Inspection on 12/04/06 for The Elms Care Centre

This inspection was carried out on 12th April 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 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

The Elms Care Centre 12/04/07

The Elms Care Centre 27/09/05

The Elms Care Centre 18/05/05

The Elms Care Centre 22/02/05

The Elms Care Centre 14/10/04

The Elms Care Centre 13/09/04

The Elms Care Centre 05/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Elms Care Centre Elm Drive Louth Lincs LN11 ODE Lead Inspector Mrs Sue Daniells Unannounced Inspection 12th April 2006 09:45 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 Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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 Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Elms Care Centre Address Elm Drive Louth Lincs LN11 ODE 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) 01507 350100 01507 350107 Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Susan Addison Care Home 86 Category(ies) of Dementia - over 65 years of age (43), Old age, registration, with number not falling within any other category (43) of places The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users who are assessed as suffering from dementia should be placed only in bedrooms within the two dementia units in the care home. 27th September 2005 Date of last inspection Brief Description of the Service: The Elms Care Home is set in the Lincolnshire town of Louth and is owned by the Four Seasons Health Care Group. The Elms Care Centre provides accommodation in 2 buildings called the Elms and Oakwood Unit. The Elms is a 2-storey building with a lift provided to enable service users to access the first floor. The building was a converted estate property, which was fully refurbished and extended in 2002. Oakwood Unit is a single storey building set in the same grounds as the Elms. There are large gardens surrounding the home and parking is provided at the side and rear of the care home. There are local transport services, which pass the care home. The home is registered as a care home providing services for 86 male or female service users over 60 years of age. Current fee levels in the home range from £335.00 to £522.00 per week. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day in April 2006. The inspector was in the home for eight and a half hours. The methodology used for the inspection included information taken from the history of the service from the previous inspection to the date of this site visit. This information was reviewed and used to gather evidence to inform the basis of the inspection. Since the last inspection in September 2005, 22 incidents have occurred, which includes injuries and/or admissions to hospital. Because of two incidents in the Oakwood Unit since the last inspection, relating to the safeguarding of adults, the inspector spent half of the duration of the inspection in that unit. Furthermore, because of the inspector’s concerns in the Oakwood Unit, it has been more balanced to give two judgements for the majority of outcomes in the report. Six residents were “case tracked” – a system that looks at the needs of the resident and follows this through by talking to the residents concerned and the staff who deliver the care. Six members of staff were spoken to. A partial tour of all three units of the home took place and staff and care records were inspected. What the service does well: What has improved since the last inspection? Meal times, in particular breakfast, are flexible in order to suit individual needs and access to the first floor of the main house has been restricted by the use of a keypad on the front door. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 6 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 Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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 Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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. Intermediate care is not provided in the home. Elms:- The assessment of service users, undertaken before admission to the home are comprehensive. Oakwood:- The assessment of service users, undertaken before admission to the home are not always completed or detailed and may put service users at risk. The home does assure all service users and their families in writing that they can meet their needs. EVIDENCE: Pre-admission assessments of five residents were examined. Assessments were varied, in that the three admitted to the Oakwood Unit were not detailed nor completed in full. Assessments for two residents admitted to the main house were much more comprehensive and evidenced the care that would be required to meet their needs. Dependency scores and risk assessments had been completed. Relatives of those with the greatest needs were not available to ask if they had been part of the assessment process. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 9 Letters are sent to all prospective residents or their relatives, stating whether the home can meet their needs. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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): 7,8,9,10 Elms:- Service user’s care needs are set out in their care plans with health needs being met in full and self-medication undertaken where appropriate. Service users feel that they are treated with dignity and respect. Oakwood:- It is acknowledged that service user’s healthcare needs are met in full, although care plans do not show all service user’s needs and do not always reflect the reason for not being able to undertake an element of care. Policies and procedures for the administration of medication are not always followed and service users are not always treated with dignity. EVIDENCE: Six care plans were examined during the inspection and it was again found that those belonging to service users in the Oakwood unit did not reflect all their care needs, especially those relating to their social needs, although some of the plans contained detailed “life history’s” of the individuals. Reviews of the care plans are undertaken. Health needs were all documented fully, although more time needs to be taken to ensure that reasons for not being able to give any planned care are documented in full. Staff stated that they had insufficient The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 11 time to complete care plans. Evidence showed that systems were in place to support one service user with a sight deficit. Service users who spoke to the inspector stated that they were very appreciative of all the care given to them by the staff. Care plans showed the input from other healthcare professionals, which included chiropody, opticians, community nurses, GP’s and tissue viability nurse. The health professional spoken to during the visit stated that they visited the home on a weekly basis and had an excellent rapport with the staff and felt that the staff in Oakwood had a particularly difficult job to do given the very high dependency of the service users. One service user with poor eyesight had a care plan outlining steps to be taken to ensure equality of care. The home does have specialist equipment such as pressure relieving mattresses and cushions for use by any service user who requires it. The home uses the MDS (Monitored Dosage System) of drug administration in all areas. Policies and procedures are in place for all aspects of medication and all trained staff and senior carers who administer medication are completing a long-distance learning module to update their knowledge regarding medicines, although it was noted that medicine sheets were not always signed after the administration of medicines. One service user had been fully risk assessed to enable them to self-medicate, with drugs being kept in a lockable facility in their room. Staff spoken to realised the importance of ensuring that service users were treated with dignity and respect and the service users stated that they felt they were given it. However, observation in the Oakwood unit evidenced a lack of dignity, as service users were sitting in the quiet lounge with white plastic aprons round their necks. The inspector was informed that they were waiting for their lunch, although this was half an hour before lunches were served. Staff stated that it saved them time when lunches arrived. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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 Elms:- Activities are provided in the home and service users were satisfied that their lifestyle and social and cultural needs were met. Contact with their family and friends is maintained as they wish and they are able to exercise choice and control over their lives, although more choice is required at meal times. Oakwood:- The activity organiser for the unit us not suitably trained to offer appropriate activities to the service users. Service users are able to maintain contact with friends and family although choices in their lives are limited because of lack of staff time. Furthermore, service users are not offered choices of main meals. EVIDENCE: Four of the service users case-tracked were unable to talk in-depth with the inspector. Evidence from the two other service users and staff were used to form a judgement for this group of outcomes. Two activities organisers are employed at the home for twenty hours each per week, one for the main house and the other for the Oakwood unit. Activity events in the Elms include bingo sessions, videos, manicures, writing letters and reading and service users were happy with this; the manager The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 13 stated that now the warmer weather is here, outings in the minibus will commence again for all the residents, including those from the Oakwood unit. The activity organiser in the Oakwood unit has not received suitable training in dementia to enable them to give the appropriate guidance and stimulation to the service users, although staff in the unit were very supportive of her. The majority of the activity hours in the unit is undertaken on a one-to-one basis. Staff stated that they have no time to actually talk to the service users on a one-to-one basis and it was observed that the majority of service users were sitting sleeping and lethargic throughout the inspectors visit. A dog show was recently held at the home, which proved very successful; a relative was very enthusiastic about it and stated that the residents really enjoyed it. Although additional activity hours for the home had been requested, this has not been increased. Holy communion is provided in both units on a monthly basis. Although no relatives were seen on the day of the inspection, service users and staff stated that visitors are welcomed at any time and information previously obtained from a relative, upheld this. Service users spoken to in the main house stated that they “did as they liked”, had plenty of choices and that staff were very flexible in their attitude. Observations in the Oakwood unit showed that staff tried to give service users choices, although this was difficult not only because of the service users limited abilities but of the lack of staff time. Food offered at lunch in the Oakwood unit was seen by the inspector and was seen to be wholesome and nutritious with generous portions served, although a choice was not available. On discussion with the kitchen staff, it was found that there was no choice of main course on that day and staff in the unit stated that choices were never given to those service users, with many of them requiring a soft diet. Over half of the service users in the Oakwood required feeding. Discussion with a service user in the Elms unit evidenced that they always had what they wanted for their main meal, even though there was no choice on that particular day for other service users, and ate in their room. It was said that breakfasts were particularly good for choices and breakfast times have been extended. Observation of the main dining room in the Elms unit showed that the table mats all needed replacing, as they were very worn. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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 Elms:- Staff and relatives are confident that any issues of concern will be dealt with satisfactorily. Staff are trained in regard to adult protection and would ensure residents are protected. Oakwood:- Staff and relatives are confident that any issues of concern will be dealt with satisfactorily, although staff felt that they would continue to get complaints in the unit until they had more staff. Staff are trained in regard to adult protection and would ensure residents are protected. EVIDENCE: A complaint regarding the Oakwood unit had been received by the Commission; the concerns were addressed through the inspection process and the complainant was satisfied with this. A complaints policy and procedure is in place in the home and service users and their relatives have copies of the document. A whistle-blowing policy is also in place. Complainants are always written to with the outcomes of any investigation. The manager stated that she had received seven complaints since the last inspection. Inspection of the complaints log showed that six of these related to Oakwood and one, possibly two, could be related to lack of staff. Staff spoken to were aware of the procedure for dealing with complaints. Service users felt confident that any problems they raised would be dealt with and a relative had received a favourable response when raising concerns in Oakwood. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 15 Since the last inspection, two allegations have been made regarding adult protection, both in the Oakwood unit. The provider has responded appropriately to the allegations with regard to the “whistle-blowing” and protection of vulnerable adults procedure. The second allegation is currently being investigated by Social Services. The manager and staff are aware of the procedure to use in the case of safeguarding adults and training for all staff members on this subject is given on a rolling basis. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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): 19 and 26 The Elms:- Service users live in an environment that is safe and well maintained Oakwood:- Although service users live in an environment that is safe, better design features in the unit, based on research, would enhance their quality of life. EVIDENCE: The parts of the home visited during the inspection were generally well maintained and safe, with a new keypad system in operation in the main house as well as the Oakwood unit. Ten rooms in the Elms have been re-decorated in preparation for possible increase in the number of service users with dementia requiring personal care only. Service users spoken to in the Elms were pleased with their individual rooms and the general communal areas. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 17 A rolling programme of decoration is in place for all parts of the home and any urgent maintenance is generally attended to within 24 hours. In light of research regarding the living environment for people suffering with dementia, the Oakwood unit lacks the homely environment and specialist design features that have been proven to aid those suffering with this disease. Staff have requested more “bean-bag” armchairs for the safety of the service users; the manager stated that these have been ordered and would be delivered over the next two months. All areas observed were seen to be clean, pleasant and hygienic, with no malodours present, although it was found that staff are required to take clothes and bedding back and forth to the laundry from Oakwood. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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): 27,28, 29 and 30 Elms:- Service users are protected by the recruitment practices of the home. Staff are able to meet the needs of the service users by the numbers and skill mix of staff in a safe manner and are trained and competent to undertake their tasks. Oakwood:- Service users are protected by the recruitment practices of the home, although service user’s needs are not being met by sufficient numbers of staff. Staff are trained and competent to undertake their tasks. EVIDENCE: Staffing levels in the home were as follows:Elms:am 1x nurse, 7x carers ) pm 1x nurse, 5x carers ) for 14 nursing and 23 residential service users, 13 night 1x nurse, 4 carers ) of which have dementia Oakwood:am 2 x nurses, 3 x carers ) pm 2 x nurses, 3 x carers ) for 28 nursing service users with severe night 1 x nurse, 2 carers ) dementia The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 19 The staff spoken to in the Elms unit felt that they could meet the needs of the residents with the current numbers of staff, and residents agreed with this. The inspector observed that the unit was relaxed during the inspection and staff had time to talk with service users. All the staff in the Oakwood unit, including a nursing student on placement, felt that staffing levels were currently not sufficient for the high dependency levels of the service users; some staff were very anxious about this and felt that care was compromised as a result, as well as the fact that they did not have time to give one-to-one time with the service users. A relative spoken to before the inspection had also had concerns about the staffing levels within the unit. A health professional stated that the reduction of tranquilising drugs in service users with dementia was on-going in the unit but they knew for that to continue, enhanced levels of staffing were required. Seven carers have achieved National Vocational Qualifications (NVQ) level 2 in care and a further six care staff will commence the qualification in the near future. In addition, all senior care staff, amounting to eleven in total, are currently undertaking level 3. Recruitment files for four members of staff were examined. All were completed appropriately and in accordance with the home’s recruitment policies and practices. Appraisals for all staff had been undertaken at the beginning of the year and the record of staff training and development was seen. Mandatory training, for example moving and handling, fire safety and protection of vulnerable adults had been undertaken on a rolling basis by all members of staff and other training such as promotion of continence and infection control had also been delivered. Dementia awareness training had been given to the majority of staff, although none of the nursing staff are qualified in mental health nursing. All staff spoken to stated that they felt well equipped to deliver the care that was required and service users were very supportive of the care they received. Observation of care delivered by staff showed they had established a good rapport with the service users, although tasks were seen to be hurried in the Oakwood unit. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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): 31,33,35 and 38 The manager is respected by the service users and the majority of staff and runs the home in the best interests of service users. Service user’s financial interests are safeguarded and the health, safety and welfare of both residents and staff is protected. EVIDENCE: The manager has experience in managing care homes and has cared for the elderly for many years. Staff and service users spoken to felt that she was approachable and did her best to solve any problems although staff on the Oakwood unit were frustrated about staffing levels. There was a distinct difference in staff morale between the Elms and Oakwood units. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 21 Staff and service users have regular meetings with the manager, which are all minuted and any items brought up are actioned. Staff felt that they knew what was happening in the home and also that the home was run for the benefit of the residents. Service users could not remember whether they had been asked about the quality of the service in the home, although the manager stated that she sent 10 questionnaires a month to service users, which were filled in anonymously and to which she responded if it was necessary. The home does not look after anyone’s pension book on their behalf; it is not company policy. Accounts of money held by the home for the six service users case-tracked were seen in a ledger. Personal monies are kept in one bank account with individual accounts records kept for each service user. Receipts are kept for any transaction undertaken on behalf of a service user. The home has a comprehensive health and safety policy in place. A variety of regular checks are carried out in the home to ensure that the health and safety of the residents and staff is protected. Records for fire drills, emergency lighting and fire equipment were inspected and found to be up to date. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x X 3 The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 (1) (a) Requirement All prospective residents must be comprehensively assessed prior to admission. This process must be documented. Care plans must reflect all of a service user’s needs. Staff must follow the home’s policy and procedures for the safe administration of medication and sign the treatment sheet. All service users must be treated with dignity and respect at all times. The numbers of staff must be sufficient in the Oakwood unit at all times, to ensure that service users receive the levels of care that they require for all their needs. At least 50 of care staff are trained to NVQ level 2 or above. The activity organiser receives suitable training to ensure that they can support and stimulate service users in the Oakwood unit in an appropriate manner. Timescale for action 30/04/06 2 3 OP7 OP9 15 (1) 13 (2) 17 (1) (a) Schedule 3 12 (4) (a) 18 (1) (a) 30/04/06 30/04/06 4 5 OP10 OP27 30/04/06 12/05/06 6 7 OP28 OP30 18 (1) (c) (i) 18 (1) (c) (i) 31/12/06 31/07/06 The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 24 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 Refer to Standard OP7 OP15 OP15 OP12 OP19 Good Practice Recommendations It is highly recommended that staff document the reason for not being able to give any element of care that is laid out in the care plan. It is strongly recommended as good practice that all service users are offered a choice of meals at lunchtime. As good practice it is recommended that the table mats in the dining room on the ground floor in the Elms unit are replaced. As good practice, it is highly recommended that activities hours for the home are increased, in particular for the service users in the Oakwood unit. In line with good practice and research, it is highly recommended that serious consideration be given to the design/layout of the Oakwood unit in order to make it suitable for service users with dementia. The Elms Care Centre DS0000002554.V300563.R02.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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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