CARE HOMES FOR OLDER PEOPLE
The White House Nursing And Residential Home Gillison Close Letchworth Hertfordshire SG6 1QL Lead Inspector
Tom Cooper Unannounced Inspection 3rd November 2005 3:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The White House Nursing And Residential Home Address Gillison Close Letchworth Hertfordshire SG6 1QL 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) 01462 485852 01462 486438 Medical Resource Worldwide Renaud Sockalingum Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61), of places Physical disability (51), Physical disability over 65 years of age (51) The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home cannot accommodate any service under the age of 55 Date of last inspection 5th July 2005 Brief Description of the Service: The White House Nursing and Residential Home, first opened in 1995, is a purpose-built establishment located in a quiet cul-de-sac in a residential area of Letchworth, near the local day centre and hospice. Following a recent extension adding 9 extra rooms and a conservatory, the home now has 61 beds, 10 of which are used for residential cases. Accommodation comprises 20 bedrooms on the ground floor with 40 on the first floor and there are 7 separate communal day areas. There is a large, well-maintained landscaped garden with a patio area, accessible to all service users. The home caters for a variety of care needs, being registered for older people as well as adults with physical disabilities and dementia. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection for the year 2005/6 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001, the last having occurred on 7th July 2005. This unannounced inspection was conducted on a weekday in the late afternoon and evening. Discussions were held with service users, the manager, the associate director, the activities coordinator, other staff on duty including an RGN, several care assistants and a visiting relative of one of the residents. Six service users’ care plans were examined and records in respect of medication, complaints, activities, staff training and induction, accidents, fire alarm tests and some equipment on the premises. A brief tour of the building was undertaken, taking in approximately twenty service users’ bedrooms. The interaction between staff and service users was observed. The inspection indicated the home was providing a service that all spoken with appreciated, with caring and knowledgeable staff. Opportunities are available for service users to lead reasonably stimulating lifestyles as they choose. The manager and staff have made considerable progress towards complying with the shortfalls in standards found at the last inspection. What the service does well:
Service users spoken with all said that they liked the home praising the food provided and describing the staff as particularly helpful and respectful. They also expressed great confidence in their ability to care for them in the way they prefer. Staff were observed to work well as a team and confirmed that the reporting system from shift to shift ensured that they were kept up to date with the changing needs of service users. Staff were knowledgeable about individual needs, lead by the manager who clearly also knows the residents well. Care plans are in place for each service user. These provide a fair overview of individual needs and the actions planned to meet them. Examples seen had been updated regularly. Service users have good opportunities to engage in a wide range of stimulating activities, coordinated by a specifically designated contractor, including going on outings with staff. Those attending the afternoon cookery session said they found the various activities really rewarding. The premises are clean, fresh and well maintained throughout and very suitable for elderly residents with restricted mobility and/or confusion.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 6 The numerous lounges and other communal spaces are comfortable and safe. Bedrooms are spacious and suitably furnished to suit individual needs and tastes. Special equipment is provided as necessary. Heating, ventilation and lighting are adequate and safe. The home was warm in all areas on the day of the inspection. Staff mandatory training has been kept up to date, for example in moving and handling, infection control and so on. New recruits are given a comprehensive induction to ensure they are competent to carry out their duties. Although the home does not yet meet the care staff qualification standard, eight staff are undertaking the NVQ2 course. The manager is well qualified and provides consistent leadership to the team, although the senior team lacks depth as there is no deputy manager (see recommendations). Staff said they felt well supported by senior colleagues and felt communications were good. However formal supervision remained patchy (see recommendations). A high standard of record keeping was found, with all records inspected well maintained. Appropriate policies and procedures are being followed to safeguard the health, safety and welfare of service users and staff. No health and safety hazards were noted. What has improved since the last inspection?
The manager stated that staff had been working hard to redraft service users’ care plans into a revised format. As indicated above, examples seen contained a fair overview of individual needs, and there was documentary evidence that the various needs documented were being met by staff. However the care plan files were bulky and difficult to access and would benefit from some streamlining to produce more effective working tools. Medication procedures had been tightened, with Temazepam now separately recorded as a controlled drug. The standard of personal care provided by staff was uniformly good. All service users seen were well presented physically, with smart clothing, clean fingernails and shoes and tidy hair. The premises were warm throughout, with thermometers in all communal areas for staff to monitor room temperatures and adjust as necessary. Hot water was being delivered at safe temperatures at taps. All wheelchairs in use were fitted with footplates, except for one in respect of which the resident had insisted on removing them. The manager has placed a risk assessment on this individual’s file. Service users in lounges said they could go to whichever communal room suited them. All areas were free from unpleasant smells. Staffing levels were adequate on the day of the inspection and have been increased since the last inspection.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 7 However some staff said that numbers dropped on some days. The manager is now supernumerary on most shifts. This situation must be maintained as he is under considerable pressure without a deputy to relieve some of the care management burden. The manager and associate director said that several new staff had been recruited. Criminal Records Bureau disclosures were being kept in a locked cabinet. 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 White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, & 5 Adequate information is available to prospective service users and their relatives/advisors to enable them to make an informed choice about whether the home is somewhere they would like to live. Contracts are issued to all residents on admission. All admissions are made following a thorough assessment of the individual’s needs. Prospective service users may visit the home prior to admission to assess the service and judge whether it will be suitable. EVIDENCE: The home has a statement of purpose and service user’s guide that contain the required information and these are available to service users. A version in Braille is also available. Contracts of occupancy are held on resident’s personal files. The manager or one of the trained nurses assesses the needs of prospective service users prior to admission and the information is used as the basis of the initial care plan. Service users spoken with and a visiting relative said that visitors were able to visit freely and could be entertained in any of the lounges, the conservatory or the garden.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 10 Staff were said to be most cooperative, friendly and welcoming. The home does not provide intermediate care. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10 Service users’ needs are set out in individual care plans covering medical, health details and personal care needs, with risk assessments in place for nutrition, falls, pressure sores, moving and handling etc. and instructions to staff on how to proceed. However the files should be streamlined to improve accessibility. Staff continuously monitor service users’ health care needs and take action as appropriate. The home has sound policies and procedures for the safe management of medication that ensure service users are protected and receive medicines as prescribed by their GPs. The arrangements in the home for health and personal care are such that service users feel they are treated with respect and that staff promote their privacy and dignity. EVIDENCE: Six care plans examined contained pre-admission assessments and details of the service users’ medical, personal care and other practical elements.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 12 Risk assessments were in place for falls, moving and handling, nutrition and pressure sores. For the two service users in the home with current pressure sores there were good details of the individual actions agreed and evidence that the care predicted had been carried out. Daily progress was noted in appropriate language. Overall the care plans seen provided a useful overview of individual needs, although the files were bulky and the volume of material made access confusing. The files should be streamlined to produce more effective working tools for staff. Another improvement would be to expand the scope of the care plans to cover social and emotional elements as these were not addressed in detail in the examples seen. Staff spoken with including the manager demonstrated good knowledge of the needs and personal preferences of residents. Residents consulted said that they had been involved to some degree in their care planning. Individual service users seen in communal areas and bedrooms looked well cared for. They were clean and tidy, wearing appropriate clothing and those in bed appeared comfortable. Fingernails and hair were well presented. Service users said that staff were very friendly and accommodating, always knocked and waited at their bedroom doors, and ensured that medical treatment and intimate procedures were carried out discreetly and in private. These issues are covered in the induction programme for all new staff. The home has a formal policy on the handling and administration of medication. Drugs are stored securely, with controlled drugs (including Temazepam as required in the last inspection report) kept in a separate locked metal cabinet within the medication room. Storage and recording procedures are sound. Fridge temperatures had been recorded daily and had been steady within safe limits. No gaps or mistakes were noted on the medication administration record sheets. Only trained nurses handle medication. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13&15 Service users can lead stimulating lifestyles as they choose. A wide range of suitable activities are provided that take into account the interests and abilities of service users. Service users can maintain social and family contacts and staff are welcoming towards visitors. Service users receive a wholesome and nutritious diet that corresponds to individual assessed and recorded needs. EVIDENCE: On the day of the inspection a group of residents took part in a supervised cookery session, which they said they enjoyed greatly. The home employs a full time activities co-ordinator who arranges and leads a varied programme of interesting activities including games, outings, quizzes visits from entertainers (a pantomime troupe and operatic society had been booked) and so on. Events participated in are recorded on individual sheets for each resident. Service users consulted praised the range of activities on offer. Newspapers are purchased for those who want them. The team maintains links with the community, for example students from local schools on work experience placements and local schoolchildren come to the home to sing from time to time.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 14 Service users said that they could have visitors at any reasonable time. They can be entertained in the service user’s bedroom or any of the communal areas. One visiting relative said that staff always made her feel welcome. All service users spoken with praised the food provided, several citing it as a real strength of the home. Alternatives to the main meal option are always available. Service users were observed being assisted in a gentle and appropriate manner by staff. Plenty of drinks were available for service users. Fresh fruit is supplied, going round with the tea trolley. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Adequate procedures are in place to ensure that complaints are dealt with appropriately. Service users feel that any issues they raise will be listened to, taken seriously by staff and management and acted upon. Policies and procedures in place and staff training ensure that service users are protected from abuse. EVIDENCE: It has previously been established that the home has an adequate complaints procedure that commits the organisation to the prompt investigation and resolution of complaints. No formal complaints had been received from service users or relatives since the last inspection. The manager said that the policy of the home was to put right any grumbles drawn to the management’s attention before the problem escalated. Service users consulted expressed confidence that any concerns they might have about the operation of the home would be sympathetically received and acted on by the manager. The home has a policy on responding to suspicion or evidence of abuse, including whistle blowing by staff. The manager was fully conversant with the relevant procedures. Individual staff interviewed were able to demonstrate awareness of their reporting responsibilities. The protection of vulnerable adults is covered during the staff induction programme and also as part of the NVQ2 course undertaken by a number of staff. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25&26 The building is suitable for the needs of elderly and physically disabled service users, providing a safe, well-maintained and comfortable environment. The home has numerous fully accessible indoor and outdoor communal facilities. Adequate toilets and bathrooms are provided, adapted as necessary to meet service users’ needs. Specialist equipment is provided as required to maintain the health and well being of service users. Heating, lighting, ventilation and the delivery of hot water are adequate and safe so that service users live in safe and comfortable surroundings. The home is clean, tidy, hygienic and odour-free. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 17 EVIDENCE: The home was purpose-built with wide corridors and doorways suitable for wheelchair users. A programme of planned maintenance and renewal of the facilities ensures that equipment, furnishings and décor remain in good order. The home meets the requirements of the local fire and rescue service and environmental health department. There are several lounges, sitting rooms and a conservatory, providing an excellent degree of choice for individual residents of where to spend time. During this inspection residents were seen relaxing in the different rooms available rather than congregating in just one or two. Décor is smart and unobtrusive and furniture is of domestic types suitable for elderly people with restricted mobility. All flooring was in good condition. Service users’ bedrooms seen were spacious and well presented, with accessible and functioning nurse call alarms and special equipment such as adjustable beds, pressure mattresses, medical devices and so on all in good condition. Hoists seen had been serviced during the last year. Adequate toilets and bathing facilities are provided in all areas of the home. The delivery of hot water was regulated within safe limits and low surface temperature radiators are fitted throughout, protecting residents from scalds and burns. Thermometers are provided in all bathrooms and lounges for staff to monitor temperatures. Individual bedrooms were organised to suit the tastes and needs of the residents, with personal items such as pictures and ornaments. The building was evenly warm throughout on the day of the inspection. All areas seen were clean, tidy and fresh smelling. No unpleasant odours associated with incontinence were detected. Staff were observed following proper infection control procedures. Staff confirmed that supplies of protective clothing such as plastic gloves and aprons were readily available. Laundry facilities are adequate and sited well away from food preparation areas. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28&30 Staffing levels are usually sufficient to meet the needs of service users. Service users’ interests are protected by the staff induction and training policies in place that ensure staff are competent and familiar with modern care practice. EVIDENCE: On the day of the inspection staffing was adequate, with three trained nurses on duty plus eleven care assistants. The manager was also present. The manager and associate director stated that following a successful recruitment drive the team had been expanded and it was now much easier to maintain adequate staffing levels. Staff interviewed gave mixed opinions as to the day to day adequacy of staff numbers, one of the nurses commenting that when the manager was included on the rota it could be quite stressful as he was under considerable pressure from his non-care responsibilities. There is no deputy manager in the home, which (as found at previous inspections) is an obvious weakness in the senior team that should be addressed by the company to spread the senior management load and free the manager to concentrate on other vital tasks such as meetings with GPs, relatives, staff supervision and so on (see recommendations). The manager reported that eight staff were currently undertaking the NVQ2 course and although the home did not yet meet the 50 standard, he was optimistic that it would reach the target by the middle of 2006.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 19 A newly recruited care assistant was able to describe in detail the induction programme she had been working through. Staff spoken with said they had received mandatory training in fire safety, moving and handling (a course took place during the inspection), food hygiene etc. and felt they had good opportunities for relevant training to maintain and increase their care practice knowledge. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,37&38 The manager is qualified and experienced and well capable of managing the home. The management team provide strong leadership to staff to promote the caring ethos and achieve the aims of the home. Staff are supervised and feel well supported. However the frequency of formal individual supervision should be increased for all care staff. Records are properly maintained and kept up to date. Policies and procedures are in place to ensure safe working practices are followed to protect and promote the health, safety and welfare of service users and staff. EVIDENCE: The manager is a qualified nurse with many years experience of working in the care industry, including eight years in charge of the White House.
The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 21 He is therefore well qualified to run the home and has good authority within the team. Service users and staff indicated that he was effective and a good communicator. However this is a very large establishment and as mentioned earlier in this report would benefit from the additional support of a deputy manager. The associate director stated that the company proposed to recruit a suitable candidate as soon as possible. Staff described the home as a happy place to work and said they felt communications and teamwork were generally good. They also felt well supported, although formal one to one supervision was not occurring sufficiently frequently to meet the standard of six sessions per year (see recommendations). Handovers take place between shifts so that incoming staff are well briefed on the progress of service users and any changes they need to be aware of, as well as setting the priorities for the coming shift. All records inspected were well maintained and had been kept up to date. The home has a formal health and safety policy and proper procedures are followed to ensure safe working practices. For example, equipment seen had been serviced recently, staff mandatory training was ongoing, medication practice and records were satisfactory and hazardous substances were locked away. No health and safety problems were noted. Completed risk assessments were on service users’ files. Footplates were fitted to all wheelchairs in use apart from one. In this case the service user was adamant that he did not wish to use footplates. The manager placed a risk assessment and note of the service user’s choice on his file. The home has suitable insurance cover in place and a valid certificate was on the hall wall. The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 3 3 The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP27 Good Practice Recommendations It is again strongly recommended that a suitably experienced deputy manager be recruited to strengthen the management team and deputise effectively in the registered manager’s absence. Formal care plans for new service users should be drawn up within five working days, based on the pre-admission assessments. Care plan files should be streamlined to create more accessible and user-friendly working tools for staff. Care staff should receive formal supervision at least six times a year. 2 3 4 OP7 OP7 OP36 The White House Nursing And Residential Home DS0000019591.V263514.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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