Inspection on 20/12/05 for Swinton Lodge

This inspection was carried out on 20th December 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Swinton Lodge 08/09/09

Swinton Lodge 10/09/08

Swinton Lodge 18/09/06

Swinton Lodge 04/07/05

Swinton Lodge 12/10/04

Swinton Lodge 08/04/04

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

CARE HOMES FOR OLDER PEOPLE Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT Lead Inspector Mike Hamstead Unannounced Inspection 20th December 2005 08:00 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 Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 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. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Swinton Lodge Address Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT 01709 586704 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) Absolute Care Homes (Swinton) Limited Rosaline Baxter Care Home 63 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (28) Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 28 Beds in the Spencer Unit for Old Age (OP) 7 Beds in the Royal Unit for Dementia - over 65 years of age (DE[E]) 28 Beds in the Windsor unit for Old Age (OP), Dementia - over 65 years of age (DE[E]) and Mental Disorder - over 65 years of age (MD[E]) Manager to undertake the Registered Manager NVQ level 4 award by 2005 A condition of registration is that one named resident under the age of 65 be allowed to reside at the home. One respite bed to accommodate service users with residential/nursing care, between the ages of 55 and 65. One respite bed to accommodate service users with EMI residential/nursing care, between the ages of 55 and 65. 04/07/05. Date of last inspection Brief Description of the Service: Swinton Lodge was purpose built in 1989, and is registered as a Care Home for Older People with nursing for 63 beds. It stands in its own grounds and is situated at the end of a cul-de-sac close to a local housing complex, but is close to local amenities and public transport. It is a two story building, divided into three separate units. Two of the units, Windsor and Royal, cater for Older People with dementia and mental disorder, but the Royal Unit is currently not being used due to a shortage of admissions. The third unit the Spencer unit accommodates Older People with varying needs including nursing needs. All bedrooms have en-suite facilities, with 59 single bedrooms and 2 double bedrooms, although one is currently being used as a single room, and the other one is empty. Each unit has a communal lounge and dining room, with tea and snack making areas in two of these. Bathing facilities include specialist baths, showers and hoist attachments for ease of users. There is also a shaft lift. The home offers physiotherapy and a relaxation room. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection methodology consisted of talking with Anne Murray (See the Management and Administration section of this report) and all staff on duty including the acting care manager Wendy Panther and general manager Sharon Thompson, and an examination of the homes records. It also included talking to a number of residents, and touring the building to observe the standards of accommodation. Additional information of the overall situation had been gained from previous inspection visits. The inspection commenced at 08:00 and finished at 16:15 and included talking to members of staff, and residents. What the service does well: What has improved since the last inspection? The management and administration of the home has been reviewed and action has been taken to improve the day-to- day operations via a number of senior appointments to the management structure. There has been a major investment in the refurbishment of large areas of the home to provide high quality living accommodation. Meetings have been held with various agencies to address the declining occupancy levels and there have been improvements in this area. The general atmosphere in the home appears to be much improved with care staff speaking in favourable terms of the new management situation. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 6 Some action has been taken to address the majority of the requirements from 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. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 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 Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The admission process continues to be well managed, and potential residents are provided with sufficient information to enable them to decide whether they would like to live at the home/not. EVIDENCE: A sample of residents files were examined which showed that people are being admitted following a full assessment. This includes a combination of information obtained via residents being referred through Care Management arrangements, and evidence of the homes own assessment documentation that meets this standard. Care and ancillary staff are currently undertaking NVQ training, to demonstrate the homes capacity to meet the assessed needs of residents, and staff training in dementia care is planned for January 2006 within the home, to be delivered by the Alzheimers society. Care staff have had other training sessions on issues such as violence and aggression, and training packs have been obtained on epilepsy, and nutrition. Further training on equality and diversity and nutrition and health was planned under the previous care manager and this will considered by the acting care manager in her new role. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, & 11. Residents continue to be generally well looked after in terms of their health and personal care needs, but immediate attention is required for those residents who have not been seen by the GP in over 2 years, and includes the need for their medication requirements to be reviewed. The home must seek out written authorisation for the restrictive seating used by a particular resident. EVIDENCE: The plans of care for residents in both units, are completed by a named nurse and by care staff, and are reviewed on a monthly basis, and where possible drawn up with the resident/representative as required by this standard. A number of plans of care were examined that are now part of a new Spandex system of care documentation that has recently been introduced, one was in order, but the other one was inadequate, and failed to include dates and signatures of significant events, and this is clearly an identified training need for staff. The social needs and activities undertaken by residents are now Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 10 recorded within the new system and this contributes to the overall care management system for residents. There are 2 residents on the Care Programme Approach, who should both receive consultancy reviews, but staff are still not receiving copies of the notes of such meetings which are an essential component of the residents care management, and must be obtained. The acting care manager is to pursue this matter with the appropriate agency in the interests of the residents concerned. There was evidence to indicate that access to all primary health care facilities for residents has improved but there are still some residents who have been in good health, have not been seen by the GP for over 2 years, contravening the need for an annual review, and also have not had their medication reviewed during this time. The acting care manager is to pursue this matter with the various GP practices to safeguard the welfare of residents. NHS chiropody still continues to be a problem, but arrangements have been made to assess a number of options and costs from a number of private chiropodists to agree the best deal for residents. The home is clearly doing all they can to promote and maintain the health of residents but clearly under difficult circumstances. The Inspector sampled the MAR sheets in the Spencer Unit, and found these to be satisfactory. The home does not have any residents who self-medicate. There were many examples of resident’s dignity being maintained throughout the day, and care staff always addressed residents in a polite and friendly manner. Personal hygiene was provided to residents with respect and dignity. Staff have addressed the matter concerning one resident who was contained on a bean bag type restrictive chair arrangement because of the danger of her constantly falling, and a frame has been designed to contain the bean bag. It is required that the home obtain authorisation in writing from the agency concerned that this type of chair is an acceptable compromise for the resident concerned. Many residents in the home display dementia related confused behaviour, and there were examples of staff treating them in a sensitive and dignified way, assisting them where required. Residents are able to spend their final days in their own rooms, surrounded by their personal belongings, unless there are strong medical reasons to prevent this. Relatives and friends of a resident who is dying are able to stay with him/her, for as long as they wish, unless the resident makes it clear that he or she does not want them to. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15. Residents can enjoy a lifestyle suited to their particular expectations and preferences and receive staff support to achieve this aim. Staff should look to providing more external recreational trips for residents. EVIDENCE: Leisure and social activities are provided and residents can choose what to participate in, and choice is also provided at mealtimes and with the other routines of daily living; such as personal and social relationships, and religious observance as defined by this standard. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 12 The interests of residents are recorded at the assessment stage, and then developed via opportunities being made available for stimulation through leisure and recreational activities in and outside the home. Activities are arranged to suit individual needs, preferences and capacities but a number of residents mentioned that they would like some trips to the coast. Particular consideration is given to people with dementia and other cognitive impairments, and reminiscence sessions are arranged for them to provide some interest and stimulation. A varied programme of activities have been arranged for Christmas, and all residents and staff will receive a Christmas present from the homes management, individually wrapped and labelled. A notice board inside the main entrance displays current and future activities that are planned and there are daily activities organised by an activities coordinator. There are visiting entertainers, dancers, and the “Lost Chord” a musical entertainment group are a monthly attraction. A resident was keen to show the inspector a collage of animal pictures that he had displayed on a large board in the dining room that was being enjoyed by other residents, and residents are able to receive visitors in private. Restrictions are not imposed except when requested to do so by the residents themselves. There are occasional visits from a local Church of England establishment, who provide a service for some residents, but no residents are currently visiting church of their own accord. Residents and their relatives and friends are informed of how to contact external agents (e.g. advocates), who will act in their interests, and there is an information rack inside the main entrance to the home. There are also contact names and numbers for the Alzheimer’s Society on the notice board. There are five residents who have some control of their financial affairs at the present time, and a sample of resident’s monies was checked and found to be accurately recorded with receipts available, demonstrating a responsible approach to resident’s finances. The menus, displayed a good supply of varied and wholesome food, and a cooked breakfast is always available, and hot and cold drinks are available at regular intervals or as requested by residents. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, & 18. Staff have a knowledge and an understanding of Adult Protection issues that promotes the protection of residents, but staff should remain vigilant in recognising when some residents may be making legitimate complaints and recording these on their behalf. EVIDENCE: There is a complaints procedure which specifies how complaints may be made and who will deal with them with an assurance that they will be responded to within a maximum of 28 days, and written information is provided to all residents for referring a complaint to the CSCI at any stage, should the complainant wish to do so. A record is kept of all complaints made and includes details of investigation and any action taken, but there have been no complaints received since the last inspection. The inspector and acting care manager discussed the possibility that some staff were not recording complaints from some residents possibly viewing them as trivial and dealing with them at the time. The acting care manager is to raise the subject of complaints at the next staff meeting to ensure that all staff remain vigilant and record all incidents from residents that could be considered as complaints. The home also has a number of letters from the families of residents thanking staff for the care given to them during their stay at the home. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 14 All residents receive ballot papers and postal votes, and staff enable them to participate in the political process if requested to do so. Two residents voted at the polling station at the May 2005 general election, and other residents used their postal votes. There are procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) to ensure the safety and protection of service users, including passing on concerns to the CSCI in accordance with the Public Interest Disclosure Act 1998. The policies and practices of the home ensure that physical and/or verbal aggression by residents is understood and dealt with appropriately, and that physical intervention is used only as a last resort and in accordance with DH guidance eg, de-escalation/breakaway techniques. It is intended that staff training on physical intervention will be undertaken in the New Year. Any member of staff identified as being unsuitable to work with vulnerable adults would be referred, in accordance with the Care Standards Act, for inclusion on the Protection of Vulnerable Adults register. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, & 26 The home has benefited from a substantial investment in the fabric fixtures and fittings, and presents as a welcoming and homely setting with suitable furnishings and decorations to meet the majority of resident’s individual tastes. EVIDENCE: An extensive refurbishment has been carried out since the last inspection as follows: 1. 8 bedrooms have been redecorated in the Windsor Unit and new beds and fixtures and fittings have been fitted. 2. The reception area has been improved and a partition has been taken down, and a visitor’s toilet has been refurbished. 3. Laundry maintenance has been carried out. 4. The lighting has been improved in all areas. 5. 4 bedrooms have been refurbished in the Spencer Unit and the ceiling has been re -boarded and skimmed in the nurses station. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 16 6. All 7 bedrooms have been completely refurbished in the currently unoccupied Royal Unit pending a decision as to how the home intends to proceed with this unit in terms of the client group to be admitted. 7. A new machine has been purchased for cleaning the carpets, and staff are to undergo training in how to use it. 8. 2 new hoists have been purchased. Proposed new developments may include additional space for day care usage and a conservatory for additional communal space for residents. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. There is a sluicing facility and, a sluicing disinfector, and washing machines have the specified programming ability to meet disinfection standards. Hand washing facilities are prominently sited in areas where infected material and/or clinical waste is being handled. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, & 30. Staffing levels and staffing deployment is aimed at the residents needs to reflect the dependencies of residents at all times. Recruitment and selection procedures are satisfactory, and the staff training needs are being identified. Attention needs to be paid to staff undertaking their NVQ Level 2 training in an effort to obtain this qualification. EVIDENCE: In accordance with the home’s staffing notice for 63 residents, the staffing complement must be an RMN in the Windsor unit and 4 care staff in the waking day, an RGN in the Spencer unit and 3 care staff during the waking day. Night-time staffing requirements are for 1 RMN and 1 RGN and 4 care staff to be on duty at all times deployed throughout the three units. There were 33 residents accommodated in the whole home at this inspection. The staffing situation found on this inspection was that there was an RGN and 3 carers in the Windsor unit on both the morning and afternoon shifts due to the reduction in resident numbers of 20 out of 27. The staffing complement in the Spencer unit was an RGN and 3 care staff in the morning and 2 care staff in the afternoon for 15 residents out of 25. The Royal unit was closed for refurbishment and there have been no admissions to this unit for some considerable time. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 18 All the staff spoken to appeared motivated and committed to providing the best possible care, and a number of the longer serving staff repeated that things were now much better in the home, since the new management arrangements have been in place. A random selection of the files of 2 members of staff employed since the last inspection revealed that the recruitment and selection process was being adhered to and where CRB’s had not been returned staff were working under supervision. There are 33 of care staff who have achieved their NVQ Level 2 qualification, and staff are receiving induction and foundation training to NTO specification. All staff have an individual training and development assessment and profile that demonstrates their ability to meet the assessed needs of residents. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 & 38. The action taken to bolster the management structure of the home should enable there to be a beneficial separation of both clinical and administrative duties in the interests of all residents. Attention must be paid to staff supervision and appraisal, and those health and safety aspects that are overdue. EVIDENCE: Since the last inspection in July 2005, the registered person has appointed Anne Murray & Associates (10th August 2005) an experienced nursing and care home management consultancy company who have been assisting in the general management and running of the home. The registered manager who was due for retirement in 2006 is taking her retirement as from the end of January 2006, and the home have appointed an acting manager who they intend to register as the manager after January 2006. In addition a general Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 20 manager has been appointed and is in post, whose role is to primarily deal with the administrative aspects of managing a care home, and a deputy manager will start in early 2006 to support the acting manager. The acting care manager intends to ensure that her management approach of the home is an open and inclusive one, and that opportunities such as staff meetings and unit meetings will exist for staff to air their views about any issue concerning the care of residents, but also terms and conditions of service. Staff supervision has fallen behind and the acting care manager intends to start an urgent review and remedy this situation. Staff continue to undertake statutory training to safeguard the residents interests. All the safe working practice certificates were examined and were satisfactory with the exception that gas boiler servicing is overdue, and the shaft lift requires a “Thorough Examination”. In addition the Legionella certificate could not be found and is to be faxed to CSCI as soon as possible. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 x x x x x X 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x x x x 2 x 2 Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that plans of care set out the detail and action that needs to be taken by staff and are signed and dated. The registered person must ensure that residents on the CPA programme are reviewed and the home obtains notes of all consultancy meetings held. The registered person must ensure that all residents healthcare needs are being met, with particular reference to the absence of annual health checks and medication reviews for some residents. The registered person must ensure that authorisation is obtained in writing for the bean bag type restrictive chair used for a resident. The registered person must ensure that sufficient external activities are provided The registered person must ensure that the supervision and appraisal of staff recommences. Timescale for action 31/12/05 1. OP7 12 31/12/05 2. OP8 12 31/12/05 3. OP8 12 31/12/05 4. 5. OP12 OP36 12 18 31/01/06 31/01/06 Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 23 6 OP38 12 The registered person must ensure that the health, safety and welfare of residents are promoted and protected. 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP31 Good Practice Recommendations The registered person should ensure that a minimum ratio of 50 trained members of staff NVQ Level 2 or equivalent is achieved by 2005. The registered person should ensure that the Care Manager achieves a qualification at Level 4 in management and care or equivalent by 2005. Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 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 Swinton Lodge DS0000003090.V270242.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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