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Inspection on 28/06/05 for The Malvern Nursing Home

Also see our care home review for The Malvern Nursing Home for more information

This inspection was carried out on 28th June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The home can meet the needs of service users whose mental health makes it difficult to look after themselves fully, by providing a safe and supportive place within the community. Service users say that they are happy with the food, their accommodation, the leisure activities on offer and the staff who support them. Service users from different cultural backgrounds can have their dietary and lifestyle needs met.

What has improved since the last inspection?

What the care home could do better:

Service users and staff would benefit from stronger, clearer leadership, to ensure consistency. Care plans need expanding, to ensure that all aspects of service users` lives are assessed, with clear support plans in place to address any needs identified. They should include risk assessments regarding lifestyle choices, as well as physical aspects of care, and greater detail of leisure activities. Care plans and risk assessments must also be evaluated and amended, where necessary, at regular intervals. Service users` involvement in their own care plans could be improved, particularly where they are not in full control of their personal allowance or purchase of cigarettes, for example, when their signed agreement to "rationing" should be obtained. Staff are not receiving the supervision and guidance, either formal or informal, which they need in order to ensure they are carrying out their work properly. Instances of poor practice appear not to be picked up and corrected as they occur, for example, not respecting service users` privacy. Systems that are in place to ensure the home is maintained in a safe condition must be kept up to, such as checking on the electrical wiring, etc.

CARE HOME ADULTS 18-65 The Malvern Nursing Home 425 Toller Lane Heaton Bradford BD9 5NN Lead Inspector Stevie Allerton Announced 28 June 2005 th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Malvern Nursing Home Address 425 Toller Lane Bradford BD9 5NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 492643 01274 499557 Mrs Rachel Halsall Mrs Rachel Halsall Care Home with Nursing 28 Category(ies) of Mental Disorder Over 65 (28) Mental Disorder registration, with number (28) of places The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2004 Brief Description of the Service: The Malvern is a 28-bedded care home with nursing, specialising in the care of adults with mental illness. The home takes both male and female service users and was established 20 years ago. The house is a late 19th century detached residential building situated on a main road approximately 3 miles from the centre of Bradford, served by a good bus route. Many of the building’s original period features have been preserved and the home includes an extension built in 1993. There is a parking area to the side of the building and a small patio area situated on the other side of the building. Access to the home is gained through the conservatory at the front and a ramp is provided for people with mobility difficulties. There are 16 single bedrooms and 6 double rooms on two floors, accessible for those with mobility difficulties by stair lift to the first floor. The home is owned and managed by Mrs Rachel Halsall, RMN. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced in advance and was the first of a series of two inspections planned to take place during the year commencing 1st April 2005. The next inspection will be unannounced. This inspection was carried out by one inspector over a full day, which allowed time to speak with service users, nurses and care staff as well as the Manager and administrative support staff. Comment cards were sent out to the home for service users and visitors to use, should they wish to make comment to the inspector about the home, but none were returned. The inspector looked round some parts of the building and some records were inspected. Ten of the twenty-seven service users, two nurses, four care assistants and the cook were spoken to during the course of the day. Views on the management of the home were also shared by two health and social care professionals who have had contact with the service. What the service does well: What has improved since the last inspection? The décor of the home has continued to improve. Fire safety has improved, by having almost all of the work recommended by the Fire Officer’s report completed. The standard of food provision has improved. There has been a cook in post for the past four months and the menus show a greater range of home cooked meals on offer, which the service users say they enjoy. Following a period when the behaviour of a former service user was causing many difficulties for both staff and other people living at the home, the atmosphere is much calmer. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 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 Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 4 Prospective service users are assessed to ensure that the home will be able to meet their care needs and have the opportunity to make visits to the home before they decide whether or not they would like to live there. This enables all parties involved to make an informed decision about choosing this home. EVIDENCE: The referral information for a prospective service user was looked at and formed the basis for a discussion with the Administration Manager about the admissions process. The home expects basic details on referral – the age of the person, their diagnosis, their physical mobility and their status under the Mental Health Act. A visit is usually made to see the person in hospital, if that is the source of the referral, then the person is invited to visit the home. Such a visit had taken place the previous day, when the prospective service user had spent half a day in the home, had lunch, met the other service users and seen the vacant room. At this point, more information was requested from the referring agency, including the person’s Care Programme Approach (CPA) and Risk Assessment. During the initial visit, the staff at the home outlined the facilities provided and explained the “house rules”, such as the policy of not having alcohol on the premises, although there is a pub very near at hand. There is a small The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 9 brochure available to take away, accompanied by a covering letter explaining the charges for care. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 & 9 It tends to be the nursing staff who maintain the care plan records, which excludes some valuable first hand information which the care staff could contribute. The role of the teams of nursing and care staff as key workers for individual named service users is not particularly clear and there does not appear to be any overall monitoring to ensure that the teams’ care planning methods are consistent. The involvement of the service users in day to day decisions about their life at the home needs to be developed, as there was very little evidence of consultation taking place. EVIDENCE: The care plans of five service users with a range of care and support needs were examined, the findings verified in discussion with the service users themselves, where possible, or with the staff. It was not clear how much service users knew about their own care plans, apart from having signed the agreement for staff to look after their medication. A large number of people have their personal allowance or cigarettes looked after by the staff and given to them on a daily basis, in order to help them to The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 11 last all week, but these agreements did not appear to be formalised and did not appear within the care plans. Where there had been some significant changes in a service user’s health and well-being, these were not consistently reflected by updated care plans. For example, one person’s physical dependency had significantly increased and this was noted within the care review notes from May 2005; however, his moving and handling risk assessment had not been updated from January 2004 and still stated that he was independently mobile. There was very little information in the care plans about social care needs or the staff’s role in encouraging individuals to achieve personal fulfilment. Written information about social and leisure activities was not being consistently recorded and was not linked to any specific plan of care. One person recently admitted was identified in the placing agency’s care plan as needing help with developing social skills, but there was no plan as to how the home would help to meet that need. In discussion with some of the service users, it was apparent that communication could be difficult, either because English was not their first language or because of mental health issues. Staff were able to say how they communicated in these instances, but these strategies were not written down as part of the overall care plan, nor were they evident in some of the exchanges witnessed between staff and service users. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 17 Service users have opportunities to take part in the activities of the local community. To what extent this occurs is largely dependent on the ability of the person to do this without staff assistance, or when there are sufficient staff available for those who need an escort. Meal provision has improved since the last inspection. EVIDENCE: The home has a vehicle, a people carrier, available for outings and some of the service users said they had been on trips recently. It was very hot weather on the day of inspection and many people were taking advantage of the good weather to sit outside on the patio, or go along to the local park. One of the service users said that he likes to help around the home, doing tasks like setting the tables at mealtimes. The dining room is one of the main areas where smoking is permitted; service users appeared to understand and respect the no smoking policy whilst meals are being served and others are still eating. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 13 Lunch was taken with the service users in the dining room. The meal was well cooked and nicely presented and service users said they enjoyed the food provided. A new cook was appointed four months ago and the staff said that the kitchen arrangements were now greatly improved. In discussion with the cook, she acknowledged that her skills, gained at home in caring for her family, were in producing simple home cooking, but that she was learning what the service users’ likes and dislikes were. The Asian staff members had also been helpful to her in providing advice about cultural diets. The menus that were seen showed more variety than at the last few inspections, with less reliance on convenience foods. The senior staff said that there were plans to develop the menus further and to put up a notice board in the dining room in order to display the daily menu. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Although all of the elements are in place for service users to receive personal support in the way they prefer, individual staff members do not always adhere to the principles of privacy and dignity. For service users whose past history or state of mental health makes it difficult to assert themselves and say how they wish to be treated, such lack of respect serves to disempower them even further. There are appropriate arrangements in place for the safe handling and administration of medicines. EVIDENCE: Care plans showed a good level of attention to service users’ personal care needs, with appropriate referral to other health care professionals where needed; for example, the Tissue Viability Nurse has been involved in managing the pressure care for one person and a physiotherapist referral has also been made. There was evidence that appropriate action is taken in response to changes in health. Service users either visit the GP surgery, or home visits can be made. At the time of inspection the nurse in charge was arranging for an appointment with the Psychiatrist to be brought forward for one of the service users she had concerns about. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 15 It was noticed in one of the service user care plans that there had been no recorded visits from a chiropodist for a long time and the person concerned was seen to have toenails that were in need of attention. In discussion with the nurse in charge it was acknowledged that some individuals are resistant to any interventions of this kind, also to hairdressing, shaving, etc., but that refusals of a service are generally not noted in the care records. One of the nurses went through the medication procedures - the ordering, storage, administration and recording, all of which appear to comply with practice guidelines. The inspector was concerned to witness two occasions where care staff barged straight into a service user’s bedroom without knocking, whilst he was in bed, also letting the door slam shut behind them. When this was questioned with the staff members they appeared to have little understanding of such core values as privacy, dignity and respect. The service user, when asked what he thought about their attitude, said that he wasn’t happy about it. This incident was relayed back to the Manager. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed on this visit. EVIDENCE: The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 28 & 30 The standard of décor continues to improve. Service users are provided with appropriate equipment to assist in their care. Levels of cleanliness were satisfactory. Laundry and sluicing arrangements, whilst not meeting the standard for general nursing homes, are appropriate for the service users living in this home. EVIDENCE: There has been some further decoration since the last inspection; the hallways and corridors are now much brighter, one of the double bedrooms has recently been completed and a bathroom was nearing completion. New table tops and chairs have been ordered for the dining room. Items of pressure relieving equipment referred to within the care plans were available and in use in the bedrooms. Protective gloves, aprons and other equipment were also readily accessible. The home does not have a great deal of incontinence to manage. Service users are generally mobile and independent enough to use WCs or commodes and the staff described the systems in place to maintain hygiene. The home does not have a sluicing disinfector, as required by the standards for nursing The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 18 homes; however, the washing machine has a sluice cycle and there are dissolvable bags in use for the hygienic handling of fouled linen. Service users make use of various shared living spaces in the home – a sitting room and conservatory to the front of the house and the dining room, sitting area and patio to the rear. The dining room is the place where most people gather, to smoke (not when meals are being served), to chat and do activities. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 & 36 There are some good staff, both qualified and unqualified, who individually have the knowledge and skills to support service users with mental health problems. However, there is a lack of consistency within the team as a whole. There was little evidence that the more junior care staff are properly supervised in their everyday dealings with the service users, leading to some poor practice that is not being addressed. Induction training, particularly with regard to the core values of caring for people, needs strengthening. The service users and the staff would benefit from stronger leadership in practice issues. EVIDENCE: All of the nursing staff are part-time at the moment, some only working two shifts per week. The staff were grouped into teams last year, each team comprising one or two qualified nurses and some care staff, linked with specific named service users. The Manager acknowledged that this was not working well, as there was no-one taking responsibility for an overview of all four teams. The inspector saw inconsistencies in the way that care plans from different teams were being maintained. Minutes from a recent staff meeting also The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 20 revealed that practices and basic systems throughout the home were inconsistent. 25 of the care staff have a National Vocational Qualification (NVQ); most of the remaining care staff are registered on NVQ training, through Keighley College or Park Lane College in Leeds. There is no in-house assessor, so competencies are assessed by an external verifier. It was not clear how this method assesses a care worker’s actual practice, when such fundamental values as maintaining privacy and dignity are so obviously not understood. More than one service user said that not all of the staff were as good as each other. The previous training co-ordinator left at the end of last year, so induction training was now being done between the Manager and the Administration Manager. Moving and Handling refresher training had taken place and First Aid training was arranged for mid-July. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40, 41, 42 & 43 The home has satisfactory systems in place for the smooth running of the home, but greater effort needs to be made in implementing all of these. Previously agreed timescales for addressing some of the routine health and safety matters had not been adhered to and are now becoming urgent. There needs to be more clarity regarding the respective roles and the areas of responsibility for the Manager and the Administration Manager; both staff members and other professionals who come in contact with the home seem to be confused about lines of accountability. EVIDENCE: The policies and procedures manual was referred to during the inspection; it is easily accessible for staff, kept in the downstairs office/nurses station. Other statutory and operational records that were seen included: service users’ care plans; shift reports; service users’ personal allowance records; accident book; medication records; fire safety records; staff rotas; induction training material; menus. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 22 Some omissions were noted, which were relayed back to the Administration Manager; the tear-off accident reporting forms were not numbered and there was no photograph of one of the service users (particularly important where individuals at risk leave the building without telling the staff). The pre-inspection questionnaire completed by the home for this visit showed that some of the maintenance tasks, which need to be regularly carried out to ensure the home remains in a safe condition, had not been done within the previously agreed timescale. This was discussed with the Administration Manager. The inspector was told that the Manager works from 9.00am until 2.00pm each weekday. Two members of staff who spoke to the inspector said that, because of their shifts, they rarely saw her. Other health and social care professionals have also subsequently told the inspector that they were confused as to who actually manages the home. The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 1 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 2 2 x x 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Malvern Nursing Home Score 2 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x 3 2 2 2 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 24 YES 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 6 Regulation 15 Requirement Care plans must be drawn up after consultation with the service user; they must cover all aspects of daily life, be evaluated on a regular basis and updated where necessary. The registered person must ensure that the home is conducted in a manner which respects the privacy and dignity of service users. The registered person must ensure that all mechanical and electrical systems are maintained in good working order, i.e. the electrical wiring is safe and the hot water system is tested for legionella. (Carried over from previous reports, timescales not met.) The registered person must ensure that all staff receive training appropriate to their job role, to include training on the principles and core values of care. The registered person must ensure that all staff are appropriately supervised. (Carried over from previous report, timescale not met.) 20050605 The Malvern S19899 V206181 Stage 4.doc Timescale for action By 31.8.05 2. 18 12 3. 24 23 Discussed and agreed with immediate effect By 31.8.05 4. 32 18 By 31.10.05 5. 36 18 By 31.10.05 The Malvern Nursing Home Version 1.30 Page 25 6. 39 24 7. 8. 41 43 17 10 The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home, which includes seeking the views of service users. (Carried over from previous reports, timescale not met.) All records must be kept in accordance with Schedule 3 and Schedule 4. The registered person must manage the home with care competence and skill, undertaking such training as appropriate to maintain the necessary management skills. By 31.12.05 By 31.8.05 No timescale agreed 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 Good Practice Recommendations The Malvern Nursing Home 20050605 The Malvern S19899 V206181 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Aire House Town street Rodley Leeds LS13 1HP 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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