Inspection on 15/01/07 for Sotwell Hill House

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sotwell Hill House 16/01/09

Sotwell Hill House 26/01/08

Sotwell Hill House 02/03/06

Sotwell Hill House 30/09/05

Sotwell Hill House 25/01/05

Sotwell Hill House 21/07/04

Sotwell Hill House 20/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Sotwell Hill House Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS Lead Inspector Julie Willis Unannounced Inspection 15th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sotwell Hill House DS0000013135.V327257.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. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sotwell Hill House Address Brightwell Cum Sotwell Wallingford Oxfordshire OX10 0PS 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) 01491 836685 Mrs Joy Patricia Butterfield Mrs Joy Patricia Butterfield Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: Sotwell Hill House is a late Victorian converted country house set in attractive and extensive grounds and provides accommodation for those older people who require day-to-day supervision and care. The home does not provide nursing care. Independence is encouraged and the layout of the grounds enables service users to take exercise in safety. Service users are able to visit the nearby town of Wallingford and other outings are arranged on an occasional basis. Cost of the service provided by Sotwell Hill House is between £530 and £690 each week. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 15th January 2007 between 10 am and 4.30 pm. The inspection was a ‘Key’ inspection and covered all the standards for older people. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents, relatives and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met all of the residents and four relatives that were visiting at the time of the inspection. The inspector also spent time talking to staff and observing how care was being delivered to the residents. The inspector gave feedback about her findings to the home’s Proprietor and Deputy Manager at the end of inspection. There were no outstanding requirements from previous inspections and the Commission has received no complaints since the last inspection. What the service does well: Sotwell Hill House is a clean, spacious and comfortable home, which is attractively decorated and furnished throughout to provide residents with a homely place to live. The gardens are appreciated by residents and are extensive covering about twenty acres. The gardens are attractively landscaped and have pleasant seating areas for residents to enjoy the views over the surrounding countryside. The home has a committed and stable staff team and many of the workers have remained at the home for a long time. There are good ratios of staff to residents and staff are generally thought of as “responsive, kind, caring and well trained”. Staff know the needs of the residents well and provide high quality care and support. The food is varied and the Chef can cater for special diets. Service users say that the food provided is “plentiful, tasty and well cooked”. This is a family run home where management react quickly to the views, concerns and comments of the residents and their relatives. Complaints are rare, as residents feel able to approach the management openly Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 6 The activity programme is varied and interesting and includes exercises to music, quizzes, board games, croquet, film club and knitting club. Trips out are arranged during the year to local places of interest including garden centres, coffee mornings at local historic houses and trips to the local donkey sanctuary. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. Service users are fully assessed prior to admission to ensure their needs can be met effectively by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the pre-admission assessment documentation for 4 residents evidenced that all necessary information about the user’s health and personal care needs are sought prior to admission. Evidence confirms that the information is gathered sensitively by a skilled and experienced member of management from the prospective resident, their family and where necessary doctor or hospital. Information is gathered about the user’s dietary needs, communication needs, mobility needs, history of falls, Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 9 continence and mental state. This information is used to provide the basis of the care plan. Prospective residents are provided with the opportunity to visit the home informally so that they may ask questions about life in the home, observe the daily routines and meet staff and other residents. One user told the inspector that they had “heard good things about the home” and “hadn’t considered anywhere else, as the home’s reputation was so good”. Service users confirmed that their expectations had been matched by the home and told the inspector that they “were very happy”, “comfortable and content”. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10. Quality in this outcome area is adequate. The care plans lack sufficient information and detail to enable new staff to effectively meet residents’ needs. Service users are provided with care in a manner which maintains their right to dignity, privacy, independence and choice. The medication system in use at the home ensures the safety of users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of four service users were examined in detail and case tracked from pre-admission assessment to date. The written records were fairly minimal in content and gave only outline guidance on how to offer the appropriate level of care to users of the service. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 11 Risk assessments require review to ensure that they effectively reflect the needs of users. Several records examined were incomplete and did not provide sufficient detail on how to reduce the level of risk particularly in relation to falls and bathing. Observation of care practice concluded that users were encouraged to remain as independent as possible by providing appropriate levels of support to maintain the user’s privacy, dignity and independence. Staff were observed to provide personal care in a discreet and sensitive manner and were heard to be polite and courteous to users at all times. Staff routinely knocked and waited until they were invited in, before entering users’ bedrooms. Service users are provided with access to other health and social care professionals for advice and support. General practitioners, community nurses, and physiotherapists are regular visitors to the home and provide advice to the staff on all aspects of care. At the time of inspection a community nurse visited twice to provide palliative care to a resident that was unwell. Senior staff were on hand to listen to the nurse’s advice and to obtain new prescriptions from the chemist. The family were being offered appropriate hospitality and support to remain with the resident throughout the day. The inspector spoke with the relative and was told that the home was offering support and care to the resident, which was “over and above what they expected in a care home”. The relative was highly complimentary about the quality of care provided and the kindness, supportiveness and empathy of staff. The physiotherapist visited two residents at the time of inspection to provide support and advice about the residents’ mobility issues following surgery. The service users said that they were very happy with the level of service provided and felt better following the physiotherapist’s visit. Service users confirm that they regularly see their GP and are referred to hospital when necessary. Routine screening and preventative treatments are provided to all residents. From examination of the medication administration system and discussion with senior staff it is clear that the home takes its responsibility for administering medication seriously. Two staff administer all medication together to ensure that there is a double check system. Storage systems appeared effective and disposal systems safe. The current medication administration system was approved as safe by the CSCI pharmacy inspector in 2006. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 12 Service users were highly complimentary about the quality of the care provided at the home. They said that they had “confidence in staff & management” and “felt safe and well cared for”. Response from CSCI surveys from visiting professionals indicated that the home was proactive in seeking help and support for residents when the need arose and that other professionals trusted the home’s judgement. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. Service users are provided with the opportunity to participate in a range of leisure activities, trips out and entertainments. Service users are encouraged to maintain contact with the local community, their friends and relatives. The meals in the home are of superior quality and offer users both choice and variety. Special dietary needs can be catered for effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection most residents were enjoying socialising in the communal lounges or spending time alone in their bedrooms. One resident was arranging a crossword puzzle afternoon in the library for a number of residents, whilst others spent time chatting in the main lounge. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 14 The majority of service users said that they felt that there was enough to do as most people spent time in their rooms listening to music, watching television or entertaining their visitors. From the response to the CSCI’s survey forms most residents and relatives were entirely happy with the service on offer, however, one response said that more activities should be provided for residents with limited dexterity or poor eyesight. One resident said that they enjoyed reading and that the library in the home was regularly refreshed with new books by the visiting library services, which were of great benefit particularly those books provided in large print. The home has a number of trips out and several residents said that they had particularly enjoyed visits to local garden centres, the donkey sanctuary and a coffee morning at ‘Moulsford Prep’. Residents told the inspector about occasional musical entertainments and of weekly film shows that were particularly enjoyed by users. Residents said that they were kept informed of forthcoming entertainments during the residents meetings. The inspector observed the daily routines. The home is run flexibly around the needs of its users, within a semi-structured framework. Meals tend to be at set times but can be adjusted to meet the needs of individuals. Service users confirmed that they rise and retire at a time of their choosing and are offered appropriate choices in relation to everyday life. Service users confirm that their visitors are made most welcome at any time and are offered appropriate hospitality during their visits. A number of social events are held throughout the year which promotes community involvement and which provide residents’ families with the opportunity to engage with the staff and users on an informal and regular basis. Relatives confirmed that they are kept well informed about the health and welfare of the users. They said that staff phone them if the resident becomes unwell and invite them to the office to discuss care. They said that they felt that they were kept involved and included in the way that care is delivered. Service users confirmed that the food provided at the home is of excellent quality. The users were eating lunch of homemade parsnip and vegetable soup followed by pasta bolognaise with runner beans and new potatoes. Dessert was ‘Eves pudding’. There are alternatives to the main course at each mealtime and special diets can be catered for including diabetic, gluten-free or vegetarian meals. The chef has recently won a ‘Regional Award’ for the quality of his cuisine and the cleanliness and hygiene of his kitchen. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 15 Discussion with service users evidenced that the food was well cooked, tasty and plentiful. A number of service users made comments such as “the food is marvellous, always well cooked”, “there is always a choice” and “generally excellent”. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. The home has a satisfactory complaints system. Service users feel their views are listened to and acted upon. Service users are protected from abuse and exploitation by well-trained and competent staff that can demonstrate knowledge of the home’s abuse of vulnerable adults and whistle-blowing policies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaint policy in the home meets the requirement of Regulation and Standard. Service users are provided with information on how to make a complaint to the CSCI at any stage in procedures. Examination of the complaints records indicated that there have been no complaints since 1st January 2006 and none have been reported to the CSCI. Service users said that that they felt confident that any concerns or complaints would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. There was evidence in staff files and from discussion with staff, that they receive training in the protection of vulnerable adults as part of their formal Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 17 induction to the home. The initial learning is later consolidated when staff undertake NVQ (National Vocational Qualifications) training in which it forms a core module. Staff interviewed were aware of the home’s whistle-blowing policy and understood the importance of protecting users from abuse and exploitation at all times. Service users confirmed that they felt safe and were being well cared for by kind, caring and knowledgeable staff. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is excellent. Standards of décor and furnishings in this home are of excellent quality and offer residents a comfortable and homely place to live. Service users benefit from living in a clean and hygienic home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of residents at Sotwell Hill House were highly complimentary about the quality of décor and furnishings in the home. They said that the home was always clean, comfortable and hygienic. Communal areas are spacious and attractive with large windows overlooking the grounds. Residents confirmed that the whole house is vacuumed, polished and dusted regularly and is generally safe and well maintained. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 19 The communal areas and bedrooms were extremely well kept with coordinated carpets and curtains. Rooms were spacious, bright and airy. All bedrooms were en-suite and highly personalised to the resident’s particular taste. Residents confirmed that they were able to bring with them small items of furniture and pictures and ornaments to personalise their own rooms. From a tour of the building and overview of the gardens it was evident that the proprietors take great pride in the home. There are extensive gardens and the 20 acres of grounds look out over surrounding countryside. Several of the service users said that they enjoyed walking the grounds and liked sitting by the fishpond. One survey response commented that the rear gardens should be more accessible to wheelchair and Zimmer frame users. There are some accessible sitting areas to the front of the home, which can be accessed by hard pathway, and similarly areas to the rear. The Proprietors said that they would undertake a review of the general accessibility and make any improvements necessary. Residents and relatives said, “The home is beautifully kept” and is “light and airy”. One user said that they “thought there could be nowhere better” and “that the views were relaxing”. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. There were sufficient staff on duty at the time of inspection to meet the needs of users effectively. The skill mix of the staff team was appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of 3 staff files evidenced that the selection and recruitment procedures at this home are robust. All necessary checks are carried out to ensure the safety and protection of service users. Records were well kept and met the required standard. All prospective staff are interviewed by 4 members of senior management to decide on their suitability to work at the home. Successful candidates are provided with job offer letters and contracts of employment. There was evidence that care staff have been inducted by management and have received training in core skills such as fire safety, first aid, manual handling, food hygiene, health & safety and infection control. All staff have Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 21 received training in POVA (Protection of Vulnerable Adults) as part of their formal induction and as a core module in NVQ training. The staff team are well motivated and have either achieved or are working towards a National Vocational Qualification at level 2. There is a need, however, to ensure that all staff are provided with regular refresher training in core skills to keep their knowledge up-to-date and current. The inspector spoke to staff on duty, observed care practice and observed the staff handover. Staff in general felt supported by management and said that they have the opportunity to express their views in regular team meetings, staff handovers and in formal supervision sessions. It was clear that those staff spoken with had a clear understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with service users. Service users and their relatives were highly complimentary about the staff and management. They said that staff were “friendly and kind” and were “always willing to go the extra mile to help”. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is good. Service users benefit from living in a well managed home, where there is evidence that their health, welfare and safety are of primary importance. The registered persons are competent and experienced to run the home for the benefit of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This is a home that service users say, “has a pleasant family atmosphere”. The Proprietor and all of the deputy managers live on site in neighbouring houses and are on-call in an emergency. The Proprietor has run the home for the last 25 years and is highly experienced, however, Mrs Butterfield has not Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 23 got any formal qualifications in care. A good practice recommendation has been made at the end of this report recommending that management acquire an NVQ Level 4 in care & management or equivalent as soon as possible. Service users and their relatives are highly complimentary about the qualities of the staff and management. They confirm that the home operates an ‘open door’ policy and that there is always someone available to deal with their enquiries. They say that management are courteous and approachable. Residents confirm that they are regularly consulted on issues that affect them and feel that their views are always taken into account. From examination of the minutes of residents meetings it is clear that when requests are made or concerns expressed in the meetings the issues raised are followed up promptly by management. The Proprietor keeps a log of all compliments and thank-you letters and uses the contents as the basis of the home’s quality assurance system. There is a need to consider formalising the quality assurance system by producing an annual development plan based on a systematic cycle of planning-actionreview, which reflects aims and outcomes for service users. The results of service user surveys should be made available to current and prospective users and other interested parties. Examination of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment are undertaken at appropriate intervals to maintain the home as a safe and risk free environment for users. There is a need to ensure that all risks to users are reviewed at frequent intervals, fully risk assessed and guidelines are put in place to reduce risk of occurrence. Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Ensure that care plans are sufficiently detailed to provide staff with enough information to effectively meet users’ needs. Ensure that care plans are reviewed at monthly intervals and that daily records properly validate the content of care plans. Ensure that risk assessments are carried out on activities that may be hazardous to users including bathing and falls. Timescale for action 15/02/07 2 OP7 15 (2) 15/02/07 3 OP7 13 (4) 15/02/07 Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 26 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 OP31 Good Practice Recommendations The Manager of the home should attain a qualification at NVQ Level 4 or equivalent in management and care to enhance their knowledge and skills. There is a need to put in place effective quality assurance and quality monitoring systems, based on seeking the views of service users, to measure the home’s success in meeting its stated aims and objectives. 2 OP33 Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Sotwell Hill House DS0000013135.V327257.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!