Inspection on 28/02/06 for Apple Orchard

This inspection was carried out on 28th February 2006.

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 found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apple Orchard 22/06/07

Apple Orchard 07/06/06

Apple Orchard 24/10/05

Apple Orchard 08/03/05

Apple Orchard 07/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Apple Orchard The Green Dean Road Newnham-on-severn Glos GL14 1AQ Lead Inspector Mr Simon Massey Unannounced Inspection 28th February 2006 11:00 Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Apple Orchard Address The Green Dean Road Newnham-on-severn Glos GL14 1AQ 01594 516582 01594 516582 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Thomas Alfred Mills Mrs Beverley Mills Mr Graham Fredrick Jeremiah Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2), Physical disability (1), of places Sensory impairment (2) Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The LD(E) category refers to two named service users. The home will revert to the original category (LD) when these service users no longer reside at the home. 24th October 2005 Date of last inspection Brief Description of the Service: Apple Orchard is in the village of Newnham-on-Severn, Gloucestershire. It is a large detached property on three floors and provides care and accommodation for 10 adults with learning disabilities. All residents are accommodated in single rooms. The home is staffed at all times. Adjacent to the home is a two-storey building which is used for activities, training, meetings and social groups. This also incorporates a sensory room and leisure facilities. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours on 28th February 2006. The inspector met with the Registered Manager and the Registered Providers, two care staff and seven of the service users. Records relating to care planning, health and safety and staffing were examined. A brief inspection of the environment was also completed. The intention of this inspection was to inspect the core standards not examined at the last inspection on 24th October 2005 and follow up the requirements made as a result of this visit. Readers are referred to this previous report for details about areas not covered in this report. What the service does well: What has improved since the last inspection? What they could do better: Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 6 The home must ensure it only admits service users who fall within their registration category and the provision outlined in the home’s Statement of Purpose. Only service users whose needs can be met should be admitted to the home. The home needs to ensure that a current Statement of Purpose is available within the home. The home needs to provide a more co-ordinated and structured programme of day-care activities. The home needs to demonstrate that it has a care planning process in place that is effective and understood by the manager and care staff. The home needs to access training relating to person centred planning. Work needs to continue on improving the information and guidance that is contained within the care plans. The home needs to provide a more detailed and comprehensive plan relating to the upgrading of the environment with regards to building work and redecoration. The home needs to ensure that restrictions on service users accessing the kitchen are properly risk assessed, recorded and kept to a minimum to ensure a normal domestic environment. 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. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 The home must follow its admission policy to ensure that service users are not admitted whose needs the home cannot meet. The home must only admit people who are within their registration category. EVIDENCE: The home has admitted one service user since the previous inspection. The new service user came for an initial visit and a further trial stay and made a decision to move into the home. Detailed assessments were provided by the placing authority, including an Occupational Therapist’s assessment detailing the support and input required. However it was evident that the new service user does not have a Learning Disability but is recovering from a stroke after being discharged from a hospital in London. They had previously returned from abroad were they had worked as a Teacher before suffering the stroke. The service user does have a physical disability and the Manager stated that the category of their registration includes one place for Physical Disability and they thought that this would cover the new service user. The home is registered for Learning Disabilities and the physical disability category means that they can accommodate one person with Learning Disabilities who also has a physical disability. The home’s Statement of Purpose, which was not available in the home at the time of this inspection, makes no reference to the home being able to meet then needs of people outside the category of Learning Disability. The Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 9 Registered manger did not contact the Commission to seek any clarification on this issue before moving the service user into the home. This placement represents a serious breach of the regulations and the home were required to take immediate action in relation to this. An immediate review of the placement was organised in conjunction with the placing authority. The home has also been required to supply in writing to the Commission their reasons for admitting someone outside of their category, and how they consider their needs can be met in the home. Subsequent to the inspection the Commission were informed that the service user’s placement was being ended shortly. . The manager said that he had recently reviewed and updated the Statement of Purpose and Service User Guide, but was unable to locate copies at the time of the inspection. A requirement has been made that copies of the revised documents are supplied to the Commission, and that copies are made available within the home. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 The care planning system needs to be further developed and improved to ensure that service users are fully involved in planning their lives. Greater opportunities for identifying goals and aspirations could result in more choice and control for service users. EVIDENCE: It was explained that the new service user had moved into the home with the intention that they would eventually move on to sheltered accommodation in the wider community. However, the care plan in place makes no reference to this aspect of his care, or how the home will progress and support this goal. A new care plan format is in place in the home and a sample of these were examined. The new format covers a wide range of areas including personal support needs, leisure interests, health needs and behaviour management. However the detail recorded in some of the sections is very limited and often provides little or no guidance to staff on how things could be supported or monitored. For example, in one section called “emotional needs” it states that the person “can become unsure of himself and needs emotional support.” No supporting evidence or detail is provided. Further statements are included that Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 11 say the person will need “extra support at the beginning of the year, his birthday and at Xmas.” The only guidance given is that the person will need time to talk to staff. Previous inspection have also resulted in criticisms of the care planning process and the manager expressed his frustration that he believed different inspectors were asking him to do different things. However, care planning is a process in which the documentation is an integral part. The new forms are an improvement in as much as they provide a wide range of areas and topics that information can be recorded against, but the lack of detail contained within them, the lack of identifiable and achievable goals and the actions required to meet them, make them still inadequate. It is also evident that whilst service users are shown the plans and have an opportunity to discuss them, there is not a person centred planning process in place. Service users should be at the centre of all planning around their care and supported and enabled to identify goals, aspirations and objectives as far as their abilities allow. At present, after a review meeting, the new care plan is written by the manager and shown to the service user for their agreement. The plans should be developed in conjunction with the key-workers and service users. The inspector was concerned about the lack of understanding around the area of care planning and the impression given by the manager that he considers Inspectors are simply requiring changes to the way the paperwork is completed and that this is confusing to him. The inspector stated that what was required was evidence that an effective person centred planning system was in place and also the evidence that the manager and staff understood what this involved. This is not the case at present and a requirement has been made that the manager and staff undertake training in this area. The home no longer holds service user meetings as the manager felt these were ineffective and produced little feedback from the service users. People can be involved with tasks or chores within the home but have limited involvement in the running of the home, or in the making of decisions that affect the running of the home. The level of disability of some service users would make this difficult for them but there is scope for the making the home a more empowering and enabling environment for the service users. A sample of risk assessments were seen and these were up to date and had been appropriately reviewed. The daily recording completed by staff about the service users was detailed and reflected an understanding of people’s need’s and disabilities. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14 & 16 A lack of co-ordination around day-care activities results in service users receiving an inconsistent service. Individual plans for day care activities developed from the care plans and done in conjunction with the service users could produce more fulfilling routines and variety. The home and service users are well established within the local community and make use of local facilities. Restrictions on access to food and drinks and the kitchen area could be better managed to protect service users rights and promote choice and independence. EVIDENCE: The home provides a range of activities in its own activity centre that is situated next to the home. This has various equipment provided such as fitness training apparatus, a pool table, television and arts and crafts materials. However during this inspection there were only two staff on duty supporting 9 Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 13 service users, plus 3 service users from the sister home run by the same providers. Staff explained that in the morning they only had time to complete domestic chores such as cooking, cleaning and laundry with the service users and that more activities are supported during the afternoon and evening. Records show that people were supported to attend various clubs and college courses and also go for walks and visit local pubs. The timetable for the service user’s activities showed that most people only had two structured activities during the day in the week. There appears to be lack of co-ordination over day care activities and also a lack of documentation in the care plans to provide information or guidance on what peoples needs and aspirations are in terms of finding valued and fulfilling activities. Service users are supported to access the local community and there was evidence that when additional staffing is requited to support evening or weekend activities that this is provided. However on the day of the inspection there was staffing ratio of 2 staff for 12 service users for the majority of the day, and with so many routine domestic tasks to complete there was little or no time to support activities or leisure interests with the service users. It was observed during the inspection that the kitchen area was secured off from the service users by means of a barrier in the doorway. Staff explained that service users were not permitted in the kitchen unsupervised and that the manager had instructed that, for the present, staff should make drinks for the service users. This is apparently due to the kitchen being left untidy and in a mess. Staff were observed providing tea and coffee in the dining room. This is an unsatisfactory arrangement and the home needs to provide risk assessments on any service users who are not permitted in the kitchen, and written guidance and documentation as to why this basic restriction is in place for all the service users. Two of the service users are smokers and whilst the staff on duty explained what the expectations were around where and when people could smoke, they were unaware of any smoking policy the home has in place. Staff are not permitted to smoke in the house. The home needs to produce a smoking policy that is clear for staff and service users. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected in detail during this visit. EVIDENCE: The individual files contain the details of the personal care and support that is required. The personal files also contain details of health appointments that have been supported and input that has been received from the Community Learning Disabilities Team. Three service users have involvement from the CLDT at present. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Positive relationships between staff and service users, and the use of communication techniques, help enable concerns or issue to be identified. A lack of training and awareness around the area of Adult Protection needs to be addressed to ensure that service users are as fully protected as possible. EVIDENCE: The manager and staff have not completed any training in the area of adult Protection and a requirement is made that the manager complete this training and provide input and guidance to the staff on this area. Whilst the home has service users who can present challenges the manager and staff stated that no physical restraint was used within the home. The home has received no formal complaints within the last twelve months and no complaints have been received by the Commission in respect of the service. The admission of a service user outside the homes registration category could potentially compromise the safety of the service users and means that standard 23 cannot be met at present. Staff were observed communicating appropriately with service users who appeared confident and relaxed with the staff and able to approach them with issues or concerns. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 & 30 Work being undertaken in the home will further improve the comfortable and homely environment that is maintained. Service users are supported to personalise their rooms according to personal taste and preference. EVIDENCE: Work is continuing on the environment with en-suites being fitted in some of the bedrooms. The provider explained some of the difficulties they had been experiencing with contractors employed to complete the work, which had resulted in some work being left uncompleted. Steps have been taken to ensure that new contractors are found and the work finished. A requirement was made following the last inspection that the home should supply a detailed plan of the work and redecoration that is planned for the home. This was supplied but in insufficient detail and the manager agreed to supply an updated list covering the full extent of the work that is planned. A number of individual rooms were seen and these were personalised, clean and reasonably decorated. Three service users indicated their satisfaction with their accommodation. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 17 All parts of the home seen were clean and hygienic. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 & 36 Service users are protected by the home’s recruitment procedure. The home is committed to providing staff training which should improve the practice and quality of care that the home provides. Formal supervision and appraisals ensure that staff are monitored and supported by the management. EVIDENCE: At the time of the inspection there were two staff on duty and the manager. The staff had responsibility for 9 service users from the home and also another 3 people form the home run by the same providers. This ratio meant that basic chores were prioritised and it was hoped that more activities would be supported in the afternoon and evening. A requirement has been made in the report relating to the coordination of day care activities, and any review of these arrangements must take into account the staff ratios that are provided. A sample of staff files were examined and these contained the required information in relation to CRB checks, P0VA checks and personal details. A member of staff has been appointed to be head of home who is an NVQ assessor and it is intended that they will provide support to staff undertaking NVQ training. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 19 All staff are up to date with the required statutory training, with the certificates being kept in the personal files. Staff are receiving formal supervision from the manager, which is recorded and a formal record kept in the office. New staff have completed, or are working through their induction course, which is run in conjunction with a local college. All staff employed for longer than a year have had an appraisal conducted by the manager. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 & 42 A lack of understanding of the regulations by the manager could compromise the safety of the service users. A lack of leadership and direction compromises the home’s ability to move forward and meet national minimum standards. A lack of clarity over areas of responsibilities affects the ability of staff to take responsibility for implementing plans or improving the quality of care. Service users are protected by the regular testing of safety equipment and staff training. EVIDENCE: The manager has completed the Registered Managers Award and an Open University course in Health and Social Care. They have also completed a NEBS management training course at a local college. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 21 The home does not have any formal quality assurance systems in place. The registered providers are involved with the home on a daily basis. The manager said that they agreed an annual plan for the home with the providers but this was not recorded. The admission of the new service user referred to under standards 1 to 6 raises concerns about the understanding of the manager about the regulations they work under, and also their understanding of disabilities. The manager stated that the new service user had “difficulty learning things after their stroke”, which he considered qualified the person to be admitted to the home. The inspector was also concerned about the level of understanding regarding the practice and process and care planning. If the staff team are to have a responsibility for this area of work they need to be supported and guided by the manager. The manager also explained that certain responsibilities had been delegated. There was a head of home, a coordinator for the day service and also a member of staff who had responsibility for “overseeing” the other home run by the Providers. It was unclear how these delegated responsibilities translated into specific tasks and the personal files contained no details or job description relating to these roles. Clarity needs to be provided by the manager over the extent of these delegated tasks. This is particularly relevant as shortfalls were identified in all these areas. There was little evidence of leadership and direction being provided to the staff team by the manager. All the required safety checks had been completed and the staff files examined showed that people were up to date with the required statutory training. Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 2 16 X 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X x 2 2 X X X 3 x Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 13(6)&18(1) (c)(i) 18(1)(c)(i) 14 Requirement The manager and staff must undertake adult protection training and provide The home must access training in person centred care planning The home must not admit service users who are outside of their registration category The home must supply the Commission with updated copies of the Statement of Purpose and Service User Guide The home must supply the Commission with details of the planned renovations and repairs for the coming 12 months (previous timescale 30/11/05 not met) The home must produce a smoking policy for staff and service users The home must continue to improve to care plans by the inclusion of Timescale for action 30/06/06 2 3 YA6 YA2 30/06/06 30/03/06 4 YA1 4&5 30/04/06 5. YA24 23(2)(b) 30/04/06 6 7. YA16 YA6 12(1)(a) &13(4)(c) 15(2)(b) 31/05/06 30/11/05 Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 24 8 YA16 9 YA12 10 YA38 greater detail and the developing of an understanding of person centred planning 12(1)(a) & 16(g)(h) The home must review the present arrangements for service user access to the kitchen area and to food and drinks. Any restrictions that are put in place must be risk assessed and recorded in the individual files. 12(1)(a)(b) The home must provide better co-ordination and planning for the day-care activities undertaken by the service users. 18(1)(c)(i)&12(1)(b) The home must provide clarification over the delegated roles of “head of home” and “day-care coordinator”. These roles must have job descriptions and a clearly identified area of responsibility 30/04/06 31/05/06 31/05/06 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 YA17 Good Practice Recommendations The home should review whether sufficient choice is provided to service users on a vegetarian diet Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Apple Orchard DS0000016365.V285280.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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