Inspection on 21/02/06 for The Alders

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Alders 20/11/08

The Alders 07/02/08

The Alders 11/10/07

The Alders 23/08/06

The Alders 27/04/05

The Alders 11/01/05

The Alders 20/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Alders 1 Arnside Crescent Morecambe Lancashire LA4 5PP Lead Inspector Mrs Joy Howson-Booth Unannounced Inspection 13.00 21 February 2006 st 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 The Alders DS0000059652.V256422.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. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Alders Address 1 Arnside Crescent Morecambe Lancashire LA4 5PP 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) 01772 825825 Calderdean Ltd Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home shall at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission 27th April 2005 Date of last inspection Brief Description of the Service: The Alders is situated in a residential area of Morecambe, close to shops and local amenities. There are three lounges and a through dining room and these are used for a variety of purposes and provide residents with a choice of where to sit and who to sit with. Resident’s rooms are all single and have ensuite facilities. There are two stair lifts in the home. In the centre of the home is an attractive courtyard which is used by residents in the warmer months. Residents are encouraged to retain links with the families and friends and contacts in the local community. The Alders is a no smoking home. The home is owned by Calderdean Limited, the Directors (Mr & Mrs Croft) visiting the home on a daily basis. At present, the home does not have a registered manager, although a new manager is currently undergoing registration with the Commission for Social Care Inspection. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced so the residents, registered provider, manager, staff at the home were not aware of the inspection. The purpose of this inspection was to assess the service against the key National Minimum Standards, which remain outstanding and also review actions taken following the requirements and recommendations made in the previous inspection report. A number of residents were spoken with as well as a visiting friend. Observations were also made of the care staff and it was noted that interactions were respectful and positive. A selection of documents held by the home were examined, including care assessments, care plans, training records, staff files and financial records. Comment cards were received from residents, relatives/visitors and local GP’s. What the service does well: The Alders continues to provide a comfortable and homely place for people to live in and residents all commented that they were happy living at the home.. Feedback received from residents indicated that they felt safe and very well looked after at the home and were very well cared for by the staff. Comment cards were received from two residents, two visitors and from five GP’s. A visiting friend was also spoken with who said that from his observations the care provided was excellent All the written comments received were positive about the home – residents stating that they feel well cared for and are treated well, they feel safe and know who to talk to should they have any concerns. Comment cards received from visitors indicated they are made welcome at the home; they can visit their relative/friend in private; they are kept informed of important matters and are satisfied with the overall care provided. GP comment cards indicated very positive responses with all saying the home communicates clearly and works in partnership; there is always a senior member of staff to confer with; they can see their patients in private; and medication is appropriately managed in the home. Residents are free to follow their own routines and lifestyles and maintain contact with friends and relatives as they wish to do so. The registered providers visit the home daily and are there not only to offer support to the management team but also to talk with the residents and monitor the care provided. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Advice has been provided to the registered provider and manager as follows : Residents should be provided with their own copy of the Service User Guide. The assessment of any potential resident must be thorough to ensure that all areas of needs are identified and assessed to enable the home to make an informed decision as to whether they are able to meet these needs. The care plans for the newer residents are not comprehensive and do not provide staff with information over the resident’s needs and how these are to be met. The care plans should also include social histories, activities, interests, routines, etc., so that staff can use this information to provide appropriate social stimulation and activities that are of interest. The water temperatures were seen to be recorded but there is no record of action taken or any follow up testing to ensure the water temperature is at the required safe level. In terms of recruitment, the manager of the home must obtain all the required documentation that can evidence the person to be appointed is appropriate to work with vulnerable people. This includes references from the last employer and POVA and Criminal Record Bureau checks. This documentation must be obtained for anyone who is to be employed at the home. A recruitment checklist may help to formalise the current system. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 7 Risk assessments were not in evidence in the newer care files and advice was provided that risk assessments must take place for both the residents and for the environment to ensure staff and residents are protected. A number of recommendations have also been included in this report. 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 Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 8 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 The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 9 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 arrangements for finding out about the needs of potential residents are not thorough. This means that resident’s needs are not fully identified and staff at the home cannot then be confident that they are able to meet these appropriately. Standard 6 was assessed at a previous inspection and does not apply to this home. EVIDENCE: A requirement made at the last inspection required that a suitably qualified or trained person must assess any potential residents to ensure the home is able to meet their identified needs. In order to reassess this, two assessment forms for recently admitted residents were examined and, although these forms prompt the assessor to obtain information, they were not fully completed which meant important areas had not been identified or assessed. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 10 Of additional concern was that information written on the assessment form did not appear to highlight the need for further questioning or clarification. For example, one assessment stated that no medical needs but from the list of medication written it was clear that the resident had significant medical needs. On one assessment the information was contradictory to that written in diary notes. A requirement at the last inspection required the home to ensure that all residents are provided with a copy of the Service User Guide. It was confirmed during this inspection that this requirement remains outstanding and must now be met. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 11 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 There is a lack of comprehensive care plans in place in the home which means recently admitted residents needs are not clearly identified, nor is there clear guidance to staff in the home. This puts both residents and staff at risk. EVIDENCE: At the previous inspection a requirement was made to ensure residents care plans provide full information on all aspects of the residents health and welfare. In order to reassess this, three care plans were examined and it was felt that the updated care plans provide good information on the needs of the residents. However, for more recently admitted residents the following was found : The lack of a thorough assessment prior to admission taking place meant that needs were not identified and therefore not included in the care plan. Information that had been put on the assessment was not always included in the care plan – another example, one resident had breathing difficulties but this was not included in the care plan. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 12 Some information appeared contradictory – for example, it was noted on one assessment that the resident was fully continent but, on the daily diary notes it was recorded that staff were aware of needs in this area. This had not been included in the care plan. This means that staff members may be working from memory about residents care needs. A requirement made at the last inspection required the home to put in place residents risk assessments and ensure these are reviewed. On the two care files examined there were no risk assessments in place. There were no weight records in place. There was no clear indication of social interests, daily routines, etc. Information taken from daily diary entries contradicted the recent initial assessment. Admission information had not been completed – for example, property lists. Discussions with residents all confirmed they felt very well cared for by the staff at the home. One resident said that they felt the staff were more like friends. A visiting friend was also spoken with and said he felt the care provided to his friend was excellent. Discussions with staff confirmed they were aware of the care plans. Staff stated they are responsible for completing the daily care diaries for residents but it was not clear that staff were fully aware of the content of care plans. The manager confirmed that the requirements and recommendations made by the Pharmacist Inspector at the last inspection have been fully addressed. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Overall the home has satisfactory outcomes in providing for residents social and daily activities needs. This means that in the main residents are enabled to maintain contact with the wider community and to participate in daily activities if they wish to. Resident’s benefit from seeing their families and friends when they want. Residents are able to exercise choice and control over their lives. Arrangements and planning to provide good nutritional food are good. EVIDENCE: From talking with residents at the home all appear to be satisfied with the fact they are able to follow their own lifestyles, have contact with friends and relatives and access the local community as appropriate. A visiting friend was also spoken with who confirmed they are made very welcome and enjoy taking part in meals, which is recognised as a social occasion. The care plans need to identify individual routines and lifestyle preferences so that staff are able to support and respect residents’ individuality. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 14 Residents confirmed they are able to make choices and are able to have control over their lives. Residents stated that visitors to the home are encouraged and made welcome. A range of activities are provided in house which include – Karaoke, bingo, skittles, indoor bowling, dominoes. These are identified via an ‘activities notice board’ in the home. Residents confirmed they are free to take part or not as they choose and enjoy those activities that are put on. Advice was provided to the manager that if a social history and interests are obtained from residents this can help the staff in identifying and organising activities that are of interest. A minister visits the home once a month to provide a communion service. Discussions with staff confirmed that they encourage residents to follow their own routines and were clear about making sure residents were given choices. The meals provision at the home has been improved with the introduction of new menus. The residents spoken with confirmed the meals have improved and they enjoy the choices on offer. Advice was provided that residents should be consulted over, for example, their choice of milk as the current system of providing only skimmed milk may not be everyone’s choice. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 15 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): 18 Standard 16 was assessed during the last inspection There are systems in place, and training provided, to ensure that residents are protected from abuse. EVIDENCE: The home has a vulnerable adult abuse procedure in place. Discussions with staff confirmed that there is a good understanding of what may constitute abuse and the steps to take should any concerns be raised. Staff confirmed that abuse awareness is covered within the training they have undertaken. One member of staff spoken with did not appear to be aware of the home’s whistle-blowing policy so it may be useful to provide staff with some refresher training - this could be covered through supervision. The management of the home are to introduce a Code of Practice for all staff which will include clear guidance over this and related areas – for example, practices regarding the involvement in resident’s finances. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 16 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): Standards 19, 20, 21, 22, 23 and 26 were assessed and met at the last inspection Standards 24 and 25 were assessed and had a requirement made EVIDENCE: Requirement 24 and 25 had requirements made that a carpet must be replaced and the water temperature must be maintained at 43 degrees Celsius. These two requirements were reassessed and the following found : It was confirmed that the carpet was replaced soon after the last inspection. The water temperature record book was examined and it was noted that whilst some anomalies were recorded it was not clear what action had been taken nor when the problem had been resolved. For example, on 5.1.06 Room 22 had a recorded temperature of 79 degrees Celsius. The manager confirmed this was The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 17 an empty room and a plumber was called but there is confirmation that this excessive temperature had been modified or any update testing. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 18 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): 30 Standards 27 and 28 were assessed and met at the last inspection Standard 29 was assessed at the last inspection with a requirement being made. Staff are still not being properly vetted before employment so that residents may be being put at risk. Training for staff should continue as this means residents can be confident they are being cared for by staff that are trained and competent to do their jobs. EVIDENCE: At the last inspection a requirement was made that the home must maintain a thorough recruitment procedure which ensures the safety of residents. To reassess this, two recently appointed staff files were examined and the following found : Neither a POVA first check nor Criminal Records Bureau check had been obtained for one recently appointed member of staff. References were also of concern – one person had two references but not one from her last employer. For the second person no references were available, although the manager advised these had been received. For this person, the manager was required to obtain further copies of the references and confirm their receipt to the Commission. It was advised that the home should produce and use a The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 19 recruitment checklist to ensure that all documentation can be audited, along with dates sent for and dates received. Since the last inspection, the home has clearly worked hard to ensure staff now have access to and receive appropriate training. Staff records evidenced mandatory training has been provided to most staff, although newer staff spoken with confirmed they are still waiting to commence formal induction training. Staff have also accessed other training including the National Vocational Qualification (NVQ) training in both Level II and Level III. At the present time, there are current 5 staff who have either achieved or are undertaking NVQ Level II. In addition, there are 4 staff who have either achieved or are undertaking NVQ Level III. Other training has included – catheter care, drug administration, diabetes, stoma care, palliative care, care of aging skin, and Psychiatric disorders and depression in elder care. The manager was advised to produce a training matrix which can outline training required, training provided and also highlight when refresher training is needed. The manager was advised to ensure that all copies of certificates are on the appropriate staff members file. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 20 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 and 35 Standards 33 and 38 were assessed and met during the previous inspection Whilst experienced management and staff run the home, the health and safety of both residents and staff is being compromised by inadequate record keeping and the management’s failure to address the requirements of the Care Homes Regulations 2001 made at the previous inspection. The arrangements to protect the residents’ money are good which means that resident’s finances are satisfactorily safeguarded. EVIDENCE: Over the last 12 months the home has endured a period of change with the previous manager leaving and a new manager being appointed. The new manager was previously the home’s assistant manager and is currently The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 21 undergoing registration with the Commission. It was confirmed that the current manager has a range of experience in the care of the elderly, has obtained National Vocational Qualification Level III and is undertaking the Registered Managers Award, with completion expected in the near future. The manager also holds certificates in moving and handling, psychiatric disorders and depression in the elderly, catheter care, drug administration, fire safety, staff supervision, medication and diabetes and Stage A of a Psychology training certificate. Over the last twelve months the registered provider has provided a great deal of management input and support to ensure that the home continues to run smoothly. It is hoped that now the manager and her management team are in place and have clear roles and responsibilities the management of the home will develop further and ensure all the areas of concern outlined in this report are addressed. Financial records examined for residents were examined and found to be accurately maintained. The manager was advised that the charges and payments records should have a dedicated page for each resident thereby ensuring confidentiality and privacy should a financial record be viewed. The charges and payments record should also have more detail and provide a breakdown of costs and contributions. It was noted that a financial contribution had been requested for a trip out. The manager was advised that financial contributions should be discussed with the resident and/or their relatives and consent gained. In addition, if any contributions for outings are to be requested this should also be contained in the Statement of Purpose, Contract and Service User Guide. A requirement made at the last inspection required the home to ensure that staff receive mandatory training and specialist training as identified by resident’s individual needs.. From examination of the training records it is evidence that this requirement is being met. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 22 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 2 X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X 2 X STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X x The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 23 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 OP1 Regulation 5(2) Requirement A copy of the service user guide must be provided to all residents in the home (previous timescale of 30.6.05 not met) Residents who are admitted to the home must be thoroughly assessed by a suitable qualified or trained person to ensure the home is able to meet identified needs. A procedure must also be put in place for any emergency admissions to the home. Confirmation must be sent to the Commission that this requirement has been addressed for any future referrals (previous timescale of 27.4.05 not met) Residents care plans must detail how the needs of the service user are to be met and contain full information over all aspects of the resident’s health and welfare. Service user care plans must also evidence involvement of the service user. Confirmation must be sent to the Commission that the care plans have been fully reviewed and the DS0000059652.V256422.R01.S.doc Timescale for action 28/02/06 2. OP3 14 17/02/06 3. OP7 15 31/03/06 The Alders Version 5.0 Page 24 4. OP12 12 4. OP25 13 5. OP29 19 6. OP38 13 above requirement met. (previous timescale of 31.5.05 not met) Residents routines, preferred activities, social history and preferences should be recorded in their care plan so that activities can be tailored to meet needs The water temperature must be maintained at 43 degrees Celsius and action taken must be evidenced. Confirmation must be sent to the Commission that this has been addressed for the future (previous timescale of 27.4.05 not met) The home must maintain a thorough recruitment procedure which ensure the safety of residents. Confirmation must be sent that the required checks have been obtained for the two staff identified during this inspection (previous timescale of 27.4.05 not met) Risk Assessments for both residents care and for working practices in the home must be clear and reviewed every 6 weeks or sooner, if required (previous timescale of 30.6.05 not met) 31/03/06 31/03/06 17/02/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 25 1. 2. 3. 4. 5. 6 7 8 9 OP8 OP22 OP7 OP33 OP30 OP30 OP35 OP29 OP15 Appropriate scales should be obtained to enable all residents to have their weight monitored Consideration should be given to the purchasing of ski chairs to enable residents to mobilise better Care plans should also include last wishes and financial arrangements The current quality assurance system should be expanded to include residents, relatives, visitors and external professional feedback The manager should ensure copies of all training certificates are held on staff files A training matrix would be helpful to identify training needs, training undertaken and when refresher training is required Separate records should be held for residents charges and payments and these should contain more detail A recruitment checklist may be helpful in ensuring all the required documentation is obtained prior to a new member of staff starting work at the home Residents should be consulted about the milk provision in the home as they may wish to have an alternative to skimmed milk, particularly on cereals. The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 The Alders DS0000059652.V256422.R01.S.doc Version 5.0 Page 27 - 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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