Inspection on 29/11/07 for Radiant Care Home

This inspection was carried out on 29th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Radiant Care Home 27/03/09

Radiant Care Home 09/08/06

Radiant Care Home 22/02/06

Radiant Care Home 20/07/05

Radiant Care Home 30/06/04

Radiant Care Home 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Radiant Care Home Highbury Road Bulwell Nottingham NG6 9DD Lead Inspector Mary O’Loughlin Unannounced Inspection 29th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Radiant Care Home DS0000045217.V352126.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. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Radiant Care Home Address Highbury Road Bulwell Nottingham NG6 9DD 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) 0115 975 3999 lota.hopewell@radianthome.co.uk Mrs Lota Hopewell Mr Derrol Paul Hopewell Mrs Lota Hopewell Care Home 18 Category(ies) of Dementia (18) registration, with number of places Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Radiant Home cares for up to eighteen older people, a maximum of ten beds are registered to accommodate people with dementia. The home is in a residential area close to local amenities and Bulwell town centre. The home is on two floors and there is a passenger lift. There are fourteen single bedrooms, one of which has an en-suite facility, and two double bedrooms. There are three day rooms. The fee currently charged at the home is £323.36 to £385.00 per week, additional expenses such, as podiatry services, hairdressing and newspapers are not included in the fees charged at the home. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One inspector conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager/ registered provider, members of staff and visitors to the home were spoken with as part of this visit. Documents were read as part of this visit and medication management was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken which included a sample of resident’s bedrooms, to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. A range of additional information was used to determine the outcome of this visit, including information provided by the registered provider within an Annual Quality Assurance Assessment (AQAA). As part of the inspection process, the registration certificate was reviewed with manager. What the service does well: The home provides 18 places for people with Dementia within a family like environment. There are three separate day areas that are small and well furnished reflecting domestic type living rooms. There is signage to all areas that is very helpful for those with Dementia. Residents said they liked the staff and found the food to be appealing and wholesome. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 6 Relatives said that the staff are caring, the manager is always available and promptly refers any health problems to appropriate health professionals and keeps them well informed of any changes in the residents condition. A relative said that when visiting she has observed all the staff go to each resident at the end of their shift to say goodbye to them. What has improved since the last inspection? What they could do better: The manager must ensure that residents are wherever possible involved in drawing up their care plans to enable them to have choice and control over their lives. The care plans should be holistic and contain sufficient information on all aspects of the person’s health personal and social care needs and describe how staff are to meet those needs. Residents should be weighed and the information used as part of the assessment of nutrition, which should be reviewed monthly along with other risk assessments. Medicines should be recorded into the home to provide an appropriate audit trail to ensure there is no misuse. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 7 When prescriptions are hand written by care staff they should be signed and witnessed to reduce the risk of error. Dietary supplements should be recorded in the care plan regarding the frequency and type along with a separate record of administration. The care plans should also include the preferences and capacities of residents regarding recreational and leisure activities. The complaints record book should be appropriately completed and the home’s complaint procedure could be followed. Auditing of care practices and improved quality assurance systems should make sure the home is run in the best interests of the residents and that they are safeguarded by staff who adhere to the homes policies. There are deficiencies in the homes record keeping which should be addressed to ensure that they are up to date, accurate and clearly written. 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. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3-6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. More could be done to ensure that all information obtained about prospective residents is used to inform a plan of care that meets their holistic needs. Intermediate care services are not provided at this home. EVIDENCE: The manager said she consults the assessment information to see if they can meet the prospective individual’s needs before they make the decision to accept the application for admission and offer a placement. Care plans showed that prospective people who use services have a needs assessment carried out before they are admitted to the home. The service has Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 10 received copies of the summary, and care plans, from those assessments carried out through care management arrangements for the residents. Pre admission assessments are generally undertaken satisfactorily, there was one instance that hand written notes were taken and not transferred to an appropriate record within the care plans. I telephoned a relative of service user case tracked who confirmed that the manager had taken the time to go out to see the prospective resident on the same day that she made the enquiry, as it was urgent to arrange admission. All three residents case tracked had cognitive impairment and were not able to confirm if they had received an assessment. I evidenced that not all information within external pre-admission assessment documents had been used to inform the care plans, a resident had been admitted and the hospital assessment stated there was a high risk of falls, however there was no care plan in place to address this. The manager demonstrated that she was fully conversant with the needs of the residents case tracked but had failed to fully document all of the information. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ personal and healthcare needs are not always fully identified in the care plan and residents could be placed at risk by unsafe practices in the receipt and recording of medicines. EVIDENCE: Each individual resident has a care plan but practice of involving the resident and or their advocate in the development and review of the plan is variable. Three care plans examined show no record of involvement by relatives/resident or advocates. The inspector spoke to two relatives who confirmed that they had been fully involved in care planning and that any changes in their relatives condition was communicated to them immediately. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 12 The care plans included basic information necessary to deliver the resident’s care but would benefit from further development to ensure that the care residents receive is person centred. The plan is not written in plain language, is not easy to understand and looks at only minimal problem areas of the individual’s life. There was no evidence that risk assessments were evaluated each month or as conditions changed. The plans were reviewed monthly but it was not clear what information was included in the review to ensure that any changes had been used to inform the original care plan. One resident had been admitted with Nutritional problems, the care plan did not identify the correct dietary supplements that had been prescribed and there was no record that the person had been weighed during their stay. Staff confirmed to the inspector that the resident was receiving dietary supplements and records of the residents diet were being recorded which showed that the resident was receiving it, however the records were poorly written and did not clearly indicate the amount or frequency of the supplements. One relative confirmed that she was very happy with the care provided, she told me that as her relatives health needs changed the manager acted quickly and responded to her changing needs by involving appropriate specialists. There was equipment in use for all residents identified as at risk of pressure sores, the service has no residents presently with pressure sores. Records of continence equipment from the primary care team show that the case tracked residents were known to the appropriate Nurse specialist, however the care plans contained no reference to continence assessments or equipment in use. Through observation and discussion with the residents it was clear that they felt relaxed and happy at the home. All seven residents spoken with were in good spirits, well nourished and appropriately dressed. All residents able to give an account of their life at the home confirmed that they felt well cared for and well fed. No resident had any concerns, all were complimentary about staff and the help they received. The arrangements for recording medicines into the home are not safe. Medicine record sheets show that not all medicines are recorded into the home, which does not provide an audit trail. The medicine record sheets were in some cases hand written without the signature of the person or a witness of appropriate checking. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. More could be done to ensure each resident has a social care plan that informs the planning of social and recreational activities in the home. The present system for catering needs to improve with the employment of dedicated catering staff. EVIDENCE: The staff were playing music and were dancing with residents during part of the day. One relative spoken with said the staff recognised her aunt’s individuality and respected her choice of being alone and not participating in activities. Seven residents said they were very happy and were clearly occupied with daily activities. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 14 The community nurse said that she had witnessed the staff at the home regularly taking residents on outings in the mini bus. The notice board had evidence of regular homely activities, birthday parties and events. Care records did not clearly record social interests or religious interests. One resident had some information on previous interests recorded and advised that these should be supported, however there was no evidence to suggest these had been supported. The manager said that local churches provide communion in house. Staff were seen to engage with residents during the day, encouraging them to participate in activities. The residents were asked about meals, each person said they were very happy with the meals provided. There is no dedicated catering staff, care staff are allocated to kitchen work, this was seen on the duty rota. The person working in the kitchen confirmed she had completed food hygiene training. Staff files examined had evidence of food hygiene certificates. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The recording of complaints must improve to ensure that it is robust and effective. Residents are protected from abuse through robust procedures. EVIDENCE: The service has a complaints procedure that meets the National Minimum Standards and Regulations. The procedure is up to date and is displayed in each person’s bedroom in the home but is not available in any alternative formats. Complaints from individuals are not always fully recorded. When they are logged, the records are incomplete with timescales, outcomes and actions not being properly logged. Policies and procedures for safeguarding people who use the service are in place. The most recent safeguarding referral, the manager had reported via Regulation 37 to Commission for Social Care Inspection, the Commission had alerted Social services who’s staff had attended the home. The manager conducted the investigation into alleged restraint of several residents in the Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 16 dining room. The manager was able to show me the evidence of the investigation. I contacted the Adult Protection Unit but they had not received an alert, arrangements were made to ensure the manager completed the alert retrospectively. The manager had conducted a full and comprehensive investigation of the issues raised, taking appropriate action where necessary. The relative of a service user said that the manager was always available on site and her concerns were always addressed immediately. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, pleasant and hygienic, providing a safe homely environment for the residents. EVIDENCE: The home was clean and well maintained; it provides a suitably safe environment that ensures residents are protected against infection. The individual bedrooms of the residents were well maintained and had appropriate furnishings to ensure residents live in a homely environment. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 18 The manager is aware of the new guidance on infection control from the Department of Health and said she had received a copy, which will inform staff at the home of their responsibilities in the control of infection. Hot water is only regulated in bathrooms. Each bedroom wash hand basin exceeds safe temperatures, the manager agreed to commence fitting one thermostatic regulator to hand basins on a monthly basis as part of the business plan for 2008. The manager said that she had obtained a grant from the council to modernise the upstairs bathroom and plans are in place to fit a suitable assisted bath, which will provide an improved system for the residents, accommodated on that floor. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-28-29-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient staff who receive appropriate training to support and protect the residents. The employment of a full time cook would also benefit the home. EVIDENCE: Staff rotas were seen and show that there are extra staff on duty at peak times, night staff are on duty till 8 and the day staff on at 7 which allows 6 plus people to help residents get up. The rota demonstrates which member of care staff is responsible for catering each day. There is a full time domestic, handyman and administrator in place. The manager lives on site and resident’s relatives confirmed that she is always there. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 20 The manager sent the Commission the evidence of staff training that was requested at the last inspection and satisfied the requirement set. Staff files examined show appropriate recruitment procedures are in place, which safeguard residents from people who may be unsuitable to work with vulnerable adults. The records of a newly employed member of staff had evidence of them attending an induction programme at Nottingham City Council. The records of a second staff member had evidence of training in all relevant areas with certification. Staff spoken with felt there were no staffing problems. Relatives spoken with said there were always enough staff on duty. Residents said they were well cared for. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-35-37-35-38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Record keeping required by regulation for the protection of service users must improve to ensure that they are clear, accurate and easily understood. The manager must improve and develop systems that monitor practice and compliance with the plans, policies and procedures of the home to ensure the health and wellbeing of the residents is maintained. EVIDENCE: Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 22 The manager is registered with the Commission; she is aware of and works to the basic processes set out in the NMS. As mentioned in Standards 3-7-8-9-16 Records such as care plans, weight records, names and addresses of specialists involved in the residents care and complaint records were not kept up to date. Staff completed records of dietary intake were not legible and did not provide a suitable format for audit purposes. Records of staff/relatives meetings were poorly recorded and were grammatically incorrect. Although there was evidence of meetings being held to seek the views of those that use the service it could be identified what action had been taken with regard to issues raised. There was no clear system in place to audit the care practices which included medicine management, the manager was shocked to find that staff were not recording medicines into the home and that hand written prescriptions were not signed or witnessed. The manager had displayed a notice to all staff to ensure that in the case of emergency she was to be contacted before emergency services, she explained that staff tended to overreact and send residents to hospital that need not have gone, she also stated that she is always on site. This could result in serious harm to the resident if emergency intervention is delayed; she agreed to remove the sign at the inspection and ensure staff followed appropriate emergency procedures. Records were looked at for Fire alarm tests that were up to date; Fire risk assessments were not seen at this inspection. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 1 3 Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 15 Requirement Make sure that information contained in external professional’s pre-admission assessments about the individuals needs are transferred into the home’s care plan To promote the health and wellbeing of the residents; Make sure that the resident or their representative signs the care plans wherever possible. If the person using the service is considered to lack capacity as defined in the Mental Capacity Act’s Code of Practice (section 3.9 – 3.23) then the care plan should record how this decision has been reached. 3. OP8 15 To promote the health and wellbeing of the residents; Each service user’s plan must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 25 Timescale for action 31/01/08 2 OP7 15 31/01/08 31/01/08 4 OP9 13 To promote the health and wellbeing of the residents; Records must be kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. A record must be maintained of current medication for each service user (including those selfadministering). This includes Diet supplements. 31/12/07 5. OP12 14 To promote the health and wellbeing of the residents; Service users’ social and recreational interests must be recorded. and they must be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities, particular consideration should be given to people with dementia and other cognitive impairments. To promote the health and wellbeing of the residents; Ensure that the complaints procedure for considering complaints, both written and verbal, made to any member of staff at the home by a service user or person acting on the service user’s behalf is documented effectively within the complaint record book. 31/01/08 6. OP16 22 31/12/07 7. OP33 24 To promote the health and wellbeing of the residents; Effective quality assurance and quality monitoring systems, 28/02/08 Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 26 based on seeking the views of service users, must be in place to measure success in meeting the aims, objectives and statement of purpose of the home. 8. OP37 17 To promote the health and wellbeing of the residents; Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 31/01/08 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 OP8 Refer to Standard Good Practice Recommendations It is recommended that you should have suitable facilities to weigh residents, and the residents weight should be recorded in their care file each month. It is recommended that for people with dementia, it is important to establish their previous routine when living at home. When writing the care plan, relatives, advocates and other interested parties should also be consulted to agree an appropriate rising time. If residents with dementia are regularly awake throughout the night providers should consult health professionals for advice. It is recommended that you should ensure that the new protocols for safeguarding adults is implemented and understood by all staff. It is recommended that you should continue to try to recruit a full time cook. 2 OP14 3 OP18 4 OP27 Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 27 Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Radiant Care Home DS0000045217.V352126.R01.S.doc Version 5.2 Page 29 - 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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