Inspection on 07/10/08 for St Michaels Nursing Home

This inspection was carried out on 7th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michaels Nursing Home 10/04/08

St Michaels Nursing Home 10/10/07

St Michaels Nursing Home 31/05/07

St Michaels Nursing Home 19/02/07

St Michaels Nursing Home 11/05/06

St Michaels Nursing Home 28/11/05

St Michaels Nursing Home 18/05/05

St Michaels Nursing Home 08/02/05

St Michaels Nursing Home 05/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandra Crosby     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: St Michaels Nursing Home Elm Grove Westgate-on-Sea Kent CT8 8LH 01843835709 01843832905 kerry@charinghealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Charing Lodge Ltd Type of registration: Number of places registered: care home 73 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 73. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Date of last inspection Brief description of the care home St Michaels Nursing Home is a large attractive three storey detached home with small garden areas. It is situated close to the sea and is a short journey to the local amenities. The home is registered for the provision of nursing care for people with Dementia, and has recently added a new extension to provide dementia residential care for 32 service users. Although the Home is registered for 45 nursing dementia care service users, it currently does not use all of these places. The Home employs a manager and a team of registered nurses and care staff for the nursing unit and a manager and care staff for the residential dementia care unit. There are waking night Care Homes for Older People Page 4 of 29 Over 65 73 0 Brief description of the care home staff employed for each unit. There is a shaft lift to access all floors and a call bell system; equipment is also available to ensure that service users can be moved safely. The new extension provides a shaft lift giving access to the first floor, and corridors are wide enough to cope with wheelchair users. Bathrooms in the new extension are supplied with lifting equipment, to ensure that service users can be bathed safely. The managers confirmed that the current range of fees at the home is from #396.84 #580.00, per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate, quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last inspection of 10 April 2008, including a visit to the home. An unannounced visit took place on the 07 October 2008 between 10:00 hours and 16.30 hours. The visit was undertaken by two inspectors and included talking to the registered provider, the manager of the nursing unit, the manager of the residential unit, a manager from another home owned by the company, staff on duty, two Care Homes for Older People Page 6 of 29 relatives and residents. An accompanied tour of some areas of the home was made, and various records were seen. One inspector over the period of the main meal of the day in the Chapel dining room of the nursing unit, observed four residents using the Short Observational Framework Inspection tool. Currently the home does not have a registered manager. There are two people who have been appointed by the registered provider, one to manage the nursing wing and the other to manage the residential wing. These two people are referred to as manager throughout the report. Following the inspection dated 10 April 2008 when the quality rating for the service was judged as poor, the home was required to complete and return to the Commission an improvement plan for the service. It was found at this inspection visit that many of the requirements had been met and that action was being taken to meet the requirements made in this report. The findings of this inspection indicate that this home is improving standards and aims to provide good outcomes for the residents, but there are some areas in relation to health and personal care, dignity and privacy, health and safety and infection control together with some management aspects that need improvement. The registered provider and the two managers of the home are aware of what changes need to be made and are committed to making these improvements. The findings of the inspection visit were discussed in a verbal feedback with the registered person and the two managers at the end of the visit clearly indicating areas where improvements were needed. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be kept up to date in relation to reviews reflecting residents changing needs. Keep a comprehensive record of incidence of pressure sores and of treatment provided to the resident. Ensure that staff follows policies and procedures in relation to the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Staff must ensure that they abide by the privacy and dignity policy and procedures. Management must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. Management and staff must ensure that all parts of the home to which residents have access so far as reasonably practicable are free from hazards to their safety. Care Homes for Older People Page 8 of 29 All staff must be trained in Infection Control, Food Hygiene and Dementia to ensure resident safety. Ensure staff use only appropriate moving and handling transfers so as to safeguard residents and themselves in relation to Health and Safety. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with the information they need to make a decision about moving into the home. Pre-admission assessments ensure that the home can meet residents needs. Evidence: It was evidenced at the inspection visit dated 10th October 2007 that the Statement of Purpose and Service User Guide were satisfactory in providing a clear description of the services offered. Prospective residents have their needs assessed by the manager of the respective service prior to admission. These assessments cover the physical, emotional and diversity needs of the resident. The assessment allows a prospective resident/relative the opportunity to ensure that this is the right service for them. It also gives the home the opportunity to ensure that they have the correct staff and facilities to meet the Care Homes for Older People Page 11 of 29 Evidence: assessed needs. Where a prospective resident is under the care management scheme a copy of the relevant County Council assessment is also obtained. This home does not offer the facility of intermediate care. Intermediate care is a dedicated service with specialised facilities, equipment and staff designed to deliver short-term intensive rehabilitation to enable service users to return to their own homes. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from care plans that mainly show that person centred care is promoted, and mostly peoples healthcare needs are met. The safety of residents may be put at risk because of the need for medication practices to be improved. Residents may not always be treated with privacy and dignity. Evidence: The home produces a care plan for each resident based on the pre-admission assessment. Four care plans were seen and contained the information required by the national minimum standards including a variety of assessments and risk assessments. All care plans are reviewed and updated, however it was seen that some reviews had not been undertaken for example it was seen in one care plan that medication needed to be reviewed on the 05/10/08, there was no evidence seen that this had been done. One care plan showed that the falls assessment was last reviewed on the 04/08/08, even though the risk of falls was determined as high on the 15/08/08 and the last fall recorded as 21/09/08. This plan required updating. Evidence was seen of relative Care Homes for Older People Page 13 of 29 Evidence: participation in the review of a care plan from the residential unit. The home are beginning to produce life books for the residents to enable the staff to understand the residents history and lifestyle, which in turn helps them give more individualised care. One life book that was seen contained comprehensive information including pictures about the life history of the resident. There was evidence on all care plans viewed, and from discussion with some residents and visitors to the home that residents have access to all specialist care from opticians, chiropodists, dentists, hospitals and community health services mainly as and when required. A requirement was made in the last report regarding nutritional screening. This is now being undertaken and where there are concerns about weight loss an additional assessment tool is completed and advice is sought from the relevant GP. Another requirement was made at the last inspection regarding the recording of pressure areas and treatment. There has been some improvement in record keeping however further improvement is still needed to ensure the records provide comprehensive information about the treatment provided. It was discussed that consent would be needed if photographs were taken to form part of the wound care records. On records seen there was no pain chart being used even though changes to medication had been made due to the level of pain experienced by the resident. It was observed on two occasions that pressure areas are being compromised by poor bed making techniques, worn and badly creased sheets that are not pulled smooth under the resident. It was further noted that the turning charts in two residents bedrooms showed long periods of time without staff signature confirming that the resident had been enabled to change position. One chart for the previous day had not been completed from 2.00pm to 7.00pm. Again this may compromise skin integrity. The medication records were seen for the Nursing Unit. Gaps were again seen in recording, and it was difficult to ascertain if the medication had been administered and not signed or not given. One of the medications checked in the controlled drugs book indicated that a large stock of the medication was being held in stock, and following discussion the manager agreed to address this issue. Medication records were seen for the residential unit these were mainly appropriately signed and up to date. Consents were seen signed by family confirming GP agreement to the crushing of tablets for one resident. In relation to persons being treated with dignity, it was observed that staff in the residential unit were interacting appropriately with the residents and treating them Care Homes for Older People Page 14 of 29 Evidence: with respect. It was observed on the nursing unit that in one bedroom the call bell was left out of reach of the resident, and with the bedroom door being closed it would be difficult for the resident to receive assistance especially as the hourly turning chart was not recorded as staff having assisted the resident to change position hourly. It was also seen that in one bedroom the warm beaker of tea was left out of reach of the resident, and no staff member was in the vicinity and in the lounge area a cup of tea was seen out of reach of a resident. Since the last inspection improvement was seen in the tea trolley set up for drinks. A new trolley has been purchased and this was clean and tidy at the time of the inspection visit. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can mainly be confident they will have satisfactory opportunities regarding lifestyle choices, however lack of fruit and dry food stores may restrict food choices. Evidence: One of the inspectors was able to speak with one of the activity co-ordinators who was providing activities at the time of the last inspection visit. Activities undertaken include for example catchball, big dominoes, use of a light stimulation machine, memory games, quizzes and planting in the garden weather permitting. At this inspection visit it was seen in the residential unit that two residents were playing cards, a group of residents were watching television in the main lounge and other residents were seen walking around the unit. Good interaction was witnessed between staff and residents. Residents are encouraged to maintain contact with their family and friends. A visitor present on the day of the visit confirmed that the home makes them welcome. Links with the community are good and this helps to enrich the residents social lives. Some Care Homes for Older People Page 16 of 29 Evidence: residents are able to go out with their families at weekends. Residents preferences are recorded in their care plans. Choices of time of getting up and going to bed are recorded with some stating variable. In the residential wing residents are able to choose where to sit, who to sit with, whether to join in activities or watch television and are able to wander around the unit without hinderance. It was stated in the last inspection report that where it is possible residents are encouraged to make decisions in regard to their daily lives and financial affairs. Due to the level of dementia all of the relatives have power of attorney for the residents financial affairs. If requested residents can have access to their own care plan or can request that their relatives are given access. Many of the rooms viewed throughout the home showed that residents are given the opportunity to bring personal possessions into the home with them. The home currently operates a two-week menu rotation but the chef is currently in the process of changing this for a four-week menu. He is also preparing visual menus to aid residents in their choice. There is a choice of meal at all mealtimes but very little fruit is available and following discussion the manager agreed to address this issue. Residents commented the food is good, the food is not bad on the whole, we have a choice but we do not get any fruit. A visitor commented I think the food is very good I eat here with my husband sometimes. It was observed that there was very little dried food storage at the time of the visit, and when later discussed with the registered provider and manager, it was indicated that a delivery was due the next day and assurances were given that this issue would be addressed. It was reported in the last inspection report about the poor delivery of the main meal of the day on the residential unit. The manager of the residential unit confirmed that a suitable heated trolley has been purchased and this is now used to serve the meals on the unit. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and visitors know their complaints will be listened to and acted upon. Some staff have good knowledge and understanding of adult protection issues, which protects the residents from abuse. Evidence: The home has a copy of their reader friendly complaints procedure on display and accessible for residents and their representatives. The number of complaints received has reduced over the past few months. All complaints are investigated within the statutory 28-day period. A discussion was held with the manager regarding the recording of complaints to comply with the requirements of Data Protection. The home is in the process of updating their staff training in the Protection of Vulnerable Adults. A training session was being held in the home on the day of the inspection visit and was due to be attended by 19 staff. Up to date training will enable staff to ensure that the residents are protected from abuse. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a mainly clean and comfortable home but cannot be sure that the environment is safe. Evidence: The home is suitable for its stated purpose; it has recently been extended to provide a residential dementia care unit for 32 residents in a care home setting. The original building provides nursing care for 41 residents with dementia. In the nursing unit, the communal areas on the ground floor have been refurbished, and work is ongoing in relation to redecoration and refurbishment of bedrooms in this unit. It was seen that hallway and stairs carpets have been renewed. The registered provider has provided a development plan for the home and at the time of the inspection visit work was in progress both inside and outside the home. A discussion was held on the day of the visit about the staff room and office that needs to be upgraded on the nursing unit. A new mechanical sluice is now in place and operational, as at the last visit the sluice machine was not working. In discussion with the registered provider he confirmed that the sluice areas were to be upgraded. Care Homes for Older People Page 19 of 29 Evidence: There were areas in the home that were not particularly clean and an odour was also noted in several areas of the home. This needs to be addressed without delay as it could compromise infection control. Although the home does have some infection control procedures in place they need to address the issue of some clinical waste bins that either do not have foot operated openings or these are broken. Quite a few members of staff have not received up to date training in infection control and this had been covered under the section of staffing. The home does not use CCTV cameras. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective staff team, in sufficient numbers to meet their needs, is available to support residents. Staff training needs to be further developed to ensure that all care staff have the skills and knowledge to meet the needs of the residents. The managers must ensure that all staff employed are properly vetted to protect the residents. Evidence: The requirement regarding staffing levels made on the last report has been met at the present time. A recruitment drive has taken place and several new staff are now in post with more appointments planned. The only agency staff currently employed at the home are Registered Nurses. A visitor commented its much better now they have more staff on duty. NVQ training for staff has improved in the home. There is now over 50 of care staff who either have or are working towards NVQ in care at Level 2 or above. The home has a clear recruitment procedure. No member of staff is employed until two references and a satisfactory check of the Protection of Vulnerable Adults register have been obtained. Where a member of staff starts work prior to receipt of the enhanced disclosure from the Criminal Records Bureau they work under supervision until this is obtained. Currently the home does not ensure they have a full employment history for Care Homes for Older People Page 21 of 29 Evidence: all staff, with gaps explored and they were reminded of this at the visit. There have been improvements in staff training over the past six months, and there are a lot of training sessions booked. However there are still shortfalls mainly in Infection Control, Food Hygiene, and Dementia. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can mainly be confident that their home is well run. The health safety and welfare of service users and staff is compromised by shortfalls in statutory training. Evidence: Since the last inspection visit the then acting manager resigned, and the deputy manager of the nursing unit has taken on the role of manager for this unit. She is a registered nurse and is about to undertake the Registered Managers Award. The home is run as two separate units with a manager for each of the nursing and residential units. Neither of these managers has yet applied for registration with the commission. It is a requirement that all registered premises should have a registered manager. The home has quality monitoring systems in place. Questionnaires to families and staff of the nursing unit are due to be circulated in January 2009. The last analysis of Care Homes for Older People Page 23 of 29 Evidence: results was produced in 2006. The residential unit circulated questionnaires in May 2008 and an analysis has been produced. Two main problems were identified as a result of these questionnaires regarding the lack of staffing and the laundry and both have been addressed. The managers carry out a variety of regular audits including accidents, medication complaints and environmental risks. Staff meetings are held monthly. The manager of the residential unit also holds relative support meetings two/three monthly and the manager of the nursing unit is planning to also start these meetings. It was reported at the last inspection visit that where service users personal allowances are handled by the home they were well managed with clear accounts being used for each service user and receipts kept for all expenditure. Each resident has their own account sheet, where monies coming in and going out are recorded; all receipts are kept of expenditure. Monies are kept in individual envelopes and retained in a place of safekeeping. These records were not seen at this visit. The health safety and welfare of service users and staff is compromised by shortfalls in statutory training as mentioned under the section on staffing. It was observed whilst undertaking the Short Observational Framework Inspection tool in the Chapel dining area of the nursing unit, that an inappropriate moving and handling transfer was undertaken by two members of staff. The resident was turned in the wrong direction and the brakes were not on the wheelchair. It was also observed that two of the wheelchairs seen used only had one footrest and residents were aided to put both feet onto the one rest. These issues were discussed with the manager and she agreed to take action to address these issues. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording, handling, safekeeping safe adminsitration and disposal of medicines received into the care home Do not keep in store more than an appropriate number of controlled drugs Ensure that MARS sheets are appropriately signed when medication is administered 31/10/2008 2 10 12 The registered person shall 31/10/2008 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users Ensure that calls bells are within the persons reach Ensure that drinks are within Care Homes for Older People Page 26 of 29 persons reach or provide assistance as appropriate Ensure that bed linen is to a suitable quality and not creased Ensure hourly change of position is maintained and recorded appropriately 3 26 16 The registered person shall 31/10/2008 (k) keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste Use only appropriate clinical waste bins Keep the hone free from offensive odours 4 27 18 The registered person shall 31/12/2008 having regard to the size of the care home and the number and needs of service users (a) ensure that at all times suitably qualified competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of service users Staff require training in for example Dementia, Infection Control and Food Hygiene 5 31 8 The registered provider shall 07/01/2009 appoint an individual to Care Homes for Older People Page 27 of 29 manage the care home where - is not or does not intend to be in full time day to day charge of the care home An aplication must be submitted for a manager to become Registered Manager of the home within three months of the date of this inspection Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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