Inspection on 01/07/05 for The Westbury Nursing Home

This inspection was carried out on 1st July 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.

Other inspections for this house

The Westbury Nursing Home 20/06/07

The Westbury Nursing Home 14/06/06

The Westbury Nursing Home 08/11/05

The Westbury Nursing Home 21/07/04

The Westbury Nursing Home 27/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Westbury Nursing Home Falcondale Road Westbury On Trym Bristol BS9 3JH Lead Inspector Sandra Garrett Unannounced 1st July 2005 9:30 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 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 Westbury Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service The Westbury Nursing Home Address Falcondale Road Westbury On Trym Bristol BS9 3JH 0117 9079971 0117 9146665 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) Westbury Care Limited TBA Care home with nursing 68 Category(ies) of OP Old Age (68) registration, with number of places The Westbury Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: May accommodate 68 Persons over 50 years of age receiving nursing care. Staffing Notice dated 01/10/2001 applies Manager must be a RN on Parts 1 or 12 of the NMC register Date of last inspection 21-Jul-2004 Brief Description of the Service: The Westbury Nursing Home is operated by Westbury Care Limited. The home is privately run and provides accommodation for 68 people who require nursing care.The building has been internally designed and structured to provide a comfortable environment for all residents. Accommodation is provided on two floors. The ground floor communal area is well lit with natural sunlight, through the glass- topped ceiling. The upper floor has a mezzanine area that looks down upon the lower floor, and also provides a pleasant place to sit or dine. The home has 62 single rooms with ensuite facilities, and four shared rooms also with ensuite bathrooms (not all these rooms are currently used as double rooms). The home is set within in its own grounds and is within a short walking distance from the village of Westbury-on-Trym. There are local shops and amenities nearby, plus a bus route into the City centre. A new, experienced Registered Manager has been appointed, who previously worked at the nursing homes sister residential care home situated within the same grounds. The manager and The Group Manager for Westbury Care Ltd who is also based at the home, are working together to oversee and manage a process of change. The Westbury Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during an evening and lasted five hours. Two inspectors visited the home and each inspected one floor. A tour of the premises took place and care records were inspected. Some records were not available for inspection and this has been addressed in the report. Eleven residents, ten staff on duty and six relatives were spoken to. A follow up visit was made within a week of inspection to give feedback to both the manager and the group manager. Some records unavailable at the time of inspection were seen at this visit. What the service does well: What has improved since the last inspection? Following the last inspection, the home now benefits from a permanent experienced manager who has worked for the Westbury Care group for several years. At the follow-up meeting on the 7 July ’05, the manager was open and positive about the inspection process and feedback and made clear her commitment to continue to bring about positive change and improvement in the service provided for all residents. One requirement in respect of clarification over terms and conditions for local authority service users on admission was met. This was included in the copy of the Service Users Guide seen in the reception area of the home. New residents can be confident and clear about the level of fees payable for their care. The Westbury Nursing Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Westbury Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection The Westbury Nursing Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 &2 Residents are given clear information about the service and what fees they are expected to pay. EVIDENCE: A copy of the Statement of Purpose and Service Users Guide was available in the reception area of the home and in individual residents’ rooms. The Service Users Guide contained a copy of the complaints procedure and the Schedule of terms and conditions for each resident. This included a Schedule for residents placed and funded by the local authority. The pro-forma also included information about the RNCC contribution. A requirement in respect of this, made at the last inspection, is now met. The Westbury Nursing Home Version 1.10 Page 9 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 standard(s) 7,8, 10 &11 Residents are appropriately cared for in respect of their health and personal care needs. However, further attention needs to be given to the revision, updating and review of care plans and the quality of record keeping. Consistency of care recording needs improving throughout the home. Essential and up to date records in respect of meeting health needs must be improved. Recording of wishes at the end of life is unsatisfactory. EVIDENCE: There was a marked difference in quality and type of care recording between the two floors of the home. Several of the care plans seen were comprehensive and detailed and gave clear evidence of actions e.g. catheter care, and records of how healthcare needs are met by visits from GP’s, Chiropodists and dental treatment. The differences were most apparent in respect of care plan reviews, some of which on the first floor repeated the same phrase e.g. ‘continue with the same management of care’. This statement was seen repeated for up to 12 months. On the ground floor reviews had been carried out although monthly review sheets were not always filled in and some reviews had not been carried out for over a month. Reviews must be done regularly and show changes in care and progress made. The Westbury Nursing Home Version 1.10 Page 10 One resident on the first floor who had both legs bandaged, said ‘they are very sore, I keep knocking them’. There was no documentation in her/his care file regarding treatment of these wounds and a senior staff member was unaware of any dressings needed. Another resident’s care records stated: ‘is depressed and anxious’. There was no care plan available or evidence of positive intervention strategy to alleviate anxiety and depression. An ‘overall assessment’ for one resident made reference to ‘can get aggressive at times’. There was no other detail recorded or risk assessment in place. Care records were examined for one resident and it was noted that staff had recorded ‘very sore groin and bottom’ for approximately 2 weeks. Although a proprietary cream was reportedly used as treatment, there was no evidence of medical advice being sought. The resident in question said s/he was not sore at this time. The quality of record keeping, in respect of continence needs, wound care and pressure area care doesn’t reflect the actual quality of care being given that residents and some relatives said was very good. Examples found that: - Scant information was available about management of continence and one relative said s/he was unsure if his/her partner was regularly toileted when s/he was not visiting. This had been subject to a requirement at the last inspection that is carried forward. - Another resident whose care plan identified a need to be turned two hourly was seen in bed lying in the same position for over two hours. Although the need for a ‘turn chart’ was written in red on the care plan there was no chart available. Further the manager and group manager said at the follow up visit that this resident was up and about and didn’t need turning. Clear and current information was therefore lacking. The Westbury Nursing Home Version 1.10 Page 11 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 standard(s) 12, 14 & 15 Residents experience a varied life in the home with regular visiting encouraged and individual choices available to them. Immobile residents need more stimulation based on their preferences. Meals provided are of good quality. Attention is needed in respect of offering individual choice at some meals. EVIDENCE: The inspector spoke with a resident and visitors and was told that although it is the resident’s choice to remain in bed there is no social stimulation. The resident told the inspector s/he loves dogs. A good practice recommendation is therefore made that information regarding dogs used for therapeutic visiting be sought. Relatives were seen coming into the home throughout the afternoon and evening. One relative said s/he spends most of the day at the home, keeping the resident company. This relative was observed enjoying tea with the resident that s/he said was a regular occurrence. Another relative was observed chatting to other residents when visiting. Information on diet seen in individual care files, recorded allergies but didn’t record ‘likes and dislikes’. Some residents said the food was ‘poor’ whilst others were ‘satisfied’. A staff member said residents get a choice in the morning regarding what they want for the evening meal. One resident who The Westbury Nursing Home Version 1.10 Page 12 prefers to stay in bed also receives her meals there. A comment was made that this individual was once seen being fed lying down. If this is the resident’s choice it is required that an individual plan to support her/him at meal times be established. The teatime meal was observed and it was noted that macaroni cheese was offered and enjoyed by several residents. However one resident who chooses to eat in her room, said that she didn’t like having a cooked meal at teatime. The resident went on to say that although sandwiches were also offered she didn’t like the choice available yet didn’t like to ask for sandwiches of her choice to be made especially. The Westbury Nursing Home Version 1.10 Page 13 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 standard(s) 16 & 18 A complaints procedure is in place in the home and complaints information is available to residents and their relatives. The complaints system needs improving to ensure complaints are investigated, resolved in a timely manner and made available for inspection. Abuse training is given priority within the home. EVIDENCE: Information about complaints was seen in the Service Users Guide in reception and in copies kept in residents’ rooms. Residents were aware of their right to complain and how they could do so. Two relatives confirmed this but felt they had no need to complain. However two other relatives spoken to said they had complained about care practice but didn’t feel the issues had been resolved satisfactorily. Complaints records were not available at inspection as they were locked in the office and the manager was not on duty. The nurses in charge were both unable to give clear information about complaints and how they are handled. At the follow-up visit on 7 July ’05 the complaints record was seen. Although evidence of investigation of complaints was documented, it is in need of attention as it was not well-organised and lacked essential information i.e. in respect of dates, outcomes and whether upheld or not. Night staff spoken to on the first floor of the home said they had not attended Protection of Vulnerable Adults training although they said they wished to do so. However, at the follow up visit the manager and group manager showed the inspector lots of training information and a video ‘Abuse in Care Homes’ that they said they regularly run. They also demonstrated a strong awareness of abuse and a commitment to regular ongoing training in the subject. Abuse The Westbury Nursing Home Version 1.10 Page 14 issues are also discussed at meetings and seminars held in the home and flyers for these discussions were seen. The Westbury Nursing Home Version 1.10 Page 15 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 standard(s) 19, 24 & 26 The standard of the environment in this home is very good providing residents with an attractive, homely and clean place to live. Minor improvements to residents’ rooms are needed to ensure they are kept safe. EVIDENCE: The home is laid out in an open plan way with large seating areas close to the dining area. Bedrooms lead off this space on either side. The upstairs floor is also open plan with a mezzanine that overlooks the ground floor lounge/diner. A glass ceiling offers plenty of light to the dining area. In one resident’s bedroom on the ground floor it was noted that the bed was positioned against the wall. However the wall light was positioned away from the head of the bed and with a very short pull cord that would make it difficult for the resident to find or reach during the night. No table level bedside lighting was seen to compensate for this. As the resident has a cognitive impairment, accessible lighting within reach is necessary to avoid risk of accident in the dark. The Westbury Nursing Home Version 1.10 Page 16 The home was very clean and hygienic throughout at this visit with no unpleasant odours. The home was generally clean and tidy. It was pleasant to see fresh flowers and plants throughout. The Westbury Nursing Home Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staffing levels within the home are satisfactory. Some attention should be given to ensuring maximum benefit to residents from the numbers of staff available. Training opportunities are satisfactory and regular training is offered and available to all staff. EVIDENCE: Staff were observed attending to residents in a calm and unhurried manner. Residents spoken with on the first floor said call bells were generally answered quickly although ‘it depends how busy they are’. The inspector pressed a call bell and it was answered promptly and courteously. However some residents and relatives on the ground floor said that they felt that there were not always enough staff available. In their view staff don’t always answer call bells promptly and there is infrequency of toileting for some residents. Care staff practice on the ground floor was observed and prolonged ringing of residents’ call bells was heard. Staff on the ground floor said that they don’t feel there are enough staff to care for the numbers and dependency levels of residents and stated that sometimes there are often not enough staff on duty. However the manager and group manager at the follow up visit disagreed with this view. Rotas demonstrated correct numbers of staff that include ‘floaters’ working between the two floors. The rota allows for a ratio of ten care staff and two registered nurses plus one ‘floating’, operating between the two floors during the day. Because of this ‘disagreement’ about staffing levels a good The Westbury Nursing Home Version 1.10 Page 18 practice recommendation is made. This is to ensure that staffing is regularly reviewed in order to monitor numbers of staff, dependency levels and time taken to complete care tasks. Night staff on the first floor said they thought that adequate staffing was available at night. The inspector witnessed the senior nurse calling for an agency nurse for this evening night shift. This ensures 5 carers and 2 RGN that staff feel are adequate. On the ground floor one of the two night staff was from an agency and was unfamiliar with the home and its layout. Night staff said they took part in statutory training that includes fire safety, food hygiene and manual handling. However staff went on to say that they had no training regarding specific issues i.e. the management of continence, dementia awareness or abuse awareness. Training records were unable to be examined as the office was locked. At the follow up visit the group manager explained that she is responsible for training all staff across the homes in the group and that regular training is offered and taken up. A box file of training records was seen that demonstrated requests for training and take up of places. However it was acknowledged that individual staff profiles may not always be completed that shows whether training has been attended. The Westbury Nursing Home Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 37 & 38 Since the last inspection stable management has been introduced. Staff supervision is carried out but attention must be given to demonstrating that this happens. Care records require improvement and should be written from a person-centred and holistic viewpoint. Health and safety issues need some improvement. EVIDENCE: The manager had recently been appointed as registered manager of the home. Previously she had managed the group’s ‘sister’ home that provides personal care only and is located in the grounds. The manager and the group manager are currently sharing management responsibilities at the home in order to ensure a process of change and development is managed satisfactorily. Both were open to the inspection process and feedback given. However because management and staff views differed when speaking with the inspectors, a good practice recommendation is made to consider team-building sessions for all staff and managers that may aid communication and working practice. The Westbury Nursing Home Version 1.10 Page 20 Staff said that they don’t get regular supervision. One night staff member said she thought she had only had two or maybe three sessions in the past year since her induction. Two other staff members who work night shifts only confirmed they had not yet had formal supervision although one had been in post for approximately one year. The other had been in post for three months and her supervision was booked for this week. No records seen at the inspection were able to show whether regular supervision is provided (at least six times yearly). However records were seen at the follow up visit that showed clear evidence with dates for a number of staff. Both managers acknowledged that supervision for night staff needs improvement. The standard of care recording was generally good, particularly in respect of the overall assessment that for one resident was clear, concise and confirmed in conversation with her/him. Key worker records were holistic and gave a flavour of how residents spend their time. However, some daily records were brief and over medicalized. Further some records were negative i.e. regarding behaviour that challenges. For one resident a gap of five weeks was seen between care staff records. A good practice recommendation is therefore made to ensure that daily records are more holistic and person-centred and completed at a minimum weekly. Health and safety issues i.e. in respect of risk assessments, consents for use of bed rails and management of incidents affecting residents were examined. A requirement made at the last inspection in respect of consent to use bedrails was not met. It was observed that some residents who used bed rails had adequate risk assessments in place. However no consent forms could be found and some relatives said they had not been asked to give consent. Although risks were identified in care records, some risk assessments were inadequate. Those seen gave little information about actions to be taken to manage the risk. A number of risk assessments were in place that identified if a resident was at high or very high risk. However it was not clear how these risks would be managed. One resident had a generalised risk assessment in respect of ‘violent outbursts’. The assessment was not dated and was unclear as to whether this was in fact because of muscle spasms that were unavoidable, causing her/him to lash out. The accident books on both floors were examined. Some incident records were brief and didn’t accurately record injuries or actions taken. It was also evident that not all regulation 37 notifications are received by the CSCI as per legislation. It was noted that doors to bedrooms on the first floor were ‘wedged’ open. Suitable ‘door guards’ must be sought to enable the doors to be fully functional in the event of a fire. The Westbury Nursing Home Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x 2 x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x 2 x x x 2 2 2 The Westbury Nursing Home Version 1.10 Page 22 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 OP7 Regulation 15(2)(b) (c) Requirement Care plans must be regularly reviewed, updated and kept in a consistent manner, detailing clear actions taken to meet residents assessed needs (timescale not met from July 04 inspection) Where specified as assessed needs in care plans, wound and pressure area care must be documented, with clear details of actions to be taken and ensuring progress is recorded, including e.g turn charts Residents must receive where necessary, access to treatment, advice and any other services in a timely fashion. Assessed and expressed needs in respect of mental health and/or behaviour that challenges must be documented in care plans, detailing clear actions taken Clear actions in respect of meeting continence needs must be identified and recorded. Proper provision for the health and welfare of residents with continence needs must be made and discreet assistance is available at regular times. (Not Version 1.10 Timescale for action 15 August 05 2. OP8 12(1)(a) Sch 4 (12)(b) Sch3 (3) (k) 13(1)(b) 1 September 05 3. OP8 1 September 05 1 September 05 15 August 05 4. OP8 12(1)(a) 5. OP8 12(4)(a) The Westbury Nursing Home Page 23 met from July 04 inspection) 6. OP11 12 (3) Residents personal histories, preferences or wishes in respect of death or any unfulfilled ambitions must be obtained and recorded Individual plans to support residents nursed in bed at meal times must be established. Residents must be offered a meal according to their preferences and made available to them at teatime Complaints records must detail investigations, outcomes and responses to complainants within a twenty eight day timescale. Complaints records must be made available at inspection on request Where necessary, suitable and accessible lighting must be made available for residents in their own rooms at night Regular supervision must be carried out for all night care staff and records demonstrating that supervision is carried out must be made available for inspection on request Specific risk assessments for residents must show what actions are to be taken to manage the risk. Accident recording must give clear details of injuries received and all actions taken. Notices of any event adversely affecting residents must be sent to the Commission. Suitable door guards must be sought to enable residents bedroom doors to be fully functional in the event of fire 30 September 05 15 August 05 7. OP15 12(2) 13(4)(c) 16(2)(i) 8. OP16 22(2)(8) 1 September 05 9. OP24 23(2)(p) 1 September 05 1 September 05 10. OP36 18(2) 11. OP38 13(4)(a), (c) 1 September 05 The Westbury Nursing Home Version 1.10 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP27 OP32 Good Practice Recommendations Information regarding therapeutic visits from dogs should be sought for residents well-being Staffing levels and practice should be monitored and regularly reviewed to ensure residents needs are met in a timely manner Team building sessions with an experienced and independent facilitator should be provided for management and staff to aid communication within the home and improve staffing practice Holistic and person-centred care records should be recorded at least weekly by all nursing and care staff 4. OP37 The Westbury Nursing Home Version 1.10 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. BS32 4RG 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 Westbury Nursing Home Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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