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Inspection on 31/07/07 for The White House Nursing And Residential Home

Also see our care home review for The White House Nursing And Residential Home for more information

This is the latest available inspection report for this service, carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users spoken to on the day of inspection said they `liked their home` and were very positive about the support they received from staff. The only concern raised was regarding the new food system introduced in May of this year. Most service users were aware of how to make a complaint should they wish, but some would clearly not have the capacity to be able to do this easily and would require support. The staff on duty were very knowledgeable about individual needs of service users, and confident in following the policies and procedures of the home. Staff was observed interacting with service users in a professional and friendly manner. Communication was good even with the people with more complex needs. The service provides a service to a high proportion of people with continence needs and several relatives commended the service stating, "It always smells nice here, and staff are quick to mop up accidental spills"

What has improved since the last inspection?

The last inspection in February 2007 was also positive, acknowledging the high level of personal/individual support, staff provide to service users. The environment was seen to be clean and odour free. Two requirements were made, one has been met and one almost met. There is one outstanding recommendation relating to the employment of a deputy manager, which the proprietor stated that the vacancy would be advertised in September, with a current member of staff already interested.

What the care home could do better:

The recording of complaints could be greatly improved. The current recording practice lacks consistency, and does not in every case clearly demonstrate the outcome. The new food system requires review. Service users and relatives should be involved, and it is important that their views, and the subsequent outcomes are recorded. The service would benefit from the ownership of a vehicle that caters for people in wheelchairs, to enable residents to go out more frequently.

CARE HOMES FOR OLDER PEOPLE The White House Nursing And Residential Home Gillison Close Letchworth Hertfordshire SG6 1QL Lead Inspector June Humphreys Key Unannounced Inspection 10:00 31st July 2007 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 White House Nursing And Residential Home DS0000019591.V347219.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 White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Nursing And Residential Home Address Gillison Close Letchworth Hertfordshire SG6 1QL 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 01462 485852 01462 486438 Medical Resource Worldwide Renaud Sockalingum Care Home No. of places registered (if applicable) 62 Category(ies) of Dementia - over 65 years of age (62), Old age, registration, with number not falling within any other category (62), of places Physical disability (52), Physical disability over 65 years of age (52) The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home cannot accommodate any service under the age of 55 Date of last inspection 3rd November 2005 Brief Description of the Service: The White House Nursing and Residential Home opened in 1995 and is a purpose built home situated in a cul-de-sac within a residential area, near both the local day centre and hospice. The home has 61 beds, 10 of which are residential and features a recent extension incorporating nine rooms and a conservatory. There are 22 rooms on the ground floor and 42 on the first floor. The home has seven different day areas and the large garden is landscaped and well maintained. Service users can access this, and a patio area is well utilised. A variety of care needs are met within the home as it is registered for older people and caters for those with physical disabilities and dementia. Current fees are from £585 - £620 per week and are reviewed annually in April of each year. Additional charges apply for personal toiletries, newspapers, hairdressing, chiropody, and dentist and opticians services. A copy of the Service Users Guide/ Statement of Purpose and the most recent CSCI inspection report can be obtained from the registered Manager who currently is Renaud Sockalingum. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains the outcomes of the unannounced key inspection completed on 31st July 2007.Evidence gathered during the inspection included: • Observation of interaction between staff and service users, • Individual interviews with four service users and four relatives. • A detailed discussion with the registered manager, the proprietor, and four members of the staff team. • A look at relevant documentation maintained in the home. • Evidence received by the CSCI from the service since the last inspection on the 21st February 2007. This was a very positive inspection, with two outstanding requirements, which are in the process of being completed. The service users seen appeared well cared for, and well presented, having been helped by staff to achieve a high level of personal care. The premises was very clean and odour free. What the service does well: The service users spoken to on the day of inspection said they ‘liked their home’ and were very positive about the support they received from staff. The only concern raised was regarding the new food system introduced in May of this year. Most service users were aware of how to make a complaint should they wish, but some would clearly not have the capacity to be able to do this easily and would require support. The staff on duty were very knowledgeable about individual needs of service users, and confident in following the policies and procedures of the home. Staff was observed interacting with service users in a professional and friendly manner. Communication was good even with the people with more complex needs. The service provides a service to a high proportion of people with continence needs and several relatives commended the service stating, ”It always smells nice here, and staff are quick to mop up accidental spills” The White House Nursing And Residential Home DS0000019591.V347219.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. The White House Nursing And Residential Home DS0000019591.V347219.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 White House Nursing And Residential Home DS0000019591.V347219.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): 1,2, and 3. Standard 6 does not apply. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with a statement of terms and conditions before admission to the home. It provides basic information on what service users can expect from the service but does not include the Weekly fee. Prospective service users have their needs assessed prior to admission to the home. The service consults the assessment information to see if they can meet the prospective service users needs prior to admission, or offer of a placement. EVIDENCE: The current Statement of Purpose and Service User’s Guide was looked at as part of the inspection. The documents have been updated since the last inspection in February 2007, when a requirement was made to comply with the revised Care Homes Regulations. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 9 Essential information has been added to the Service User Guide, but the weekly fee charged is still not included. The registered manager advised that the service user contract has been revised, but was not available at inspection as this was currently being discussed with the company’s legal advisor. There is a thorough process of assessment of need completed prior to the admission of a prospective service user. A recently completed assessment was selected as part of the inspection process. It was concise and thoroughly completed, clearly outlining the person’s needs. The care plan seen involved a range of health and social care professionals as well as the prospective service user. The service user whose documentation was looked at had been admitted to the home just three weeks prior to the inspection; and was interviewed along with their relative. The service user stated that the staff had made a “great deal of effort to make them feel welcome”. The relative said that they were “very pleased with the service and the level of assistance provided by staff with personal care.” The relative confirmed that the manager had invited them to visit the home before making a decision regarding the admission. The White House Nursing And Residential Home DS0000019591.V347219.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. Care plans were clear and precise and service users and their family were involved regularly wherever possible. Staff were aware of the care needs of the people they were looking after. There is an efficient medication policy, supported by procedures and practice guidance which staff understand and are able to follow. EVIDENCE: Four care plans were looked at as part of the inspection. They contained good detail of service users needs. The care plans were up to date and easy to access. Care staff spoken to had a good understanding of the needs of people they were caring for i.e. “they prefer to have their meals there, and doesn’t usually come into the dining room”. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 11 Observation of the care staff at work showed that interaction with service users was caring and respectful. Personal care observed was delivered discreetly and appropriately in keeping with peoples needs. The service users who had contact with the inspector had been helped to achieve a high standard of personal care; which included attention to their hair, nails, teeth and clothing. Feedback from service users spoken to was also positive. One-service user said, “The staff here are always kind and pleasant”. Medication appeared to be managed appropriately with protocols having been put in place should individuals choose to self medicate. Medication was observed being administered and no concerns were raised. Medication was appropriately stored, and no gaps were found on the medication records. The White House Nursing And Residential Home DS0000019591.V347219.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 adequate. This judgement has been made using available evidence including a visit to this service. There is no restriction on when family and friends visit, and with agreement some service users are supported to go out on a regular basis. Service users have access to community-based activities, but it is limited for those people who are wheelchair users. The new food provision and menu needs to be regularly reviewed to ensure that it meets the residents’ needs and expectations. EVIDENCE: The service has adopted a new system for food provision from May this year. The system called ‘steam ability’ is one, which the manager and provider said they researched carefully, and allowed service users to try the food, before adopting it. The provider stated that evidence had proven the food to be healthier, and now used in a large number of services. The service had agreed a twelve-month initial contract. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 13 The manager stated that there had been few complaints and in one case where there had been an issue, special meals were being prepared. As part of the inspection, service users, relatives and staff had been provided with the opportunity to talk about the food provided. Without exception every person interviewed raised concerns; from small grumbles to full-scale complaints. Service users were asked if they had made a complaint to the manager - most said no, but that they had raised it with staff (see section re recording of complaints). Several members of staff acknowledged that many service users were unhappy about the food. The issues range from the menu being ‘too fancy’ i.e. Chicken al a king, to too much of one type food i.e. ‘pasta and chicken’. Another service user who complimented many aspects of the service said that “the vegetables are either too hard or too soft, and we never get roast potatoes with Sunday lunch.” The manager must clearly demonstrate that the menu and meals are regularly reviewed with the service users, and that the complaints/grumbles are recorded and the comments are fully considered and acted on. The activity organiser provided information about the activity programme in place and several service users spoke about how much they had enjoyed the exercise programme in the morning. There are now two activity co-ordinators, one part time, and one full-time post. The new co-ordinator has limited experience and has been in post approximately 8 to 10 weeks. The feedback from service users and their relatives was extremely positive. One service user said, “For me it’s the only time I go out. I love it, we have a good laugh, and they are nice girls”. Several staff, and four residents interviewed said that going out was limited because the homes own vehicle did not have wheelchair access. The provider stated that once per month the service hired a vehicle to accommodate these people, but obviously not every one can go out on every occasion. Four visitors were spoken to during the inspection and confirmed that they are both encouraged and welcomed by staff to visit. Quarterly service user meetings are held, and the minutes were looked at as part of the inspection; clearly the registered manager is committed to involving service users and was approached, and spoken to when showing the inspector around. The White House Nursing And Residential Home DS0000019591.V347219.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. A system is in place to safeguard the service users from abuse, neglect and self-harm. Staff are aware of the policies and procedures in place and committed to protecting service users. The service has a complaints procedure that is up to date and on display to residents, however the recording of complaints with follow- up responses requires improvement. EVIDENCE: Staff spoken to were aware of the complaints policy, and able to advise where a copy was on display. Staff generally were very proactive about ensuring residents concerns were reported and one person said “residents are treated very well here, but I wouldn’t hesitate in speaking out if need be”. The service currently records complaints in a complaints book. The complaints are hand written and recorded in several formats. Several had actions plans but it was difficult to ascertain the response and timescale. The registered manager has agreed to devise a form that clearly dates the complaint, investigation completed, and the response to the service user. Service users generally said that they spoke to staff if they were unhappy, but this sometimes meant that complaints were not recorded. The registered manager The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 15 said he always tried to sort out complaints, and usually by talking to residents he could usually resolve things. One service user however did say he felt he was not listened to about a certain issue, and there did appear to be a discrepancy between what he was saying and the management of the service. No complaint was registered and it appeared that no formal complaint had been made. The introduction of a formal recording system will allow for a clear trail of complaints to be audited. The White House Nursing And Residential Home DS0000019591.V347219.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): 19,21,23,25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment was exceptionally clean and well maintained, nicely decorated and odour free. EVIDENCE: There is an ongoing maintenance programme within the home. The bedrooms examined have personal items on display that reflect the individual lifestyle of the service users. The service users spoken to are very pleased with the bedroom facilities, and spoke highly of the quality of the communal areas. The service provides a service to a high proportion of people with continence needs and several relatives commended the service stating, “It always smells nice here, and staff are quick to mop up accidental spills”. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 17 The provider and manager spoke about the planned new improvements to the home. This includes a new conservatory area, and a sensory garden. One Relative said that “the home was continually updated, and refurbished with the residents in mind”. On the day of inspection the laundry was seen to be well organised despite a member of staff being on annual leave. The storage of hazardous substances was now secure indicating that the concerns raised at the last inspection had been addressed. The White House Nursing And Residential Home DS0000019591.V347219.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. Residents are supported by committed, trained staff that receive regular updating to enable them to carry out their jobs safely and effectively. The recruitment process is in accordance with current legislation, and includes all the relevant checks to protect vulnerable people. EVIDENCE: Evidence was available to demonstrate that statutory training is being undertaken including an adequate induction. The service would benefit from a training matrix which lists clearly at a glance the number of staff who has completed the different training and when. This information is currently available in a paper format and does not reflect the amount and quality of the training offered to staff. The service is committed to staff being involved in National Vocational training (NVQ) at level 2. 50 of staff is now qualified with a further number working towards their N.V.Q qualification at the time of this inspection. The rotas seen demonstrated that adequate numbers of competent staff are on duty i.e. the average being 4 residents to 1 member of staff. The service currently operates three-day shifts, which are 8am to 2pm, 8am to 8pm and The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 19 2pm to 8pm. Some staff interviewed felt that ratio’s could be better, especially when supporting service users to get up or go to bed. There also was some dissatisfaction expressed about care staff having to help in the kitchens. Nursing staff felt this did impact on the smooth running of care provision. The manager stated that this request for care staff to help out would not be a permanent part of their duties. Although the proprietor stated that everyone including herself if necessary must undertake any work related to the benefit of residents. Staff spoken with said they were very well supported both by senior staff and the current manager. A relatively new member of staff discussed the support she had received, and how helpful, care staff, nurses and the manager had been. It should be noted that carers spoken to praised the quality of care, and said that the staff were a “committed, caring bunch”. A system is in place to ensure that all staff has the necessary checks prior to employment. This administration role is undertaken by the proprietor and she advised that this is something that she likes to ensure is completed properly, including the taking-up of references. The White House Nursing And Residential Home DS0000019591.V347219.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 management of the home is effective in ensuring that changing needs of service users are assessed and met and that the home is meeting its expressed aims and objectives. The health, safety and welfare of the residents is promoted and protected. The overall standard of record keeping is good, with the exception of the recording format for complaints. EVIDENCE: There is a competent management and staff team who are committed to providing a high standard of service. Collectively as a team they have a range The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 21 of experience and skills necessary to meet the needs of the service users in their care. Service users and their relatives commented on the manager style has being ‘open and friendly’. One service user said, “ He’s so kind, and always tries to help”. There is evidence to indicate that staff members receive formal one to one supervision, and that individual training needs are met in the range of training regularly offered. Maintenance and health and safety records were looked at and all checks were seen to be up to date. Recording generally was seen to be of a satisfactory standard. The size and complexity of the home puts a considerable burden of responsibility on the manager and this could be helped if, as has previously been discussed on several occasions, a deputy manager could be appointed to assist the current manager. This recommendation is again taken forward, although assurances were received during this inspection that an appointment is likely to be made in September/October 2007. The current arrangement is that a named nurse who is very experienced ‘takes on’ the manager’s role in his absence. The proprietor also appears to have a significant involvement in the service and stated that she endeavours to be available when the manager is absent. The White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 4 X 3 X 3 X 3 4 STAFFING Standard No Score 27 2 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 White House Nursing And Residential Home DS0000019591.V347219.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5 Requirement Timescale for action 31/10/07 2. OP15 OP12 16(2)(i) The Statement of Purpose and Service User Guide must be reviewed and amended as necessary to ensure it is accurate, up to date and includes a copy of the fees so that people considering using the service have the most up-to-date information. The new food system must be 31/10/07 reviewed with service users and advocates to ensure that it meets their needs and expectations. 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 OP2 OP16 Good Practice Recommendations The homes contract should be reviewed to ensure that it is produced in line with guidance issued by the Office of Fair Trading. The recording of complaints should clearly show the stages DS0000019591.V347219.R01.S.doc Version 5.2 Page 24 The White House Nursing And Residential Home 3. OP27 4. OP12 and timescales of the process. All complaints should be recorded. It is again strongly recommended that a suitably experienced deputy manager be recruited to strengthen the management team and deputise effectively in the registered manager’s absence. The service has access to appropriate transport to enable wheel chair users to go out more frequently. 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