Inspection on 24/07/07 for Sycamore Lodge Care Home

This inspection was carried out on 24th July 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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sycamore Lodge Care Home 24/04/06

Sycamore Lodge Care Home 27/09/05

Sycamore Lodge Care Home 20/06/05

Sycamore Lodge Care Home 04/02/05

Sycamore Lodge Care Home 17/06/04

Sycamore Lodge Care Home 02/12/03

Sycamore Lodge Care Home 02/06/03

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Sycamore Lodge Care Home 3-5 Hardy Street Nottingham NG7 4BB Lead Inspector Susan Lewis Key Unannounced Inspection 24th July 2007 3:15pm 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 Sycamore Lodge Care Home DS0000026475.V341222.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 Adults 18-65. 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. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sycamore Lodge Care Home Address 3-5 Hardy Street Nottingham NG7 4BB 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) 0115 978 4299 F/P 0115 978 4299 Mrs Aisha Khan Javed Khan, Dahood Mohammed Younas, Fakhra Parveen Younas Lesley Karen Morton Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2006 Brief Description of the Service: Sycamore Lodge is a converted Victorian property in its own grounds, situated in Hardy Street in Nottingham. The home is registered to provide nursing care for up to 16 residents with a learning disability. The accommodation covers two floors and there are both single and shared bedrooms available. There is a stair lift to provide access to the upper floor for residents with mobility difficulties. There is a minibus available for some of the time and at other times transport is arranged by hiring a minibus and driver. Both forms of transport incur costs for the residents using it. The home is a five minute walk from shops for a person with good mobility and there are public houses, restaurants, places of worship and access to local transport within Hyson Green itself. The fees for Sycamore Lodge vary greatly depending on the diverse needs of the residents and the levels of support they are receiving. The resident’s weekly fees range from £505 - £1,305. The most recent report can be found in the manager’s office. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 6 hours, including teatime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Most of the people who live at this home have a limited ability to understand and communicate. Therefore all judgements in this report are from observation of staff and resident interactions Two members of staff were spoken with as part of this inspection. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. Included in this information is the random inspection that took place on 5th September 2006, this report is not published but a copy is obtainable by contacting the local Commission office. 14 questionnaires were sent to the manager for distribution to residents and their relatives before this inspection to give them the chance to air their views and speak to an inspector directly, twelve were returned What the service does well: All residents are assessed prior to coming to the home to ensure that staff are able to meet their needs. The trained staff are good at recognising when residents need help from other Health care professionals to improve their health and well being. There are enough staff to meet the needs of the residents at the home. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 6 Over half of the staff have achieved their National Vocational Qualification to make sure they are trained to meet the needs of residents who need care. Proper checks are done on all staff who come to work at the home to make sure they are suitable to work with vulnerable people. Residents’ finances are securely held and properly recorded to make sure their interests are protected. The tests and servicing of equipment at the home is done at the intervals suggested and this ensures that residents and staff have their health and safety protected. . What has improved since the last inspection? What they could do better: Residents or their representative should be involved in the assessment process. Where care plans describe a resident’s food dislikes this should be respected and alternatives should be given. Where residents have particular social, cultural and religious needs these should be respected and every effort should be made to enable to resident to participate and to ensure that staff give people the care they need. Some staff could treat residents with more respect for their dignity and the manager could make sure they know the policy and philosophy of the home to avoid poor practice. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 7 When the manager or provider follow up a complaint the response letter could make it clear what action has been taken. The owners could develop the quality questionnaire that will ensure the home is being run in the best interests of the people living there. The manager must tell the Commission about all events, which adversely affect the health and wellbeing of residents so the service can be monitored. 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. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. New residents are assessed before they come to live at the home but are not involved in the process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were viewed including a person who had recently moved to the home. All plans contained detailed assessments from social services carried out prior to the person moving to the home. There was also an assessment carried out by the manager or deputy manager and this informed the care plan. This ensures that staff have all the information they need to be confident that they have the skills and staff levels to support the person. Most people’s care plans looked at had very limited abilities to communicate but there was no evidence to say if they were involved in creating their plan and if in what format that was suitable to the needs of the person, and their families, for example, appropriate language, pictures, Braille. If staff use innovative methods to make the information they give meaningful and Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 10 interesting, the person moving to the home may feel more at ease to share more information about themselves and feel more involved in moving in. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. Residents assessed needs and personal goals are reflected in their individual plan and they are assisted to live full and active lives. However some inconsistencies may lead residents not receiving the care they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans viewed showed that general care plans were well-completed giving details of the assistance residents require as well as what they are able to do themselves. The care plans reflected the preferences of the residents advising care staff what their likes and dislikes were. However there were some discrepancies in that one plan referred to a resident’s dislike of a particular food, yet the diary record of what that person had eaten over the last three months recorded that Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 12 they had been given it to eat. This does not support residents to live their life as they would choose. Care plans included a list of triggers that identify causes of challenging behaviour and provide staff with methods of minimising that behaviour. This ensures that staff are able to provide sensitive and safe care that supports residents rights and dignity. All plans provided detailed risk assessments that supported residents in their daily lives and provided clear action plans that minimised risk enabling residents to live full lives. From reading care plans it was clear that the manager or the deputy manager prepares all the care plans and review them every month. Staff spoken with said that care plans are updated as necessary and may be reviewed more frequently than once a month if a residents needs change more quickly. Staff said they are able to discuss care plans with the manager and that they try to read them regularly to keep up to date as they found them useful. Staff said they are made aware if any changes are made to care plans. Staff were observed making additions to the diary notes at the end of the shift. Relatives are also asked to look at care plans and are written to regularly to keep them informed of how their loved one is. Copies of these letters were seen on the files. This ensures that families remain in contact with their loved ones. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. Residents are able to take part in appropriate activities, which involve them in the local community. Residents are offered a healthy diet, which they enjoy. However, residents’ personal care needs are not addressed in a way which is consistent, safe and respectful, this places them at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans include details of resident’s gender, religious beliefs and any disability but do not record their ethnic origin and did not mention if a resident followed any religious practice. It was seen in a plan that the social worker’s review of a resident that they liked to attend a monthly church service. From further information supplied after the inspection visit each person has a file that provides information regarding their religius beliefs and whether they are ptracticing memebers. A Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 14 simple church service is held each month that people who live in the home can choose to attend or not. Where people express a desire to atend church staff are provided to ensble them to go. All care plans viewed provided information on how the person spent their time at the home. Some residents did more during the week and this, from what the care plan said, was as a result of the residents’ choice or as a result of their age and mobility. It was also apparent that where residents had communication issues staff had received specialist training to ensure that they were able to maximise the persons experience in the home. On the day of the inspection visit seven residents had gone on holiday with staff. This shows that the staff support residents to experience community life outside the home. Care plans also identified that residents went to local pubs for meals and enjoyed using the minibus for trips out. As mentioned in standard 2 care plans showed that family members were kept informed about the person and residents were encouraged to maintain contact with their families through visits and letters. Care plans showed daily routines are on residents’ activity planners. Staff said that the routines are different for each resident to take into account their preferences. During the course of the inspection a number of residents had been seen moving freely around the home. At the end of the inspection as a new staff group came on duty the inspector noticed that a member of staff had placed her chair in the doorway of the lounge and was sat there preventing residents from leaving the lounge. This was observed for at least five minutes and then was brought to the officer in charge’s attention who told her to move. This does not support residents’ rights to unrestricted access in the home. In a subsequent telephone conversation with the manager she reported that the staff member had been disciplined and been told to reread all residents care plans. There is a four week menu which does not provide a choice of meal, although staff said that alternatives are available if wanted. In further information provided after the inspection visit this is due to the diverse range of dietary needs and approapriate diets are therefore provided to meet these needs, such as lactose intolerant, gluten free and diabetic. Therefore specialist diets are provided to those who need it to ensure their nutrtional needs are met. Staff said that meals are taken in the dining room, however this space is not large enough to take all residents at once but staff said that residents come in groups to have their meal and this way they can provide them with the individual help they need. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Residents receive personal and health care support in an appropriate way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with said residents are given help with their personal care as needed and care plans provide guidance and suggestions on how to do this to maintain the dignity and safety of the person. Staff said where residents have the ability to do things for themselves this is supported and where possible they choose their clothes for that day otherwise staff prompt appropriate choices with the person. Staff said they respect residents’ privacy and dignity when assisting them and were able to give examples in their day to day practice where this took place. Staff were seen assisting residents in a relaxed manor and residents were comfortable with staff. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 16 Care plans and diary notes showed that residents are able to access healthcare services including dentists, opticians and chiropodists. Staff confirmed that residents were supported to access these services ensuring that their health needs are met. A separate file documented residents’ healthcare support and any appointments they may have. Only qualified nursing staff who have been assessed as being competent to give out medication do so, and this is usually a senior member of staff. They pharmacist provides training in the safe handling and administration of medicines. Staff described the correct practices for administering medication and said that they felt that medication was handled in a safe and correct manner with residents. Medicine Administration Records were fully completed ensuring residents received their medication as prescribed. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. Residents’ concerns and complaints are responded to and investigated but it is not always clear what the outcome is. Staff have the skills and training to protect residents from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff said they were aware of the complaints procedure understood their responsibility to support residents to make a complaint or make one on their behalf. This ensures that residents are able to make complaints. Staff knew where the policies for safeguarding adults and whistle blowing and the Nottinghamshire adult protection procedures are stored. Staff said they have had training on safeguarding adults, this was supported by training records. Staff have the skills and knowledge to ensure that residents are protected from abuse. There have not been any safeguarding adults investigations at the home. Looking at the complaints log for the service, a complaint was received by the manager from a visiting social worker who observed a member of staff walk a resident naked through the home and over heard another say ‘You better behave yourself now we have visitors’. A response letter was seen, however it Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 18 was not clear from this what the outcome was or what action was taken. In discussion with the manager following the site visit she reported that the members of staff involved in the incident had been disciplined. Records of residents’ personal allowance showed what money was spent on and it was checked at the end of each shift to ensure it was correct. All records were signed and were clear and no obvious errors. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. Residents live in a homely, comfortable and safe environment, which is kept clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the building showed that the lounges were clean and the fixtures and fittings were in good order. Residents were seen using several communal areas, sometimes alone and sometimes with others. There are two lounges and a large reception area that has comfortable seating in. The smaller lounge is also used as a relaxation room with lighting and music. The main lounge is mainly where the television is watched. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 20 Residents are able to access their bedrooms. There is a pleasant enclosed garden which resident can also use. Staff said the home is kept to a good standard of cleanliness and records showed that they had training on infection control. There are suitable arrangements for managing laundry, including making sure there are not any infection risks posed. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. Recruitment procedures are robust and protect residents from people who may abuse them. Staff receive training to enable them to carry out their role in supporting residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with said that the home is always staffed properly with the correct number of staff on duty. The home employs male and female staff and they are of varying ages and different ethnic and cultural backgrounds. Ensuring residents with different cultural and social needs can be supported. A sample of staff files seen showed the correct recruitment practices had been followed. Staff training records showed that regular training is provided and staff confirmed they have regular training including Learning Disability Award Framework training and National Vocational Qualification level 2. This is ensures that staff are competent to carry out their role. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. The systems are in place to ensure that the home is well maintained and staff know what is expected of them, however it is not always clear that the home is run in the best interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was not present during the site inspection as she was away with seven residents on a unit holiday. However she was spoken with on her return in a telephone call to ensure she was aware that the inspection had taken place and what had been observed. The manager is registered with the Commission and is suitably qualified. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 23 In discussion with staff they said that she gave clear guidance and direction as to the standard of care she expected. Paperwork was recorded in a clear and structured way. The home has a copy of the Quality Tree quality assurance system but the officer in charge on the day of the site visit was unable to give any information regarding this. The pre inspection information mentions that they need more information to put it into action. The registered person carries out a monthly check of the premises and informs the Commission of the outcome to ensure that they know what is going on wihtin the home. All staff receive mandatory training this includes Infection Control, Moving and handling, Fire Training, Health and Safety, and First Aid It was noticed on a care plan that a resident had restraint used. Although this was fully documented in the diary notes describing the restraint used and why including length of time instigated, the Commission was not informed as it should be according to the Care Home Regulations. This is to ensure that any incident that may adversely affect the resident can be monitored. Staff spoken with said that they had received training on how to use restraint techniques safely. Information from maintenance records showed that fire training and drills took place and that the systems were checked regularly. Sycamore Lodge Care Home DS0000026475.V341222.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 Adults 18-65 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 YA2 Regulation 14(1)(c) Requirement Timescale for action 01/10/07 2 YA7 12(2) 3 YA16 12(2) Where appropriate residents must be involved in their assessments to ensure that all their needs are identified. Where care pans identify a 01/09/07 resident dislikes a particular food staff should be aware not to give that food to a resident to ensure that residents are supported to make decisions about their lives. Unless risk assessed 01/09/07 otherwise residents should have free access around the home and staff should not prevent residents moving freely from communal areas. This ensures residents rights and dignity are respected. The manager must inform the Commission without delay of any incident which may adversely affect the residents wellbeing. Where restraint has been used by staff on a resident this DS0000026475.V341222.R01.S.doc 5 YA42 37 01/09/10 Sycamore Lodge Care Home Version 5.2 Page 26 must be reported to Commission so that it use can be monitored to ensure the well being of residents. 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 YA22 Good Practice Recommendations Clear outcome of action taken with complaints. Sycamore Lodge Care Home DS0000026475.V341222.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 - 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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