Inspection on 06/08/08 for Silversea Lodge Care Home

This inspection was carried out on 6th August 2008.

CSCI found this care home to be providing an Poor 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

Silversea Lodge Care Home 16/03/09

Silversea Lodge Care Home 26/02/08

Silversea Lodge Care Home 24/08/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Silversea Lodge Care Home 46 Silversea Drive Westcliff On Sea Essex SS0 9XE Lead Inspector Ann Davey Unannounced Inspection 09:00 6 & 7 August 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Silversea Lodge Care Home DS0000068495.V365138.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. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silversea Lodge Care Home Address 46 Silversea Drive Westcliff On Sea Essex SS0 9XE 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) 01702 480502 01702 710482 Mr Pritesh Patel Mrs Shaila Rashid Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th February 2008 Brief Description of the Service: Silversea Lodge provides care and accommodation for fifteen elderly people. The premises and facilities are provided on ground and first floor levels and have been suitably upgraded and adapted for the accommodation of elderly people. There is one main lounge and a separate dining room. There is single bedroom accommodation throughout, some of which have en-suite facilities. A passenger lift is provided for residents to gain access to the first floor. There is a medium size garden to the rear of the premises and limited parking available to the front. Silversea Lodge is located in a residential area of Westcliff on Sea. It is in close proximity to local shops, bus routes and other local community amenities including Chalkwell Park. There is a Statement of Purpose and Service User’s Guide available. A copy of the last inspection report was also available. The weekly charges range from £388.01 - £465.00. The exact fee depends on the type of accommodation requested/available, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a key unannounced site visit that took place over a two-day period. The first day started at 9am and finished at 4.30pm, the second day started at 9am and finished at 2pm. The last key inspection took place on 26th February 2008. On the first day, we were assisted throughout the inspection by the registered provider and a senior member of staff (referred to as ‘senior’ for the purposes of this report). On the second day, we were assisted by the acting deputy manager (referred to as the deputy manager for the purposes of this report). The home had completed and returned their Annual Quality Assurance Assessment (AQAA) to us prior to the last inspection. We have requested a new AQAA as the last document was completed over a year ago and does not contain current information. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months and as their future plans for improving the service. Information and detail from the new AQAA will be referred to in the next inspection report. Shortly after the last inspection (February 26th 2008) we received some completed surveys from staff and relatives. There were none from residents. The information from the surveys reflected their views held at that time and supported our findings of that inspection. Staff, residents and visitors may not necessarily hold those same views now. We have therefore sent new surveys to the home asking that they be distributed for completion and sent back to us. We will then view their contents. This was discussed and agreed with the registered provider. Over the period of the two days, we spoke with the majority of staff and residents and to four visitors. We did ask to speak to a visiting community nurse on the second day, but their commitments prevented this happening. A survey for completion will be sent instead. Both days in the home were pleasant and all staff were co-operative and helpful. A tour of most areas of the home took place. Throughout the inspection, care practices were observed and a random selection of records viewed. A notice was displayed advising any visitors to the home that an inspection is taking place. Two visitors told us that it had been seen. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 6 The registered manager (as detailed under Service Information), left the home after the last inspection. The details as they appear in that section of this report are inaccurate and will be amended in the next inspection report. Following the last inspection we asked the provider for an Improvement Plan. This gave the provider an opportunity to tell us when the identified failings from the inspection would be addressed. We have no record of receiving that document so the provider gave us another copy during the inspection. Our findings at this inspection did not always support the information supplied by the provider in the Improvement Plan. For example, the provider reported that a letter would be in place (as from 18th June 2008) and be sent to prospective residents confirming that their needs could be met. This was not evident. The provider reported that a resident centred care plans would be in place by 20th June 2008. This was not evident. The provider reported that every resident would have updated risk assessments in place by 31st may 2008. This was not evident. The provider reported that medication practices, storage, recording practices and training would be in line with required practice by 20th June 2008. This was not evident. The provider reported that residents meeting would take. There were no records to demonstrate the outcome of these meetings. The Improvement Plan also stated that staff would receive training from the deputy manager and a senior about safeguarding adults from harm by 31st May 2008. At this inspection, neither the senior nor the deputy manager were competent in describing the correct procedure to manage such an incident. The provider reported that an annual maintenance plan would be in place on 31st May 2008. This was not evident. Within the document, the provider reported that in the absence of a manager, they would take the responsibility of management until a new manager had been appointed. The provider confirmed that they have no experience in the management of care. The provider has failed to address all the shortfalls identified at the previous inspection within their own set timescale. This places residents at potential risk because practice within the home is not in line with regulatory requirements that are in place to protect the health, care and wellbeing of residents. All matters relating to the outcome of the inspection were discussed with the provider and/or deputy manager. They took notes so that development work could be started immediately where necessary. Full opportunity on both days was given for discussion and/or clarification where necessary. We spoke with the provider by telephone on 8th August 2008, who advised us that they have received a feedback from the deputy manager about our second day of the inspection and confirmed that they are fully aware of our findings and the concerns. In particular we discussed the lack of staff awareness about what they should do if a safeguarding adults from harm incident be suspected, the lack of medication training for senior staff, poor staff recruitment Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 7 documentation and poor record keeping. The provider confirmed that they were aware of the risk that these shortfalls place on residents and was currently taking measures to minimise risk. What the service does well: What has improved since the last inspection? It was positive to note the following improvements since the last inspection. As referred to within this report, the provider has made a number of new purchases. For example a new washing machine, tumble dryer, fridge, freezer, and a fridge for storing identified medication have been purchased. Carpets have been cleaned, new flooring has been laid, some decoration has been carried out, the staff rota was current and infection control measures have improved. The Fire and Rescue Service have visited the home and provided guidance. The above means that another positive outcome for residents is that they live in a cleaner environment where some of the fitments, fixtures and appliances are new and function better. There is now a current version of the home’s Statement or Purpose and Service User’s Guide. This means that anybody wanting to know what the home can provide or offer can have a copy if they contact the home. All current residents have a copy of the Service User’s Guide in their bedrooms. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 8 What they could do better: As referred within the summary section of this report, the provider has failed to meet their own timescales in addressing all the shortfalls (or non compliance) with regulatory requirements identified at the last inspection. The following report details within each section what we found and the impact the findings could have or does already, have on residents. Documentation associated with the care planning system does not identify individual resident’s current care and health needs, how they are to be addressed and who by. There was a lack of adequate risk assessment documentation. The medication administration and recording system does not comply with available guidance or the home’s own polices and procedures. Staff spoken with did not know the correct procedures to follow should a suspected safeguarding resident’s from harm incident be detected. The outcome of the above means that residents are vulnerable and at potential risk because of the lack of recorded information about them and the staff could not demonstrate competence in dealing with care practices or safeguarding issues. Records relating to staff recruitment, training and supervision do not comply with regulatory requirements. The provider could not demonstrate that staff are recruited properly or that suitable documentation was in place. There was no established system for identifying what training is required for staff, there were no staff competency assessments in place and no system in place to demonstrate that staff had been formally supervised. The outcome of the above means that residents are vulnerable and at potential risk because they are cared for by staff that are not recruited, trained or supervised properly. Other records such environmental and safe working practice risk assessments, accident records, records relating to complaints and concerns were not adequate in detail or were not available. The outcome of this for residents means that residents, staff, visitors members of the public can not be assured that the correct information is in place to keep them safe or that their interest will be properly recorded and dealt with. We are not being informed of incidents such as deaths and accidents that require medical assistance. The provider is not preparing a monthly report on the conduct of the home. There is no quality assurance system or annual development plan in place. The outcome of this for residents means that there is no effective communication between all interested parties (residents, Commission, provider, relatives, stakeholders) about what happens in the home on a day-to-day basis. The provider in their Improvement Plan recorded that whilst there is no manager in post, they would take management responsibility for the home. Our findings demonstrated that the day-to-day management of the home is not effective and competent. As recorded, the provider has not addressed a Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 9 number of shortfalls from the last inspection. The provider reported that they are committed to raising standards and thought that prior to our inspection, all regulatory requirements and standards were being met. The outcome of our findings means that residents live in a home that is not managed properly which leaves them in a vulnerable position. 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. Silversea Lodge Care Home DS0000068495.V365138.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 Silversea Lodge Care Home DS0000068495.V365138.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 (standard 6 was not inspected as intermediate care is not provided) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are able to receive information about the home and have their care needs assessed before a decision is made about admission to the home. EVIDENCE: The pre-admission documentation of two of the most recently admitted residents was viewed. Pre-admission assessments had been undertaken using a tick box format. There was very little text to describe or explain in any detail the identified care needs. The content of the subsequent care plans that had been put in place did not reflect the care needs identified on the pre-admission assessments. For example, care needs associated with a heart problem and the care a resident needed from a community nurse had been identified on the assessment, but had not been recorded on the care plan. This means that residents may have their care needs assessed before admission, but those Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 12 needs may not be recorded on the daily care plan and care staff may not know what care is required and how this should be provided. There were entries within the documentation to demonstrate that residents/relatives had been asked about their personal preferences and wishes. Residents and/or relatives are normally given (whenever possible) the opportunity to visit the home before any decision is made about moving in. A relative told us that staff had made their relative feel very welcome when admitted and confirmed the above aspects of the pre-admission process. The provider could not demonstrate that letters had been written to prospective residents advising that following assessment, the home could meet the assessed care needs. The provider also confirmed that of the two residents, only one had received a contract/terms and conditions. Within each bedroom we saw a current copy of the home’s Service User’s Guide. This provides relatives and residents with information about the home. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive care based on an intuitive understanding of need, but may be at risk because their care, health and medication needs are not underpinned by robust documentation systems. EVIDENCE: Five care plans and associated documentation such as risk assessments and accident records were looked at. We looked at different aspects in the records. The provider and deputy manager confirmed that the recording systems we looked at were in the main incomplete and disorderly. Information about a similar care issues were held in several places on some files and some handwritten entries were not easy to read. The system(s) in place were not user friendly and the process of us attempting to track identified care needs and how they were/are to be met was difficult and time consuming. Information about resident needs and how they were to be met did not always cross-reference and care needs that had previously been identified in another associated record were not always recorded in the care plan or recorded as Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 14 being followed up during daily care practices. The provider could not demonstrate that the home has an efficient and competent recording system(s) in place to record and document residents care needs, how they are going to be met, who by and when or how often. We found a number of examples to support the above statement. For example, one resident had been in hospital and her care needs had changed following discharge back to the home. The care plan had not been updated since May 2008. Another resident required the services of a community nurse, the care need or how the need was to me met had not been recorded on the care plan. The health of one resident had deteriorated significantly in the week leading up to the inspection, the care plan had not been changed since May 2008. We saw bedrails on one bed, but there were no protective bumpers in place neither was there a risk assessment in place. One resident had requested that his bedroom (fire door) be left open at night, but there was no risk assessment in place. One resident had developed care needs associated with poor memory but these were not reflected in the care plan. Another resident had been admitted requiring the services of a community nurse and with previous mental health needs. These matters were not recorded on the respective care plan. One resident had an accident in the home and had been taken to hospital. They had been discharged back to the home with specific needs (according to the hospital discharge letter), but the care plan did not record what these were. Two residents were found to have a history of falls, but the risk assessments were inadequate and the information was not reflected in the care plans. Within the daily records for residents we noted the following entry about a resident made on 18/6/08 following an accident as ‘please observe’, there was no further reference to this matter or what carers should be observing. Details about specific care needs within care plans were minimal or nonexistent. Some residents have diagnosed medical/clinical conditions such as insulin dependant diabetes or require blood-thinning medication. Whilst such matters may on some occasions be referred to somewhere within the accumulation of various records, there was no clear care plan to identify the specific for care, the consequences of the identified condition and what needs to be done by staff to meet the need. In general, all the care plans had two or three headings i.e. mobility, nutrition, grooming and hygiene. The vast majority of the care plans seen had not been reviewed since May 2008. As demonstrated above, the documentation seen did not reflect the current needs. Residents are cared for by a core team of established staff, some have worked in the home for a long time. When we spoke to various members of staff all knew about the current care needs of residents. Residents were dressed appropriately for the environment and climate. Residents spoken with said that Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 15 their needs were being met and were happy with the care provided. Relatives told us that apart from some staff shortages at times, they had no concern about the care provided and indicated that they felt staff met their relatives care needs. The rapport between residents and staff was natural, warm, friendly and supportive. We overheard two positive and informative conversations between staff and relatives. On both occasions the respective relatives were asking for an update on their relatives care. On each occasion the member of staff and the resident the relative was making enquiries, about was different. We were encouraged by the amount of knowledge the carers had and in the competent manner they were able to speak to relatives. However, when we checked, the information provided during the conversation was not reflected within the care plan. Residents living in the home are reliant on core staff being on duty that may have a good memory or ‘head’ knowledge of their respective care needs. Should these staff not be on duty or leave and new staff or agency staff work in the home, there is insufficient information in place about individual residents care needs and how they are to be met in place. This put residents at potential risk of not having their care needs known by people who are caring for them and how those needs identified elsewhere, other than in the care plan are to be met. The home has policies and procedures about care planning issues, but these were not being followed. We looked at and sampled various aspects of the medication administration, storage and recording system(s). We looked at a random selection of MAR (medication administration records) and found a number of unexplained gaps or anomalies within the system. Some tablets were ‘missing’ but could not be accounted for within the recording system whilst another tablet was till in the blister pack but had been recorded as being administered. We found duplications of medication. For example, for one resident they had the same medication in an opened box dated 6th June 2008 together with some identical medication in the blister pack that had been delivered to the home on 6th July 2008. The senior was unsure about where staff had been taking the tablets from i.e. the blister pack or the box. We found prescribed cream medication in bedrooms with no dates of when they were opened. In one bedroom there were two tubes open of the same cream, one had lost the pharmaceutical label. The senior told us that the resident self administers the medication, but was unable to demonstrate that a risk assessment or a self administration protocol was in place. Senior staff undertake ‘blood glucose’ testing on some identified residents. The senior informed us that this had been done because there was a shortage of community nurses and they had been ‘told what to do’. There was no protocol or training documentation in place for this procedure to be managed in a safe manner. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 16 We asked to see the document that details all used medication that is taken and returned to the pharmacy. Documentation was available, but the last recorded date was 20th April 2008. There were other sheets, but these were undated. We spoke to a senior and deputy manager about all of the above. They were unable to explain or clarify our findings. The home stores controlled drugs. The deputy manager said that the provider was aware that the current storage cupboard does not meet regulatory specifications. We provided information about how to obtain the correct storage facilities. The deputy manager told us that staff administrating medication have only attended a ‘how to use the system’ training course provided by the local community pharmacist. The home has a Medication Policy and Procedure in place, but we were informed by the deputy manager and a senior that this is not referred to. The home does not have a copy of The Handling of Medicines in Social Care (published by the Royal Pharmaceutical Society of Great Britain 2007) that would have provided guidance about safe medication administration practices. The deputy manager reported that the home has a good working relationship with all social and health care professionals. We saw entries within various parts of the care planning documentation demonstrating that residents have full access to all community health care professionals. As recorded previously within this report, entries made by staff regarding residents’ health and medical care are inconsistent and patchy. There is a risk that significant and important information may be mislaid, not recorded in the care plan or not recorded at all. Should this happen and core established staff are not on duty, there is a risk that identified individual resident’s medical/health needs will not be known and therefore not met. We asked residents about how they are treated by staff in daily care practice. Everyone we spoke with indicated that they were treated kindly, with respect and dignity. All indicated that they have a degree of choice about routines in the home, for example getting up and going to bed, everybody expressed that they were happy with things as they were. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good nutritional diet but experience a limited activity/occupation/social programme. EVIDENCE: The senior informed us that all current residents have regular visits from either their family or friends. During the two days we were there, there was a steady stream of visitors to the home. We overheard visitors on arrival being greeted by staff at the front door in a warm and friendly manner. The visitors we spoke with said that they were always made to feel welcome and found the home to be friendly. The home does not have a designated area where residents can see their visitors in private. If this was to be a resident’s choice or preference, the only place there would be is their respective bedroom. The home does not have any direct connections with local churches, but two residents attend local places of worship on a regular basis. This was recorded in their care plan records. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 18 There was a weekly activities programme on the lounge door dated June 2008. The senior informed us that the same activities take place each week. These activities include ball games, bingo, going into the garden, music day, feet exercise, leg exercises, hand exercises, head exercises, fish and chips day and ice cream day. We spoke to the deputy and senior about these activities who agreed that many were not really social activities and should be part of the core care planning for residents. The deputy agreed that the current range of activities lack imagination and variety. In some care plans we saw that residents had been asked about their hobbies and previous pastimes, but in reality there was no evidence to support that residents are encouraged to pursue them. There was no evidence to demonstrate that staff have received any training in providing suitable occupational/social activities for residents. The senior showed us a record of what activities have taken place as part of the current programme. Activities were well recorded and identified where residents were either unable to participate in the communal activities arranged or declined the opportunity. Visits from family were also recorded. We spoke to residents about this aspect of care and received a varied response depending on their individual ability, independence and circumstance. One resident who was quite independent was very happy with reading and watching TV but felt ‘more could be done’. Another resident said ‘I get bored really, it’s good when some one comes to see me’, whilst others didn’t seem to have a view. The deputy manger informed us that the provider is aware that an activities programme needs to be developed. They said that the difficulty is that with the existing staffing levels, there is no time ‘to do anything else’. On one of the days we were in the home, a clothes party had been organised. An outside clothes agency had brought in a wide selection of clothing for residents to look at and purchase. Many of the residents were actively involved in the activity. Staff and relatives were also available to assist and advise where necessary. Over the two days, we did not see any residents isolated either in the bedrooms or in the lounge. A member of staff was always in attendance or near by. A visitor commented on this by saying that ‘there is always someone around, there’re never left alone’. Although a lot of the interaction between members of staff and residents was task based, there was a lot of good humour and we overhead staff talking to residents on a regular as they were passing. We saw lunch being cooked, served and eaten on both days. The menu was displayed on the second day. On the first day, two residents spoken with said they normally had a choice for lunch, but were unable to tell us what it was. On the second day, the same residents were spoken with again and this time were clear about the choice that would available at lunchtime. The food looked appetising and was nicely presented. On the second day there was a choice of chicken curry or cottage pie with a section of ice creams or yoghurt to follow. A Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 19 resident told us that fresh fruit is ‘normally’ around and ‘there for us if we want it’. We asked residents about food provision and there was an overwhelming response of comments such as ‘it’s lovely’, I get too much’, I enjoy it thank you’. A visitor also commented on the ‘lovely food….always looks appetising’. We noted that in the last two weeks, beef was on the menu for two consecutive days running as was chicken. The deputy manager explained that the provider buys joints of meat that are too large and it has to be eaten over the two days. It was suggested that this is managed better so that residents can have more variety. We saw the records of what individual residents had eaten for lunch and breakfast on previous days. These were in good order, but there were no records of what residents had eaten for supper on 2nd, 3rd, 5th August and 27th July. The home provides accommodation for 15 residents, but only 10 can be comfortably seated at the table in the dining room. This means that some residents have to eat their meals either in their bedrooms or in the lounge area on a lap tray. Although this is not acceptable to us, it does not present any problems for the current 13 residents. The home must address this, as when new residents are admitted or other residents wish to eat their meals at the dining table, there will be insufficient seating space. The lunchtime table was nicely laid. Members of staff were sensitively assisting those residents who needed help with eating their lunch. On both days the cook came out to speak with residents whilst they were eating their lunch to ask if any more food was required. One resident asked for more gravy that was quickly arranged. Another resident asked for some help, which again, was quickly provided. We asked residents and relatives about the level of choice and control people have in the home. There was a sense that everybody accepted that the home has routines, but within that there was a degree of personal choice. Two residents told us that although they go to bed quite early, it was their choice. With food and drink, all reported that there was choice and variety. No residents or relative indicated that they had any problem with daily routines in the home. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be confident that their concerns will be managed well or that staff understand how to protect them. EVIDENCE: The complaints procedure was displayed in the hallway and is within the Service User’s Guide that is in every bedroom. The deputy manager informed us that any concerns raised would be recorded in the daily logbook for the provider to deal with. The home could not evidence that it has a systematic system of recording complaints in place or has an established process in where complaints are investigated and the outcomes recorded. This means that should a complaint be made, the complainant cannot be confident that their complaint will be logged, investigated and the outcome recorded in accordance with the home’s policy and procedure. In April 2008 we sent a letter a letter to the provider asking them to investigate a number of concerns we had received in a letter. The concerns raised were about the management of the home. We asked that the concerns be investigated in accordance with the home’s complaints procedure. We sent a further letter asking for a response. At this inspection we asked the provider about the situation. The provider informed us that a response was sent to us but was unable to say when. We confirmed that there was no record of their response on our files. The provider could not demonstrate that this complaint Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 21 had been recorded on the home’s complaint recording system. Neither could they produce a copy of the response sent to us. The provider explained that it was a member of staff who had since left that had responded to the complaint and therefore could not comment further. The provider was unable to comment on how the complaint had been investigated and by whom. In the main entrance hallway, there was a notice advising the reader how to contact the local advocacy service. Residents told us that they would feel comfortable about raising any matter of concern with a member of staff. Relatives shared this view indicating that they felt confident that any matter would be properly dealt with. The deputy manager and a senior member of staff were not aware of the current safeguarding adults from harm procedures. They told us that they had not received any training. This means that if an incident were suspected, staff would not know the correct procedures to follow that could place residents at further risk. We asked the deputy manager to contact the Southend Borough Council (safeguarding adults from harm section) and arranged for urgent raining. This was done. The home has a copy of the Southend/Essex/Thurrock Safeguarding Adults Guidelines issued in April 2008. The deputy manager advised us that it had not been read. Staff we spoke with were not able to discuss the home’s policy of ‘whistle blowing’. There seemed to be little awareness and understanding of what this term meant. Residents told us that they would feel confident about talking to any member of staff about a concern. One member of the current staffing establishment does not converse in English. The deputy manger told us that any interpretation is carried out via their next of kin. The deputy manager was unable to explain how this member of staff would be able to deal with any complaint made by a resident, how safeguarding adults from harm issues are dealt with and/or how whistle blowing matters would be dealt with. There is also the issue of confidentially if all matters relating to the home are dealt with via somebody not employed with the home. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, comfortable and pleasant. EVIDENCE: Since the last inspection, significant improvements have been made. For example, carpets have been cleaned, extractor fans have been cleaned, a new dishwasher, fridge, washing machine and tumble dryer have been purchased. The oilskin tablecloth and tatty tablemats on the dining room table have been removed. Infection control measures have improved. In all toilet areas we saw liquid soap and there was a good supply of paper towels. There were no unpleasant odours in any part of the home on either day of the inspection. Bedrooms were comfortable and contained personal items belonging to the occupant. We noted that the senior who showed us around the home, knocked Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 23 on all bedroom doors before entering. The lounge was comfortable, light and airy. Two residents told us that they like the lounge because of the large clear patio doors that overlook the patio and garden area. The dining table remains too small for the number of residents the home can accommodate. For example the home can accommodate fifteen residents but the senior told us that the table could only seat ten/twelve. This means that some residents have to eat their meals in their bedrooms or on a lap tray. There remains insufficient storage space in the home for equipment. We found a hoist in a communal hallway outside a bedroom, in one of the two bathrooms we found an ironing board, iron and four washing baskets, a mop and a bucket. We found two wheelchairs in a resident’s bedroom. Only one belonged to the resident in whose room they were. The senior said that the cleaner had put it there whilst cleaning, but this could not be confirmed, as we could not verbally communicate with this member of staff. At the last inspection we reported that because the laundry area is outside at the back of the main building, soiled/dirty laundry is transported via the lounge or via the dining room and kitchen. It was recorded ‘in each case the way in which this action may detract from residents’ rights to treatment with dignity and any risk of infection was not considered via a risk assessment with suitable action taken to decrease the risks’. At this inspection the duty manager informed us that a risk assessment has not been put in place. This means that without an adequate risk assessment, staff handling soiled/dirty laundry have no clear instructions on how to risk manage this task. The outside rear grass was well maintained and pleasant. The patio/courtyard area outside the patio door that leads to the grassed area was unkempt. A relative told us that they take responsibility for looking after the potted plants in this area because ‘if I didn’t, they would die’. The relative told us that ‘care staff just don’t have the time to look after it’. At the last inspection concern was raised with the provider about fire doors being wedged open. We saw a letter from the Fire and Rescue Service who visited the home on 16th July 2008 to carry out a fire risk assessment. The provider is still waiting for a confirmation letter about their findings. The provider told us that Fire and Rescue were ‘generally happy’ with their findings. The provider told us of their intention to take up the carpet in the dining and lounge area and replace it all with a washable floor surface. We reminded the provider that the outcome for residents is that they should be able to live in an environment which is homely. There remains no annual maintenance plan in place for the home. The senior told us that maintenance issues are recorded, but there is no designated person to undertake these duties. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 24 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 poor. This judgement has been made using available evidence including a visit to this service. Residents are cared for by friendly, well intentional staff that are not adequately recruited, trained or supervised. EVIDENCE: On both days, all staff on duty were pleasant and friendly to us and to the residents. Staff spoke to residents in a dignified yet friendly manner. There was a lot of good humour and the rapport between residents and staff was warm and supportive. Staff on both days wore clean practical uniforms. Care tasks were observed to be undertaken sensitively. Relatives spoke very highly of the staff, but all said that the numbers on duty were not always adequate to meet care needs. Two reported ‘at weekends things are so very stretched’ and ‘there is little by way of activities because they are all so busy’. One relative said ‘it’s a shame the provider isn’t around more to see what it’s like here for the staff…..I come here at lot and I’ve only seen him a few times’. The staff we spoke with were knowledgably about residents current needs, but residents may be at risk because the care delivered is not underpinned by detailed or current care plans. One relative told us that until the past three months, there had been a lot of changes with members of staff. They felt that things were much better now. The provider and the deputy manager confirmed this view. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 25 On the first day we noted that the staff rota was clear and reflected the staff on duty. There is a minimum of 3 care staff on duty during the day Monday to Friday. There is also a cleaner and cook on duty Monday to Friday. At weekends, the three staff on duty also undertake cleaning and cooking duties. Two members of staff told us that this distracts them from their caring duties. At night there is a minimum of one ‘awake’ member of staff and one ‘asleep’ member of staff who is on call to give assistance. The provider told us that the home has a vacancy for a part time carer and a cook. The senior told us that the home has a team of ‘bank’ staff and they can use agency staff in times of sickness leave or holidays. The home does not have a manager in place. Since the last inspection the provider told us that two potential managers have been employed, but neither of them were suitable and have left. The acting deputy manager keeps an overview on the management of the home, but role is counted as part of the three care staff on duty and does not therefore have any designated or supernumery hours to carry out any management duties. The provider showed us the records of the last three members of staff recruited. There were Criminal Records Bureau checks in place on all three. It was unclear as to whether or not two had any form of POVA 1st checks undertaken. There was no evidence that this had taken place. There was no employment history in any of them. The names and addresses of referees were recorded on the three application forms, but there were no verbal or written references recorded. There were no induction records in place. The provider could not clarify or explain our findings. Our findings mean that residents cared for by some members of staff who have not been properly recruited, could leave them at potential risk. We asked the provider to show us records of staff supervision sessions. The provider said that there are no supervision sessions undertaken. The provider explained that staff meetings take place but could not evidence this through records. We asked the provider to show us evidence that staff have attended training sessions. The provider explained that there was no system in place to identify what training was needed and there was no system in place to log what training had taken place. After some searching, the provider found some various recent training certificates (in different places) that had taken place since the last inspection. These had not been logged, recorded and were in no order. There was no training register or matrix in place. The provider was unable to clarify or explain the current staff training programme. The provider was not able to clarify the current situation regarding which staff had NVQ qualifications. This means that residents are cared for by staff that receive no formal supervision and their training needs are not properly identified or recorded. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 26 As recorded previously within this report, staff were not able to demonstrate competence in medication administration procedures, care planning processes or how to deal with safeguarding adults from harm issues in particular. The provider was unable to demonstrate that any staff have undertaken competency assessments following the training that had been given. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents live in a home where management systems are not robust and is operated in a manner that does not safeguard their health, care and welfare. EVIDENCE: Shortly after the last inspection, the registered manager left the home. The provider informed us that since then, two managers have been employed but both have now left. There is no designated manager now in post. The acting deputy manager oversees some of the management issues, but this member of staff does not have any designated management or supernumery hours. The deputy manager is unable to spend any designated time overseeing management issues because they are ‘counted’ as one of the carers. This Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 28 means that there is no consistent competent management input or influence in the home. The provider told us that they visit the home twice/three times a week and attend to shopping, some administration duties and some maintenance tasks. The provider does not undertake any management duties. Two members of staff told us that the provider is normally available at the other end of the phone. The provider confirmed that they have not completed any Regulation 26 reports. A Regulation 26 visit (and report) is required if the provider is not active in the day-to-day management processes of the home. The purpose of the visit and subsequent report is clearly documented in legislation and provides the person undertaking the role to be sure that regulatory requirements are being met and that the day-to-day management complies with regulatory requirements. As recorded within this report, the provider was not clear about a number of regulatory requirements, neither was a suitable system in place to monitor and address the non compliance issues from the last inspection. The provider confirmed that no Regulation 37 documentation had been completed and sent to us. A Regulation 37 is a notification that informs us of notifiable incidents that have happened in the home. For example, we were not notified of the deaths of two residents since the last inspection or received any notification about an accident that resulted in a resident requiring hospital treatment. As previously recorded, the provider confirmed that there is no formal staff supervision system in place. This means that staff are not formally monitored or assessed to ensure that their duties are undertaken in accordance with regulation, the home’s policies and procedures or good practice guidance. From our findings of this inspection, some aspects of staff practice are not compliant with regulation. For example, care planning documentation, medication practices, accident recording and complaint documentation. The provider confirmed that there is no quality assurance system in place. There was no evidence that residents and/or their relatives are formally consulted about life in the home and their views recorded or noted. This means that there is no system in place whereby residents can directly influence the day-to-day management of the home. Following the last inspection we asked the provider for an improvement plan detailing their intention to address the identified shortfalls, how this was to be achieved and the timescale. According to our records this was not returned to us. We asked the provider about this. The provider advised that this had been sent to us but didn’t know when, as a member of staff who no longer worked in the home had sent it. The provider gave us another copy. The timescales set Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 29 by the provider to address and meet the shortfalls identified at the last inspection, had not been met in some instances. Details are in the summary section of this report. The deputy manager could not evidence that there are any environmental or safe working practice assessments in place. There was no current Control of Substances Hazards to Health (COSHH) register in place. We did note that there were safe machine operating instructions and infection control procedures in place. For example, there was a COSHH poster and infection control instructions in the laundry. At the last inspection, the system that manages residents’ personal monies was viewed and assessed as being in good order. We did not view the system again at this inspection. As referenced within the ‘Choice of Home’ section of this report, only one of the two residents who had been admitted since the last inspection had a contract/terms and conditions of residence. This means that not all residents were aware of what their fee included. We asked to see a sample of maintenance and safety certificates. A random sample selected at the last inspection was noted to be in good order. At this inspection, it was established that there is no system in place whereby these certificates are, logged, recorded and stored in one place. Some were in a pile of unlogged documents, papers and reports in the provider’s office, some were on the wall, others were in one of two folders. There was no systematic management approach to record keeping which made this aspect of the inspection lengthy and difficult. We did not pursue this aspect of the inspection any further. The provider informed us that all certificates were current. The Fire and Rescue Service visited the home on 16th July 2008. The provider informed us that there were no outstanding matters following the visit. The provider is waiting for a confirmation letter from them. Following that visit, the provider put in place a new system to record when fire drill, emergency lighting and fire fighting equipment would be undertaken or recorded as being in good working order. The home’s record format for this activity is headed up ‘weekly’. The inspection took place 6th/7th August and the last entry in the records was 16th July. This activity was not being managed in accordance with the home’s own procedure. We saw a letter from Southend Borough Council to inform that a Food and Hygiene Standards inspection had taken place. In their report dated 15th May 2008, we noted that some requirements had been made. This was in respect of health and safety issues, storage of food and staff training. The deputy manager was unsure about any follow up to these requirements, but advised that all requirements had been addressed. The home has a staff communication book. This is a good tool for communication between shifts and individual members of staff. We found a Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 30 mixture of personal information about individual residents as information for staff members recorded. To record personal information about individual residents in a communal book is an infringement of their right to privacy. Such information and detail must be recorded in the personal care records. The provider confirmed that they have access to our website. We encouraged the provider to make full use of this facility as it contains information and advice that if implemented effectively, will assist in the day-to-day management of the home. Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 31 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X 3 1 1 1 Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 32 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 OP2 Regulation 5(1)(b), Schedule 4(8) Requirement Residents must be provided with a clear definition of what elements of the care provision is included in their fees within their terms and conditions of residence/contract. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 2 OP3 14, Schedule 3(1) The service must be clear that it understands the needs of proposed residents prior to their admission by carrying out a needs assessment. This should identify the levels of support they will require and the resources required to meet this. The previous timescale of 30/04/08 to meet this requirement has not been achieved. 3 OP7 15, Schedule 3 (2) Residents needs, strengths and aspirations must be discussed with them and documented in care plans and risk assessments DS0000068495.V365138.R01.S.doc Timescale for action 30/11/08 30/11/08 30/11/08 Silversea Lodge Care Home Version 5.2 Page 33 to support the consistent delivery of person centred support to each resident. Information must be current. The previous timescale of 30/04/08 to meet this requirement has not been achieved. 4 OP8 12(1), Schedule 3 (3) (m) Residents’ health and welfare must be supported by the documentation of health care advice. The use of monitoring records must be in place to assist staff in supporting identified health issues. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 5 OP9 13(2) 08/11/08 A metal cupboard of specific gauge with a specific double locking mechanism must be fixed to a solid wall or a wall that has a steel plate mounted behind it and can be fixed with either rawl or rag bolts must be put in place to ensure that controlled drugs are stored safely. The timescale for action reflects the period of time needed to purchase and fit such a cupboard. 6 OP12 12(2)(3)1 6(2)(m)(n ) Residents must be consulted as to their preference in relation to aspects of daily living such as activities and daily routines. The outcome must be recorded together with the arrangements in place to meet their individual wishes and preferences. This demonstrates a respect for their individuality and independence. DS0000068495.V365138.R01.S.doc 30/11/08 30/11/08 Silversea Lodge Care Home Version 5.2 Page 34 The previous timescale of 30/04/08 to meet this requirement has not been achieved. 7 OP15 16(2)(i) A daily record must be kept of all food and drink provided to each resident. This is to monitor the quantity, variety and frequency of food/drink provided and consumed. Residents must be able to raise concerns and be assured that these will be responded to appropriately within a timescale. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 9 OP18 13(6) Staff must understand how to recognise and take steps to protect residents from abuse. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 10 OP19 23(2)(b) (o) The provider must be able to demonstrate that there is a programme of routine maintenance, renewal of fabric and decoration in place. This is to ensure that all areas of the home, the facilities and the services are kept in good order and all matters are kept under review. Residents must be protected from the risk of fire by the homes fire safety systems and these must be maintained in good working order. Records to DS0000068495.V365138.R01.S.doc 30/11/08 8 OP16 22(3)(4), Schedule 4(11) 30/11/08 30/11/08 30/11/08 11 OP20 23(4), Schedule 4 (14) 30/11/08 Silversea Lodge Care Home Version 5.2 Page 35 demonstrate that systems have been checked must be kept in good order. 12 OP27 18 (a), Schedule 4 There must be sufficient staff with designated care hours on duty at weekends to meet the care needs of all residents. This does not include care staff that are designated to undertake cooking or domestic duties. 30/11/08 13 OP28 18 (c) Residents must be supported by 30/11/08 staff that are provided with sufficient training to gain appropriate and adequate skills and expertise and are assessed as being competent to meet the assessed needs of the residents they support. Records must be in place to support this. The previous timescale of 30/04/08 to meet this requirement has not been achieved. 14 OP29 19(1)(b)(c Residents must be protected by )(4)(c)(5) staff who have been subject to a (d) through recruitment check. This includes a full employment history being recorded, suitable references being received and a full induction programme provided and recorded. 18 (c) 30/11/08 15 OP30 Residents must be supported by 30/11/08 staff that are provided with sufficient training to gain appropriate and adequate skills and expertise and are assessed as being competent to meet the assessed needs of the residents they support. Records must be in place to support this. The previous timescale of 30/04/08 to meet this Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 36 requirement has not been achieved. 16 OP31 10(1) Residents must benefit from a 30/11/08 leadership that has sufficient skills and expertise and is able to support staff in meeting the Statement of Purpose, protect residents’ wellbeing and understand how the service will achieve compliance with the Care Homes Regulations 2001. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 17 OP32 10(1) Residents must benefit from leadership that has sufficient skills and is able to support staff in meeting the service’s Statement of Purpose, protect residents’ wellbeing and understand how the service will achieve compliance with the Care Homes Regulations 2001. The previous timescale of 31/03/08 to meet this requirement has not been achieved. 18 OP33 24 Residents and other stakeholders 31/12/08 must be consulted about how the service delivery matches the Statement of Purpose and individuals’ expectations. The previous timescale of 31/05/08 to meet this requirement has not been achieved. 19 OP37 37(1)(2) The registered person must notify the Commission of all incidents or matters referred to under this regulation. DS0000068495.V365138.R01.S.doc 30/11/08 31/08/08 Silversea Lodge Care Home Version 5.2 Page 37 20 OP37 26 As the registered provider is not in day-to-day control of the service, they must visit the home and prepare a report in accordance with this regulation. Staff must receive regular and consistent supervision from their line manager that supports their development and provides them with feedback on their practice. The previous timescale of 30/04/08 to meet this requirement has not been achieved. 31/08/08 21 OP36 18(2) 30/11/08 22 OP38 12(1)(a), 17 (2)(3)23( 2) Record systems must be in place to demonstrate that all matters relating to the health, welfare and safety of staff and residents are considered, assessed and addressed are in place. This includes risk personal assessments, COSHH requirements, environmental and safe working practice assessments, accidents and all other matters as referred to under national minimum standard 38. 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Silversea Lodge Care Home DS0000068495.V365138.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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