Inspection on 11/07/07 for The Dales

This inspection was carried out on 11th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE The Dales Draughton Skipton North Yorkshire BD23 6DU Lead Inspector Sean Cassidy Unannounced Inspection 11th July 2007 09:00 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 Dales DS0000069339.V345850.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 Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dales Address Draughton Skipton North Yorkshire BD23 6DU 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) 01756 710291 01756 710629 belinda.green@barchester.com Barchester Healthcare Homes Ltd Care Home 56 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (19), Old age, not falling within any other category (37), Physical disability (37), Terminally ill (4) The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users in DE(E) and MD(E) to be accommodated soley in the Devonshire Unit (OP), DE(E), MD(E) 60 years and upwards Service users in the category PD must be: I) aged 50 years and upwards for permanent placement and ii) aged 40 years and upwards for short respite placements for no more than 2 service users at any one time. Date of last inspection Brief Description of the Service: The Dales offers nursing and personal care for up to 56 residents aged 60 years upwards for people with dementia, mental disorders, physical disabilities and end of life care. The home has two floors, with a vertical passenger lift to aid access to the first floor. The home is split into three units. Residents requiring nursing support are cared for on the ground floor, in the Pemberton and Clifford Units and there is a separate Dementia Unit on the first floor called Memory Lane. Twenty bedrooms have an en suite facility. There are attractive well-maintained gardens for the residents to enjoy, and car parking is available on the site. The home is situated in the small village of Draughton close to Skipton and Ilkley in the Yorkshire Dales. Residents may need transport to easily take advantage of facilities and amenities in the local villages. The weekly fees are from £625 - £756 week. This does not include hairdressing, chiropody services and individual items like newspapers. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from service users, relatives and staff. An unannounced visit to the home was conducted by one inspector and lasted one day. The majority of this time was spent speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, recruitment files and health and safety details. The information required from the provider in the form of the Annual Quality Assurance Assessment was provided prior to the inspection and information from this is also included in the report. What the service does well: The staff show good communication skills when providing the care needs for the people who live in the home. They were observed to be responsive, kind and helpful. Good up to date information about the home is provided to prospective and existing residents. People who live in the home said they felt safe and well protected. A good training package is provided to the staff that work in the home. This means people will receive care from a well-informed staff group. The environment of the home is of a good standard and is well maintained. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 6 A wide and varied menu with lots of choice is provided. People are assisted to eat their meals by staff. The quality assurance processes used in the home help to ensure the quality of care is maintained and improved. What has improved since the last inspection? What they could do better: The staff working at the home should ensure that all the people identified as being at risk of falling have an up to date falls risk assessment in place to try and minimise the risk of this occurring. A more structured activity programme must be developed that has a particular focus on those people living at the home who have dementia. A review of staffing levels must take place to ensure they are set at the correct levels so as to meet the care needs of all the people living in the home. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 7 The environment of the home must be risk assessed by a person qualified to do so. This will help minimise risk of harm to people who live there and also staff working there. The memory lane dementia documentation should be implemented for all those in the home with this specialist condition. Improvement is needed with the provision of dental care for the people living in the home. The End of Life care pathway should be implemented into peoples care plans when the need is identified. The environment should be reviewed and changed to assist those in the home with specialist dementia needs. 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. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 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 Dales DS0000069339.V345850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a good standard of information to help them make the choice of moving into the home. EVIDENCE: The home has recently had to apply for a new registration due to changes in ownership. The Statement of Purpose and Service User Guide have both been reviewed to reflect these changes. They are both very informative documents that give the reader an up to date guide as to how the home is run and what the responsibilities of the provider and resident are. Evidence was found to show people are assessed prior to moving into the home. A person qualified to do so assesses each individual. Two people said they were offered the opportunity to come and visit before they moved into the home. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 10 Three people that live in the home and three relatives said that they were provided with a good standard of information that helped them make their decision to move in. Both documents are available at the entrance for all to view. The deputy manager said that all prospective users of the service are sent out copies of the Service user guide when they first make contact. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home receive a package of care that is based on their individual needs. The principles of respect privacy and dignity are put into practice. EVIDENCE: The key worker system continues to be implemented in the home. Staff spoken to said they worked well with this care system. One member of staff said, “It helps me to have a better understanding of the care needs of the people I am looking after.” Each person is provided with a care file that is written to ensure all the care needs of the person will be met. This is a new care planning system that the staff have implemented and they have received training from the senior management team on how to develop and use the documents. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 12 Four care files from the Devonshire and Clifford units were inspected. The standard of care planning and risk assessment was generally good. They contained a good assessment of each person and when a care need was identified a care plan was developed. The care plans were easy to read and contained evidence of a person centred care approach. For those people living in the dementia unit an extra document was developed. This was called ‘Memory Lane’ and it provided the reader with an in depth picture of that individual prior to the onset of the dementia condition. Along with a ‘Pen Picture’, staff are provided with enough information to help them gain a good insight into who each individual really is and how to meet their individual care needs. Not all the people with dementia have had the Memory Lane document developed within their plan of care. This is an ongoing process within the dementia unit. There is a large proportion of people living in the different units that have dementia and it was recommended that this document be developed within all their care plans. The care files showed evidence that people living in the home are regularly reviewed by other healthcare specialists such as general practitioners, opticians and chiropodists. The care files seen showed no consistent evidence to show people are assessed regularly by a dental practitioner. The deputy manager highlighted the difficulties with getting dental reviews but said she would look into the matter with the local Primary Care Trust. Evidence was seen to show that wherever possible, either the person living in the home or their representative is involved with developing the care documentation. The care plans and risk assessments were reviewed regularly and care staff said that they did read the documents to get an update on care needs if they changed. This is good practice. The care files showed that residents are well risk assessed in areas such as continence, pressure care, nutritional care and moving and handling. There was an absence of falls risk assessments for people that were at risk. This placed people at possible risk of harm. The home has signed up to implementing ‘End of Life’ care pathways for those in need of that care package. This has been implemented on at least two occasions already within the home. One resident has also been identified of benefiting from this pathway. It was recommended that the home think about implementing this pathway earlier in peoples care package. This will enable empowerment with decisions made about their care. This was evidenced through staff questioning and observing the care that was provided during the day. Relatives spoken to and contacted by other means were overall confident that the care needs were being well met. Staff were observed to be kind and attentive. They were seen to have good The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 13 communication skills, especially with those people with dementia. There was a lot of touching, talking and smiling observed between people and staff. Privacy and dignity was obviously a priority within the home. People were well dressed and clean. The hairdresser called regularly and people are assisted to attend this service. Some comments made were, “The care staff really do care. We feel they do an excellent job.” “My relative has full nursing care and I am very satisfied with the care and attention they are given”.” My relative cannot speak but I am always informed by senior staff of their well being and care.” A random inspection of the medication charts showed no omissions. A new system of administration has just been implemented for which training was given. The medication policy is robust and the home has developed a risk assessment to assist those wishing to self medicate. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social, cultural, religious and recreational needs of the people living in the home are planned for. Residents are provided with a varied menu according to their choice. EVIDENCE: The care files contained social activity care plans for each individual and records were kept as evidence to show what activity each individual was involved with. Both the people living in the home and the relatives spoken to said that they were not pushed to get involved with group activities but they were encouraged. They have the choice to opt out if they choose. The activities and entertainments are highlighted at the entrance and throughout the rest of the units within the home. Entertainers are regular visitors and are well attended by people living in the home. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 15 People said they were regularly taken out of the home on excursions. Families and relatives also take people out of the home on regular visits. Religious services are arranged monthly and are provided in a quiet room for those who wish to attend. Three other people are enabled to visit their local church to maintain their beliefs. People are given regular massages and nail pampering sessions, some of which were seen being carried out during the inspection. After discussions with the deputy manager and looking at the activities records, it was clear that there is an absence of focus on the specialist dementia needs with regards to activities provided in the home. The deputy manager said the activities coordinator is part time and she finds it difficult to provide for these specialist needs. Everyone spoken to said the home was very good and ensuring they kept regular contact with family and friends. They said visiting was very open and unrestricted. Relatives and friends said they were always made very welcome by the staff. Feedback from people and relatives who use the service was overall good with regards to the activities. Those who could comment said, “The entertainment is great. They come very often and I thoroughly enjoy it.” “They always provide us with good entertainment.” The home provides a wide and varied menu to the people that live there. The diet of the people living in the home is a high priority for the organisation and there was a lot of evidence to prove this. Peoples likes and dislikes are recorded twice yearly and this information is used to change the menus within the home. The home is currently aiming to achieve the internal 5* dining award by the organisation. The lunchtime meal was observed in the Devonshire unit of the home. This was observed as a very social occasion. Staff interacted and communicated very well with those having their meals. People were enabled to exercise choice of meals by being presented with the different meals on offer. This was good practice. The dining tables were very well presented with napkins, cutlery and condiments. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are confident that the systems and processes used to protect them are robust. EVIDENCE: The home has an open door policy, which encourages people and their representatives to feel confident about registering their concerns complaints. The complaints policy is included in the welcoming pack and is also highlighted throughout the home. Information provided by people that live there and also their relatives said they were confident that any complaint or concern they might have would be properly investigated. Advocacy services are also on display for those who wish to use this service. Comments made were, “ I can go to anyone here and tell them if I have a complaint. I know they will look into it for me.” “ I know how to complain if I need to.” The complaints book was not available during the inspection but the deputy manager said that there had been no complaints made since the last inspection. Staff spoken to during the site visit possessed a good understanding of Safeguarding Adults. They were aware of the internal procedures and policies The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 17 of the home in relation to this area. Evidence was seen to show staff receive training in this area. Training in managing challenging behaviour has also been provided to some staff. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in an environment that is well monitored and maintained. EVIDENCE: The home is divided up into three units. Systems have been developed to ensure the environment of the home is maintained to a good standard. There is a wide range of equipment available to assist staff to provide for the care needs. This includes wheelchairs, hoists and assisted baths. The internal décor is good. People said, “Its home from home for me.” “I couldn’t ask for a better place to live. I have all the comforts of home.” The back gardens have recently been landscaped and these are used frequently, weather permitting. There are plans for a new lift to be installed. New catering equipment has recently been installed in the kitchens. A number The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 19 of areas around the home have recently been refurbished, including bathrooms and the lounge in Pemberton Unit. Discussions were held with the Devonshire unit manager about changes to the environment that are research based and have proven beneficial to improving the care for people with dementia. It was recommended that the staff in the home look to implementing some of this good practice. The deputy manager said the home is provided with an identified yearly budget specifically for refurbishment. A yearly maintenance plan is developed and adhered to. The domestic staff showed a good awareness of COSHH and infection control issues. The home was very clean and tidy. Many positive comments were made during the inspection regarding this area. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is provided by staff who are trained and recruited to a good standard. EVIDENCE: The home has developed a monthly rota system to ensure the correct numbers of staff were on duty at all times. The deputy manager said that the staffing is reviewed at regular intervals as part of the equality monitoring process. A recent audit identified that additional staff was needed and this was acted upon. Each unit has the same levels of staff on duty. The staff were observed to be busy in each unit, carrying out the physical elements of their role. They were always pleasant with people and responsive to needs. Although feedback from those talked to was very responsive about the staff, some comments were made about how busy they were and how they did not have enough time to actually sit down and chat to people. This was observed over the course of the day, mainly in the two units where people with dementia were cared for. A discussion was held with the manager who said they would review staffing levels in these areas. The recruitment files of three recently employed carers contained all the required information needed before they started work. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 21 The home monitors the training provided to all the staff. They respond to highlighted gaps in training and attempt to ensure staff are trained to a good standard. The records seen showed staff received training in areas such as moving and handling, fire training and infection control. At least 6 people have received training in palliative care to enable the new End of Life care plans to be implemented. Other areas where training is provided is: pressure ulcer training; mentor update; dementia training and basic food hygiene. People living in the care home and their relatives provided information to say they were confident in the way the staff worked. Comments made were, “ They always seem to know what they are doing.” “ They must receive good training because they are good at their jobs.” “ The staff seem to be very well trained.” The care staff are all automatically enrolled onto the NVQ level 2 training programme. The deputy manager said that 85 of staff are now trained to at least NVQ level 2. Evidence was seen to show those that had recently been employed had also received a structured induction. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management systems and processes adopted by the home help to assure the quality of the service. EVIDENCE: The registered manager for the home has recently moved to another service within the organisation. The deputy manager is managing the home at present. She has worked there for over twenty years. The deputy said that they were expecting the post to be filled very soon. The evidence found during the inspection showed that the absence of the registered manager has not had a detrimental affect on the management of The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 23 the home as the evidence seen shows the deputy manager has managed the service well in the absence of the registered manager. Those people spoken to said they were happy with the way in which the home was managed and could name the person managing at present. Those who were able to comment said that they were aware that a new manager would be appointed. Monthly internal audits take place as directed by the Director of Quality of Care. In addition, the organisational manager carries out monthly visits. The organisation has recently appointed a Compliance Officer who undertakes audits. All of the above-mentioned audits attempt to ensure that the home provides effective quality assurance. Evidence was seen on the day to show this does take place. Public liability insurance cover is in place and displayed within the reception area of the home. The Dales has a fulltime maintenance person who is responsible for all aspects of Health & Safety both internally & externally. An external body carry out Health & Safety inspections of the home. Copies of the safety checks were examined and found to be in good order. The environment accessed by staff and the people who use the service has not been risk assessed. This should be carried out to ensure any hazards are identified and appropriately dealt with. Staff are provided with up to date training in areas such as manual handling and fire training. The Dales DS0000069339.V345850.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 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 3 3 x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 12(1)(a) Requirement Timescale for action 30/09/07 2 OP12 16(2)(n) 3 OP28 18(1)(a) 4 OP38 23(1)(a) Falls risk assessments must be carried out for all those identified as at risk in this area. This will help minimise the risk of harm. People must be provided with 31/10/07 structured activities that are specifically focussed on their specialist dementia needs. Staffing levels must be reviewed 31/10/07 to ensure they are appropriate for the needs of the people who live in the home. The environment of the home 31/10/07 must be appropriately risk assessed by a person qualified to do so. This will help minimise the risk of harm to people who live and work there. 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 Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 26 1 2 3 4 OP8 OP8 OP8 OP19 The manager should ensure the memory lane dementia document is developed for all residents living in the home. People in the home should have their dental health reviewed at regular intervals. It is recommended that End of Life care pathways are implemented sooner into peoples’ care packages. Some areas of the environment should be changed to improve the care of those people with dementia. The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 The Dales DS0000069339.V345850.R01.S.doc Version 5.2 Page 28 - 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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