Inspection on 24/09/08 for Silver Howe

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Adequate service.

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

Silver Howe 05/12/07

Silver Howe 10/01/07

Silver Howe 21/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Silver Howe Dalton Drive Sedbergh Road Kendal Cumbria LA9 6AQ Lead Inspector Jenny Donnelly Unannounced Inspection 24th September 2008 09:30 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 Silver Howe DS0000066837.V368165.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. Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silver Howe Address Dalton Drive Sedbergh Road Kendal Cumbria LA9 6AQ 01539 723955 01539 723955 silverhowe@hometrustcare.co.uk 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) Hometrust Care Limited vacant Care Home 30 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (30) of places Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 30. Date of last inspection 5th December 2007 Brief Description of the Service: Silver Howe is a large detached Victorian building, set in its own grounds in a quiet residential area, on the outskirts of Kendal, Cumbria. Public transport is within walking distance and the town centre is approximately a mile away. Silver Howe is registered to provide residential care to thirty older people, including people with dementia. The home is on three floors, which are accessed by a passenger lift or one of the two staircases. The top floor is only used by staff. There are four lounge areas on the ground floor, and one on the first floor with two dining areas, one for each floor. There is a separate dementia care unit. There is parking to the front of the building with wheelchair access to the side door. The grounds and gardens are attractively landscaped and well kept. To the rear of the home there is ramped access to the garden and patio areas. The home provides information to residents and prospective residents in an informative brochure, inspection reports and service user guide, which are regularly updated. The current weekly fees range from £386 to £552 according to the room and length of stay. There are additional charges for personal sundry expenses such as hairdressing. Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the key inspection of the service for this year. Jenny Donnelly inspector, and Penny Wilkinson regulation manager, made an unannounced visit to the service on 24th September 2008. During the visit we (the commission) toured the building, spoke with residents, staff and management. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed lunch and the day’s activities. Prior to this inspection the manager had completed and returned an Annual Quality Assessment Audit (AQAA) that we had requested. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys out to some of the people who live in the home, and to staff. The findings of the surveys are included in this report. We carried out a short random inspection in April 2008 to gather information from the home in relation to a safeguarding investigation being conducted by the adult social care team. Copies of this report can be obtained on request from the commission. What the service does well: Silver Howe provides good written information for people about the services they offer. The notice boards in the home are informative and give a good picture, through photographs and other information, about what daily life in the home is like. People living at Silver Howe told us they felt well looked after, and said that staff ‘looked out for them’. The staff team were described as ‘friendly’ and ‘kind and caring’. The atmosphere was warm and welcoming. There were sound arrangements in place to meet people’s healthcare needs, with good access to local doctors, community nurses, opticians and dentistry. The home was well maintained and decorated and furnished to a good standard. People were very happy with their own private accommodation. The provision of meals was complimented, with people appreciating the choice and quality of food served. People said they were consulted on menus and other aspects of the service and felt management listened to them. Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Following this inspection there are four statutory requirements and four good practice recommendations made of the service. The service is required to ensure everyone has an up to date individual plan of care in place to guide staff in supporting people appropriately. Staff need to ensure they are administering medicines correctly and as prescribed, to ensure people receive the right treatment. People who manage their own medicines must be provided with secure storage and have documented risk assessments in place to demonstrate they understand their medicines. The new manager must apply to be registered with the commission. The good practice recommendations are that pre-admission assessments be more thorough and lead to a plan of care being drawn up. There should be better information for staff about medicines for ‘as required’ use, so they know when these should be given and why. The provision of hot water in some Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 7 areas of the building should be improved. The deployment of staff around different areas of the home should be kept under review. 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. Silver Howe DS0000066837.V368165.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 Silver Howe DS0000066837.V368165.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): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care home provides good information for people, but admission assessments and initial care plans need to be strengthened to help staff support new people and meet their care needs. EVIDENCE: Silver Howe has produced an updated Statement of Purpose and Service user Guide, which was a good source of information for people interested in the care home. This information was on display in the home and copies could be obtained from the manager. The notice boards gave visitors a good feel about what went on in the home. In response to our survey, some people said their admission to the home had been well planned, whilst others said it had happened as an emergency. We looked at the admission of arrangements of a person quite new to the care home. The manager had visited this person in hospital and completed a basic needs assessment. The information supplied by the hospital did not add any Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 10 further detail to this. Where there is no social worker assessment, as in this case, it falls on the care home to undertake a more thorough assessment, and a recommendation is made about this. We found there was no care plan in place for this person, although they had been in residence for over a week. An initial care plan based on the needs assessment should be in place for all new people, to guide staff in how to support the person. Silver Howe DS0000066837.V368165.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were well cared for at Silver Howe but care planning and medicines management do need further improvement to ensure people receive really good quality care. EVIDENCE: The manager had devised a new person centred care plan, which looked promising and we look forward to seeing this in full use. We looked at four of the old style care plans and risk assessments, which staff were using, and found them rather muddled and lacking in detail. We hope the new system will be an opportunity to review everyone’s care needs and produce a plan that is individual to each person. There is an outstanding requirement about care plans, and we have agreed additional time for the new manager to achieve this. The people we spoke with during the inspection, and those we surveyed told us they were happy with the way they were looked after; • “I’m very grateful for all the support I get” • “We are all very well looked after here.” Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 12 We saw that people interacted well with the staff group and there was a relaxed and friendly atmosphere throughout the home. One person was concerned that access to bathing was restricted to once a week and we did see bath lists to this effect. The manager was aware of two people who were bathed more frequently at their request, and it is hoped the new care planning system will be an opportunity to review and record people’s choice in this. Healthcare records showed that people had good access to normal healthcare services such as their doctor, district nurse, dentist and optician. Since the last inspection, the home has started to use its separate unit to care for people with dementia. This has had a calming effect and improved the quality of life for everyone in the home. Medicines managed by staff were safely stored and administration records were generally well maintained. But, we noted that a wrong dose of blood thinning medication had been given to one person. Staff need to take more care when administering medicines prescribed in alternating or variable doses. The manager had set up a separate information file for staff, that listed peoples ‘as required’ medication. We had some concerns about this being kept separately from the medicine administration charts and found in some cases the two records did not match. This system should be reconsidered. A few people in the home were managing their own medicines, which is good in maintaining their independence. However there were no individual risk assessments to demonstrate people’s ability to manage their medicine safely and not everyone had secure storage in their bedroom. Whilst we do not wish to discourage people from managing their own medicines, it needs be done within a risk assessment framework to ensure the safety of everyone in the home. Silver Howe DS0000066837.V368165.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offered people choices and consulted regularly about the kind of lifestyle people wanted. The quality and choice of meals were praised, and people’s special dietary needs were met. EVIDENCE: We arrived at the care home at 09.30 am and found that a number of people were up and having breakfast. Other people were still in bed or being assisted by staff, and the atmosphere was relaxed. Since the last inspection the home had employed a dedicated activity organiser, but this person had since left and the manager was trying to put some activities back in place. There was a knitting circle, a scrabble group and an ongoing communal jigsaw. There had also been visiting musicians and there were plans for a Halloween party. There were examples of people’s artwork on display throughout the home along with photographs of various events. The minutes of residents meetings showed that suggestions for activities and outings had been discussed, along with menus. The home had a number of local visitors and there were regular multi faith services arranged. We received some mixed comments on activities with people saying; Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 14 “I like knitting squares for a blanket” “The piano concert was very enjoyable” “There’s never any activities” We found that whilst there had been a reduction in the provision of activities, this was now being rectified through proper consultation with people. • • • People spoke highly of the meals served, although one person thought there was little variety of sandwich fillings. The printed menus showed there were two choices of main course and desserts at lunchtime, and high tea consisted of a hot dish, soup, sandwiches and a sweet. We saw lunch being served in the three dining areas, and saw people received the correct choice of shepherds pie or vegetable frittata. Staff were available serving drinks and offering discreet assistance where needed. We spoke with the chef who was knowledgeable about individuals’ special dietary needs and was able to explain the kitchen processes. Food was temperature checked and the chef plated each meal individually and handed it directly to staff for serving, so no hot food was kept waiting. Soups and cakes were homemade and there were always three choices of sandwich filling. Silver Howe DS0000066837.V368165.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. With the new management in place, concerns and complaints were being well managed and people were being listened to. EVIDENCE: The service has a complaints procedure, which is given to people as part of the service user guide pack, and there was a copy on display in the home. From our surveys a number of people responded that they did not know how to complain, although other people said they did. One person told us their complaint had not been properly addressed. We could not follow this case up as this survey had been completed anonymously. We thought it likely that during the homes period of unstable management earlier in the year, complaints may have gone unresolved and unrecorded. The complaint records we saw showed two complaints had been made and had been responded to appropriately. We felt the current manager was aware of the importance of addressing peoples concerns in a professional way, and the process for doing this was robust. The Hometrust Care Ltd operations manager visited the home monthly and checked and reported on the progress of any complaints received. There were monthly residents meetings where people could raise any issues, and the manager was available for private discussions. Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 16 Silver Howe was subject to a safeguarding investigation in April, and we undertook a random inspection of the home at that time, to gather information pertaining to this. The investigation was led by Cumbria adult social care and Hometrust Care Ltd co-operated well with the investigation. Seven staff have received training in safeguarding and the new manager is booked onto a training course in November. Staff we spoke with were aware of their responsibilities to protect people from harm, and understood how to report any concerns or allegations. People we spoke with said they felt safe and protected at Silver Howe, and thought staff ‘looked out for’ them. Silver Howe DS0000066837.V368165.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, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, comfortable and safe environment for people to live in. EVIDENCE: Silver Howe is a large detached Victorian building, set in it’s own grounds in a quiet residential are, on the outskirts of Kendal. It is accessed by a private road and there are public transport links near by. The home has three floors, two of which are used for resident accommodation. These are accessed by a passenger lift and two staircases. There is plenty of communal space offering a choice of lounges and dining rooms. There is a secure dementia care unit based on the ground floor, with access into a secure garden. There are further gardens and courtyard areas for other people. Bedrooms are all single and eleven of them have an ensuite toilet, of which three also have a shower. Some rooms have an ordinary bathtub. There are Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 18 two assisted baths in the home, but no showers except in some ensuite bedrooms. There are plans to provide a wet room in the future and to provide additional ensuite facilities. There are spacious toilets around the home and a hairdressing salon on the first floor. Bedrooms varied in size and shape, all were nicely decorated and most had been made very homely and personal to the occupant. The building was clean, tidy and fresh throughout, and people said this was normal. There is a small laundry that is operated by care staff and a professional kitchen. There were hand-washing facilities throughout the home for staff and management of infection control was good. We received one comment that there was no hot water in a person’s bedroom. We did find the provision of hot water variable around the building, with some bedrooms checked, only having barely warm water. The manager said she hoped this would be resolved with the future planned work to provide additional ensuite facilities and a shower room. Silver Howe DS0000066837.V368165.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were benefiting from having a more positive staff team, who were receiving training relevant to their roles. Staff deployment may need further monitoring. EVIDENCE: There have been some staff changes over the last year, and three new care staff had been taken on in recent months, to provide a full staff compliment. There has been very little use of agency or temporary staff. Staff spoken to said numbers were generally sufficient, but in the mornings they had little space to do any other than basic care tasks. There is just one member of staff based in the dementia unit, which is generally sufficient, but there are occasions where someone needs individual support with wandering or challenging behaviour, and others also need help such as at mealtimes. Staff deployment in this area should be kept under review according to peoples needs. We saw that staff interacted well with people and there was a friendly relaxed atmosphere in the home. Staff morale and teamwork had improved under the guidance of the new manager and this had created a much more positive atmosphere in the home. People made the following comments about staffing; • “We are very happy with the staff” • “There’s a big improvement since new manager came” Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 20 • “You never see them”. The service supports staff to gain National Vocational Qualification (NVQ) in care and 61 of care staff have achieved this, which is very good. New staff now have three days induction, plus a couple of shifts shadowing more experienced staff, and those we spoke with, said this had been really useful. Eleven staff had attended a one-day dementia care course, and other staff were due to attend this shortly. Seven staff were continuing to complete a more in depth dementia course through Stirling University using workbooks and projects. We saw evidence of recent training in moving and handling, equality and diversity, infection control and safe handling of chemical products. Further training was planned on providing person centred care and using the new care planning system. Staff meetings were being held every month, and minutes of these were maintained. We looked at the files of the three newly recruited staff. These contained all the necessary pre- employment checks to show people were suitable to work with vulnerable adults. There was also evidence that new staff had received induction training for their role. Silver Howe DS0000066837.V368165.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, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is now being competently managed both within the home and externally, and people who use the service are being listened to. EVIDENCE: The home has experienced some instability in management during the last year, with changes to the home manager and the operations manager. A new manager, Kathleen Mann, was appointed in June 2008 and she is supported by a new operations manager, who visits the home at least monthly. The manager and staff also received regular visits from Mrs Joyce the director of Hometrust Care Ltd. The new manager has not yet applied for registration with the commission, and must do so. Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 22 Regular meetings had taken place for staff and residents, and these were recorded and showed that comments made by people using the service were fed back to staff for action. The new manager conducted satisfaction surveys of residents and relatives when she came into post in June, and she used the responses to guide her future plans for the service. The results were mostly positive with some concerns about the level of activity on offer, which has been addressed. Quality audits of care plan records was started, but abandoned as a new system is to be introduced. The service did not handle or store anyone’s personal monies. Staff were receiving regular and structured supervision from the manager. Policies and procedures were in place to guide staff, and these had been reviewed, and staff were asked to read so many each month to be familiar with them. The fire risk assessment was updated in August 2008 and the fire log showed regular checks took place on fire alarms and equipment. Accident records were maintained, and the more recent ones seen, tallied with other records relating to the people concerned. The manager has kept us informed of any accidents or untoward events affecting people’s wellbeing, and we received copies of the operation managers’ monthly monitoring visits. The Annual Quality Assurance Assessment (AQAA) was completed and returned to us promptly when we requested it. Silver Howe DS0000066837.V368165.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 3 X 2 X X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 3 3 Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement Care plans must be kept up to date and describe in detail what actions are needed by staff to meet the persons’ care needs. (Previous timescale of 01/07/08 not met). Staff must ensure that medicines are administered correctly and as prescribed, to ensure people received the correct treatment. People who manage their own medicines must have a written risk assessment completed, and must be provided with secure medicines storage to safeguard themselves and other people in the home. The service must have a manager who is registered with the commission. Timescale for action 01/01/09 2. OP9 13 01/11/08 3. OP9 13 01/11/08 4. OP31 8 01/02/09 Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 25 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 OP3 Good Practice Recommendations Care plans should be written based on a comprehensive pre-admission and dependency assessment to ensure a consistent and responsive service is provided. The information held about ‘when required’ medications should be correct, with clear instructions for staff about why and when these medicines should be given. The provision of hot water around the building should be reviewed to ensure everyone has an adequate supply in his or her bedroom. The deployment of staff within the home should be monitored to ensure there are sufficient staff in the right place, to meet peoples needs. 2. OP9 3. OP25 4. OP27 Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Silver Howe DS0000066837.V368165.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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