Inspection on 20/06/06 for The Briars

This inspection was carried out on 20th June 2006.

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

The Briars 24/06/09

The Briars 27/06/07

The Briars 23/03/06

The Briars 30/08/05

The Briars 31/03/05

The Briars 07/01/05

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 Briars 4 Station Road Thornton Cleveleys Lancashire FY5 5HY Lead Inspector Ms Jenny Hughes Unannounced Inspection 20th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Briars Address 4 Station Road Thornton Cleveleys Lancashire FY5 5HY 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) 01253 854722 Mrs Ellen Hewitson Mr Martin Paul Hewitson Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd March 2006 Brief Description of the Service: The Briars is situated in Thornton Cleveleys near Blackpool, shops and amenities are nearby. It is a detached property offering residential care for 15 elderly persons. There are bedrooms on the ground and first floor, 13 are single rooms, two of which are ensuite. There is one double room on the ground floor. Bedrooms are pleasantly furnished, as are lounge and dining areas. A passenger lift facilitates access to the first floor. There is a large main lounge and a dining room, with a sun lounge facing the garden, which is also the designated smoking area for residents. A pleasant garden area is available for the use of residents. The home has achieved the Investors in People Award. Information about the service the home provides is available in the form of a standard brochure, and also a detailed and clearly written guide which tries to cover everything a resident needs to know about daily life in the home. Copies of these can be found in the entrance hall, along with a copy of the latest CSCI report. As at 12th June 2006, the fee scale ranges from £329.50 to £350. The families of the residents arrange any payments made to additional services such as chiropodist and hairdresser visits. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit to the home, in that the owners were not aware that it was to take place. The length of the visit was for 5 hours. Before the visit took place, the owner/manager was asked to complete a preinspection questionnaire, and surveys were received from residents and their relatives, and visiting professionals. During the inspection visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. The manager, residents and care staff were spoken to, along with a relative who called during the visit. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: What has improved since the last inspection? Where needed suitable heaters have been placed in bedrooms, removing those considered a risk to the resident. Care plans are available to be viewed by all staff, with a senior carer always on duty to pass on further information to staff when needed. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 6 Formal reviews of care are carried out, and are discussed with the resident and relatives, with a signature from both when possible. Induction training of new staff is recorded. A training matrix is in place, which clearly shows what training all staff members have attended. Some medication procedures have been improved, with more secure storage, and more efficient records on receipt and disposal of medication. There have been improvements in the systems used to create the care plans and review formats for each person. The manager and staff now need to consolidate and sustain these systems, and this will be evidenced at the next inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information the home gives to people about the services available means that proper choices can be made about the suitability of the home. The information gathered and recorded about new residents is not always complete, meaning that the service may not be able to meet some residents’ needs. EVIDENCE: Individual records are kept for each of the residents, and there is a set procedure for admitting someone to the home, with a pre-admission assessment form being seen on three selected files. These are used by management to check that staff can give suitable care to each person, before the manager agrees that the home is the right place for them to live. The assessments are signed by the resident or their family to show that they agree with it. One of the files viewed had an incomplete assessment, although staff were aware of the needs of the individual. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 9 The owner confirmed that the systems are continually being developed over time, and this was evident from the differing types of assessment records in the files, with the most recent showing good improvement in the information it provides about the resident. These improvements need to be sustained, and will be examined again at the next inspection visit. One visitor commented that her relative asked to stay at the home on a permanent basis, following a short respite stay there, because she liked it so much. GP’s responses to a survey said that the home always communicates clearly and works in partnership with them, and staff show a clear understanding of the care needs of the residents. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a developing care planning system in place, which adequately provides staff with the information they need to meet service users needs. Where medication systems are in need of action, the owner is working towards improvement to ensure the safety of the residents. EVIDENCE: Individual care plans are available, identifying the areas of need for each person, and with instructions for staff for what they must do to meet that need. The owner regularly reviews the way things are recorded, and tries to improve the information and instructions to staff to make improvements to the lives of the residents. There were some gaps in information, but staff were able to give a verbal update. Again improvements need to be constant and sustained, and will be examined at the next inspection. Daily notes made by staff for each resident are very clear, and all contact with health professionals, and the care agreed, is also recorded. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 11 One resident, who requires regular district nurse input, is able to stay at the home following a detailed care plan, and staff training and supervision, so that they are able to meet that person’s needs. Appropriate equipment such as a special mattress and cot sides on the bed, alongside ongoing liaison with nursing staff, and daily records and information, means that the care provided is very effective. Care plans were signed and dated when possible by the resident or their representative, to show that they were involved in deciding what the care needs were. Reviews are carried out regularly, signed and dated, again where possible by the resident or relative. A relative commented, “The owner always lets us know as soon as anything happens. For instance he rung me to let me know there had been a problem, and that the doctor was called. And today, as soon as the staff saw me arrive, they let me know how mum was”. “If you ask for anything, they get it straight away you know”, said a resident. “I ask them to speak to the doctor for me, and they make sure he sees me”, said another. Residents can choose to go where they wish in the home, and may see visitors in the lounges, or in their own room. Some residents prefer to stay in their own room, where staff were seen to knock and wait for an answer before entering. “I like to sit in my room quietly, but sometimes I sit in the lounge and join in what’s going on there”, commented a resident. A visitor said “I pop up to mum’s room if she’s not in the lounge, and we have a chat up there. I’ve brought my grandson today, she’ll like that”. The pharmacy inspector examined the medication procedure on 12th June 2006. Some requirements were made, and a separate report is available. The procedures had been improved since the last pharmacist inspector’s visit, but the quality of the handling of medicines was still found to be inadequate, with further improvement required. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 12 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 and 15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents daily lives and social activities are catered for, and all people benefit from living in a home that works hard to try and ensure that people are provided with opportunities to live lives that are fulfilled. EVIDENCE: The individual care plans include information on each person’s likes and dislikes. The residents said that visitors are welcome at the home at any time, and some called during this site visit, obviously relaxed and at home with the staff and owner. Activities are organised, such as gentle exercise with a T’ai Chi instructor, games of bingo, outside entertainers, clothes parties, and indoor games. The owner occasionally takes some residents out for a drive in his car for a change if they wish, and has also held a barbeque in the garden, which the residents said they enjoyed. One resident said, “Some of us like to try and join in, but not all of the people here want to”. A staff member commented, “We try to think of different things for the residents to do.” A relative said, “The owner is great with the residents. He gave them all a rose on Valentine’s Day, and flowers on their birthday. I thought that was lovely”. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 13 Religious needs are met by visiting clergy. Residents said they are able to rise and retire when they wish. “I like to get up at 8 o’clock”, stated one resident, I wake up so I have to get up, I can’t stay in bed. I come downstairs and might have a little read.” Most of the residents enjoy their breakfast in bed, before they arise to either sit in the lounge, or stay in their rooms. The owner has a medium sized dog, which happily trots around the home visiting all of the residents in turn. Staff address any diverse and individual needs in order to make sure each person is cared for equally, and feel as much at home as possible. Residents who are unable to join in the communal part of the home are visited regularly by staff in their room, with a special visit by the home’s dog as well if that is their wish.” I like to see the dog. I like to stroke it. I used to have a dog at home”, said a resident. Visitors call in the home through the day, all recorded in the visitors’ book by the front door, with some service users enjoying trips out with family. The sample meal taken was steak and kidney with mashed potatoes and vegetables, followed by apple pie and custard. Most residents ate their meal in the pleasant dining room, while others preferred to eat in their own room. Staff quietly served the meal, tactfully helping where necessary. “We don’t have a set menu here”, stated the owner, “we buy our groceries fresh through the week, and everything is home-made. We ask the residents what they would like to eat, and take it from there. Our cook and staff who help in the kitchen have completed a food hygiene course. We’ve tried to vary the food we provide, for instance with spaghetti, but in the main residents prefer simple, basic meals, although we would be prepared to make something different if anyone fancied a change”. “Lovely food”, commented a resident. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 14 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 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a detailed complaints procedure in place, and it is readily available for residents and their visitors in the Service User Guide, and in the entrance hall to the home. A complaints book records any complaints, which have been made. There have been none since the last inspection. Residents spoken to said they would “tell any of the staff” if they were not happy with something. Several ‘thank-you’ cards and letters from family and friends were seen on the notice-board in the hall, although some of these were up to two years old. Staff spoken to knew about the Adult Protection procedure, and what to do if they had any concerns. They said they would always act if they thought a resident was at risk. Also if it were a member of staff causing concern they would inform the owner. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 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 and 26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a generally well-maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant, and homely place to live. EVIDENCE: The small lawned garden at the rear of the home is usually kept neat and tidy, with patio furniture for residents to use in the better weather. A wooden bench placed under the shelter of trees keeps residents out of the sun. This pleasant seating area was spoilt at the visit by a large number of cigarette butts left on the lawn by staff during breaks. These should be removed by the staff they belong to, so as to make sure the residents continue to have a nice garden and outlook. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 16 “I don’t like sitting outside. I’ll watch from the lounge window though”, commented a resident. “I might sit outside sometimes”, added another. Generally the décor in the home is of a good standard, making the environment a homely and relaxing place to live. At the time of this visit, the handyman was painting and varnishing doors and wood surrounds in the home. All of the rooms viewed were nicely decorated, and where there is a need for some refreshing the owner has the work as part of a plan of ongoing maintenance and decoration. For example, a small damp patch in the corner of the lounge has occurred due to damage to the flat roof. This damage has now been repaired, any leakage stopped, and the lounge is ready for some redecoration. The manager stated that this has to be organised so as to cause the least amount of disruption to the residents as possible. The bedrooms were full of residents’ personal possessions, with pictures, photographs, and ornaments filling the rooms. “It’s very warm and homely,” commented a visitor. Grab rails, assisted bath, raised toilet seats and a lift all go towards helping the mobility of people around the home A handyman is employed to deal with the day-to-day work that staff record on a board in the kitchen, such as new light bulbs, or minor fixes to fixtures and fittings that have broken. The owner said “I keep an eye on what needs doing in the home maintenance-wise, and tell the handyman each day”. A suggestion was made that staff record any small maintenance jobs in a book, so that the handyman could sign and date against them to confirm the work had definitely been done. Environmental Health had visited the home in May 2005, and confirmed that there were no problems. A fire officer had visited the home in May 2006, and confirmed that some work needed to be carried out to comply with fire regulations. This work has been completed. Staff records show that they all have fire awareness training. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 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, 28, 29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is properly staffed, which means that the residents are supported by sufficient numbers of trained staff. EVIDENCE: Staff files showed that the necessary recruitment checks had been carried out to ensure the protection of residents. References and Criminal Records Bureau checks were available. The owner has updated the application form used to include more relevant information. All new staff have induction training, which gives guidance and information on their terms and conditions, and working practices in the home. The staff group are a mix of long term, experienced, and younger male and female carers. The rota showed appropriate numbers of staff on duty at the home every day. At the visit the owner and two care staff were on duty, and the handyman was at work. Basic training has been attended by staff, including moving and handling, first aid, food hygiene, and fire safety. A moving and handling video is used for The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 18 staff refreshers, but advice was given that staff also should attend formal training to make sure they carry out procedures safely. NVQ Levels 2 and 3 are attended, and 60 of the staff have achieved NVQ qualifications. The owner stated, “ We look for other courses outside of the NVQ, for example, staff attended a Dementia Awareness course”. Staff said, “You get plenty of support. Most of us are NVQ trained now, and we like to make this place as homely as possible for everyone. I think all of the staff get on. It’s a nice place to work. Our priority is the residents”. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 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, 33, 35 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The present manager has a vision for the home, and has a good understanding of the areas in which the home needs to improve. He is supported well by senior staff who have a good understanding of residents’ support needs. EVIDENCE: The owner/manager has worked in residential care for just over two years, and is attending the NVQ Level 4 Registered Managers Award. He is supported by some experienced care staff in the home, and is keen to gain as much experience as possible and develop the home to a good standard. A visiting relative confirmed that she is always able to speak to the owner and staff about the care provided, and felt it was a friendly place to be. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 20 A survey is used by the home to find out what the residents and their relatives feel about the care they receive. The last one was sent out in February 2006, prior to the last inspection, when the responses were all good. CSCI survey forms are left on the hall table for people to complete and return as they wish. Residents’ meetings are held every three months, and records were seen of the last one, when residents stated that they did not like certain activities, (the clothes party), they were happy with new chairs purchased for the lounge, and residents who were diabetic commented that they were happy with their meals. Staff meetings are also held every three months, and individual staff supervision takes place three times a year, to identify training needs and confirm correct working practices. The manager is not responsible for handling any residents’ finances, and any personal allowances are made available from their families. Some staff has attended moving and handling training, but the manager needs to ensure all staff have been formally trained as part of the home’s health and safety policy. Records are generally up to date, although some gaps were found in recording in assessments, care planning and medication. However, there is evidence that shows improvements are being made, with new systems and staff training. Fire safety issues are discussed, with instructions in place. The Briars DS0000059597.V295869.R01.S.doc Version 5.2 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Briars DS0000059597.V295869.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement The registered person must ensure all medication is administered and recorded as prescribed. (Previous timescale 30/04/06 not fully met) The registered person must ensure all staff that handle medication have received appropriate training and have been assessed as competent. (Previous timescale 30/04/06 not fully met) Timescale for action 30/06/06 2. OP9 13(2)18(1 )(a) 30/07/06 The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 23 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP9 OP9 OP9 OP9 OP9 OP9 OP9 OP3 OP7 Good Practice Recommendations The medication policy should be reviewed and updated as necessary. All handwritten MAR should be double-checked and countersigned as evidence. Regular documented audits of the medication should be carried out and retained for inspection purposes. All medication not supplied in the monitored dosage system should be dated upon first opening. Controlled drugs handling should be reviewed to ensure the storage and recording arrangements are suitable. All patient information leaflets should be obtained and retained for information and staff training. All prescriptions should be seen and checked prior to the pharmacist dispensing. All pre-admission assessments should be fully completed to make sure the home can meet the individual needs prior to admission. The developing care plan system should at all times hold complete and detailed information about each person’s needs and how to care for those needs. This system should then be continuous and sustained. The garden area should be kept tidy and attractive, with any unsightly rubbish such as cigarette butts removed. All staff caring for residents should have moving and handling training. The manager should continue to attend and subsequently achieve the NVQ Level 4 Registered Managers Award 10. 11. 12. OP19 OP30 OP31 The Briars DS0000059597.V295869.R01.S.doc Version 5.2 Page 24 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. 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