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Inspection on 16/01/07 for The Hawthorns Care Home

Also see our care home review for The Hawthorns Care Home for more information

This inspection was carried out on 16th January 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents and relatives spoke highly of the staff and the quality of care they received, `I am happy here`, `the standard of care is very good`. There is a stable staff group. The key worker system works well and several residents referred to the positive relationship they had with their key worker. Staff spoken to were knowledgeable, well trained and said they worked well as a team. They received regular supervision and felt supported by the management team. Relatives spoken with felt that communication with staff was good and that they were kept appropriately informed about the health and welfare of their relatives. The home provides a comfortable environment for the residents and is maintained to a good standard. Recent redecoration has taken place and a new shower installed. All areas of the home examined at this inspection were seen to be in good order.

What has improved since the last inspection?

Work has been undertaken on implementing a corporate care planning system. Further details are given later in the report for comments on the documentation. The manager has obtained a copy of the local authority safeguarding adults guidance. The induction programme for new staff has been reorganised as outlined by `Skills for Care`.

What the care home could do better:

At the time of inspection a new management structure had been introduced and roles and responsibilities are in the process of being clarified. The Statement of Purpose will need to be updated to reflect these changes and also the change in the registered representative of the provider. A new administrator needs to be appointed to free the manager to develop her role and that of the management team. The arrangements regarding activities need to be formalised and developed to meet the changing needs of the residents. A number of good practice recommendations have been made regarding training for safeguarding adults, updating training in dementia and challenging behaviour, and developing methods of consultation with residents. An audit could be undertaken of policies and procedures to ensure that copies held in the home are up to date.

CARE HOMES FOR OLDER PEOPLE Hawthorns (The) 5 Burlington Road Buxton Derbyshire SK17 9AR Lead Inspector Denise Bate Key Unannounced Inspection 16th January 2007 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 Hawthorns (The) DS0000020007.V325384.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. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorns (The) Address 5 Burlington Road Buxton Derbyshire SK17 9AR 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) (01298) 23700 Salvation Army Major Elaine Holder Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: The Hawthorns is a care home registered to provide personal care and accommodation for up to 34 older people. It is situated in the town of Buxton in the Peak District. It is close to a park and formal gardens and there is access to local amenities such as the theatre and shopping centre. The home is on three floors and has a passenger lift, 32 single bedrooms, 22 of which are en suite. There are 3 lounges, 2 of which are on the ground floor and 1 on the second floor. Gardens are provided including a sensory garden. Charges are variable up to £484.34 per week. Residents pay additional charges for hairdressing, chiropody, toiletries, magazines, name tapes and personal telephone calls. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over eight hours. During the inspection nine residents, four relatives, and five staff members were spoken with. The manager and senior staff were present during the inspection and provided assistance and information. Written information was provided by the manager prior to the inspection. A number of records were examined, including care planning documentation, minutes of meetings, regulation 26 visit records, staff files and medication records. Four residents were case tracked. A tour of the building took place. The inspector was informed that there have recently been changes to the national structure of the Salvation Army, and that a new representative of the registered provider has been being appointed. In addition the management structure within the home has changed from a manager, deputy manager, and two senior carers to manager and three principal carers. The role of administrator has been extended to include extra duties and this post was vacant at the time of inspection. What the service does well: What has improved since the last inspection? Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 6 Work has been undertaken on implementing a corporate care planning system. Further details are given later in the report for comments on the documentation. The manager has obtained a copy of the local authority safeguarding adults guidance. The induction programme for new staff has been reorganised as outlined by ‘Skills for Care’. 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 summary of this inspection report can be made available in other formats on request. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to ensure residents can make an informed choice about where they live. EVIDENCE: Standard 1 was not fully inspected but the inspector was informed that the home have a guide that is given to prospective residents and their advocates, and the Statement of Purpose is also made available. Prospective residents are encouraged to visit the home to help them make an informed decision. The contract was seen and clearly states that residents move in for an initial trial period before committing themselves to making the Hawthorns their permanent home. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 9 As noted elsewhere in this report, there have been management changes nationally within the Salvation Army, and within the home’s management structure. At the time of inspection these were being finalised and the manager is in the process of updating the Statement of Purpose to reflect these new structures and lines of responsibility. The inspector was informed that care managers and other professionals provide useful assessment information, and that in addition the home also carry out their own assessment prior to residents moving to the home. The residents spoken to were long term residents, all of whom had had detailed reassessments carried out by the home within the last two months. They felt satisfied that their choice of home had been appropriate for them. The home do not provide intermediate care. Hawthorns (The) DS0000020007.V325384.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. 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. Care plans are suitably completed to demonstrate that residents’ health, personal and social care needs are being met. EVIDENCE: An outstanding requirement at several inspections identified that personal care plans were not routinely updated after reviews. The Salvation Army have introduced a new national system of care planning documentation, and it is not clear whether this system will fully address this issue. On the day of inspection in order to get full information on an individual resident one has to read all the documentation i.e. not just the care plan, but also assessments, reviews, status change forms as well as risk assessments. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 11 As presently arranged the care plan does not have room to be easily and conveniently updated. Although all information required is contained in the documentation, the assessments do not feed in to a single working document (i.e. care plan) that informs staff on how residents changing needs are to be met on a day to day basis. The set of assessment documents are also rather repetitive and contain language that is not entirely appropriate e.g. care nurse (they are not nursing home), working and playing, feeding behaviour. In addition there are assessments for mood and an assessment for ‘orientation’, which may not be appropriate for all residents to undertake. A recommendation made at the last inspection that space for the residents signature should be included has not been taken up, although on various assessment documents there are a sections for residents comments and these had helpfully been filled in by staff in some care tracked documentation. A care plan that included all aspects of resident care and was regularly updated could help the home’s aim to develop a ‘person centred’ approach to provision of care. However, feedback from residents and relatives spoken to regarding the actual care provided was very positive. Staff are viewed as helpful, sensitive, patient and kind. There is a positive relationship between some residents and their key workers that enhances their quality of life. Relatives said that staff communicated any changes to them and they were ‘highly satisfied’ with the quality of care provided. Staff were observed treating residents with dignity and respect while they carried out the tasks of day of day living. Aspects of residents’ health needs and medication were presented in the assessment documentation. There was a system for regular monitoring of weight, nutrition and skin care issues which was included as part of the new care planning documentation. Changes in medication were recorded on case tracked residents. Residents said they had regular access to health care professionals when needed. There was a good relationship reported between the home and GPs and District Nurses. In addition there was access to other specialist health professional where necessary, and one was visiting on the day of inspection. There is a separate medication room with a medication trolley, lockable fridge and a controlled drug cabinet. The home uses the monitored dosage system. The medication records of some case tracked residents were seen and found to have been recorded correctly. There are no residents who are currently taking controlled drugs, but the home have an appropriate system for recording administration and storing controlled drugs. There were no sample signatures for staff dispensing medication. There were no current residents using eye drops but the home’s practice is that the date of opening is recorded on eye Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 12 drops to ensure they are always ‘in date’. The manager reported a good relationship with the supplying pharmacist who visits on a regular basis, and copies of the reports were made available. These found the arrangements at the home satisfactory. The home have access to medication reference books to provide information about particular drugs and their uses and side effects. A copy of the latest guidance provided by the Royal Pharmaceutical Society was available but had not been read by all staff who dispense medication, although the inspector was informed that appropriate training had taken place. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities are provided that generally suit the expressed preferences of residents. Improvements would assist in contributing to the overall level of satisfaction for residents. Dietary needs of residents are generally catered for with a balanced and varied selection of food available that meets most residents’ tastes and choices. EVIDENCE: Some activities do take place in house, e.g. bingo and quizzes, but at present there is no member of staff who takes overall responsibility for organising activities. Residents said they do not have as many activities as they used to have. On the day of inspection a volunteer had come to pay the piano and this was enjoyed by residents. Staff reported that sometimes it is difficult to get residents motivated, and this is an area that the home recognises needs development. At present quite a few residents have dementia and memory Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 14 loss. However, activities could be done in small groups and usually activities like reminiscence therapy or handicrafts can still be enjoyed by most people. Regular religious services are held at the home for the benefit of residents. At present there are no residents meetings taking place, although these have been held in the past. Relatives said that they were always made welcome at the home and were encouraged to visit whenever they liked. Several residents did not have relatives living nearby but said they had regular contact with friends who were also made welcome. Some residents had spent Christmas with their families. Catering is supplied by a contracted service. Most residents said the food was good, although a couple of people said the quality was variable. Residents and relatives gave examples of where their suggestions had been taken up, or where specialist diets had been provided. However, feedback could be obtained via the residents meeting and quality assurance systems (either through surveys or regulation 26 visit reports). Sample menus indicated that residents were given a choice at lunch times. The meals were described as being ‘well presented’ and served in a pleasant dining room. Residents are able to have some meals in their bedrooms if this is what they prefer. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. Complaints and safeguarding adults procedures are in place to ensure residents can be confident that any issues raised would be acted on effectively and promptly. EVIDENCE: The Salvation Army has a corporate protection of vulnerable adults procedure which also refers to the arrangements in local authorities. The manager has obtained a copy of Derbyshire County Councils Multi disciplinary Safeguarding Adults procedures and is making arrangements to attend an appropriate briefing. A number of issues that touched on safeguarding adults were discussed with the manager, and the home had acted appropriately and in one instance had liaised with social services as well as informing CSCI. There is a clear system of responsibility and support within the corporate organisation. Staff spoken to showed an understanding of their responsibilities in relation to safeguarding adults. They had received some protection of adults training, but training records provided indicated that they had not had recent training. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 16 Residents and relatives indicated that they would raise issues of concern or complaint with the home. Several examples were given of where this had been done and led to an improvement. Most concerns would be dealt with informally but the home have a formal complaints procedure which is displayed and details of which are also in the guide for residents. A complaints book is kept which clearly records what the complaint was, how it was dealt with, and in addition a three month ‘follow up’ to ensure the complainant is still satisfied and there has been no reoccurrence of problems. One concern has been reported to CSCI and drawn to the home’s attention. At the time of inspection the manager indicated that she was taking appropriate steps to deal with the concern. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 17 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, 21, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents with an attractive and homely place to live. EVIDENCE: The home consists of an older building with a modern extension. Communal areas of the home are well decorated and maintained and provide comfortable accommodation. There are two communal lounges and a conservatory on the ground floor that interlink, and a further small lounge upstairs. There is a pleasant dining room. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 18 Some bathrooms have parker baths, and a shower has recently been installed in a downstairs bathroom. There is a pleasant garden area for residents’ enjoyment in the summer. Bedrooms are not standard and are of differing sizes. Some bedrooms are en suite. All bedrooms seen had been personalised and arranged to reflect the tastes and wishes of residents. Some were small and cosy, others were larger and had been equipped as bed sits. Several residents said that the home was kept clean and this was appreciated. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 19 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and competent workforce are in place which meet the dependency needs of residents currently accommodated within the home. EVIDENCE: Staffing rotas were discussed. There had recently been some pressure on staffing levels because of illness and holidays, but these were now resolved. The inspector was informed that the home use bank or agency staff when necessary to ensure that staff rotas are fully covered. Staff spoken to were knowledgeable and experienced and showed an understanding of their roles and responsibilities. Samples of personnel information were examined at inspection and the evidence contained within them indicated that robust recruitment practices are in place for the protection of service users. The personnel files of two staff provided the evidence that Criminal Records Bureau Disclosures and other necessary checks had been carried out. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 20 There is an active programme of development for staff in National Vocational Qualification (NVQ) training. This promotes the delivery of skilled care by staff to the residents of the home, which could be further enhanced by discussion in supervision or staff meetings, of how knowledge gained through training can be applied. There has been some training in dementia and challenging behaviour, but this has not been made available to all staff and may need updating. It was noted that currently there are a significant number of residents with dementia or memory loss. The inspector was informed that Skills for Care material is now being used for staff induction. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 21 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is suitably qualified and experienced and staff demonstrate an awareness of their roles and responsibilities, thus ensuring the home is generally run in the best interests of residents. EVIDENCE: The manager is suitably qualified and experienced to run the home. As noted previously, there have been some recent changes in management structure within the home and the home are still adjusting to these new arrangements. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 22 There was a general feeling that staff and senior staff would continue to be committed to the home and provide appropriate support to each other and the residents during this time of change. The manager and her team are committed to continuing to provide high standards and implementing improvements. Both the management team and staff welcomed feedback. The inspector was informed that the home is visited regularly by a representative of the registered person and copies of recent Regulation 26 visits were made available. The Salvation Army has reorganised nationally and a new system of accountability and support is being implemented. The matters discussed at regulation 26 visits reflected the recent changes as well as matters pertaining to day to day management. It is the inspectors view that as the management changed settle down the representative of the registered person will be able to spend more time gaining the views of staff and residents. It was noted that a senior representative from the Salvation Army was to attend a full staff meeting in February. There had been a quality assurance exercise which indicated that relatives feel the home provide an good overall service: ‘the standard of care is outstanding’, ‘senior staff are very supportive’. However, this was carried out in April 2006, did not include residents, and there has been no formal feedback. Obtaining up to date information would help the home be proactive in identifying and acting upon areas for improvement. Copies of corporate policies and procedures are available in the home. The manager said that she plans to undertake an audit to ensure that all policies and procedures are up to date and made available to staff. This matter should be discussed in more detail at a future inspection. Most residents have their finances dealt with by their family or other appointees. The inspector was informed that at present residents’ personal finance records are kept manually which appears to work satisfactorily. Information on maintenance and health and safety records was provided by the manager in the pre-inspection questionnaire and indicates that matters relating to health and safety are satisfactory. CSCI have been informed of one serious matter relating to health and safety which was investigated. Systems have now been put in place to ensure that there is no repetition of this incident. Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 23 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 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 2 X 3 X X 3 Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Statement of purpose must be updated to reflect recent changes in management structure. Timescale for action 31/03/07 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 Refer to Standard OP7 Good Practice Recommendations Consideration should be given to developing a personal care plan that can be informed my various assessment documents and gives a clear and up to date instructions to staff on how to provide all aspects of care for individual residents. A record should be kept of sample staff signatures for all staff who administer medication. An audit should be undertaken to ensure that all medication practices are in accordance with advice contained in the latest guidance provided by the Royal DS0000020007.V325384.R01.S.doc Version 5.2 Page 25 2 3 OP9 OP9 Hawthorns (The) 4 5 6 7 8 9 OP12 OP12 OP16 OP16 OP30 OP33 Pharmaceutical Society. programme of activities, entertainment and outings suitable to the needs and wishes of residents should be formally implemented and recorded. Residents meetings should be held on a regular basis to get feedback from them on a variety of day to day issues. Training in safeguarding adults should be updated for care staff. The manager should undertake a local authority safeguarding adults briefing. Training in dementia and challenging behaviour should be provided and/or updated to reflect the changing needs of residents. A quality assurance exercise should be carried out that involves both residents and relatives and is fed back within a reasonable time scale. An audit should be carried to ensure that policies and procedures are up to date and all staff are familiar with them. 10 OP38 Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Hawthorns (The) DS0000020007.V325384.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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