Inspection on 09/06/05 for Windmill Lodge

This inspection was carried out on 9th 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.

Other inspections for this house

Windmill Lodge 09/11/06

Windmill Lodge 18/05/06

Windmill Lodge 05/11/05

Windmill Lodge 13/10/04

Windmill Lodge 05/05/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Windmill Lodge 115 Lyham Road, London SW2 5PY Lead Inspector Lynne Field with Mary Magee & Duncan Paterson Announced 09 June 2005 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. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Windmill Lodge Address 115 Lyham Road, London SW2 5PY 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) 020 8855 0055 Excelcare Holdings Cecilia Henry IN Private 93 Category(ies) of PC Care Home only registration, with number of places Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home must appoint a Deputy Care Manager There must be team leaders on every floor Respite care must be limited to 4 beds on the ground floor and four beds on the first floor Intermediate care must be restricted to the third floor and no other form of care may be provided on that floor. There must be a minimum of two nurses on shift on each of the first and second floors during the waking day. Date of last inspection 13 October 2004 Brief Description of the Service: Windmill Lodge Care Centre is a newly built care home with nursing facilities run by Excelcare for 93 older persons in Brixton. It was first registered in January 2004. There are eight respite beds in the home, which are limited to four respite beds on the ground floor and four respite beds on the first floor. Intitally there were plans for intermediate care on the third floor. After consulting with the CSCI, the home has opened this floor to provide nursing care for 13 service users. There is a general store next to the home, which is frequented by service users and staff. Brixton shopping centre with a variety of transport links is a short drive one way from the home and about the same distance in the other direction is Streatham Hill shopping centre and station. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors undertook the announced inspection at the home. It lasted over eight hours. The inspectors toured the premises. Service user and staff personnel files were viewed including recruitment and training records as well as complaints and mandatory records that the home is required to keep on Health and Safety. There were twelve service users and five staff members spoken to at various times throughout the day. The home had arranged the Summer Barbeque for the day of the inspection, which gave the inspectors an opportunity to meet and speak to a large number of relatives and friends who attended. What the service does well: What has improved since the last inspection? What they could do better: There needs to be a more consistent management approach with stronger leadership skills in directing and developing the staff team. The manager needs to ensure that all complaints are recorded and that they are fully responded to in a timely and appropriate manner. The home needs to demonstrate in all identified areas that they can meet the needs of the service users before they come to live at the home. Staff need to be more aware of the general nursing and personal care needs of the service users, particularly those who are bed bound, and not just the Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 6 importance of record keeping but actually doing what they record they have done. Communication and record keeping is poor and potentially places people that live there at risk. 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. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 & 3 Service users and their families are given sufficient information about the home to help them decide whether they wish to live there. Pre-admission assessments have improved and are now completed by senior staff. This ensures that the home has sufficient information to make a decision about whether they can meet the service users needs. The home is failing to follow its procedures by not assessing the service users once they are in the home in the timescales set down in the policies and procedures. EVIDENCE: There were good pre- admission assessments available for service users recently admitted to the home but it was noted that a Waterlow score, a continence assessment and a nutrition assessment had not been completed for one service user. This service user had been in the home for one week at the time of the inspection, whilst the Excelcare care planning paperwork stated that such assessments should be completed after 5 days. There is no intermediate care offered at the home. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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, 9 & 10 The arrangements for care planning and recording information relating to service user care is inconsistent and record keeping is poor. There is poor communication between staff, between staff and other professionals and staff and relatives. There are some areas of good care practices in service user care but these still need to be improved and to be built on. Complex nursing needs were not always being met and specialist advice was not always being followed. EVIDENCE: The files of 12 service users were inspected. A sample from the ground, first and second floors using the case tracking system was taken. Care plans were available for all service users. There were good pre-admission assessments available for those recently admitted to the home. While plans contained good details of individuals needs and how the home was working with other professionals such as the palliative care team, the following areas of shortfall were identified. Risk assessments had been completed and were available. However there were occasions where assessments were not completed for a service user that had Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 10 experienced a fall. A review had been done but the outcome was not recorded to keep staff informed of what action should be taken to reduce falls. Dates signified that reviews had been done but on investigation, this was a paper exercise. When comparing the daily recordings of events the actual changes that had occurred were not reflected in the updated care plans. One service user had a catheter removed and was now using incontinent pads. However, the review recorded did not mention this and neither had the care plan been amended. Local authority reviews had been completed for a number of people. One service user had an enteral feeding tube. She had seen the speech and language therapist. Following the local authority review it had been identified that she did not verbalise but was able to comprehend, recommendations were made that she should have some communication books. No action had been taken by the home to follow this up. When asked, staff reported that they had requested specialist communication books for two service users and that an additional order would go for the other lady in question. It was also recommended that thickeners were used to thicken fluids but no mention was made of this in care plans. The records made by the HEN team (team to support those on PEG feeds) indicated that the site of the tube required regular flushing out but that this had not always been done consistently and debris had been found there on occasions. Continence assessments were available but the care plans did not reflect the outcome of the continence assessments. Catheter care was not always followed according to plans or within specified dates. Recording in care plans was inconsistent. One service user who had a pressure ulcer, had a care plan that was detailed, up to date and included a wound assessment with evidence that the tissue viability nurse was involved in the care. One service user with pressure ulcers had a care plan that said she should be out of bed for at least two hours every day. There were no records available such as daily diary to indicate that this happened. Another service user who was in bed most of the day, only getting up for 3 hours, had a blank turning chart. The nursing staff said they recorded this on the daily notes but they could not find many examples of this. For another service user living at the home with pressure ulcers, there were photographs taken at monthly intervals available to demonstrate that the Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 11 healing process was underway. There were records of recommendations made by the tissue viability nurse. The diary notes held by the home did not always demonstrate that the wound care was done in accordance with the recommendations made. For one service user the records stated that on alternate days dressings were to be changed yet evidence was not available to indicate that this had been done. One service user spoke to the inspector about life at the home. She said that she was capable of “getting to the dining table and looking after her personal care needs” but that “she was concerned that those less independent did not receive all the attention they required’’. She spoke of service users with restricted mobility sitting in wheelchairs for long periods without any offer from staff to assist them to the toilet. Three relatives visiting the home also drew the inspector’s attention to this and were concerned that there were no toilet regimes in place to support people discreetly. The handover records were very poor. On some occasions, there were entries that included just one or two service users, and for a number of days there were no entries. This clearly is affecting communication at the home and leaves service users at risk if the communication system is poor. The negative feedback received from relatives (five) all included comments about poor communication by staff. From evidence seen in service user files it was difficult to tell if medication reviews are being done. The home operates a system where a record of the GP visits, are kept in a separate GP book. There is a section in the care plans to record GP visits but two of four inspected were blank. There will be a fuller medication inspection report from the pharmacy inspector that will follow seperately. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15 The food is appetising and nutritious but at times food that should be hot was served cold. Service users did not always get the necessary support and encouragement they need to help them eat and enjoy the meals they are served. Staff need to be more aware of service users individual dietary and personal needs and address these at all times. Families and friends are made welcome. Service users are able to go to visit relatives and community based activities as they wish. EVIDENCE: The inspectors shared lunch with service users. The meal was appetising and nutritious. Observations made were that the service of meal was slow. Service users had to wait too long a period for assistance at meal times and did not always receive the necessary support and assistance that they required to help them eat. Some service users felt there was not enough food and the selection of vegetables was poor. An example of this was the way in which a bed bound service user was served lunch. The meal was placed on the bedside table but it was some ten minutes later before a carer assisted her with eating, as result the food was cold and the service user was disinterested. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 13 Relatives and service users spoke about the way meals were served generally at the home and of the need for improvement. They said they had witnessed staff place meals in front of service users who were blind or that needed help, members of staff had not cut the food or explained what the meal was. Mealtimes they said were often hurried with little consideration given to making it as pleasurable as possible and encouraging and supporting people that required help. Sometimes the service users did not get tea and biscuits at 3pm. The inspectors spoke to a large number of service user’s family and friends who attended the BBQ. Many said they felt welcome and were happy with the service their relative received from the home. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The response to complaints is generally poor. Service users and families complaints were at times not listened to or acted on. Not all complaints are being recorded or dealt with appropriately. Staff were clear that they would take appropriate action if they had concerns about the welfare of service users, but the protection of vulnerable adult training needs to be reinforced to include what constitutes abuse. Service users have the opportunity to manage their own money if they are able to or their families are encouraged to do this on their behalf. EVIDENCE: The complaints records were examined. There have been 25 complaints logged in the past 12 months. The inspectors were told each of these have been responded to within 28 days and four of these are pending an outcome. Two are being dealt with by the CSCI. The home has co-operated with adult protection investigations undertaken by placing authorities. There were three unresolved issues of this nature at the time of the Inspection. Some service users spoken to said that when they complained they are listened to. Some service users said when they complained it still took some time for the home to respond to the complaint. For example on the day of the inspection, a service user said he had complained about night staff not responding to the call bell. This had led to the bed becoming wet from a leaking catheter bag so he had to lie in a wet bed all night. Staff had blamed the service user for not calling the staff. The manager admitted that she had not had time to investigate the matter nor was it recorded in the complaints book. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 15 An area where more development is required is regarding complaints about staff behaviour. Recently a member of staff was alleged to have spoken inappropriately to a service user and refused her request to turn on her light. The staff member completed a witness statement and she no longer works for the organisation. It is essential that members of staff regardless of whether they are bank or full time employees be interviewed as part of a thorough investigation. Disciplinary procedures must be followed more robustly and thorough investigations conducted when an allegation is made against a member of staff Another service user said she had not been able to use their call bell for one month because of her arthritis. She said that the manager was looking to see if she could get a different type of call bell. However, in the meantime she was having to rely on shouting out for help. This service user also said that she had to wait a lot for help such as being assisted to go to the toilet. The laundry is well equipped with three sluice washing machines and two large dryers. They use the red bag system and use one dedicated washing machine for this. There were two staff on duty at the time of the visit. The housekeeper said that she often helped out if staff were ill. The home does not mark service users clothes but ask the families to do that. Staff said that there had been some mix ups with identifying service user’s clothes which at times have gone missing. This does not always get recorded as a complaint. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 standard(s) 19-26 The standard of the environment within this home is good and the service users live in an attractive and homely place. Service users are able to bring personal possessions from home and are encouraged to personalise their rooms. EVIDENCE: The building was found to be clean at the time of the Inspection with no unpleasant odours. There are a number of communal facilities in the home. All floors have a large living room, a dining room as well as a number of small sitting areas set in the corridors where service users can entertain visitors in private. There is access to a garden through the ground floor unit which all the service users in home can use. Service users from other floors were using the garden on the day of the inspection and when they wished to return to the floor they were living on, a member of staff from that floor was called to take them back. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 17 All bedrooms meet the standard, are well decorated, attractive and have ensuite facilities. Service users are able to bring some personal furniture from home and some had chosen to do this. All bedrooms doors were fitted with a lock for privacy and security. Service users are offered keys and those who require a key have been given a key. Specialist equipment, such as hoists and standing frames, are available to assist service uses be moved in a safe way. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 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, 29 & 30 There are enough staff on duty to make sure that service users needs for care and support can be met. Staff recruitment records examined, were, in the main, in good order. Care needs to be taken to make sure that independent references are always taken up so that service users are cared being for by people who have been judged to have the appropriate experience and skills as well as no gaps in employment history. An internal audit of all the homes staff files would be beneficial to ensure all documentation held and that had been requested had been received. Although there is a staff good training programme in place, more emphasis must be placed on the importance of personal care and record keeping. EVIDENCE: Staffing levels on the day matched the agreed staffing levels. There are enough staff on duty to make sure that residents’ needs for care and support can be met. There are 13 qualified nurses employed to work at the home and 38 care staff. Staffing levels have been agreed with the CSCI and were judged to be appropriate for the current numbers and needs of the service users. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 19 There has been a comprehensive training programme over the last year and future training is planned for the year ahead. The home has a significant number of staff are undertaking training to NVQ level 2 and 3. This means that staff are provided with training to assist them in meeting the service users’ needs. The home has what it describes as a revolving training program for the staff, which means if staff are not available for one session of training there will be another session of the same training in a few weeks time they can access. Eight staff files were looked during the course of the inspection and appeared to be in order. Although the staff files viewed had two references from the previous place of employment it was not clear whom had supplied the reference and whether they were qualified to do so. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 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 & 38 The overall management of the home needs to be stronger with the two managers working in partnership. Service users and staff health and safety is protected by having the appropriate checks and records in place. Staff need to be made aware of what supervision is and how it can help their professional development. EVIDENCE: The home has two managers, a General Operations Manager, who would be the registered manager and is responsible for the home and the Care Manager who is responsible for ensuring a high standard of care is delivered and is directly responsible to the General Operations Manager. Each department has a head of department who also reports to the General Operations Manager. On the day of the inspection one manager had told a member of staff to do one Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 21 thing but had not informed the other manager so information was not passed on which lead to conflict within the staff team. Staff said they were supervised by the team leaders on a regular basis. Care staff didn’t appear to be sure what supervision was. One said they were supervised when assisting service users in personal care. They said they wer not given a copy of supervision notes and did not know it should be recorded. Health and Safety systems are in place and the appropriate certificates were seen. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x 2 x x x 2 x 3 Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 23 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 Reg 15 Requirement The registered persons must ensure care plans are kept up to date and contain clear guidance to staff on the actions to be taken to meet their health care needs. Professional guidance to be incorporated into care plans and followed. All changes to be documented and reflected in the care plans. The registered persons must ensure that people living at the home are treated with dignity and respect and with particular regard for personal care giving and for using the toilet. The registered persons must ensure the service users receive continuity of care, handovers must be documented daily to communicate clearly all service users conditions and progress. The registered persons must ensure that staff offer assistance in eating where necessary, discreetly, sensitively and individually taking into account service users’ capacities and requests. The registered persons must Timescale for action 30th September 2005 2. OP8 & 10 Reg 12 (1) 30th September 2005 3. OP8 Reg 12 30th September 2005 4. OP15 Reg 12 (1) a, b. 30th September 2005 5. OP16 Reg 22 Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 24 (3)(4) 6. OP18 & 29 Reg 12(5)(a)( b) Reg18 (c)(i) 7. OP30 8. OP32 Reg10(1) 9. OP36 Reg 18 (2) review how it deals with and responds to complaints. The registered persons must ensure staff must maintain good personal and professional relationships with each other and with service users. The registered persons must ensure persons employed at the care home receive training appropriate to the work they perform, with particular regard to nursing and personal care. The registered persons shall , having regard to the size of the care home, statement of purpose and the number and needs of the service users carry on and manage the care home with sufficent care, competence and skill. The registered persons shall ensure that staff working at the care home are appropriately supervised. 30th September 2005 30th September 2005 30th September 2005 30th September 2005 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 OP29 Good Practice Recommendations An internal audit of all the homes staff files would be beneficial to ensure all documentation held and that had been requested had been received. Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH 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 Windmill Lodge G52-G02 S58177 Windmill Lodge V226929 090605 Stage 4.doc Version 1.30 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. You have been warned!