Inspection on 02/08/06 for The Elms Residential Home

This inspection was carried out on 2nd August 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 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 Residential Home 26/05/09

The Elms Residential Home 02/06/08

The Elms Residential Home 10/11/05

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE The Elms Residential Home 111 Melbourne Road Ibstock Leicestershire LE67 6NN Lead Inspector Keith Charlton Unannounced Inspection 2nd August 2006 09:30 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 Residential Home DS0000063308.V305155.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 Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Residential Home Address 111 Melbourne Road Ibstock Leicestershire LE67 6NN 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) 01530 260263 01530 260263 The Elms Residential Home Limited Mrs Helen Rachel Wiggs Care Home 18 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (18) The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No one falling within category OP may be admitted into The Elms Residential Home where there are 18 persons of category OP already accommodated within the home No one falling within category DE (E) may be admitted into The Elms Residential Home where there are 9 persons of category DE (E) already accommodated within the home No one falling within category MD (E) may be admitted into The Elms Residential Home where there are 6 persons of category MD (E) already accommodated within the home The maximum number of persons accommodated within The Elms Residential Home is 18. 10/11/2005 Date of last inspection Brief Description of the Service: The Elms is situated on Melbourne Road in the village of Ibstock. The home is within walking distance to most amenities and shops within the village. With a bus stop just outside the home, it is easily accessible both by car and public transport alike. The home offers spacious accommodation to 18 older persons and is a large modernised building with half an acre garden, mature trees and shrubs. There is ample car parking space available. The weekly fee is from £319 - £380, which was provided in information contained in the pre inspection questionnaire sent to the Commission for Social Care Inspection in May 2006. There are additional costs for hairdressing, toiletries, transport, chiropody and dry cleaning. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for residents and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Registered Manager was present and helped in carrying out the inspection. Planning for the Inspection included looking at notifications of significant events sent to the Commission for Social Care Inspection and the issues contained in the last Inspection Report. There has been no formal complaint made to the Commission for Social Care Inspection about the service since the last inspection. The Inspection took place between 9.45 and 15.45 and included a selected tour of the building, inspection of records and indirect observation of care practices. The Inspector spoke with seven service users, three members of staff, two visitors and the Registered Manager. What the service does well: There was again evidence of promoting the welfare of residents in terms of good relationships between staff and residents with staff listening and consulting with residents. Residents said generally that the care provided by staff was generally very friendly. Residents are consulted about life at the home with events and trips planned to meet their needs. Facilities used by residents are generally comfortable and homely. Staff are encouraged to take training and have supervision to support them in their jobs. Residents and staff thought that the Registered Manager was doing a very good job in that she was very caring and fair and gave good support to staff. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents welfare could be more effectively met by staff ensuring that: All aspects of care – e.g. challenging behaviour, pressure area care etc are in Care Plans to assist staff to meet all needs. Activities are extended as per residents preferences to provide more stimulation. Health checks are recorded, e.g. dental and optical checks, to ensure that there is a system to monitor that they have been carried out in order to improve health care for residents. Staff are always careful in how they assist residents with personal care to ensure residents always feel they are treated properly. Staff always knock on doors before entering thereby respecting the right to privacy. That the home has more signs to assist residents with dementia – e.g. on bedroom doors and a notice board in a communal area and memory boxes with treasured items for individual residents to provide prompts and stimulation to make everyday living clearer. That two choices are recorded in the records for lunch every day, as per the National Minimum Standard, so that more meal choice is seen to be available. There were a number of comments regarding how busy staff were, especially when there are only two care staff on duty on daytime/evening periods, to be able to quickly care for service users with increased care needs – e.g. with dementia or confusion/ have challenging behaviour/ and service users who wandered/were at risk of falls. It would normally be expected that there would be a minimum of three care staff on duty for a home accommodating eighteen residents with a significant number of people with dementia needs. The Registered Provider needs to review staffing levels again as there is a duty to ensure that service users needs are met at all times, and also the role of Registered Manager to ensure that the Manager is not mainly working on the floor and she has time to undertake Management duties, and that an office area is created within the home to assist the Registered Manager in carrying out management duties in a confidential and private manner. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 7 The staff training programme is generally comprehensive though would aid staff understanding if training on all service users conditions – mental health, challenging behaviour, parkinsons disease, diabetes, strokes etc – were added to the programme. Regarding the carrying out of Quality Assurance of the service it was recommended that quality assurance results be published to give more information to all stakeholders. 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 Residential Home DS0000063308.V305155.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 Elms Residential Home DS0000063308.V305155.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are generally well assessed before admission so that staff are able to meet their needs. EVIDENCE: Residents said that someone from the home came to see them before admission and they were encouraged to visit. The Registered Manager said she and another staff member carry out assessments for new residents - as per the policy contained in information about the service - the Statement of Purpose. Assessments were seen on file – this allows staff to be aware of a new resident’s needs. The service does not offer intermediate care. The Elms Residential Home DS0000063308.V305155.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The individual needs and choices of residents living in the home are generally well met. EVIDENCE: None of the service users spoken with said that they could recall having Care Plans. The Registered Manager said that residents would be reminded they could see their Care Plan and discuss them if they wished. Care Plans seen by the inspector contained information as to the physical, social and medical needs of service users. However one Care Plan did not have identifed pressure area care as part the Plan and another did not have a Risk Assessment regarding how to deal with challenging behavior – the Registered Manager said any such needs would be recorded in future to assist with staff awareness regarding care needs.Staff said that they were encouraged to regularly read Care Plans to ensure they were aware of changing needs. Monthly reviews of service users needs were noted in Care Plans. This was The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 11 behind schedule – the Registered Manager said this would be followed up so any changing needs are recorded and acted upon by staff. Not all heath checks were recorded in Care Plans – e.g. dentist, optician and chiropodist. The Registered Manager isaid she would follow this up. Residents said when they felt ill then staff would swiftly summon medical assistance – residents contacts with medical personnel were documented in their Care Plans. Accident records were checked. There have been accidents where service users sustained head injuries though medical assistance was not sought. The Registered Manager said staff are expected to ring NHS Direct service as a minimum. It was agreed that this would be recorded on accident reports in future to show service users welfare is fully protected. No service users asked wanted to self medicate and all asked appreciated the staff holding their tablets and giving them at prescribed times. There was evidence of staff training in training records and staff members confirmed this. Medication was issued by two staff which provides good back up for safety reasons. The records were well kept with only a small number of gaps. Medication is kept securely in the medication trolley which is securely attached to a wall. Residents again said that their privacy and dignity was generally well respected though it was observed that a staff member did not knock on a bedroom door before entering. The Registered Manager said staff would be reminded to always do this to ensure privacy and dignity is upheld at all times. Staff were observed being respectful and kind when talking with residents and care giving. Some residents had chosen to stay in their bedrooms longer in the morning and their choice and right for privacy was respected. The Elms Residential Home DS0000063308.V305155.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living at the home have a generally good lifestyle, and meals continue to be seen as very good. EVIDENCE: Residents again said that they were generally satisfied with the range of activities on offer and they liked it when staff had time to sit and chat with them, though staff were often busy so did not always have time. There were comments received that service users can go on outings and this was confirmed by the Activity folder and the staff responsible for organising actities. Residents said that activities were provided in the afternoon by an activities person, and there were a number of suggestions for other activities – more bingo and quizzes and reintroducing music and movement sessions. The Registered Manager said this would be followed up. Residents said they liked being outside and enjoying the garden, which they did on when the weather was good. Service users can go out if they wish and attend clubs. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 13 Residents said that their visitors were made welcome by staff and this was supported by visitors comments. Residents said there were no rules, e.g. going to bed and getting up times, whether to stay in their rooms or go to the lounge etc., and staff respected this. Staff said that it was important that residents were able to keep their independence so they could still do things for themselves. This was confirmed by comments made by residents. Residents said they enjoyed the food and they could ask for an alternative if they wished. The Registered Manager is arrange recording of two choices for lunch every day, as per the National Minimum Standard. Food records showed there were a variety of vegetables offered. A service user was asked if he wanted an alternative as she did not want the main meal and was supplied with an omelette instead. Staff were aware of service users food preferences and this information was in Care Plans. The food tasted was found to be of a very good standard with two vegetables offered and a homemade dessert. A service user said she liked to have her meals in her bedroom and these were always provided there. Staff were observed to assist residents to eat in a friendly way. The Elms Residential Home DS0000063308.V305155.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acted upon and they and their representatives can be confident their concerns will be properly attended to. EVIDENCE: Service users again said that they would have no hesitation about going to management or staff if they had a problem and were confident it would be properly sorted out. The Registered Manager said there was no Complaints book. There has been one anonymous complaint since the last inspection, which was not proven by the Registered Provider. She said she is to set up a complaints book to record this information in the future. The Commission for Social Care Inspection has not received any formal complaints since the last inspection. There is a Complaints Procedure, which nearly complied with the National Minimum Standard – the Registered Manager said this would be altered to fully comply with the National Minimum Standard. Staff members were asked about their understanding of the adult protection procedures, and demonstrated a generally good understanding though were unsure as to which Agencies to contact – the Registered Manager said staff The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 15 would be provided with a clear, simple procedure so that they all knew who to contact. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients live in a generally homely and comfortable environment, though standards of hygiene need improvement so that all areas of the home are odour free. EVIDENCE: Residents all said that they liked their bedrooms and they could bring in their own things including furniture. These were observed to be personalised and homely by the inspector. The lounge was comfortable and furnished in a homely fashion. The Registered Manager said she would again follow up the comments from residents about hard to pick up cups, to the satisfaction of residents. Service users also appreciated the well-maintained garden and the colourful flowers in pots in the home, which are watered by a resident. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 17 Facilities were found to be generally clean and tidy though there were odours to toilets, and the dining room carpet was heavily stained. There were no designated cleaners as care staff had to carry out this function. This was discussed with the Registered Manager who then contacted the Registered Provider. It was agreed that a domestic would be employed each day to ensure hygiene standards are maintained. The Registered Manager said that the dining room, and the corridor area, by the kitchen were being redecorated and there is to be a new carpet installed there. The bath temperature on the first floor was measured at 42.4 degrees centigrade, within the National Minimum Standard of 43c. The Registered Manager stated that most radiators were guarded throughout the property, but that the Risk Assessment was to be reviewed with consideration to fitting radiator covers, if assessed to be needed. In regard to the issue identified in the last Inspection Report attention has been given to replace a sealant to the kitchen floor to ensure it is hygienically maintained. However this was not entirely clean and this sealant needs to be reviewed to improve this issue. The Registered Manager said this would be followed up within the following few days. The only office is located on the first floor of the annex in the grounds of the home – the Registered Manager recognised this was not ideal and said she thought an area on the landing could be created to give easier access for residents and their visitors, and maintain her presence in the home as needed. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current staffing levels and recruitment practice may lead to service users welfare needs not being fully met. Staff training is generally comprehensive. EVIDENCE: There were comments received that staff were very busy. The staff rota indicated that there are three carers on duty in the morning until 3.30pm. This then reduced to two care staff and there were only two care staff on duty for weekend periods. This staffing level includes the Registered Manager and also one of these staff had to carry out domestic duties. It appears that the care staffing ratio was reduced when the registration was altered to allow residents with dementia to be admitted, as night staffing ratios had to increase to two awake staff. In other words the dependency level of residents increased but staffing decreased for daytime periods. This does not make logical or practical sense. The Registered Manager was asked to carry out a swift review of this issue and consulted with the Registered Provider. It was agreed that staffing is to increase in that there is to be domestic cover seven days a week and the hours of the Registered Manager to increase to provide extra care cover. There is also an intention to ensure that there is a minimum of three care staff for all daytime/evening shifts. The Registered Manager needs to ensure that staffing levels are sufficient to cover residents needs at all times. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 19 As the Registered Manager was behind in a number of management issues it was also recommended that care staffing is in place to ensure she has the time to deal with management issues. Staff records were inspected. The Registered Manager has ensured that two references are obtained, though there were not always copies of identification – copies of passports, birth certificates etc - this needs to be in place to offer increased protection for service users. Criminal Records Bureau checks and Protection of Vulnerable Adults checks were in place. Staff said that training is emphasised by the Registered Manager and that there is encouragement to complete National Vocational Qualification training in essential care issues. There is also an induction programme that covers important care topics. Staff have been undertaking training in the awareness of service users with dementia. The training records were viewed for the staff team and a good range of training has been undertaken. The inspector recommended that the Training Programme cover all service user medical conditions and associated issues – schizophrenia, challenging behaviour, diabetes, parkinsons disease, stroke management etc. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems generally protect the welfare needs of service users. EVIDENCE: Service users and staff spoken to said that the home was generally very well run and they could not think of any improvements that were needed, apart from increased staffing levels. Staff said that they were listened to and supported well by ther Registered Manager.This situation is commended. There is a Quality Assurance system in place. This is carried out on a yearly basis to ensure that the service is effective in meeting service users needs and wishes. Some questionaires were seen. The Registered Manager said that they will be analysed and this information published in the Statement of Purpose, to be made available for prospective residents. There are also residents and staff meetings to ensure that there is a forum to air views and preferences, put The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 21 forward suggestions etc, though the Registered Manager was asked to increase their regularity as residents meetings in particular had an eight month gap between meetings. Staff said there is a staff supervision system in place and this was recorded in staff records. This was falling behind schedule due to the hands on care the Registered Manager was expected to undertake. The Registered Manager said this would be followed up. Records indicated the frequency of fire drills meets the requirement and there is emergency lighting and fire bell testing though these were behind schedule. Staff members spoken to had a good awareness of the fire drill procedure. A fire risk assessment was seen which covered relevant issues. A fire door was seen to be wedged open which could compromise fire safety. The Registered Manager followed this up and said she would remind staff not to wedge open doors. Service users monies accounts were checked and found to be behind schedule though this was then rectified by the Registered Manager to include balances, receipts and two signatures recorded. Regarding Health and Safety training all staff are expected to complete fire training, infection control training, moving and handling training, first aid and food hygiene training. There were written Risk Assessments for safe working practices and these were evidenced in the Health and Safety records. The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 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 3 X X 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 1 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 Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 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 OP27 Regulation 18 (1)(a) Requirement The Registered Provider and Registered Manager need to review the staffing levels, and further increase them if necessary, to ensure residents needs are met at all times. Timescale for action 02/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms Residential Home DS0000063308.V305155.R01.S.doc Version 5.2 Page 25 - 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. 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