Care Home: The Tiled House and Cottage Annexe

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What the care home does well The home provides care in an improving pleasant and welcoming environment by a well managed supported, motivated, well-trained and qualified staff team who work in a manner that recognises resident`s need for personal privacy and dignity. What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE The Tiled House and Cottage Annexe Southdown Road Shawford Winchester Hampshire SO21 2BY Lead Inspector Peter J McNeillie Unannounced Inspection 22nd August 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 The Tiled House and Cottage Annexe DS0000069890.V369509.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. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Tiled House and Cottage Annexe Address Southdown Road Shawford Winchester Hampshire SO21 2BY 01962 713 152 01962 714 858 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) Mr Amin Lakhani Mrs Malek D Lakhani, Dr Azim D Lakhani Position vacant Care Home 29 Category(ies) of Dementia (0), Learning disability (0) registration, with number of places The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Learning disability (LD) - maximum number of places 5 - Cottage Annexe only The maximum number of service users to be accommodated is 29. 2. Date of last inspection 31st August 2007 Brief Description of the Service: The Tiled House is one of a group of homes owned and managed by Saffronland Homes Partnership. The home is registered to provide support, personal and nursing care and accommodation for up to twenty-four older persons with dementia and up to five younger adults with learning disabilities in the Cottage Annexe. Accommodation is available in a large converted property on the outskirts of Winchester near to the M3 and M27 motorways, with easy access to Southampton Airport, Eastleigh, Basingstoke, Southampton, and Portsmouth. The building sits in its own grounds comprising several separate and secure garden areas and a large parking area at the front. Fees at the home ranged from £620 to £680 per week in the main house and from £2,184 to £3,187 in the Cottage Annexe. The Tiled House and Cottage Annexe DS0000069890.V369509.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 stars. This means the people who use this service experience good quality outcomes. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, sampling residents, staff training and recruitment records and talking with residents, staff, visiting health care professionals and relatives. We also considered information provided by the manager in a pre inspection Annual Quality Assurance Assessment. (AQAA). During this inspection which took place on 22/08/08 between the hours of 9.15 am and 1.45 pm all of the key standards for older persons and any previous requirements were inspected. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? What they could do better: Following this inspection no requirements were made and there were no areas of concern, however attention should be paid to the following: • To ensure that all residents are able to understand the daily menu this should be produced in a format or formats that all residents can understand. • Regular checks should be undertaken too ensure all staff adheres to the infection control procedures. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 6 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. The Tiled House and Cottage Annexe DS0000069890.V369509.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 The Tiled House and Cottage Annexe DS0000069890.V369509.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 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided so this standard does not apply. EVIDENCE: The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 9 We were informed that residents were only admitted in accordance with corporate pre admission policy and procedure requires that a detailed written assessment of need and risk by a member of the homes management team being carried out in consultation with the prospective resident. Samples of four resident’s pre admission assessments were viewed. These were produced in a very detailed format that took into consideration the needs, wishes, choices and aspirations as well as any present or potential risks. The procedure allows for pre admission visit and a trial admission followed by a review before a permanent place is offered. This procedure ensures both resident is happy with the placement and the home is sure they can meet the assessed needs. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be taken into consideration when developing a plan of care. Records also confirmed ongoing assessments of need and risk for all residents are carried out on a regular basis and care plans (Section 7-11 of this report refers) updated to reflect any changes. Respite care is not available in the home. The Tiled House and Cottage Annexe DS0000069890.V369509.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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures resident’s needs are met within a risk management policy involves residents and resident’s representatives or relatives in decisions that affect them. EVIDENCE: As part of our inspection plan, we viewed a random sample of four residents care plans. All of the care plans which were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks. (The previous section of this report; standards 1-6 refers). Some residents verbally confirmed they were consulted about and The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 11 participated in the production of the plan, others could not remember. Records seen confirmed this. All of the residents spoken with confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect. Visiting health care professionals and relatives were spoken with. All confirmed the home keeps them informed about individual residents, made them feel welcome and dealt with any queries or questions in an open frank and professional manner. All parties commented that the general atmosphere, professionalism and staff attitudes had improved considerably since the new manager had been appointed. (Section management and administration of this report also refers). Resident also confirmed that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. Resident’s right, and the opportunity to take risks is seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how they were to be managed however in many instances due to their dementia a large number of the residents would have difficult in understanding the concept of risk. Staff who had a good understanding of the contents of the care plans and risk assessments and were able to explain how the care plan was put into day-today practice. Residents informed us were able to see the doctor of their choice or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses, physiotherapists, occupational therapists, other specialists had been consulted when required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. To ensure equality and diversity are promoted within the service the home informed us in their Annual Quality Assurance Assessment (AQAA) completed by the manager that:” We do not discriminate against any potential resident. The decision to admit is based solely on whether we can meet the identified and assessed needs. All residents are treated as an individual ensuring that their rights to a safe, dignified, abuse free life are maintained. We respect all religions and pastoral visits are arranged if requested. Independence is The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 12 promoted for all our residents within their capabilities and within the confines of risk assessments.” Medication records confirmed all prescribed drugs, which are securely stored are administered in accordance with the homes medication policy and procedure by staff all of whom have received training in recording and handling resident’s drugs and medication. All staff handling medication told us they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure was in place to enable residents who wish to assume responsibility for their own medication. At the time of the inspection no resident was managing his or her own medication in accordance with an individual risk assessment. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Family contacts, the availability of social and recreational activities and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. EVIDENCE: A varied and busy social activities programme, which is regularly updated and reflects residents choices was available including bingo,videos,dominos,visiting entertainers and weekly trips out in the homes own transport to local shops,pubs,garden centres,shops and other place of interest dependant on the time of year and the weather. Residents expressed how important the activities were and how much they enjoyed them. All confirmed that participation was up to the individual; no one was forced to join in. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 14 The manager informed us that she would be contacting the local Alzheimer’s for advice to ensure that the needs of residents with dementia were also being fully addressed. We were informed that despite requests the home has not been unable to arrange regular visits from local Church of England or Roman Catholic Clergy however, if required will arrange for residents to be taken accompanied to local churches. The needs of members from any other faiths would be catered for but at the time of this visit no members from other faiths were residing in the home. Visitors are always welcome, and can share a meal in private if they wish all are encouraged to feel at home, and make drinks freely. Residents said they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. All residents had been registered to vote. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. A written daily menu based on resident’s likes and dislikes was displayed. Although a daily menu is displayed, we highlighted the need to ensure that the menu was displayed in format that all residents would understand. This is of prime importance for persons with dementia who may find the addition of pictures would be beneficial to understanding the daily menu and when making choices The manager gave a verbal undertaking he would look into the way menus were displayed in future. Vegetarian options are always available. Persons on special diets for religious or medical reasons can also be catered for, following individual written nutritional assessments, which are carried out, for all residents. We observed residents taking their mid day meal. This was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Residents informed us meals could be taken in their own rooms if they wished. Tea and coffee making facilities were available to all residents and visitors at all times as was water and fruit squash. We observed staff encouraging residents to drink water to ensure they did not become de hydrated The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 15 The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 16 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.The complaints procedure was satisfactory with evidence that residents feel their views will be acted upon in compliance with a previous requirement.The home has clear policies and procedures in place which ensures residents are protected from abuse. EVIDENCE: The complaints procedure, which is also included in the service users guide included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was the record of complaints. All members of staff spoken with of stated they felt confident in discussing any concerns, complaints with management either in house or external on behalf of any resident. The homes corporate adult protection policy is works in tandem with the procedure produced by Hampshire County Council, which is based on National Guidelines and the document No Secrets and is designed to safeguard residents from abuse. Management and staff who were spoken with confirmed they had all received training in recognising various types of abuse, this was confirmed by records viewed. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 17 All were able to demonstrate they knew the procedure to follow should they witness or suspect the abuse of any resident. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service live in a safe, well maintained, clean, and hygienic home. EVIDENCE: All areas of the home were clean and free from unpleasant odours and obvious hazards. Residents confirmed the home is always clean and smells fresh. Furniture was comfortable, homely and in a good state of repair, in keeping with the décor and met resident’s individual and collective needs. All communal areas were accessible by residents including the well-tended established and safe garden. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 19 Apart from personal mobility aids a number of communal aids had also been provided to assist residents, these included special beds, lifts, hoists, grab rails, and ramps. Residents commented how satisfied they were with their accommodation. Since the last inspection a major refurbishment of the home has been undertaken in line with an action plan previously sent to CSCI. Improvements include all windows being replaced with double glazed units, the hall stairs and landing redecorated soon also to be recarpeted, a dining room recarpetsd and redecorated as well as a number of bedrooms being decorated as part of the a rolling programme of maintenance. As well as the refurbishment and redecoration health and safety issues highlighted during a focused inspection in June 2008 have been addressed. Future plans include the reciting of the laundry and a toilet near to the main lounge. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 20 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. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: The planned daily staffing levels in the main house for each day is: 7am–1pm: The Manager, five carers (including a senior carer/shift leader) plus a cook and kitchen assistant, a cleaner and laundry assistant. 1pm-7pm: The Manager (for part) plus five carers (including a senior carer/shift leader). 7pm to 7am three carers (including a senior carer/shift leader) The daily staff rota confirmed these staffing levels. At the time of this visit, in our view the number of management, care and support staff available met residents needs between the hours of 7am and 7pm, a view supported by the manager, staff and residents who informed us there were always enough staff on duty and they rarely had to wait for attention However it is our view the number of care staff between 7pm and 10pm is likely to have a detrimental affect on the highly dependant residents choice, the quality of service, care and support they would receive. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 21 Staffing numbers could also compromise the health and safety of residents due to the absence of supervision brought about when two staff were required to assist the same resident. This matter is also commented on the Management and Administration (standards 31-38) section of this report. In the cottage where three persons are being looked including we were satisfied the staffing levels met the needs of all of the residents in a safe manner. We viewed three staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust recruitment, equal opportunities and selection procedure, which is designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment, records seen confirmed that all staff are subject to an in house/corporate induction and a training programme that include first aid, handling medication, food handling, moving and handling, safeguarding, infection control and dementia. All staff are expected to undertake a National Vocational Qualification N .V. Q.) Course. Information provided by the Manager in the AQAA indicated that 45 of permanent staff has been trained to at least NVQ level two, with a further 25 currently on a course leading to a level two qualification. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 22 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 management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents, whose views about living in the home are formally sought. EVIDENCE: The manager who is in the process of applying for registration has experience of managing resources for older persons for many years is currently undertaking a Registered Managers NVQ level four qualification. In talking with staff we were satisfied that the home has a clearly defined management structure, staff were aware all of their responsibilities and the The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 23 limits of their authority. Staff who described the management as approachable and accessible and willing to listen to any ideas they may have for the improvement of the service also commented that since the arrival of the new manager two months prior to this visit moral within the staff team has improved which has led to an improvement in the delivery of care. This is a view supported by visiting health care professionals and relatives (As commented on earlier in this report). As part of the homes quality monitoring system, residents and resident’s relatives/representatives and health /social care professionals are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. The new manager expressed her support for the current system and intends to implement a new survey as part of her action plan for the future. Following concerns express to CSCI regarding health and safety within the home we conducted a focussed inspection on this issue. All of the matters raised in our subsequent report have been or are in the process of being attended to. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health/ safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents, procedures to follow in the event of fire (including evacuation) and that all of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered to prevent a resident or staff being burnt in compliance with a requirement made at the last inspection. During our visit we were concerned that not all staff had easy access to hand gels as part of the infection control procedures. The manager informed us that all staff is issued with personal supplies of gel and showed us a large stock both of individual supplies and refills to static containers. Before the inspection finished all staff had been re issued with gel and the checking of this matter added to the daily hand over routine. Despite the attention paid to health and safety issues residents safety in our view is being compromised by the number of staff on duty between the hours of 7pm and 10pm as described in the staffing section of this report. The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 24 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 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 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 The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement A review of the number and deployment of staff must be undertaken and staffing adjusted to ensure sufficient trained and competent staff are available at all times to ensure residents needs can be met at all times. The health, safety and welfare of all residents must be protected at all times with particular reference to the number and deployment of staff employed between the hours of 7pm and 10pm Timescale for action 10/10/08 2 OP38 12(1)(a) (b) 10/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Tiled House and Cottage Annexe DS0000069890.V369509.R01.S.doc Version 5.2 Page 27 - 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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