Inspection on 21/07/05 for Acorns Care Centre

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acorns Care Centre 23/01/07

Acorns Care Centre 12/12/05

Acorns Care Centre 05/11/04

Acorns Care Centre 17/06/04

Similar services:

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Acorns Care Centre Parkside Hindley Wigan WN2 3LJ Lead Inspector Lindsey Withers Unannounced 21st July 2005 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 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. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Acorns Care Centre Address Parkside, Hindley, Wigan, WN2 3LJ. 01942 259024 01942 259024 Telephone number Fax number Email 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 Kevin Hall Ms Norma Pennington Care Home with nursing 39 Category(ies) of Old age 39 Terminally Ill 2 registration, with number of places Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Total number of places - 39. 2. That at all times suitably qualifed, competent, and experienced persons are working in the home. 3. That at all times a suitably qualified registered nurse is working in the care home. 4. Minimum staff ratios are as adhered to 5. Within the total registered number of 39 , there can be up to 2 TI(E) which will be service user specific places for the duration of the placements. Date of last inspection 5TH November 2004 Brief Description of the Service: The Acorns Care Centre is located on the outskirts of Hindley town centre, close to shops, a park, and other amenities. The main bus route runs close by. The Acorns is purpose-built, and accommodation for service users is provided on three floors. Accommodation is provided for a total of 39 service users, both male and female, who are over the age of 65. The Acorns provides nursing and personal care. Within the total of 39, two service users may be accommodated who are over the age of 65 and who are terminally ill. All accommodation is offered on a single-occupancy basis. All bedrooms have en suite facilities. Parking for visitors is limited. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 6 hours on one day, and was unannounced. Part of the time was spent in the office talking to the Deputy Manager, looking at four care plans, one staff file, and papers used to manage the Home. The remainder of the time was spent looking around the building, speaking to four residents, three visitors, and two members of staff. Other residents were spoken to over the course of the inspection. What the service does well: 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. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The pre-admission assessment was not carried out equally across all prospective residents, so some residents could not be assured that their needs would be met. Residents can be assured that their specialist needs will be met. EVIDENCE: Four files were examined that related to residents living at The Acorns. Three files indicated that a good assessment had been carried out, and that service users could be assured that their needs would be met. However, one showed that a person had been admitted with a known mental health disorder. The Home is not registered to admit people with mental health disorders. Since admission, it had become clear that the resident’s needs could not be met, and that the resident’s behaviour was affecting other residents and staff. Staff were at the point of arranging for the resident to be re-assessed. This matter is discussed further in the next section of this report. In a comment card, the relatives of a service user highlighted the simple needs of their relative, such as placing the TV or clock where it could be seen by the Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 8 resident, who was nursed in bed. These would be significant needs for this person that ought to have been identified during assessment. The records shows that, where a resident’s specialist needs cannot be met by the Home, these are arranged, for example with the diabetic nurse, tissue viability nurse, etc. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 10 The quality of care planning was not maintained for all residents, so some would not have had their identified needs addressed. Residents can be assured that they will be treated with respect and dignity, and that their right to privacy will be upheld. EVIDENCE: Four care plans were looked at. Three contained detailed and clearly expressed information to show that the resident’s health, personal and social care needs were taken into account. Reviews had been done at least four weekly, with changes recorded, as appropriate. However, one care plan did not reflect the true status of the resident’s condition as it was described to the Inspector by the Deputy Manager, or as it was recorded by an RGN in the staff communication book. Other residents and staff were being affected by the resident’s changing, more challenging, behaviour. It was clear, therefore, that this resident’s mental health needs were not being met, and that the care plan was not being accurately maintained. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 10 A check with the Deputy Manager on the mental health needs of other residents showed that nine had a diagnosis of dementia, but that, of these, eight had nursing needs that were greater than their mental health needs. Their care appeared to be being managed well within The Acorns. However, a note in the staff communication record indicated that night time care can be difficult when residents with dementia are wandersome or agitated. The records showed that the health and well-being of residents is promoted and maintained in that they are assisted with all aspects of their personal care, and such nursing care as is required. Nursing care is either provided by Registered Nurses within The Acorns, or by specialist nurses from the hospital or community services, as appropriate. Residents had had access to a range of specialist medical, dental, pharmaceutical, chiropody and therapeutic services, according to need. However, a delay in completing the care plan for wound care management was seen within the sample examined. The wound had been identified on 21st June 2005, but the care plan had not been written until 1st July 2005. When it had been drawn up, the care plan gave very detailed entries, and indicated referrals to the GP and Tissue Viability Nurse. The delay in writing the care plan would have been significant, particularly given the other medication conditions suffered by the resident. The relatives of one resident completed a comment card in which they expressed that there was a need for simple exercise, and more attention to oral health was required. However, they said that they found the overall care provided at The Acorns to be “generally OK”. Good examples were seen at this inspection which indicated that residents were treated with respect, and that their right to privacy was upheld. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 Residents can be assured that they will be helped to exercise choice and control over their lives. EVIDENCE: There were good examples seen at this inspection of residents maximising their personal choices. Residents were moving freely about the Home, with assistance from staff and relatives if it was needed. Residents spoke about changing bedrooms, using different parts of the building, the times they got up and went to bed, and how they preferred to spend their day. In conversation, the Deputy Manager focussed frequently on resident choice within the activities of daily living. Information on advocacy services is advertised widely throughout the building, including Age Concern, Voice, and Victim Support. Residents had taken the opportunity to bring personal possessions to keep in their own bedroom - some to a greater degree than others. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 12 Of the four care plans examined on this occasion, one resident user had signed to show that the document had been made available. A family member was recorded as having seen another. There was some indication, therefore, that residents (or their representatives) had had access to personal information that was maintained by the Home. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The Home has a complaints process that is easily accessible by residents and their representatives. Residents are protected from abuse in any form by the Home’s written policy, and by the Home’s ethos of zero tolerance. EVIDENCE: The complaints process is advertised in a Notice at the main reception desk, together with copies of blank complaints forms. The records showed that no complaints had been made to the Home since the last inspection, and none had been received at the CSCI. It was clear from care plans that, where residents had had concerns or wished to record their dissatisfaction about something, the details had been recorded, along with any action that had been taken. Good levels of communication were observed between residents, relatives and staff. The Acorns has a policy and procedure in place in relation to the protection of vulnerable adults (POVA, which includes whistleblowing. Staff had received POVA training. A copy of the local authority’s Practical Guide to POVA was displayed prominently in each of the staff offices, as well as a copy of the Department of Health’s guidance booklet, “No Secrets”. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, and 25 Although well-maintained and generally clean, the presentation of the Home was not satisfactory as there was a high level of clutter, some of which posed a risk to fire safety. Toilets were not easily identifiable to all residents. Residents had insufficient personal storage space. The main telephone system was not working properly, and was inadequate to cover the whole building, so making it difficult for staff to make and receive calls relevant to the health and well-being of residents. EVIDENCE: The accommodation for residents is provided over three floors. On the day of this inspection, the Home was generally clean, though the carpet in the lower ground dining room requires deep-cleaning to remove stains. The Home appeared to be reasonably well-maintained, and there was evidence that paint had been purchased for emulsioning walls. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 15 The Home was a little untidy. Untidiness was most evident in bathrooms, particularly the bathroom opposite bedroom 35 where continence products were piled on the floor and other items appeared to have been dumped. This matter had been raised at the last inspection. The lounge on the top floor, used for activities, was cluttered. An office-type phone/fax machine was also seen in one of the lounges. Clutter was also stored in stairwells, and on one landing, clutter was such that the fire extinguishers could not be reached. The Deputy Manager was asked to clear this area that day. Arrangements must be made for the proper storage of equipment, continence products, etc., so that the Home is presented in a homely and comfortable way. Fire safety is discussed further in the final section of this report. A problem was in evidence at this inspection with the main telephone. The Deputy Manager said that there was a telephone on the ground and first floors but none on the lower ground floor. The portable handpiece must be carried to the ground floor, but the line cuts out en route. The Deputy Manager said that this had been discussed at the last staff meeting. This now requires prompt attention. The system is not fit for purpose and wastes staff time. Instructional signs were seen around the Home that were aimed at staff. For example, remembering to switch off lights because “we are burning electricity needlessly”, and in the Residents’ Smoking Lounge, “.. if you are caught smoking you will be dismissed”. Signs like these are not appropriate and detract from providing the homely feel that is expected of care homes. They would constantly remind a resident that they were “in care”, rather than being “at home”. These are training and supervisory issues for staff that require to be dealt with in that way. A recommendation is made for communal toilets to be clearly marked in a way that would be suitable for residents and that supported their independence. Currently toilet doors are the same style and are painted in the same colour as all other doors on that floor, and signage is not clear. This would make it difficult for an elderly person, especially one with a visual impairment, to identify a toilet door quickly. A number of suitcases, boxes and bin liners were seen to be stored in residents’ rooms, indicating that the Home does not provide sufficient storage for residents to put away their personal belongings. It is not acceptable to leave suitcases in full view – or, as in one case, being used to prop open a door – as it creates the impression of “passing through”, rather than “moving in”. Sufficient storage facilities must be provided for residents. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 16 The Deputy Manager advised that there had been a problem with the hot water supply, in that the hot water was sometimes ”freezing” in the morning. However, she said that it had not been a problem in the previous two weeks leading up to the inspection, and that it had been raised with the owner of the Home. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, and 30 Staffing was not sufficient to meet the needs of residents at all times. Staff practice during the shift posed a risk to the control of infection. There was a high incident of sickness among the staff group which affected the overall level of care. Records were not available for all staff so proper recruitment could not be clearly demonstrate. Some elements of the supervision of staff were inappropriate, and meant that staff competence could not be measured. EVIDENCE: The nurse on duty at this inspection was the Deputy Manager, who, in the absence of the Manager, was also responsible for the management of the Home. An immediate requirement was left because there were not enough staff on duty to meet the needs of residents. It was clear from the staff communication book, and from conversation with the Deputy Manager, that this was not an isolated event. In some cases, this has affected the care of residents, for example, “no supper done”. The Inspector, hearing one resident calling for help from in the garden, brought her back indoors and returned her to her bedroom. Another resident was helped to walk to her room by the Inspector. At this inspection, there was one nurse on duty 8 a.m. to 8 p.m. supported by 6 care assistants. There were 20 residents with nursing needs accommodated over three floors, and the majority of the balance of residents were also highly dependent. The Deputy Manager said that some residents, who are failing and Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 18 at the end of their lives, require a good level of input from nurses, and that this was hard to do with the numbers of nurses rostered on each shift. A number of residents were seen to be nursed in bed. A high number of residents take a quantity of prescribed medication in the morning, to the extent that the medication round can take up to two hours to complete. Thus the nurse is unable to provide any other nursing input, arrange GP visits, organise referrals, etc. until this task is finished. Notices had been posted in the staff office setting out what was considered to be the minimum staffing level. However, this did not take account of residents’ dependency levels, or the layout of the Home. Another notice stated that, in the afternoon, three people (E, S, and M) counted as one carer between them. E is listed a kitchen assistant on the staff rota, and would have been moving between kitchen and care duties, which is not an acceptable situation as it poses risks to the control of infection. The staff communication book also showed that there was a high incidence of sickness among the staff group. For example, in the three weeks prior to the inspection five members of staff had taken sick leave. In addition, four carers were on holiday at the same time (w/c 30.6.05). The file for one person (LG) was asked for because the Deputy Manager said that LG was the housekeeper but helped out on the care side, as kitchen assistant, and with cooking duties. No staff file could be found. No training record could be found. It was not clear, therefore, whether LG had been properly recruited or that she had the relevant qualifications to undertake the range of duties that it was stated she did. The Deputy Manager provided other training information for examination. It was seen that 10 members of staff had been identified as needing training in dementia. This training had been completed over half a day on 21st October 2004. 8 of the 10 members of staff were still employed at this inspection. Mandatory training sessions in fire safety, moving and handling, and health and safety had taken place. POVA training had taken place, the stated aim of which was “to assist the promotion of zero tolerance towards any abusive behaviour”. Notices located around the Home must be replaced by proper training and supervision of staff, so staff know what is expected of them without the need for instructions being posted on the wall. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38. Policy documents had not been reviewed so guidance was not up to date. Residents were put at risk by lapses in safe working practices. EVIDENCE: The Home has a set of employment policies and procedures that had been developed by an external provider. The folder was located in the staff office and so was readily accessible. There was a separate staff handbook. The documentation had not been reviewed or updated since 15th March 2002 and so ran the risk of not being in line with current legislation or up to date with good practice. It was noted that the policy on discipline and grievance was missing from the main binder. However, a copy, that clearly set out the process to be followed, was later found in the staff handbook. Staff supervision sessions were seen to be in progress, but the documentation was not examined on this occasion. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 20 Staff are trained so that, so far as is reasonably practicable, safe working practices are adhered to. The Home’s owner takes responsibility for checking that systems are working properly, but the records were not examined on this occasion. There is a set of health and safety policies and procedures that staff can easily access. Accident forms were available for completion in the event of an accident or incident involving a resident or a member of staff. Concerns were raised by the Inspector at the amount of clutter in stairwells and on landings, to the extent that fire safety was compromised. The rear of the premises, where the main reception is located, is very secure, with a keypad entry system to all floors. However, the Inspector noticed that one door leading from the garden into the main building was regularly left wide open. In fact, staff used this door to come and go during their breaks. Often the office opposite to this door was left unattended, and staff were busy with their work away from this area. This poses a risk to the security of the premises and, indirectly, therefore, to the security of the residents. Sluices throughout the building were found to be unlocked. This posed a risk to residents as products harmful to health had been left on drainers. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 x 2 x x 2 3 x STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 1 Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 22 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. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Standard 3 7 8 19 19 19 19 27 29 30 36 38 38 Regulation 14 15 12 23 16 18 23 18 17 18 18 13 13 Requirement The pre-admission documentation must be completed for all residents. Care plans must be accurately maintained. Care plans must be reviewed and updated. Adequate storage must be provided for equipment and products. The telephone system must be appropriate for the building. Instructional notes aimed at staff must be removed. Adequate storage must be provided for residents in their own bedrooms. Sufficient staff must be on duty who are appropriately trained and experienced. Recruitment records must be available for all staff. Staff must be trained and competent to do their jobs. Employment policies and procedures must be reviewed and updated. A review of the security and safety of the premises must be carried out. Sluice rooms must be locked F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Timescale for action 16th August 2005 16th August 2005 16th August 2005 30th September 2005 30th August 2005 16th August 2005 30th September 2005 Immediate and ongoing 16th August 2005 30th August 2005 30th September 2005 16th August 2005 9th August Page 23 Acorns Care Centre Version 1.40 when not in use. 2005. 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 21 25 Good Practice Recommendations Doors to communical toilets should be made more easily identifiable. Hot water should be available at all times. Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Botlon, BL6 6HG. National Enquiry Line: 0845 015 0120 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 Acorns Care Centre F56 F06 S30090 Acorns V230439 25.07.05 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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