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Inspection on 09/08/05 for Adderley Care Home

Also see our care home review for Adderley Care Home for more information

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Residents spoken to all praised the care they receive from staff at the home. As at the previous inspection, they said they especially appreciated the individual attention they receive and clearly enjoyed all the food in the home. The visitors spoken to described the care their relative received as "excellent" and said that individual food preferences were always catered for. These comments reflected comments made from a visitor at a previous inspection. In both cases the residents in question were over 90 years and their needs were able to be met by staff in the home.

What has improved since the last inspection?

A review has taken place for one resident identified at the previous inspection, and this lady was no longer staying in her room, but was sitting in the lounge during the visit.

What the care home could do better:

Although residents appreciate the care provided, two of those spoken to, who were not over 90, felt there was still little to do in the home and levels of activities have not improved. There were shortfalls in virtually all the areas inspected and some Health and Safety requirements, carried forward from two previous inspections, had not been resolved and Statutory Enforcement Notices have therefore been served on the home. These are for removing wedges from fire doors, ensuring COSHH items are appropriately stored, inappropriate storage, and fire drills are conducted and a fire policy developed.Individual service user records have not been adequately maintained and there is an immediate requirement for one resident to have a thorough review of health care needs. The one recent staff appointment also showed that appropriate recruitment procedures are not being followed. In summary, although current residents are not unhappy in the home, Bethel does not provide the standards required for care delivery as envisaged by the Care Standards Act leaving service users at possible risk.

CARE HOMES FOR OLDER PEOPLE Bethel Residential Home 822 St Albans Road Garston Watford WD25 9FL Lead Inspector Pat House Unannounced 18 August 2005 10:00 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. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bethel Residential Home Address 822 St Albans Road Garston Watford Hertfordshire WD25 9FL 01923 662109 01923 465356 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) Mrs. V. Rodricks Mrs V Rodricks Care Home 8 Category(ies) of OP Old Age - 8 registration, with number of places Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 May 2005 Brief Description of the Service: Bethel is a residential home providing care for eight older people. The building is a two storey, older house with parking to the front and a large garden at the back. Bedrooms are sited on both floors and there is a passenger lift. There is a large communal lounge and kitchen on the ground floor and the laundry is situated in a separate small building behind the main house. All the bedrooms are for single occupancy and one has en-suite facilities. The home is located on a main road in Garston where there are shops, pubs, a Post Office and Churches. There is easy access to buses and the busy town of Watford, with its wide range of transport and facilities, is nearby. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over half a day with two inspectors. The last inspection, on 17th May, raised some serious concerns about the home and so this visit was made to ensure progress had been made to improve services. There were six residents in the home during the visit and most were spoken to, as were two visitors to the home. The manager was on duty during the inspection along with one other care worker, who was also spoken to. All areas inside the house were visited and records were examined. The outcome of the visit was that most of the requirements made previously had not been rectified and other concerns were raised. Just 3 of the 13 Standards assessed at this inspection were met. The Manager explained that the financial constraints involved with running the home had increased and that the decision had recently been taken to close the home after giving a period of notice. What the service does well: What has improved since the last inspection? What they could do better: Although residents appreciate the care provided, two of those spoken to, who were not over 90, felt there was still little to do in the home and levels of activities have not improved. There were shortfalls in virtually all the areas inspected and some Health and Safety requirements, carried forward from two previous inspections, had not been resolved and Statutory Enforcement Notices have therefore been served on the home. These are for removing wedges from fire doors, ensuring COSHH items are appropriately stored, inappropriate storage, and fire drills are conducted and a fire policy developed. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 6 Individual service user records have not been adequately maintained and there is an immediate requirement for one resident to have a thorough review of health care needs. The one recent staff appointment also showed that appropriate recruitment procedures are not being followed. In summary, although current residents are not unhappy in the home, Bethel does not provide the standards required for care delivery as envisaged by the Care Standards Act leaving service users at possible risk. 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. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3. Standards 1 and 4 were assessed at the last inspectionand were met. Standard 6 does not apply to this home. The home completes assessments for all new service users but cannot ensure that all needs will be met, as care plans are not completed at an early stage. EVIDENCE: One new service user has been admitted to the home since the last inspection. Records examined included assessments from the Health services and the home’s Manager’s own assessment. However, although the individual has been a resident since July, as yet no written care plan or risk assessment has been completed. It is acknowledged that in a small home information can be relayed by word of mouth, but without a written plan to follow staff can miss important information and can easily forget details. Bethel Residential Home I52 s19291 bethel v243239 180805 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, 9 and 10. Individual care plans in the home are not adequate to ensure that appropriate care is provided and it is not clear that all service users’ health needs are being met. This may leave service users at risk. Medication procedures in the home are generally thorough but the few shortfalls in the system could lead to mistakes being made in administration. Service users and their families are satisfied that they are all treated with respect at all times and have confidence in the staff. EVIDENCE: The residents’ care plans were checked and, as at the last inspection, they did not contain adequate or up to date detail of current needs and information. The Manager uses a separate book to note information for all service users, such as visits from the doctor or instructions from other professionals. However, even these notes are not properly recorded with names of people spoken to and important information is not transferred to individual records. This is a very inefficient system and does not protect service users’ interests, as important information is not readily available to those caring for residents. Risk assessment recording is also completely inadequate and does not follow guidelines for completion, although the home has a copy of “The five steps to risk assessment recording” in its Health and Safety file. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 10 Weight records for service users were seen recorded, although these have not been completed since March. Records indicated that annual medical reviews were overdue for residents and few had monthly reviews recorded. Several residents were sitting in wheelchairs in the lounge and one lady said she found this uncomfortable. Staff said that one resident was not transferred to a chair because “she slid down”. It was suggested that this lady should be re-assessed for the use of current non-slip devices and that reasons for the lack of control should be examined with other professionals. This particular resident had recently had a re-assessment and had had her medication changed. There was no evidence that the home was monitoring any resulting changes to ensure the new dosage was appropriate or that feedback was given to the doctor or community psychiatric nurse. In addition, the decision about an increase to the dose of medication in this case was apparently given over the telephone to the Manager, and was recorded in the small book but with no name of the person giving the instructions. The Manager was observed using a hoist to transfer one service user from bed to wheelchair and this individual sleeps on the hoist sling every night as staff said they could not get the sling under the lady without hurting her. This is not good practice as it could lead to the skin breaking down and the procedure must be re-assessed by a professional. In addition the lady subsequently sat in the wheelchair with no footplates and no means to support her legs, although her legs were oedematous. Staff said that a district nurse had instructed them not to use footplates for this lady, but the resident had not actually seen a nurse for over a year. There was also a written note in records that a G.P. left instructions for the lady’s legs to be kept elevated. An original moving plan for this resident also said that two staff should use the hoist and this was no longer being adhered to. The lady in question could also stand for a short while, against the bed, and would possibly benefit from an adjustable bed being provided. Two original notes for the resident also said that prescription stockings should be used. However the Manager said that these had never been used as “no stockings had been sent”. It appears no one from the home followed this up. An immediate requirement was made that a complete professional reassessment must be made for this lady. The Manager is continuing to maintain the improved system for medication administration noted at the last inspection. However, one or two amounts of medication could not be reconciled with records and medication for a service user who had left the home after a few days respite was still being held. The Manager was again reminded that actual amounts of medication given should be noted when these amounts were variable. The proposed revision of the dispensing of medication from the pharmacist, as detailed at the last inspection, has not happened as the pharmacist currently used is closing the business. Residents and visitors spoken to all confirmed that service users in the home were always treated with dignity and respect by staff. It was clear that relations between care staff and residents was mutually supportive and that all residents were treated in an individual way. However, it is of concern that the lack of appropriate written information could leave service users at risk. Bethel Residential Home I52 s19291 bethel v243239 180805 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) 12 and 15. Daily life in the home does not fulfil the preferences of all service users or offer stimulation, but all service users enjoy the food provided for them. EVIDENCE: One of the service users spoken to said that there was “nothing to do” in the home and another said there was “nothing much to do during the day” and they spent their time in the lounge, sitting in their wheelchair with the television on. On arrival at the home the Manager was painting the nails of one resident and the television was on during the visit. There was a staff “duties” list on a notice board, where daily tasks were listed. There were no activities at all listed on any of the days. The lack of stimulation for service users is not acceptable. However, all residents praised the food provided in the home and visitors said that if their relative asked for something special, this was always provided. There were menus available for inspection, but these did not note the variations provided for residents including one vegetarian diet, as is required by Health and Safety regulations. Residents confirmed there were always drinks available at all times in the home. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 12 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 at the last inspection and the standard was met. These standards were not assessed on this occasion. EVIDENCE: Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 13 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, 20, 24 and 26. The fabric of the home is currently not adequately maintained although some lighting has been improved for the benefit of service users. There are no unpleasant odours in the home but infection control could be improved to maintain hygiene standards and the provision of lockable space for service users must be clarified to ensure all individual requirements are met. EVIDENCE: Residents in the home said they found their surroundings comfortable and there is a homely atmosphere at Bethel. However, some of the décor is now in need of refurbishment and wallpaper is beginning to come off in some areas. The side of the ground floor bath is also broken off. The home does not have a dining room as such, but has a table outside the kitchen, where up to four residents can sit at once. The chairs around this table were covered over with pieces of polythene, which, it was felt, was undignified for residents and for the visitors who were also using these seats. Some areas in the home were not very clean, including the first floor toilet and bath. Some kitchen cupboards were dusty inside and a coffee-making machine and fruit bowl were also dirty. There was a baby-alarm in the first floor corridor, but its use was unknown. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 14 The use of such listening devices impinges on service users privacy and confidentiality. The rationale for use must be carefully risk assessed and recorded. The manager said that there was no lockable space or bedroom door keys provided for residents but that they could have these if requested. The Manager should however record when these are offered to the residents and should note the responses. The Manager said that the resident who had been self-medicating some homely products had had these “taken away” and therefore did not need lockable space. The light in the upstairs bathroom was now brighter than at the previous inspection, although still a little dim. There is still no contract for clinical waste at the home although the bin where used incontinence pads were placed now has a lid on it. The ground floor bathroom is still being used for storage and the ironing board, mop and sundries were stored beside a cupboard. There was also a stool next to the bath with wheelchair footplates piled on top. A requirement that this storage must be removed has been made through two previous inspection reports and a Statutory Enforcement Notice has now been issued. The bathroom also contained a trolley with a variety of toiletries and hair rollers, as well as used flannels. There were also flannels draped on the hoist and a sponge and soap on the side of the bath. Such individual items should not be kept for general use and should be stored in individual bedrooms. The wheelchair in the bathroom was in a very poor state with one arm worn through and padding exposed where residents would lean their arms. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 15 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) 29. Standard 27 was assessed and met at the last inspection. The recruitment procedures in place do not protect service users or promote their interests. EVIDENCE: The records of one new care worker were checked and showed that no written references had been requested or received and no CRB clearance had been sought. There were no details of previous employment on the application form and no notes written to explain this. In addition, this member of staff was working on her own in the home at night. This leaves service users at possible risk. An immediate requirement was made that all employment checks must be in place before this care assistant can work in the home unsupervised. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 16 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) 38. The health, safety and welfare of service users and staff are not promoted or protected by the practices within the home. EVIDENCE: This standard continues to be ignored by staff in the home and all concerns listed at the last (and in some cases two previous) inspections have still not been addressed. Fire doors were still being wedged open and one service user said that bedroom doors were held open at night. A Statutory Enforcement Notice has now be served on the home to rectify this. COSHH items, including oven cleaner, were stored in an unlocked cupboard in the bathroom and in an unlocked store on the first floor. General toiletries were also left in the ground floor bathroom, which is still used as a store area, as already stated. The home’s policy of not using footplates on wheel chairs must be risk assessed in individual cases. There was no evidence of electrical PAT tests taking place and no evidence that the bath hoist has been serviced, although checks on the freestanding hoist are complete. Records of fire alarm tests were seen but only Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 17 one fire drill has taken place in the past year according to records, and only two staff members took part. The home has no written Fire Policy. One accident where a resident was seen by a G.P and subsequently sent to hospital was not recorded in the accident book and no notification was sent to the CSCI as required. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 18 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x 2 x 2 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 19 Yes 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. Standard 3 7 Regulation 15(1) 15(1)&(2) (b) Requirement The Registered Provider must prepare a written Care Plan for all service users in the home. The Registered Provider must ensure that care plans are kept up to date with details of all care needs and with adequate risk assessment in place. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Person must ensure that all service users have regular health checks and receive reviews and assessments from other health professionals when this is needed. The Registered Person must ensure that adequate records are maintained for the administration of medication and that drugs are returned to the pharmacist when appropriate. The Registered Provider must consult service users about their interests and plan a programme of appropriate activities. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Provider must Timescale for action 15 September 2005 15 September 2005 3. 8 13(1)(b) 15 September 2005 4. 9 13(2) 18th August and henceforth 5. 12 16(2)(m) &(n) 1st October 2005. 6. 19 23(2)(d) 1st Page 20 Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 7. 24 23(2)(m) 8. 26 16(2)(k) 9. 29 19(1)(b) (i)&(c) 10. 38 23(4)(a) (c)(d)&(e) 13(4)(c) 11. 38 13(4)(c) 23(4)(a)& (c)(iii) 12. 38 23(2)(c) 13. 38 13(4)(a) ensure that all parts of the care home are kept clean and reasonably decorated. The Registered Provider must provide lockable storage facilities in service users bedrooms, or should record why this is not appropriate. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Provider must make suitable arrangements for the disposal of clinical waste. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Person must obtain full employment histories; two appropriate written references and CRB or POVA clearance for all staff prior to commencement of employment. The Registered Person must ensure that regular fire drills take place in the home. A fire policy must be in place relating to the home. An enforcement notice has been served. That the fire doors must close properly and that fire doors must not be wedged open. THIS REQUIREMENT IS CARRIED FORWARD FROM TWO PREVIOUS INSPECTION REPORTS. An enforcement notice has been served. The Registered Provider must ensure that all equipment in the care home, including hoists and wheel chairs are maintained regularly and are in good working order. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS INSPECTION REPORT. The Registered Provider must keep all chemicals locked away September 2005 1st October 2005 1st September 2005. 18th August and henceforth 28th September 2005 1st September 2005 1st September 2005. 1st September Page 21 Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 13(4)(c) 14. 38 23(2)(1) 13(4)(C) 12(4)(a) 15. 38 37(1)(c) &(e) in the home and keep communal areas clear of toiletries. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS TWO INSPECTION REPORTS. THAT COSHH ITEMS MUST BE KEPT LOCKED AT ALL TIMES WAS MADE IN THE PREVIOUS INSPECTION REPORT. An enforcement notice has been served. The Registered Provider must provide suitable storage, other than the bathroom, for equipment in the home, including the ironing board, iron and wheel chairs. THIS REQUIREMENT IS CARRIED FORWARD FROM THE PREVIOUS TWO INSPECTION REPORTS. An enforcement notice has been serviced. The Registered Person must notify the CSCI of all incidents and accidents affecting the wellbeing of service users in the home. 2005 1st September 2005 18th August and henceforth. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations There are none. Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ 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 Bethel Residential Home I52 s19291 bethel v243239 180805 stage 4.doc Version 1.40 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!