescale for action 30/04/07 2. OP7 13(4a,c) Staff must receive training in 30/04/07 writing risk assessments so that they are explicit including the perceived level of risk and any action taken by the home or staff to minimise the risk of an accident/incident occurring. That the fire brigade are 30/04/07 consulted to ascertain if the current arrangements for limiting access to first floor accommodation are safe. [This was a requirement of the previous inspection timescale 11/2/06]. The home must seek advice from 31/05/07 Environmental Health regarding the action to be taken by them to minimise the risk of cross infection as access to the laundry area is via the kitchen. 3. OP19 23(4)(a) 4. OP26 16(2j) Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 22 5. OP27 18(1a) An urgent review of the staffing arrangements must be carried out to ensure that there are suitable numbers of staff on duty at all times for the wellbeing of the residents. Particular attention must be given to night arrangements. 30/04/07 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. Refer to Standard OP9 Good Practice Recommendations When changes are made to prescribed medication, in addition to updating the care plan, the change should be signed and dated and an explanation of the change given on the rear of the MAR chart. All visitors to the home should be advised not to approach the dog. In relation to staff recruitment, where possible references should be sought from previous employers and any gaps in employment history should be explored. A review should be carried out in relation to accidents/incidents in the home to determine if there are any emerging patterns in relation to time and place. 2. 3. OP14 OP29 4. OP38 Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Park House DS0000021183.V307661.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!