Care Home: Smallcombe House

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What the care home does well Smallcombe House provides a homely and welcoming environment with staff who have a strong commitment to providing care which meets the needs of individuals who live in the home. A number of individuals spoke very positively about the "caring" staff and this was also confirmed by comments received from relatives "staff are very caring and kind to all residents" "all staff treat my relative with great care, respect and friendliness" "the home provides a safe, caring environment where my relatives says they feel safe". Other comments received: "picks up on relatives needs very quickly, all staff treat her with great care, respect and friendliness. Any problems are soon resolved due to experienced staff knowing the best way to overcome difficulties" "we feel we made a good choice of residential home" What has improved since the last inspection? A number of requirements were made at the previous inspection these related to care planning, medication records and practice around fire drills. This inspection identified that some improvements had been made in relation to medication and fire drills. However there remains a need to improve careplanning practice specifically around moving and handling assessments. What the care home could do better: This inspection identified that as noted previously care planning practice and information about individuals must be improved to alleviate risks to individuals and staff. Specifically moving and handling assessments must be recorded so that staff have clear instructions about how to assist individuals with their mobility and when moving and handling tasks such as bathing are undertaken. Supervision practice in the home is poor and this was recognised by the manager as an area for improvement. Quality Assurance system which involves formal consultation with residents and others must be established on a regular basis to inform the home about areas which need improvement or provide an opportunity for individuals to make suggestions and comment on the quality of the care they receive. There was some dissatisfaction from staff about what they saw as poor communication in the home and staffing arrangements. They described staff morale as low and this is of concern. This was discussed with the manager at the time of this visit and she recognised that this was an area that she needed to address. CARE HOMES FOR OLDER PEOPLE Smallcombe House Oakwood Gardens Bathwick Hill Bath Bath & N E Somerset BA2 6EJ Lead Inspector Jon Clarke Unannounced Inspection 14 January 2008 09:30 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 Smallcombe House DS0000008146.V352258.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. Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smallcombe House Address Oakwood Gardens Bathwick Hill Bath Bath & N E Somerset BA2 6EJ 01225 465694 01225 465769 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) Salvation Army Mrs Ena Margaret Caddy Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 32 persons aged 65 years and over requiring personal care only. 24th August 2006 Date of last inspection Brief Description of the Service: Smallcombe House is a purpose-built care home for older people aged 65 years and over. It is owned and managed by the Salvation Army. However it should be noted that, whilst the ethos of the home is based on Salvation Army beliefs (in particular no alcohol and daily prayers are held), residents do not need to be of the Salvation Army faith. The home has 32 single en-suite rooms arranged over two floors with lift access. There is one main lounge with a smaller lounge area and a dining room. The home is set in extensive grounds and all the residents rooms overlook the grounds. A decking area, accessed from the front of the home, provides a pleasant seating area, along with patio areas at the rear of the home. The home is located about a mile from the city centre on a steep hill, but on a main bus route giving access to the shops and facilities of Bath. The mission statement of Smallcombe House states: To provide long term residential care in a secure, safe, homely and loving environment for elderly people who can no longer manage in their own home. Our staff aim to give a high standard of quality care, ensuring physical, emotional and spiritual support for each resident, while at the same time encouraging the residents to live as independently as possible. Smallcombe House DS0000008146.V352258.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 was an unannounced visit to the home as part of an inspection, the manager was present throughout the visit. A number of documents were looked at including care plans, staff recruitment and training, staffing arrangements. The arrangements for storing and managing medication were also looked at. “Have Your Say” questionnaires were sent to the home however there was no response from individuals in the home and this was discussed with the manager at the time of this visit. There were 7 responses from relatives and 4 from professionals whom visit the home. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires have been used to help make a judgement about the quality of care provided in the home. What the service does well: What has improved since the last inspection? Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 6 A number of requirements were made at the previous inspection these related to care planning, medication records and practice around fire drills. This inspection identified that some improvements had been made in relation to medication and fire drills. However there remains a need to improve careplanning practice specifically around moving and handling assessments. 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. Smallcombe House DS0000008146.V352258.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 Smallcombe House DS0000008146.V352258.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): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: The home’s Statement of Purpose was looked at and it provides the required information about the service that individuals who live in the home can expect. Included was details about facilities, information about the manager experience and staffing arrangements. Also outlined are the rights of Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 9 individuals around their privacy and dignity “treating each resident as a special and valued individual” Other areas covered are social contact, meals, activities, spiritual needs and making a complaint. As part of the admission procedure the home undertakes an assessment visiting the prospective resident. A number of these were looked at and gave information about the health and social care needs of the individuals. Where the person is known to social service the home obtains a copy of their assessment. Smallcombe House DS0000008146.V352258.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. However individuals and staff are potential placed at risk through the lack of moving and handling assessments being completed. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: The home has introduced new care planning arrangements and a number of these care plans were looked at. Assistance needed with personal care tasks was clearly outlined and reviews take place on a monthly basis. Risk assessments had been completed though in one instance there was no risk Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 11 assessment around an individual’s aggressive behaviour to give guidance about triggers for this behaviour and how it could be managed. Four of six care plans had no moving and handling assessment. There was limited if any information about the individuals routines, likes and dislikes they did not provide a person centred approach to care planning to also include details about the individuals life history, employment, hobbies and important social contacts. Malnutrition screening had been completed in one of the six care plans looked at giving valuable dietary information about the individual. Residents have full access to local health service and there is visiting district nurse service available where individuals need such support. Other services such as chiropody, dental and optician are all arranged by the home and will visit the home or where able individuals who live in the home may use local services. The home has good links with GP surgeries and residents can choose to remain with their GP if they are still in the catchment area. There are also good relationships with the local social services and in particular the community mental health team who are available to provide support and assistance where there are concerns about an individual’s mental health. Some comments were received from GPs “ generally above average for care homes” “I have always been impressed by the staff and felt they are sensitive to the needs of residents” “one of the best in Bath”. The arrangements for the storage and management of medication was looked at and found to be satisfactory. Administering records had all been completed as required with no gaps where medication had been given to individuals. Controlled drugs are in secure storage and administering records had been signed by two members of staff as required stock was checked against recorded amounts and were found to be accurate. The home has introduced a homely remedies policy and this was satisfactory other then as advised to the home all medication given should be recorded on the individuals administering sheets. Returns of medication had been signed by the pharmacist or their representative. In talking with individuals who live in the home they all confirmed that staff are respectful in their approach one individual saying that she found them all “very helpful and never had to complain about how they treat me”. Staff were observed in their interaction with individuals and this was always appropriate and supportive especially when assisting individuals with care tasks. Individuals also said how they felt their privacy was “always” respected and how they felt “able to do as I want there’s never any pressure on us very relaxed”. Smallcombe House DS0000008146.V352258.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: The home has appointed an activities organiser and this is a positive step in improving the activities undertaken in the home. Some comments were received from relatives about the amount of activities available stating that they felt there “should be more social activities in the afternoons” and “we feel there could be more activities”. The notice board advertised activities for the week which included scrabble, musical bingo, quiz, art group and cooking group. In talking with individuals they spoke positively of the activities Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 13 available in the home saying that they felt there was “enough” “its better then it was”. There are regular religious services held in the home and the home’s chaplain provided pastoral care. A relative commented on the “ good spiritual input”. Individuals where able are encouraged to attend local clubs and community resources and on arrival at the home I spoke with an individual who was waiting for transport to attend a local day centre. Individuals spoke of the friendliness of staff towards their visitors and the home has an open visitors policy. One relative commented that “visitors are always welcomed” and another “ very friendly staff, they welcome visitors”. People I spoke with said that they felt they were able to make choices about how they spent their day specifically getting up and going to bed. One individual said that they felt “it really up to me what I do” “staff never say we have to do anything”. One individual who needs assistance in getting up and going to bed said she felt “I can choose when I want to, will say if I don’t want to get up and staff will come back later”. In looking at daily records there were entries where individuals had for example refused a bath and this was rearranged illustrating flexibility in the home “routines”. The home’s menus were looked at and showed a variety of meals available. Individuals said they were always offered a choice and spoke positively “its always good” “I enjoy the food here”. On the day of my visit I was present during the lunchtime and the meal was well presented with a relaxed and unhurried atmosphere. Staff were available to give assistance and I observed one staff member feeding and assisting an individual with their meal in a sensitive and supportive manner. Smallcombe House DS0000008146.V352258.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: Individuals I spoke with were all very clear that they would say if they felt unhappy about anything and knew they could make a complaint if they wished. One person said they would “always speak to one of the staff” another “tell the manager” who they described as “someone you can always talk to”. No complaints have been made since the last inspection. The home has policy and procedures in place relating to Safeguarding Adults and these are linked to the Bath & North East Somerset Adult Protection policy. Staff have completed Safeguarding Adults training and the manager has undertaken Investigators training to enable her to response effectively to any concerns or allegations of abuse. There has been one concern raised since the last inspection and this was dealt with professionally and actions taken to protect people who live in the home. Smallcombe House DS0000008146.V352258.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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In walking around the home during the visit it was evident that there is a good standard of maintenance with the home being clean and people I spoke with stated “yes it’s kept very well” “always clean”. Since the last inspection the dining room has been re-furbished and decorated and is now an inviting and attractive room. Further improvements have been the decorating of corridors with differing colours to help in individuals who live in the home who may at times be dis-orientated. It was discussed with the manager that this could be Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 16 further improved with clearer identification of specific areas of the home such as toilets and bathrooms. Policies and procedures are in place to minimise the risk of infection and maintain a good standard of hygiene. Staff have undertaken Infection Control training. Smallcombe House DS0000008146.V352258.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): 27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. However the manager needs to ensure that staffing arrangements are maintained at all times so that individuals in the home are not placed at risk through their care needs not being met as required. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rotas were looked at for a period of 5 weeks. They showed that there had been shifts (weekday 5 days 2am 6 days 2 pm) where the staffing had not been at the level normally in place namely 3 care assistants and principle care worker (PCW) am and pm. In addition six am weekend shifts only had 2 care assistants and PCP on duty. The manager advised the inspector that there is currently one vacancy for 16hrs weekend post and this is being advertised. Recruitment and selection records were looked at for 4 members of staff and confirmed that the required checks had taken place. Two references had been obtained and full Criminal Record Bureau checks had been obtained. Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 18 Application forms were completed as necessary with full employment history and the applicant completes medical declaration. Training records seen showed that staff had completed the necessary mandatory areas of training: moving and handling (though this needed updating in the current year), health and safety, Safeguarding Adults. Some members of staff have undertaken Mental Health training. Staff also undertake Food Hygiene, First Aid and Infection Control training. Smallcombe House DS0000008146.V352258.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): 31,33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for residents and others to express their views about the service they receive need to be improved. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected though improvements must be made to improve Fire Safety practice and arrangements. There is a failure to provide adequate and appropriate formal supervision to staff so that management can review and monitor their practice, look at performance and give staff the opportunity to express any concerns and discuss their professional development. EVIDENCE: Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 20 The manager Ena Caddy has extensive experience of working in a care setting and has completed NVQ 4 Registered managers Award. She has a good understanding and knowledge of the needs of older people and has a sensitive and supportive approach. Individuals described her as approachable and someone they could talk to however there were members of staff who felt the distance between her and care assistants was such that communication was not as good as it should be. They felt unable to always express their view or that what they said was actually passed to her. This was a factor in the low morale referred to elsewhere in this report. Whilst team meetings are held the last being September and one was planned for the week following my visit it maybe of benefit to look at increasing the frequency of such meeting. A further factor in improving morale and communication is that of frequency of supervision. Records showed that this is poor, seven records were seen. One member of staff had not received formal supervision since April 06 indeed of the 7 three had not received any formal supervision since 2006. One last recorded was March 07, another July 07. When asked about supervision staff confirmed that they rarely received one to one supervision in a structured way. Residents meetings are held the last being September and the minutes were looked at and showed that individuals were asked about catering arrangements and a number of suggestions were made about food provided in the home. Cleaning arrangements were discussed with some concern expressed about the service provided. This has now improved and was confirmed to the inspector by individual I spoke with on my visit. Other areas discussed were suggestions about activities and outings. Questionnaires have not been issued to individuals who live in the home and others such as relatives to provide an opportunity to express their views and opinions about the quality of the service provided. The manager recognised that this is an area that must be addressed and also advised that they are planning to involve relatives in some of the meeting held in the home. An inspection by Avon Fire Service took place on 10/01/08. It identified a number of areas which required improvement including upgrading of fire alarm system, improved safety training and Fire Safety Risk assessment needed to be reviewed. The manager advised that all these areas are to be addressed as recommended. It further identified that fire drill practice in the home was satisfactory as were records of weekly tests (fire alarms) also confirmed by the inspector. Maintenance of equipment takes place annually the lift being serviced 03/01/07,Gas Safety Report 09/11/07, Hoists and Parker bath 10/01/08. An environmental health inspection of the kitchen took place may 07 and was found all to be satisfactory and standard as required. Smallcombe House DS0000008146.V352258.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 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 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Smallcombe House DS0000008146.V352258.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. Standard OP7 Regulation 15 (2) Requirement Ensure all elements of an individual’s care plan are completed specifically Moving and Handling assessments. Timescale for action 31/01/08 2. OP33 24 3. OP33 24 (2) 4. OP36 18 (2) The manager to ensure a system 31/03/08 is in place to reviewing and improving the quality of care in the home and shall provide for consultation with service users and their representatives. (This refers to quality assurance questionnaires to provide opportunity for individuals to formally express their views about the service they receive) The manager to provide a report 31/05/08 in respect of quality review (as in above requirement) to the Commission and make a copy of the report available to service users. The manager to ensure that staff 31/03/08 are appropriately supervised. (This refers to formal one to one supervision recommended frequency being 6 times a years as in Standard 36.2) Smallcombe House DS0000008146.V352258.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 Refer to Standard OP7 Good Practice Recommendations Care plans to provide improved information about the individual such as likes and dislikes, daily routines, personal history and social contacts so providing a more person centred picture of the individual. To use monthly dependency levels as a method of monitoring staffing needs and identifying possible need to adjust and reviewing the level of staffing based on identified levels of need in the home. A monthly report to be established showing dependency levels in the home this would also assist in making decision about capacity of home in terms of perspective new residents. 2 OP27 Smallcombe House DS0000008146.V352258.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Smallcombe House DS0000008146.V352258.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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