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Inspection on 11/11/08 for 3 Salmon Street

Also see our care home review for 3 Salmon Street for more information

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 3 Salmon Street 3 Salmon Street Kingsbury London NW9 8PP two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Lawrence Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: 3 Salmon Street 3 Salmon Street Kingsbury London NW9 8PP 02082006718 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): salmonst@walsingham.com Walsingham Name of registered manager (if applicable) Andrea Cully Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: disability Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 Date of last inspection A bit about the care home Brian Ward House is one of 40 care homes operated by Walsingham since 1986 to provide accommodation and care support to adults with learning disabilities. The home is located in Northwest London close to Wembley with easy access to a range of public transport services, shopping, leisure and community facilities and services. The home is also close to a range of health and social care facilities and services. It is a detached property with single room accommodation for up to 5 residents. One bedroom has en-suite facilities. At the time of this inspection, there were five residents living at the home. There is also a staff sleeping room for night duty cover. The home provides 24 staffing cover with on-call support from the manager. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection took place on Tuesday 11th November 2008 from 09:15 - 15:45. We spent time talking to the homes manager and staff and observing staff supporting people living in the home. We also checked care records kept in the home and saw all parts of the home. The manager sent us an Annual Quality Assurance Assessment (AQAA) in October 2008. The AQAA is a self assessment that focuses on how well outcomes are being met for people living in the home. We have used information from the AQAA to write this report. What the care home does well We saw that residents care plans were person centred. This means that residents were listened to and the homes care plans were based on providing care that met their individual needs and aspirations. Peoples religious and cultural needs were well assessed and recorded and staff worked well to meet identified needs. The provider makes information for people living in the home available in easy read formats to make information easier for people to understand. The home was well staffed when we visited and all three people living in the home had individual support during the day so that they could take part in activities they chose in the local community. What has got better from the last inspection What the care home could do better The provider must make sure that each resident has an individual written contract. Two residents bedrooms, the lounge, dining room and hallway need to be redecorated. The provider should make sure that staff do not work extended hours or long periods without appropriate breaks. The manager must make sure that hot water is delivered at safe temperatures. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Lawrence 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Potential residents have information they need, in formats that are easy for them to understand. Residents know that the home will meet their assessed needs and aspirations. The provider needs to make sure that all residents have an individual contract. Evidence: Salmon Street has an admissions policy and pack and an easy information Service User Guide and Statement of Purpose. The Service User Guide and Statement of Purpose have been reviewed and updated. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this visit the manager told us that the two places in the home had been vacant for more than 12 months. The homes admissions policy and procedures included the completion of care needs assessments and a transition plan that included visits to the home before the person moved in. We saw that the Service User Guide and Statement of Purpose had been produced in easy read versions to make the information easier for some residents to understand. We also checked two of the residents care plan files during this visit. The files did not include an individual contract or statement of terms and conditions of residence. The manager told us that the provider was developing individual contracts, but these had not yet been introduced. To provide information about residents rights and responsibilities, the provider must make sure that each person has an individual written contract. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . More work is needed to implement the homes person centred care planning systems. Residents and their relatives can be confident that staff work well to minimise potential risks. Evidence: All service users have very detailed support plans and person centred plans which are reviewed monthly. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this visit we checked the care plans and risk assessments for two people living in the home. We saw that the manager and staff in the home have introduced detailed support plans that are person centred. This means that residents are listened to and the homes care plans are based on providing care that meets their individual needs and aspirations. The care plans and risk assessments we saw had been produced using pictures that made the information easier for some residents to understand. The manager and staff working in the home also told us that they talked to residents and their representatives about the goals that were included in their care plans. We saw that each plan included some short and medium term goals, but these had changed little in the previous 18 months. In one case, staff had not been able to support the person to achieve two out of three goals, but these had been repeated at the last three reviews, with no changes made to make the goal more realistic. There was a need for managers and staff to make sure that support plan goals were relevant and achievable. This would make sure that residents are supported to achieve the goals that they have agreed. Support plans also needed to be reviewed and updated when a persons needs changed, rather than routinely each year. For example, one persons Evidence: plan included detailed guidance for staff supporting her to use the bath. Since the plan was last reviewed in March 2008, the person had chosen to use the accessible shower room on the ground floor. While the persons risk assessment had been reviewed, there was a need to provide updated guidance for staff in the support plan. This would make sure that people received the care they need, with consistent support from staff. We also looked at the risk assessments that managers and staff in the home had completed for two people. The assessments covered road safety, challenging behaviours, activities and holidays. We saw that the assessments were well completed and reviewed regularly, minimising potential risks to residents. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be confident they will be supported to take part in appropriate activities they choose. Residents are supported to keep in touch with relatives, friends and other people. Evidence: All service users are encouraged and supported to participate in all areas of daily life, which includes social interaction with others within the home and the local community, library, pubs, post office and local church. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this visit we saw staff supporting all three people living in the home. We also checked peoples support plans and daily care notes to check the way they were supported to take part in activities they chose. Staff told us that all three people living in the home had recently stopped going to a local day service for people with a learning disability. More money had been provided to the home to enable staff to support people to take part in activities in the local community. We saw that each person had a weekly programme of possible activities. The Manager and staff told us that the programmes were being developed, based on residents preferences and their experiences taking part in each activity. We saw from the records staff kept that residents were supported to visit local shops, cafes, pubs, tea dances, the cinema, swimming sessions, pottery classes, aromatherapy and local beauty/ hair salons. When we visited, three staff supported the three residents to go out during the afternoon. One person went out for lunch and to do some personal shopping and the Evidence: two other people both went to local shops. Each person was supported by one member of staff and all three people travelled on public transport. The daily care notes showed us that each person was asked if they wanted to go out at least once each day. Staff told us that if people did not choose to go out, their choice was respected and people were supported with activities in the home. We also saw that the home was well equipped to enable residents to take part in leisure activities in the home. The care plans included peoples cultural needs and how these would be met. Staff told us that one person went to a local church every week and a second person went occasionally. The third person also went occasionally to a local Hindu temple. The care plans that we saw included details of each persons family, friends and other significant people. Staff told us that two people had regular contact with relatives and we saw that this was well recorded in their care records. The manager told us that one person used to have an independent advocate, but it had been difficult to access this service recently. She also told us that the provider had set up its own advocacy service and the person would be referred when the service became operational. Staff who spoke to us had a clear understanding of residents rights. They told us that all three people had a front door key, their choices were respected at all times and they were registered to vote in local and general elections. The manager was also aware of the implications of the Mental Capacity Act and the impact this could have on the services provided in the home. We saw that the staff had developed excellent, person centred guidance on supporting residents with their diets. The weekly menus were varied and nutritious and included meals that met residents cultural needs. One residents care plan included an Indian take away meal each week and a monthly visit to a local South Indian restaurant for a meal. Staff told us that choices were always available at meal times and we saw these were well recorded. The home had a comfortable and bright dining room where residents could choose to eat their meals. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home can be sure that their personal and health care needs will be assessed, recorded and reviewed regularly. People will be referred for any specialist support they need and their medication will be managed safely. Evidence: We regularly assess the needs of service users and have responded to one service user who has arthritis and needed to be assessed for callipers and foot support to help her walk better. She was also assessed for a wheelchair which she now has and this has allowed her more freedom to access activities outside the house. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this visit we looked at the personal and health care records for two people living in the home. We saw that the health care records were very person centred. This meant that residents were involved as much as possible in directing the care and support they received. We saw that both residents preferences were well recorded, but staff must make sure that these are updated as peoples needs change. For example, when residents choose to use the shower instead of the bath. We saw that peoples health care needs were also well recorded as part of their care plan. We also saw evidence of good joint work with health care professionals, including GPs, dentists, District Nurses, chiropodists and physiotherapists. Both of the care plan files we looked at included a Health Action Plan completed in September 2007. These plans detailed peoples needs and how these would be met by people from different organisations. The plans had been produced using pictures to make the information easier for some people to understand. During this visit we checked the homes arrangements for managing residents Evidence: medication. We saw that the home used a monitored dosage system provided by Boots. This meant that all prescribed medication was delivered each month to the home. The manager and staff we talked to told us that all staff had successfully completed medication training provided by Boots. Medication was securely stored in a lockable metal cabinet. Managers and staff had produced individual medication guidance for staff working with each person living in the home. We saw that these guidelines were very clear and person centred, placing each persons preferences and routines at the centre of the homes medication procedures. We checked the Medication Administration Record (MAR) sheets for all three people living in the home. These records were well completed, we found no errors or omissions and residents could be confident they would get the medication they needed, safely and efficiently. We also saw that each of the two care plan files we looked at included good information about the persons wishes regarding end of life care and funeral arrangements. We saw that this information had been recorded sensitively and included the views of residents relatives and other people close to them. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents, their relatives and representatives can be confident that people are cared for safely in the home and any complaints or concerns will be dealt with promptly. Evidence: During this visit, two members of staff working in the home told us that had completed safeguarding adults training. One person had done this with the provider and the other with the agency that had supplied her. Talking to both staff we found that they had a good understanding of the importance of safeguarding policies. Both people also knew about the provider and the local authoritys procedures and were clear about how they would report any concerns they had. We saw that the home had a copy of the local authoritys safeguarding adults procedures in the office. We also saw that the providers procedures for reporting concerns were also displayed on the office. The manager told us that information about the homes complaints compliments and suggestions procedures had been produced in an easy read format, making the information easier for some residents to understand. Staff told us that they would explain the homes procedures to residents, their relatives and other people involved in their care. The manager told us that there had been no formal complaints since our last inspection. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides spacious and well furnished accommodation, but there is a need to make sure that some parts are redecorated. Some parts of the home are accessible to people with limited mobility or people who use wheelchairs. Evidence: The service has been decorated with new bathroom / shower room and kitchen, new sofa set which better supports service users to sit in and get up from, new TV for the lounge and new gardener who has made the garden more accessible for the service users to use. Extract from the providers Annual Quality Assurance Assessment (AQAA). 3 Salmon Street is a large detached house on a busy residential road, close to the shops and transport links in Wembley. It is suitable for use as a care home and has five single bedrooms, two on the ground floor and three on the first floor. On the ground floor there is a shared lounge and dining room, accessible shower room, kitchen and laundry room. The staff office, three bedrooms and a bathroom are on the first floor. The ground floor of the home is fully accessible. There are ramps to the front door and back garden and the shower room is fully accessible. Both of the bedrooms on the ground floor are large enough for someone who uses a wheelchair. There is a large, well-kept and accessible garden at the back of the house. During this visit we saw all parts of the home. When we last visited the home we made a requirement that all parts of the property must be redecorated. The manager told us that this work had been completed in the kitchen, both bathrooms and one residents bedroom. We saw that other parts of the building were still in need of redecoration and this work must be completed by the end of March 2009. We saw that minor repair works we asked to be done following our last inspection had been completed. We saw the five residents bedrooms during this visit. The three occupied rooms were Evidence: comfortable furnished and very individual. The manager and staff told us that residents were supported to choose their own colour schemes and furniture and we saw that all three occupied rooms were very individual and well personalised. All parts of the home we saw during this unannounced visit were clean and hygienic. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff working in the home are well trained, managed and supported. The providers pre-employment checks make sure that staff are suitable to work with vulnerable adults. The provider should review additional hours worked by permanent staff to make sure they are able to work effectively at all times. Evidence: All permanent staff have Induction and Foundation and mandatory training, initial review after 6 months, annual appraisals, objectives linked to the companys business plan and regular supervision. Development training discussed / agreed at supervision. Extract from the providers Annual Quality Assurance Assessment (AQAA). When we arrived at 09:15 for this unannounced inspection, two members of staff were on duty. The homes Manager was on duty from 10:00 and another member of staff arrived at 12:00. During the day there were enough staff on duty to support residents and each person had 1:1 support from staff when they went out later in the day. We checked the homes rota and saw that this accurately showed the staff on duty. When we checked the rota we saw that one member of staff regularly worked additional shifts, providing cover for vacant posts. While this provided continuity of care, the member of staff regularly worked long days and periods of up to six days without a day off. The provider should review the additional shifts worked by permanent members of staff to make sure that they are able to work effectively. We checked the personnel file for one person working in the home. We saw that this included all of the information and pre-employment checks needed to make sure that people employed are suitable to work with vulnerable adults. The manager told us that the Criminal Records Bureau (CRB) checks for staff were kept at the agencys Head Office. The provider should make sure that a record of all CRB checks is kept in the home for inspection. The staff members file we checked included a good record of training courses completed, supervision and appraisal showing that staff working in the Evidence: home were well managed and supported by the provider. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well managed and the organisation supports the manager and staff to provide good standards of care. Policies and procedures are in place and are regularly reviewed. Managers and staff makes sure that care records are up to date and well completed, providing evidence that residents are well cared for. Evidence: The manager is working towards her Registered Managers Award. The Manager has worked in the home for 15 years and has regular supervision with her line manager. The manager has attended core management training, including health and safety, recruitment and disciplinary training. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this inspection we spent time talking with the homes manager. She told us that she had worked in the home for 15 years and had been the deputy manager for 3 years before being made manager in 2006. She told us she was completing her NVQ Level 4 Registered Managers Award and we have registered her as a suitable person to manage a care home for people with a learning disability. Information the provider sent to us in the AQAA showed that the manager had completed a number of appropriate training courses since her appointment. The AQAA also showed that the provider had developed all of the policies and procedures needed to meet these Standards and these were reviewed regularly. The manager told us that the provider regularly sent people living in the home easy read surveys to record their views on the services they received. Key workers also told us that they would complete these surveys with residents. The manager also told us that the providers Operation Manager visited the home each month to review the day Evidence: to day running. Written reports were sent to the home following each visit. We saw that the manager and staff were well supported by the provider to regularly review and improve the quality of care provided in the home. During this visit we checked a number of records kept in the home, including residents care plans, risk assessments and medication records. We found that all records were well kept and up to date. The manager confirmed that a fire safety risk assessment and environmental risk assessments had been completed and were regularly reviewed. We discussed one health and safety issue with the manager. We measured the hot water temperature in the wash hand basin as 47 degrees. This could present a scalding hazard to residents. We recommended that the manager arranged for the mixing valves fitted to the hot water supply to be serviced and adjusted to make sure that hot water was delivered at a safe temperature. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 5 5 The provider must make sure 29/01/2010 that each person living in the home has an individual written contract. This will provide information about the residents rights and responsibilities and the main terms and conditions of residence. 2 6 15 care and support plans must 31/12/2008 be reviewed and updated whenever a persons care needs change. This will make sure that people receive the care they need, with consistent support from all staff. 3 25 23 Two residents bedrooms, the 31/03/2009 lounge, dining room and hallway must be redecorated. This will improve the standard of accommodation provided for residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Managers and staff should review the goals included in residents support plans to make sure that they are realistic and achievable. The provider should review the additional shifts worked by permanent members of staff to make sure that they are able to work effectively. The provider should make sure that a record of all Criminal Records Bureau checks is kept in the home for inspection. The manager should arrange for the mixing valves fitted to the hot water supply to be serviced and adjusted to make sure that hot water is delivered at a safe temperature. 2 33 3 4 34 42 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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