Care Home: Davenham

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What the care home does well People who use the service benefit from an experienced and competent management team that knows how to run a home in the best interests of the residents. The managers constantly check people`s satisfaction with the home. They look for things that could be done better and then decide what they will do to further enhance the quality of the service. The staff are well liked by the residents and they work in a way that makes people feel safe and comfortable. They are carefully selected before being offered work at Davenham and then they receive regular training and support to help them work effectively. The building and grounds are very attractive and well maintained. The meals and social opportunities are very popular. What has improved since the last inspection? There has been an increase in cleaning and activity organiser staff hours. New staff are put through a more comprehensive induction programme that meets national specifications. More staff have obtained a relevant national vocational qualification (NVQ) The way care is planned, provided and recorded has been developed so that it better reflects the individual preferences of each resident. What the care home could do better: There should be more information written into the home`s Annual Quality Assurance Assessment. It should provide a more detailed picture of the way the service is being managed. It might help staff if they had more training in the causes and effects of the health conditions most commonly found in the residents at the home e.g. diabetes, dementia. Policy and procedure documents should show the date of the most recent review (even if there has been no change to the content) as supportive evidence of a robust reviewing programme. CARE HOMES FOR OLDER PEOPLE Davenham 148 Graham Road Malvern Worcestershire WR14 2HY Lead Inspector Wendy Barrett Key Unannounced Inspection 6th May 2008 09:15 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 Davenham DS0000018647.V364147.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. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Davenham Address 148 Graham Road Malvern Worcestershire WR14 2HY 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) 01684 574385 01684 575491 manager@davenham.fote.org.uk www.fote.org.uk Friends of the Elderly Claire Louise Berrow Susan Patricia Copson Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability over 65 years of age (1) of places Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2007 Brief Description of the Service: Davenham is a fine imposing Victorian house set in beautiful grounds in Malvern Town, close to local shops and the common. A service is offered to a maximum of 37 people over the age of 65 years who have mild to moderate care needs and one person can be accommodated who has a mobility difficulty necessitating the use of a wheelchair. There are 35 single bedrooms with en-suite or private toilet/bathroom facilities close by and a self contained flat for a couple. Although there are two shaft lifts some rooms can only be reached via some stairs. In addition to the private bedrooms there is a communal drawing room, a library, a dining room, a chapel, seating areas on all floors, kitchenettes and a laundry for service users to use. The house is surrounded by an extensive and famous garden, which it shares with the nursing home called Perrins House, which is owned by the same registered provider, the charity Friends of the Elderly. The service providers representative (the responsible individual) who oversees the management of the home, is Lorna Long. The web address is www.fote.org.uk In March 2007 the fees for the home were stated to be between £507 and £600. Up to date figures are available from the home. Additional charges were made for hairdressing, chiropody, newspapers, dry cleaning and community transport. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report has been written with reference to information gathered in a number of ways. Mrs. Copson was asked to complete an annual quality assurance assessment report (AQAA) prior to the inspection. A sample of survey forms were sent out to people who use the service, relatives of people who use the service, staff who work at the home and external care professionals who have contact with the service. There was an unannounced inspection visit to the home. Records held by the Commission about the service were also checked as part of the inspection planning. Sometimes the Commission conducts a national exercise to gather additional information on a particular theme from a key inspection. During this inspection an exercise was conducted to find out how residents are kept safe from any abusive behaviour. What the service does well: People who use the service benefit from an experienced and competent management team that knows how to run a home in the best interests of the residents. The managers constantly check people’s satisfaction with the home. They look for things that could be done better and then decide what they will do to further enhance the quality of the service. The staff are well liked by the residents and they work in a way that makes people feel safe and comfortable. They are carefully selected before being offered work at Davenham and then they receive regular training and support to help them work effectively. The building and grounds are very attractive and well maintained. The meals and social opportunities are very popular. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. (An intermediate service is not offered by this home. Therefore standard 6 was not assessed.) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good opportunities for prospective residents to ‘test’ the home by offering an initial trial period of admission. Careful assessments are made of prospective residents’ needs and expectations so that places are only offered if the home can provide the service required. EVIDENCE: When people show an interest in coming to stay at Davenham they are given written information that describes the home and what sort of service they can expect from the staff. Mrs. Copson, or her Deputy, like to meet prospective Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 9 residents in their own home (or in hospital) so they can find out about all their care needs and what sort of lifestyle they enjoy. This information helps in deciding if the home will be able to satisfy the prospective resident’s expectations. As part of the pre-admission work, there is the opportunity for people to have a short stay at Davenham so that they can have a brief taste of living at the home. Otherwise, people are encouraged to visit the home and look around. A resident remembered coming to look round with her son before she was admitted to the home. Relatives and visiting care professionals feel confident that Mrs. Copson is careful to only admit people whose needs and preferences can be met - ‘very well cared for’. The staff usually feel they have enough information to help new residents settle in comfortably. One care assistant said that it isn’t always easy for them to read up about new residents during morning work periods because they are very busy, but there is time to do this when they are covering afternoon duties. Davenham DS0000018647.V364147.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): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The way that the care is planned and provided covers all the important areas of each resident’s life. The handling of medication at the home is managed carefully so that all people who use the service are protected - including those who prefer to manage their own medication. People who use the service are very happy with the way staff look after them. This satisfactory situation might be strengthened if the care staff had more training in the common health conditions they come across in their work. EVIDENCE: The people who use the service, and their relatives, are happy with the care provided at Davenham. Comments in survey forms included - ‘staff always listen and explain’, ‘very well cared for-treat her with dignity’, ‘medical care excellent’, ‘staff will call if they are concerned’. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 11 The staff look for any new things they can do to further improve the quality of the care and make residents safe. The written plans of care now contain more detail about the individual preferences of the residents as well as the care needs. The records include examples of staff picking up signs that skin may be at risk of breaking down, and taking prompt action to reduce the likelihood of a pressure sore developing. When residents are experiencing regular falls the staff refer the resident to a specialist falls clinic for further advice. Any resident who chooses to manage their own medication is carefully monitored by the staff in case they become less able to handle their own medication safely. Individual and secure medicine cabinets have been fixed in bedrooms. All staff who handle medication receive relevant training. Their competency is reviewed every 6 months. The Staff are happy with the training provided. There is a little less confidence in the current system of sharing information about residents’ conditions between staff. Mrs. Copson has already recognised a need for more work on the way this is done and she already has plans to improve the situation. It might help the care staff if there was more attention to offering staff training in the common medical conditions found in residents e.g. dementia, diabetes. The key worker of a resident with diabetes had little theoretical knowledge of the condition and would welcome a training session. Another key worker described a resident’s short-term memory loss. She may be able to work more effectively with the resident if she had a better awareness of possible causes, effects and ways to try and support a person with short term memory loss. Both staff obviously knew the residents well as individual human beings and were able to describe the things that are important to the residents to help them enjoy their life at the home. It was also very good to hear how the interviewed senior care assistant had recognised a change in a resident’s weight, consulted the doctor, and increased the frequency of weight monitoring until the weight stabilised. This is an example of the way written records can help keep residents well if the information is used appropriately as in this example. Davenham DS0000018647.V364147.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): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have access to a variety of group and individual activities should they choose to participate. Relatives are happy with the way they are helped to keep in touch with their resident. The meals are popular and the staff know how to make sure each resident has a well balanced diet and is protected from the risk of malnutrition. EVIDENCE: Relatives are happy with the way the home helps them stay in touch with their resident and keeps them informed if there is a change in the resident’s condition. One of the relatives described ‘ a lovely atmosphere’. There is a guest room available for relatives to use. This is particularly helpful when residents are nearing the end of their life and relatives want to be close at hand. Relatives are also welcome to stay for meals if they want. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 13 An activities co-ordinator is employed to help organise leisure activities and the number of hours available for this work has been increased during the past year. Every resident has a copy of future activities programmes and a copy is displayed in the home for all to see. Mrs. Copson is trying to make sure all these budgeted hours are used and comments suggest that residents and their families appreciate the consideration of individual activities and access to group activities. Survey responses also mention good attention to residents’ dignity and respect. The meals are very popular-‘always plenty of choice and the food is excellent’, ‘food support for a good diet, and it’s excellent’. A catering manager is employed and meets with the residents to discuss menus etc. The care staff keep an eye on residents’ weights and use a special calculation that helps them identify anyone at risk of malnutrition. Davenham DS0000018647.V364147.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by a sound recruitment and training process. There is written guidance relating to complaints and adult protection. Residents feel safe at the home and confident in a staff group who would support them with any concerns. EVIDENCE: People who use the service feel that the staff do listen to what they say and take any action needed to deal with their requests or concerns-‘comments on any subject always listened to and help given when possible’. They also know how to make a formal complaint although there haven’t been any received at the home. The Commission hasn’t received any complaints about the service. Sometimes the Commission conducts a national exercise to gather additional information on a particular theme from a key inspection. During this inspection an exercise was conducted to find out how residents are kept safe from any abusive behaviour. Mrs. Copson, two care assistants and three people who use the service helped by answering a few questions. Three staff files were checked as well. This exercise identified a home where staff are selected carefully to be sure they will be safe to work with vulnerable adults. This means that they are subject to checks like a criminal records bureau check, and they have to supply two Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 15 written references (one from the last employer). No staff start work until this information has been received to confirm the applicant’s suitability. The staff understand how to recognise and report any indications of abuse. They have written guidance on this at the home although it hadn’t been recently updated and may need review. A training matrix showed that all the staff receive training in abuse awareness. The interviewed residents felt safe at the home and would feel able to talk to staff if they had concerns about their safety or that of any other resident. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained. The residents live in a beautiful house and have access to beautiful gardens that suit their taste and needs. Building extension plans for this next year will make access to the top floor easier and more reliable for residents who can’t use stairs. The work will also strengthen infection control measures through the provision of a separate laundry facility for Davenham’s adjacent sister home, Perrins. EVIDENCE: Davenham is a most attractive building that provides large, airy internal space and high quality furnishing s and fittings that are in keeping with the age of the house. The accommodation has been adapted to suit the particular needs of the people who use the service e.g. passenger lifts, grab rails, lifting Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 17 equipment, specialist beds. This work is ongoing e.g. hand rails have recently been fitted in the garden and on the veranda, tarmac on pathways. The environmental safety of residents is monitored through 6 monthly checks (or earlier if required) of any potential hazards. There is a passenger lift that needs replacing as soon as possible –it isn’t big enough to take a wheelchair and it breaks down quite regularly. This is creating difficulties with access to the top floor so Mrs. Copson doesn’t offer rooms to anyone who can’t manage the stairs. Replacement is a very expensive and complicated affair because the current shaft will not be large enough to accommodate a lift that meets current space requirements. It is, therefore, good to know that this problem has been sorted out and a site for a new passenger lift has been found. This work will be done as part of an imminent extension to the building. It is also reassuring to know that the extension work will include the provision of a separate laundry for Davenham’s adjacent sister home, Perrins. The current arrangement of sharing a laundry facility between the two homes is not ideal because it increases the risk of cross infection between the two sites. All the surveyed residents agreed that the home is always clean and this was true on the day of the inspection visit. Mrs. Copson has recently been able to increase cleaning staff time by 25 hours. The staff know how to go about their work hygienically. A care assistant said she received regular training on infection control and there is written guidance in policies and procedures at the home. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs. People trust the staff and are happy with their attitude and abilities. New staff are only employed once Mrs. Copson is satisfied that they will be safe to work with the residents. There is a well organised system for training staff and encouraging them to obtain a qualification. EVIDENCE: People trust the staff and are happy with their attitude - ‘good staff - kind and genuine’, ‘understanding and kind - always treat with dignity’, ‘responsive to wishes of residents and their families’, ‘agency staff seem to be instructed well’. Most of the survey responses indicated that there were always or usually enough staff. Although there was a comment suggesting too few cleaning staff there had already been an increase in available hours before the inspection took place. New staff are carefully chosen to be sure they will be suitable to work with the residents e.g. background and criminal records bureau checks. An induction programme that meets national specifications has been introduced this year so new staff get the all information they need to work safely with the residents. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 19 Three quarters of the staff who provide care have obtained a national vocational qualification (NVQ) in care. This is an improvement on last year. A training matrix lists regular attention to health and safety training so that staff know how to work safely and hygienically. There is a supervision and appraisal programme to support and supervise each staff member. In fact, Mrs. Copson had 3 staff appraisals arranged on the day of the inspection visit. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in a way that leads to high satisfaction in the people who use the service. Appropriate systems, policies and procedures are implemented so that people in the home receive a high quality, safe service. The way the service reports its self assessment evidence would benefit from further development. EVIDENCE: Mrs. Copson has obtained the required qualifications for her post and has considerable relevant experience. She is supported by a national, specialised organisation. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 21 People like the way Mrs. Copson and Friends of the Elderly manage the service. A visiting care professional commented ‘I think the home is wonderful and I visit many homes’. A relative described ‘ongoing evaluation and service changes communicated well’. The quality of the service is monitored in a variety of ways. Friends of the Elderly publish an annual review report-copies for 2007 were available at the home. Questionnaires are sent out each year to obtain feedback about the service. The safety of residents is checked through regular audits exercises e.g. checking records of accidents and incidents, regular checks of the building for any potential hazards. The views of people who use the service are obtained through monthly residents’ meetings. This opportunity encourages the residents to participate in decisions about the way the home is run e.g. the minutes of recent meetings included reference to a ‘falls prevention’ talk from a visiting physiotherapist, a request for internal windows to be cleaned, a discussion about problems arising from the unreliable passenger lift and proposals to replace it. The information provided in the AQAA report was rather brief in some areas so it didn’t always give a comprehensive picture of evidence. The Key Lines of Regulatory Assessment (KLORA) offer considerable guidance about the sort of information needed. Although the home has all relevant policies and procedures to inform and guide the staff, it is unclear whether these are being reviewed regularly as part of the overall quality monitoring work. There were recent examples of the organisation supplying revised or new policies to the home but many of the existing documents had been written some time ago, e.g. 2001. It may be that the dates on these documents are not being altered when a review has taken place. The arrangements would be clearer if there was a practice of showing at the bottom of each policy/procedure the date of the last review, and the due date of the next review. The following evidence was included in the last inspection report. It was observed that some residents held money in safekeeping. Records were kept and residents signed for withdrawals. Receipts were kept for all expenditure. The balance of two accounts was checked and was found to be correct. This satisfactory situation was not reviewed on this occasion. This report includes examples of the way health and safety is competently managed. At the time of this inspection Mrs. Copson was involved in producing a ‘disaster plan’. She had also been asked to complete a new fire risk assessment and would soon be receiving a new fire policy from the organisation. It is important that these things reflect the individuality of the service as well as the standard ‘corporate’ approach e.g. internal stairs at Davenham that could affect evacuation procedures. Mrs. Copson may benefit from some specialist advice to help her with the risk assessment because the Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 22 fire authority hasn’t conducted a recent inspection. This would have provided local, specialist advice. The staff receive fire safety training twice a year and a drill takes place each week. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 23 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 24 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 2 Refer to Standard OP4 OP33 Good Practice Recommendations Staff may benefit from additional opportunities to learn about the causes and effects of some of the more common conditions e.g. diabetes, dementia. It is recommended that policies and procedure documents show the date of the most recent review as supportive evidence of a robust reviewing programme. Davenham DS0000018647.V364147.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Davenham DS0000018647.V364147.R01.S.doc Version 5.2 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. 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