Care Home: 67 Birch Avenue Nursing Home

What the care home does well The standard of documentation and communication between the staff was good. Because of this staff had immediately recognised changes in a person`s health and so medical advice had been quickly sought. People said that the care they were receiving was good and consistently added comments such as " the staff are nice, friendly and helpful". Relatives made comments such as "the staff are caring" and "the care at Birch Avenue is excellent. ". People were very well dressed in clean, age appropriate clothing and attention had been paid to hair and nail care. Staff were observed to treat people with respect and courtesy. People said that they had a choice of food and that the quality of food served was generally good. The home was clean and tidy. Relatives and people said that the home was always kept clean. Throughout the day friends and family were seen visiting the home and there seemed to be a very friendly and welcoming feel in Birch Avenue. What has improved since the last inspection? The standard of the care plans had improved since the last inspection. The plans contained more detail on the activities that the people participated in and recent health care checks that they had received. All medications were securely stored in the home and staff had completed the information required on peoples Medicine Administration Records. Carpets in communal areas and peoples bedrooms have been recently replaced which has further improved the aesthetics of these areas. There had been some improvements in recruitment practices and the frequency of staff receiving management supervision since the last inspection. What the care home could do better: Relatives, health professionals and staff surveyed and spoken to raised major concerns about low staffing levels. The low staffing levels were having a detrimental affect on some elements of care that people were receiving. Some staff need to consider peoples dignity more when they are providing any care. There needs to be more information displayed in the home that may help people with orientation. All staff employed at the home must undertake a CRB check. CARE HOMES FOR OLDER PEOPLE 67 Birch Avenue Nursing Home 67 Birch Avenue Chapeltown Sheffield South Yorkshire S35 1RQ Lead Inspector Michael O`Neil Key Unannounced Inspection 2nd October 2007 08:50 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 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 67 Birch Avenue Nursing Home Address 67 Birch Avenue Chapeltown Sheffield South Yorkshire S35 1RQ 0114 245 3727 0114 245 4015 none None South Yorkshire Housing Association 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) Vacant post Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following catgory of service only: Care home with Nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 40 13th November 2006 2. Date of last inspection Brief Description of the Service: 67 Birch Avenue is a one-storey purpose built home, which provides nursing care for older people with dementia. The home has four, ten bed units with an interlinking corridor surrounding a large garden and patio area. Each unit has a communal lounge and dining room. All of the forty bedrooms are single and all have en-suite facilities. A central kitchen and laundry serve the home. The home is near to the centre of Chapel town, bus routes and local amenities. A car park is available. Copies of the last Commission For Social Care inspection reports were available for service users and their families to read. The weekly fee is £460. This information was provided on the 2nd October 2007. The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out by Mike O’Neil and Sue Turner regulation inspectors. This site visit took place between the hours of 8.50 am and 4:00 pm. Sue Spooner and Adrienne Wright, who are temporary managers appointed by the Sheffield Care Trust were present during the inspection and Mike O’Neil spoke, by telephone, with Jill Meek, registered provider, during the course of the inspection. The CSCI sent out questionnaires asking people who use the service, relatives and staff about the care and the service provided. Six people/relatives and 6 staff returned questionnaires. The manager submitted an Annual Quality Assurance Assessment (AQAA) to the CSCI prior to the actual visit to the service. Some information from the AQAA is included in the main body of the report. Opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home, and check the homes policies and procedures. Also to talk to 8 staff, 5 relatives, 3 people who use the service and a visiting health professional. Because people with dementia are not always able to tell us about their experiences, we also used a formal way to observe people in this inspection. We call this ‘Short Observational Framework for Inspection (SOFI). This involved us observing 4 people who use service for 2 hours and recording their experiences at regular intervals. The observations recorded included peoples state of well being, and how they interacted with staff members, other people who use services, and the environment. The inspectors wish to thank the staff, relatives and people for their time, friendliness and co-operation throughout the inspection process. A copy of the previous inspection report was displayed and available in the foyer of the home. Information about how to raise any issues of concern or make a complaint was on display in the foyer. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 7 Relatives, health professionals and staff surveyed and spoken to raised major concerns about low staffing levels. The low staffing levels were having a detrimental affect on some elements of care that people were receiving. Some staff need to consider peoples dignity more when they are providing any care. There needs to be more information displayed in the home that may help people with orientation. All staff employed at the home must undertake a CRB check. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3.Standard 6 is not applicable to this home. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ assessments prior to admission took place. These enabled staff to be aware of peoples needs to ensure that they could be met. This home does not provide intermediate care services. EVIDENCE: Three peoples files were checked and each contained a copy of their full needs assessments. The information from the full needs assessment had been incorporated into the peoples care plans. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main peoples health and personal care needs were being met. EVIDENCE: Three plans of care were checked. Care plans contained a full range of information, in a concise and easy to read format. They contained specific information on all aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. Staff were aware of the contents of care plans and were knowledgeable about peoples individual needs. It was identified in one care plan that a person had become unwell and their mobility had deteriated in the last 12 hours. Because the standard of documentation and communication between the staff was good staff had immediately recognised this problem and sought medical advice quickly. A visiting health professional said that staff communicated very well with them. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 11 People and/ or their relatives were involved in drawing up and reviewing the care plans. Staff were updating risk assessments and care plans on a monthly basis. People said that the care they were receiving was good and consistently added comments such as ” the staff are nice, friendly and helpful”. Relatives made comments such as “the staff are caring” and “the care at Birch Avenue is excellent. “. Health care professionals said that the standard of care delivered at the home was good. Some people were not able to say whether they felt that they were being well cared for; these people were very well dressed in clean, age appropriate clothing and attention had been paid to hair and nail care. Medicines were securely stored around the home in locked cupboards. The inspector observed a staff member dispense medication to people in a safe and hygienic way. Medicine Administration Records (MAR) checked were completed with staffs’ signatures. During the SOFI observation the inspector found that in the main when people were awake their state of well-being was positive or passive. It was noticeable that people were seen to be alert and engaged with other people and their surroundings when staff were in the lounge with them. Some staff also had the skills to include everyone in the room in the conversation. In view of this positive staff interaction it was all the more concerning to observe that there was one period of nearly 40 minutes when no staff member was in the vicinity of the lounge. People during this period were either asleep or disengaged with their surroundings. In the main staff were observed to treat people with respect and courtesy. Some staff in particular were very warm and accepting to all people who used the service. These staff members frequently held or touched people who were agitated and this seemed to provide comfort to them. The inspector saw some staff interactions that could have been handled more appropriately, as the information provided by staff was too quick for some people to understand. Some staff did not communicate effectively with some people and talked “over them” or talked to each other as though the person was not actually in the room. Staff would therefore benefit from additional training on how to communicate effectively with people who use the service. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to make some choices about daily living and being involved in some social activities. The home had an open visiting policy, which assisted in maintaining good relationships with people’s representatives. Meals served at the home were of a good quality and offered choice to ensure residents receive a balanced diet. EVIDENCE: People said they were able to get up and go to bed when they chose, and people were seen to be “getting up” at various times during the morning. Relatives spoken to said they were able to visit at any time and were made to feel welcome. Throughout the day friends and family were seen visiting the home and there seemed to be a very friendly and welcoming feel in Birch Avenue. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 13 The inspectors saw that people received varying amounts of staff interaction and stimulation. Staff were knowledgeable about the benefits of providing one to one activities with people such as hand massage and reading a daily paper together. However staff said they had not had the time to provide this interaction with people during the recent staff shortages. Relatives were concerned that there was not enough stimulation for people in the home and they said that this was due to the lack of staff. There were some activities taking place during the day and people were enjoying the time they were spending with each other and the staff. Progress has been made but a more individualised activity programme is still needed which should encompass the likes and dislikes of people, this information could be discussed with relatives and the person’s key worker. This would enable people opportunity to exercise their choice in relation to social and leisure activities. It was noticeable in the bungalows of the home that there was not enough information that may help people with orientation. There were clocks displayed and there was an information board but this only contained the day and date. A board containing information such as the weather, the place where the people were living, or a news item, may help people with orientation to time, and place. Some people’s rooms did not show their name on the door. People said that they had a choice of food and that the quality of food served was generally good. No menus were on display for people to see the choice of lunch and the staff did seem very rushed at lunchtime trying to serve and then assist people to eat their lunch. It may be beneficial to look for improvements to the lunchtime routine to see if the mealtime experience for people can be less rushed. The inspectors and managers did discuss some possible solutions and ideas to the mealtime periods. Staff sat with some people assisting them to eat. This assistance was provided at a relaxed pace. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures were in place and staff were aware of these. People and their relatives felt confident that any concerns they voiced will be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected from abuse. EVIDENCE: People and their relatives said that they felt very comfortable in going to any member of the staff or management team, knowing that any concerns they may have would be addressed without delay. An adult protection procedure was in place. Staff undertook training on adult protection to equip them with the skills needed to respond appropriately to any allegations. All people spoken to said that they felt safe living at the home. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,21,24 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment within the home was well maintained and clean providing a comfortable, safe environment for people. EVIDENCE: The home was clean and tidy. Lounge and dining areas were domestically furnished to a high standard and felt “homely”. Carpets in communal areas and peoples bedrooms have been recently replaced which has further improved the aesthetics of these areas. Bathrooms were clean and bright. Bedrooms checked were comfortable and homely. People said their beds were comfortable. Bed linen checked was clean and in a good condition. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 16 No unpleasant odours were noticeable in the home. Relatives and people said that the home was always kept clean. The hot water temperature in one bathroom checked measured a safe temperature below 45 degrees centigrade. This will assist in maintaining peoples safety. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In addition it reflects the prompt action taken by the registered provider regarding recruitment. Sufficient staff were not provided to meet the needs of people. The recruitment information obtained for some staff was insufficient to adequately protect the welfare of people who lived at the home. Staff had completed training, including induction, which ensured that they had the competences to meet people’s individual needs. EVIDENCE: Relatives, health professionals and staff surveyed and spoken to raised major concerns about low staffing levels. Staff said that they were able to “provide basic care but no more on some occasions when staffing levels were really low”. The managers agreed that over the last week particularly, even with the use of agency staff; there was a shortfall of between 1 –4 staff on every shift. Staff felt they were reaching breaking point and voiced concerns as to how much longer they could cope. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 18 It was recognised that staff sickness had played a significant part in the staff shortages, however staff said that there had also been delays in recruitment of new staff, which had added to the problem. To the credit of the staff and managers of the home a good level of care for the people at Birch Avenue had been maintained. The inspectors were so concerned with regard to the staffing levels that the Registered Provider was immediately contacted and a discussion was held with regard to this matter. The Registered provider gave assurances that she would look into the issue immediately and speak with the managers at Sheffield Care Trust, who provide the staffing at Birch Avenue. Later in the day confirmation was received that 7 posts would be advertised immediately and that further efforts would be made to ensure that agreed staffing levels would be maintained on every shift. The recruitment records of 2 recently employed staff members were checked. The staff had provided employment histories and the home had obtained two written references for each of them. These were satisfactory. Protection Of Vulnerable Adults (POVA) checks had been made. Enhanced Criminal Record Bureau (CRB) checks had been obtained for the staff members. The inspector however saw records that indicated that some staff who had been employed at the home for some years had not completed an enhanced CRB check. The managers said that all staff were currently undertaking another CRB check and evidence was seen of these checks being undertaken. There was a training and development plan for the staff. Staff said they were encouraged to attend training on various care topics and that there were good training opportunities available to them. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures and ethos of the home ensure that in the main the home is run in the best interests of people who use the service. The homes policies and procedures promoted the health, safety and welfare of people and staff. EVIDENCE: The temporary managers at Birch Avenue are very experienced in the care of older people and those with dementia. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 20 The managers were very positive about the inspection process and were committed to improve the service of Birch Avenue. It is highlighted in this report that staff moral is very low. The staff have recognised that the managers are doing their best to improve the situation over staff shortages and improve the atmosphere within the home. Staff and relatives said that they met regularly with the managers of the home and spoke positively about their approachability and helpfulness. The home had an active quality assurance system. There was evidence of internal auditing of the homes environment, services and records. Staff and relative meetings were regularly held and minutes of these meetings were seen. The responsible individual visited the home on a regular basis, a report was written following the visits. A copy of the responsible individuals monthly report has always been sent to the local office of the CSCI. The home handles money on behalf of some people. A receipting system and statement sheets were seen for each person. Formal staff supervision, to develop, inform and support staff took place at regular intervals. All staff were offered formal supervision and staff said that they found this useful and beneficial. Accident/incident records were being maintained and the manager was monitoring these records. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. Fire records stated that weekly testing of the fire alarm system had occurred. A sample of records showed servicing of the homes utility systems had occurred. At the time of inspection fire exits were clear and window restraints were in situ at first floor windows checked to prevent falls. Hazardous products were safely stored in the home. This will promote the safety and welfare of people. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 22 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. 1. 2. Standard OP10 OP12 Regulation 12 16 Timescale for action The privacy and dignity of people 01/11/07 must be respected at all times. People must have the 01/01/08 opportunity to exercise their choice in relation to social and leisure activities. Arrangements must be 01/01/08 implemented to ensure that people are orientated to date, time and place. Sufficient staff must be on duty 10/10/07 at all times to ensure that peoples needs are being met. All staff employed at the home 01/11/07 must undertake a CRB check at the appropriate level. Requirement 3. OP12 16 4. 5. OP27 OP29 18 19 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 23 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. Refer to Standard OP10 OP12 Good Practice Recommendations Staff would benefit from additional training on how to communicate effectively with people who use the service. The homes management should look at the lunchtime routine so that staff have more time to serve and assist people to eat their lunch. 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 67 Birch Avenue Nursing Home DS0000021769.V349735.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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