CARE HOMES FOR OLDER PEOPLE
Rosewell Country Home Church Hill High Littleton Bath & N E Somerset BS39 6HF Lead Inspector
Kathy Marshalsea Unannounced Inspection 10:00 23 & 31st May 2006
rd 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 Rosewell Country Home DS0000044632.V295731.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. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Rosewell Country Home Address Church Hill High Littleton Bath & N E Somerset BS39 6HF 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) 01761 472062 01761 479124 European Care (UK) Limited Ms Gillian Galloway Care Home 94 Category(ies) of Old age, not falling within any other category registration, with number (94), Physical disability (6) of places Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 6 Beds may be for young physically disabled persons age 18-50 years. Staffing Notice dated 18/04/2001 applies. Manager must be a RN on parts 1 of 12 of the NMC register. May accommodate up to 60 persons aged 50 years and over requiring nursing care, in the Main House. May allocate up to 34 persons aged 65 years and over requiring Personal Care only, in the Farm House May accommodate up to 40 persons aged 65 years and over requiring personal care only, in the Main House. May accommodate one named individual requiring nursing care in the `Farmhouse` until such time as her nursing needs increase to the point that the `Farmhouse` is unsuitable to meet those needs, or she chooses to move 15th November 2005 Date of last inspection Brief Description of the Service: Rosewell Country Home is an extended farmhouse situated in the village of High Littleton. The accommodation consists of an open style conservatory entrance area, which links the Farmhouse and Main house. The conservatory area provides a focal point for the home, housing the main reception, hairdressing salon, manager’s office, service user seating, a piano and a small bistro. The accommodation in the farmhouse consists of single and double en-suite rooms (WC & hand basin) with 3 stair lifts and is registered for social care (residential) service users. Not all rooms in the Farmhouse have level access from the stair lifts The main house provides accommodation over three floors. There is lift access to all floors and each floor has a separate communal lounge and dining facility. Bedrooms vary in size, most are en-suite (WC & hand basin) and there are assisted bathrooms and shower rooms on each floor. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 5 The home is registered for a maximum occupancy of 94 but the usual operational maximum is lower than this because few of the 12 double-sized rooms are in shared use at any one time. The home offers respite care subject to bed availability. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced so that a residents meeting could take place as part of the inspection. This was because the home has many residents and the inspector wanted to meet as many residents as possible. Survey forms were also sent to the home for residents and relatives to complete and sent to the inspector. While confidentiality was maintained the information in those forms was used to inform the inspection process.24 were returned. The inspection took 2 days and included case tracking residents who have different levels of dependency. Records were read, staff were spoken with plus some relatives. Apart from the residents meeting the inspector had lunch on Bluebell and observed interactions between staff and those residents. The Manager, Clinical Lead nurse and Residential supervisor also helped the inspector gather the information needed. What the service does well:
Over the last 2 inspections there have been sustained improvements in implementing management systems that have had a positive outcome for the residents and staff. The requirements and recommendations from the last inspection have been met or are still being implemented. For example there was not consistent evidence that the residents are included in the drawing up if the care plans, new plans were being written for new short term problems, fire safety tests are being tested in a timely way, there is now a structured format for ensuring staff have their fire safety updates. The programme for the renewal of furniture is being implemented. The training programme staff has undertaken is impressive. To ensure a positive outcome the manager has implemented a reflective summary following each course staff attends. This enables her to assess the effectiveness of each course and gauge if staff needs further training. This is commended. Most care staff are enrolled on NVQ training so underpinning their existing knowledge. Residents should feel confident that staff is up to date and able to meet their varying needs. The comment cards, records seen and the residents meeting verified that the activities provision has improved and is more inclusive. This means that those residents who previously did not or could not join in group sessions are now included in the activities organiser’s time. To supplement that staff (observed on Bluebell) are taking time to occupy the residents in activity which is
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 7 meaningful to them. This includes those residents who can no longer communicate and is commended. The residents meetings and survey forms confirmed that: The home is conducted to maximise residents’ choices and independence. This allows the continuation of them having control over their lives. Residents are mostly offered a wholesome and nutritious diet. They are able to influence what meals are planned and offered. The home is well maintained and shows a commitment to a safe environment. The house is also kept clean to a high standard. Records seen, discussion with staff and observation confirmed that: Staffing accountability has improved with the introduction of a named nurse and keyworker system. This means that each resident has their own special nurses who are responsible for their well-being. Dependency levels are monitored and staffing levels fluctuate to meet changing needs. The recruitment policies and procedures are followed so that residents are protected from unsuitable staff being employed. Staff the home has recruited themselves have satisfactory references. The induction of staff is achieved using a staged approach and using the Skills for Care programme. Staff are also regularly supervised and supported. Health care needs are met by the staff and where necessary external Primary health care professionals. Residents can be assured that staff will monitor their health needs and respond to any changes. Some positive comments relayed to the inspector were: “ I would like to say that I am well cared for by the home and my family. There is always someone to talk to. The carers are very friendly.” “I think the staff do a good job. They are always friendly and work hard.” “I am happy with the home. It’s better than a lot I visited.” “ On the whole good. The care is good and its improved greatly over the last few months.” “ The best care I have ever witnessed”. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 8 “ I have never had cause to complain about anything, in fact I have recommended to others.” What has improved since the last inspection? What they could do better:
The staff need to evidence that they have drawn the care plan up with the residents or their representative. This had been done in some residential plans but not the nursing ones seen. The special needs of those with a low weight needs to be more imaginatively handled so that as many calories and nutrients are delivered in whatever way is best for each resident. The registered nurses employed who are not part of the adaptation programme need to have their clinical competence assessed during their induction. The breakfast bar on Bluebell needs to be finished so that the edge is not rough. There were some negative comments on the survey forms related mainly to cleanliness. These comments were passed on to the Manager. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 9 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. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 10 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 Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The overall quality of this outcome area is good. No resident moves into the home without having their needs assessed so they can be reassured that the home can meet their needs. EVIDENCE: Pre-admission assessments were seen in the files of those residents who were case tracked. These assessments were comprehensive and had been reviewed since admission. These assessments had informed the staff so that the risk assessments and care plans could be developed. Where the placement was funded by social services their care plan and assessments were also present. The registered nurse input assessed by NHS nurses for nursing care was also present. This standard is fully met. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The overall quality of this outcome is good. Care plans for health, personal and social care needs are planned for and realistic actions described to meet individual needs. Health promotion has a high profile so that residents can be assured that the home or specialists will fully meet their needs. Residents and relatives can be sure that they’ll be treated with respect and steps taken to promote their dignity. EVIDENCE: 7. Three care plans were examined in detail. These plans were chosen by the inspector as part of the case tracking process. Detailed actions needed to meet health needs and reduce any risk to health were present. Staff spoken with were aware of the content of the care plans. Social assessments were present with life histories in some instances. Staff were aware of the preferred occupation of their residents and demonstrated this on Bluebell while the inspector was present.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 13 Risk assessments were also seen for numerous identified risks to health and welfare. The actions described to reduce the risks were realistic and achievable and had been reviewed regularly. All three plans had been reviewed monthly. The plans seen did not evidence that the plan was drawn up with the residents themselves. During the feedback session the residential supervisor was able to show the inspector plans which contained the signature of the resident on their plan. This was not so for the nursing plans. This will need to be done to demonstrate that this process includes the resident. 8.Health care needs are met and supported by staff. Appropriate and recognised tools are used to determine any risks such as the development of a pressure sore, falling, weight and nutritional problems, mobility problems and continence issues. This enables the staff to plan to reduce any risks and review that regularly. Suitable equipment was being used for the pressure relief for those residents at risk of developing a pressure sore such as air cushions and special mattresses. Nutritional screening is preformed on admission. This identifies the risk of obesity as well as from low body weight. Regular weighing of the residents also takes place. One resident who was case tracked had a very low body weight and had been identified as needing a high calorie diet. The weekly weight chart showed weight being maintained but not increased. The GP had recommended that the staff do not use supplemtary drinks so the staff were advised by the inspector to find extra ways of increasing this resident’s calorie intake. Body charts are completed to identify and sores or skin tears. These are then assessed and their treatment recorded. The home had a low incidence of residents suffering from a pressure sores at the time of the inspection. Evidence was seen and residents confirmed that they are able to see their GP at their request, and receive visits from a chiropodist, optician and other community services. The home has close links with the local hospice and Psychiatric team. 10.Observation, survey forms and residents confirmed that they are treated with respect and their dignity maintained. One risk assessment was completed to maintain the dignity of one resident which is commended. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The overall quality of this outcome is good. Activities are now flexible and attempt to meet residents’ preferences and expectations. Residents can be sure that they are able to influence who visits them and when. An appealing and nutritious menu is offered and taken in congenial settings. Residents can choose what they eat and influence the menus. Any residents who need additional high calorie diets need to have their meals reviewed to ensure that they are receiving this. EVIDENCE: 12.Since the last inspection a new activities co-ordinator has been appointed. They were a care assistant in the home previously. There is a planned weekly programme which is flexible. They have introduced Happy Hour which includes Karaoke! Comment cards stated how much this is enjoyed as a social event and also at the resident’s meeting.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 15 The co-ordinator also contacted the local gym and persuaded an instructor to come to the home. The first session has taken place and enjoyed by those who participated. Regular sessions are now planned. There is also a pampering afternoon with a beautician. Records show and staff confirm that the activities person spends time with those residents who can’t or do not want to join in the group activities. Imaginative thought is being given to how best to use this time. Information is being sought from the other staff and families. This aspect to the social care provision had not been fulfilled before so this is commended. 13. Residents are able to receive visitors in private with out any restrictions. Relatives and residents spoken with confirmed this. The inspector observed visitors being greeted warmly by the receptionist of the home who was obviously familiar with them. Information about the home such as the Statement of Purpose, Service user guide, Complaints procedure and last inspection report are on display at the reception desk. Out of 23 residents asked 17 had received a contract of terms and conditions, 21/23 stated they had enough information about the home before moving in. 15.The inspector joined the residents on Bluebell for lunch on the second day of the inspection. It was noticed that the tables were attractively laid with attention to detail. The food which was presented looked appealing with positive comments from the residents. Puréed meals were also presented attractively. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 16 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): The overall quality of this outcome is good. Residents and relatives are mostly aware of the home’s complaints procedure enabling them to do so if they wish. The abuse training given to staff has a positive outcome enabling them to better protect residents from abuse. EVIDENCE: 16.The record of complaints was examined. This contained three since the last inspection. One of these was a concern about activities which has been resolved. Mrs Galloway responded in writing to the complainants but did not record their satisfaction or not with the result. Mrs Galloway stated that she asks the staff daily if any residents have raised any issues with them however small so that she is aware of them and can action them. The residential supervisor stated that she sees the residents and relatives a lot and encourages open discussions. She also said that the reviewing of the care plan meeting is a useful time to deal with any issues however small. 18.Mrs Galloway stated that she has not received any allegations of abuse since the last inspection. The staff have recently been updated in this subject. Hygea who are the trainers for the home are aware of the local procedures, enabling them to direct staff.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 17 Staff are supervised while working and also on a one to one basis. The home uses bed rails following an assessment for its appropriateness. Consent is then obtained from the resident themselves or their relative. The only other form of restraint used is a wheelchair strap for one resident. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The maintenance response to Heath & Safety matters has improved making the environment safe and well maintained. The areas seen were clean, and free from offensive odours. EVIDENCE: 19. The home is being well maintained and checked upon during the provider’s monthly visits. The home is intending to cover all of the radiators in the home. This will be done in a staged way so that the higher risk radiators are covered first. Other areas of the home were not a focus of this inspection and will be checked at the next inspection. For example the programme of re-furbishment. 26.There were a couple of negative comments for the survey forms about the cleanliness in the rooms with regard to them not being hoovered often enough. This was discussed with the manager. Not all rooms were inspected and will be looked at during the next inspection.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 19 Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The overall quality of this outcome area is good. Staffing numbers and the skill mix are appropriate to meet the assessed needs of the residents. The training programme has a positive outcome for staff who are equipped to perform their job competently. The recruitment process follows the correct procedures to promote the safety of the residents. References obtained for those staff recruited by Head Office do not give sufficient information for the suitability of the post they are applying for. EVIDENCE: 27. Since the last inspection the manager has re-introduced the named nurse and key worker system. This was introduced by the manager meeting with the staff and explaining their role then they were given the policy. There was discussion about which residents they would like to key work. One of their responsibilities is to keep the care plans up to date and record any changes, a senior member of staff reviews this. A senior member of staff is allocated to be on each floor daily. Due to the occupancy levels being reduced an agreement was reached for there to be a reduction in the trained nurse levels on a temporary basis. This will cease once there are 45 nursing residents.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 21 Dependency levels are monitored by the home to ensure that the correct number of staff are on duty. This also includes looking at the skill mix of staff which has resulted in the allocation of a senior member of staff on each floor. The manager stated that staffing levels have increased when necessary. The home has re-established its adaptation programme for overseas nurses who are registered nurses in their country of origin. The manager has completed a mentorship course and the programme is supervised by Manchester University. 28.The NVQ programme is running well with 14 staff enrolled and 10 already having achieved their certificate in Level 2.Staff spoken with appreciated this opportunity. 29.The recruitment records were checked for three members of staff. 2 were from overseas and one from the UK. The references for those recruited from abroad were vague and addressed “ to whom it may concern”. Otherwise the records necessary were in place and of an acceptable standard. POVA First checks are obtained as well the CRB checks are done. The induction process is a gradual process ensuring competency. The induction used does not include a clinical assessment, which would be useful. 30. The training programme staff have undertaken is impressive. To ensure a positive outcome the manager has implemented a reflective summary following each course staff attend. This enables her to assess the effectiveness of each course and gauge if staff need further training. Most care staff are enrolled on NVQ training so underpinning their existing knowledge. Residents should feel confident that staff are up to date and able to meet their varying needs. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The overall quality of this outcome area is very good. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose and aims and objectives. Residents are consulted about the running of the home and it’s run in their best interests. The Health, Safety and welfare of the residents and staff are promoted and protected. EVIDENCE: 31. Mrs Galloway is the registered manager of the home. The residential manager and clinical nurse leader support her in the home. Externally her line manager and the organisation support her.
Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 23 She has sustained the improvements noted at the last inspection and made further improvements. 33. The inspector attended a residents meeting, which Mrs Galloway chaired. 18 residents attended with 2 relatives. Each resident was asked in turn about any problems they had and if anything could be done to improve their life in the home. Issues raised at the previous meeting were reviewed so that anyone could contribute. Various issues were brought up which included on e resident thanking the staff for the efforts the staff made to make it a happy festive time at Christmas. One relative also complimented the home for their efforts to make it as happy a place as was possible. It was evident that residents are consulted regularly through these meetings. Quality assurance surveys were used for this inspection. Otherwise the home is using a self-audit which the manager is completing gradually. The Maintenance person is also completing a Heath & safety audit. 38.The Fire Log was checked. This showed consistent and timely recording of fire safety tests including drills. A matrix is kept identifying the night and day staff to distinguish the different timescales needed to update them. Faulty equipment is reported for prompt attention. The annual servicing of equipment also takes place. Other Heath & Safety tests are completed such as hot water outlets and wheelchairs are checked 3 monthly. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 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 4 X 3 X X 3 3 3 Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP38 OP15 OP36 OP7 Good Practice Recommendations Evidence that the care plans are written and reviewed with the resident and/or their representative. To make safe the edge of the breakfast bar on Bluebell. To liaise with the cook and ensure that those residents who require a high calorie intake receive them. For new registered nurses to have their clinical competence assessed during their induction period. Life histories should be completed for each resident. Rosewell Country Home DS0000044632.V295731.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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