Inspection on 07/06/06 for Apple Orchard

This inspection was carried out on 7th June 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 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 28/02/06

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 Key Unannounced Inspection 7 , 9 & 13th June 2006 10:00 th th Apple Orchard DS0000016365.V291575.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.V291575.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.V291575.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 To be appointed 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.V291575.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. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home was not available at the time of the inspection. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This unannounced inspection was started on June 7th 2006 and continued on 9th and 13th June. The inspector met with the Provider, Registered Manager, Deputy Manager, care staff and all of the service users. Records relating to medication, staff recruitment and training, health and safety and care planning were examined. The environment was also inspected. In the three months since the last inspection a new manager has been appointed who is yet to be registered and this inspection focused upon the progress made towards the requirements of the last inspection as well as looking at the majority of the core standards. Whilst there is still work to do progress has been made in the relatively short time since the last inspection and the home appear committed to improving the quality of care they provide. What the service does well: What has improved since the last inspection? The home has begun developing a person centred approach to care planning and providing training for staff in this area. The environment of the home has been improved by re-decoration, some new carpets and the provision of en-suite facilities for two of the service users. Service users are being supported and encouraged to have more involvement in domestic tasks such as food preparation and laundry. The administration within the home has been improved. Restrictions on the use of the kitchen have stopped. Day care activities and leisure activities are being monitored and greater efforts to identify individual interests and needs are being made. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 6 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. Apple Orchard DS0000016365.V291575.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.V291575.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): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Provision of an updated written admissions policy will help ensure that service users are admitted in line with regulations and that their needs can be met by the home. EVIDENCE: Following the previous inspection a requirement was made in relation to the home only admitting service users within their registration category. The person this referred to has moved on from the home and there have been no admissions since then. The new manager, who has only recently been appointed, was unsure about the admissions process for the home and whether there was an up to date written policy. The admissions policy should ensure that service users are only admitted to the home whose needs can be met, and that the correct procedure is followed in terms of assessment and preliminary visits. A requirement has therefore been made that the home provides a written admissions policy in line with the current regulations. A copy of this must be forwarded to the Commission. The home has supplied the Commission with the updated Statement of Purpose and Service Users Guide that was a requirement following the previous inspection. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 9 Apple Orchard DS0000016365.V291575.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,&9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The provision of person centred plans for all the service users should improve the quality of care and support provided. Service users are encouraged and supported to make decisions about their daily lives and activities. Improved risk assessments help to promote the safety of service users and increase opportunities for activities inside and away from the home. EVIDENCE: Work has begun on producing person centred care plans after the manager and deputy completed some training in this area. The manager explained how they intended to develop plans for all the service users and also develop the staff teams awareness and involvement in the planning and reviewing process. Service users will be fully involved in the developing of their care plans. There is considerable work to do in this area but good progress has been made since the previous inspection. As these plans have not yet been developed for Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 11 all service users the requirement made at the last inspection in relation to care planning has therefore been repeated. There was evidence in the files of good recording being completed on a regular basis. Discussions with service users and staff demonstrated that people are encouraged to make discussions and choices about daily events. All risk assessments seen were up to date and had been periodically reviewed. A number of these had been improved and efforts are being made by the manager to improve the effectiveness of risk assessing within the home. Apple Orchard DS0000016365.V291575.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, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A more structured and planned approach to day care activities is providing the service users with more organised day care arrangements. Service users are supported to access and be part of the local community. Service users receive the required support to maintain their family relationships. Service users are being supported to use the kitchen facilities and maintain and develop their living skills. EVIDENCE: The home has made some improvements in the provision of day care activities. The “day centre” has been reorganised making activities easier to complete and all organised day care is recorded in the “activities file”. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 13 People are attending college, evening clubs, gardening, cooking, shopping, games evenings, trips out and DIY. Service users expressed their satisfaction with the quality and quantity of activities supported, though one person commented that they could get bored at times. There still appears to some extent a limited choice of day care options, with some service users having little variety in their routines. However, the improved recording and monitoring of activities should ensure that further developments are made in this area. The development of person centred plans may also identify more individual needs that can be met. Service users access the local community either independently or with staff support. Records are kept of the regular contact that is kept with families. The kitchen is now fully accessible to the service users and people were observed being involved in the preparation of food and drinks. The menus showed that healthy eating is promoted but choice is provided. Service users expressed their satisfaction with the quality of food and confirmed that they had the opportunity for more involvement in the kitchen if they chose to. The home has now produced a smoking policy for staff and service users and efforts have been made to raise the awareness of health risks of smoking Apple Orchard DS0000016365.V291575.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): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. Service users are supported to access the healthcare professional they require to ensure that physical and emotional health needs are met. Service users are protected by the homes medication and administration procedures, though some minor errors were identified. EVIDENCE: Monitoring sheets in the personal files record health appointments and a recommendation is made that individual sheets are used for different health professionals. These record that regular checks are maintained and that peoples health needs are monitored by the staff team. The individual files contain the details of the personal care and support that is required. Service users spoken expressed satisfaction with the personal care they receive. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 15 Staff have to complete medication training before being responsible for administration and a list of staff is kept in the front of the medication records. There were some gaps in the signing of medication records for the morning of the inspection and the reasons for this were explained. Some temporary recording sheets were being used but they did not contain sufficient information about the medication being administered. All medication was securely stored and appropriate stock control systems were in place. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users are able to approach care staff and the Providers to raise concerns, and feel confident that they will be listened to. Training in Adult Protection for the management and staff team will provide further protection for the service users. EVIDENCE: The requirement that the manager completes Adult Protection training has been made and the process for accessing this was explained to the manager. This training should be cascaded down through the staff team. The inspector was informed during the course of the inspection that this training had been arranged and both the manager and deputy would be attending the course. Staff spoken to were able to demonstrate an awareness of the issues but greater understanding is required around the procedures and processes that should be followed when an issue is identified. One incident involving a disagreement between two service users was not recorded in sufficient detail, nor was the Commission informed, as it should have been. The inspector has been previously informed that physical intervention is not required or practiced in the home, and accepts that this incident was not a regular occurrence. However when an aggressive incident occurs, resulting in an injury to a service user, this should be recorded in detail and the Commission should be notified. A requirement has been made in relation to this. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 17 Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 18 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Continuing improvements to the environment are making the home more comfortable and homely for the service users. The staff work as a team to maintain a clean and hygienic home. EVIDENCE: The home have made improvements to the environment in the past few months which has greatly improved the appearance of the internal environment. A new carpet has been fitted throughout the large hallway and stairs, two rooms now have en-suite facilities and various parts have been decorated. The living room was being prepared for painting and the provider also explained the plans for the improvements to the kitchen, which hopefully will be completed whilst the service users are away on holiday. Service users were satisfied with their accommodation and individual rooms were personalised and homely. The “day-centre” building has also been reorganised and tidied up making it more homely and welcoming for those undertaking activities or hobbies. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 19 One service user has been provided with a garden shed in which to practice their hobby of DIY. The home was clean and hygienic throughout and staff were clear about their responsibilities in this area. Efforts are being made to further involve service users in household tasks. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 20 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): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Positive relations between staff and service users help to ensure that people’s needs are met. Service users are protected by the home’s recruitment policy that complies with the current regulations, though one minor shortfall was identified. Improvements to the induction procedure for new staff should ensure that service user needs are better understood and met by new staff. Steps are being taken by the home to improve the quality and monitoring of staff training. EVIDENCE: The new manager is qualified NVQ assessor and has started two staff on NVQ 2. They will have an external assessor, but will be supported through by the manager who will help to undertake observations of practice. Other staff will Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 21 be started in a few months. Two staff already have an NVQ, or equivalent qualification. The manager has been developing a training matrix to establish when the required statutory training requires updating. The home should ensure that people are up to date with fire safety, food handling and first aid training, and a requirement has been made in relation to this. Staff spoken to were positive about the recent changes and felt well supported by the team and the management. New staff complete an induction package that is supplied through Learn Direct. This package provides a good value base but the home needs to develop its own induction process. This should provide specific guidance on practices within the home, the individual support and care services users require, and be competency based. All new staff should also be allocated a mentor, which is a requirement of the regulations. Staff were observed communicating and interacting with service users in an appropriate and positive manner. All service users spoken to were positive about the support they receive from the staff team. One person commented, “staff are friendly and helpful” and another that they, “enjoyed talking to staff and the owners” who were “really nice”. Staff have been receiving some supervision but this has not been particularly structured or geared towards professional development. The new manager explained that they had little experience of this type of supervision and it is required that some training is completed in this. Supervision needs to be installed into the home’s routine both for monitoring and supporting staff and also for ensuring that the care planning process is being developed and understood by the staff team. The inspector was informed that the manager and deputy would be undertaking a “Supervisory Course” shortly. The home has had regular staff meetings over the past several months. The staff records were examined and were in order apart from one staff member for whom there had been trouble obtaining references. This situation was discussed with the manager, who will take steps to resolve the matter. A requirement is made that the Commission is provided with confirmation of this. A record was also found on one file of disciplinary action that was taken against one staff member. Whilst this appeared to be good practice the home had failed to notify the Commission of this, as it is required to under the regulations. The requirements under Regulation 37 were discussed with the manager. A requirement was made in previous report that clarification be provided over the roles of Head of Home, Manager and Day-Care Co-ordinator. All roles should have clear job descriptions, but none appear to be available for these positions. This requirement is therefore repeated. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 22 Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 23 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): 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Improvements in the administration of the home and the co-ordinating of the staff and activities of the service users have led to more effective management in the home. Improved leadership and direction from the management team have improved the effectiveness of the staff team. Improvements in the home could be consolidated by the provision of formal support and supervision for the new manager and the introduction of more formal quality assurance sytems. EVIDENCE: The home has very recently appointed a new manager who is waiting to go through the registration process. They have begun identifying the areas they wish to prioritise for improvement and have already undertaken some training Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 24 in person centred planning, which is an important area for the home to improve in. They have made a positive and enthusiastic start to their role but with such a variety of issues to address and develop there would be a benefit in the manager being supported by the Providers in developing a structured plan for the coming months. The manager stated they were well supported by the Providers but in view of the work required and the relative inexperience of the new manager it is important they receive regular formal supervision and support over the coming months. All safety checks have been completed and recorded. The home have responded positively to the requirements made in the previous report and made progress within the timescales agreed. The manager has plans to develop the quality assurances process within the home by the use of questionnaires. As part of this inspection the inspector left a number of questionnaires for service users, staff and outside professionals. The feedback from these will help inform the next inspection of the home. The manager has an NVQ 4 in Care and will be enrolling on the NVQ Registered Managers course within the next few months. Staff interviewed were positive about the support and direction they have been receiving. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 25 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 X 2 1 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 x Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 26 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. Standard YA2 Regulation 23(2)(b) Requirement Timescale for action 31/08/06 2. YA6 15(2)(b) 3. YA23 13(4&6) 4. YA23 13(6)&18(1)(c)(i) The home must produce, and provide a copy to the Commission, of their current admissions procedure The home must continue 31/08/06 to improve to care plans by the inclusion of greater detail and the developing of an understanding of person centred planning (Requirement carried forward from last inspection) The home must ensure 31/08/06 that any incidents involving service users are correctly recoded and where appropriate the Commission informed. The manager and staff 31/08/06 must undertake adult protection training and provide (Requirement carried forward from last inspection) The home must ensure that all medications are 31/08/06 5. YA20 13(2) Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 27 6 YA20 7. YA42 8. YA35 9. YA35 10. YA36 11. YA34 12. YA37 13. YA39 10 YA38 correctly signed for when administered 13(2) The home must ensure that medication administration sheets contain the full detail about the medication being administered. 18(c)(1) The home must ensure that all staff are up to date with the required statutory training in fire safety, first aid and food handling. 18(c )(iii) The home must provide an induction package that includes competencies relating to the practices and care within the home. 18(c )(iii) The home must ensure that all new staff are provided with a mentor from within the staff team for their induction period 18(2) The home must ensure that all staff receive regular formal supervision that is recorded 19(1) The home must supply confirmation of the details regarding staff references detailed in the text of the report. 37 The new manager must ensure they are aware of the range of notifications covered under Reg 37 24 The home must ensure that there are formal quality assurance systems in place. 18(1)(c)(i)&12(1)(b) The home must provide clarification over the delegated roles of “head of home” and “manager”. DS0000016365.V291575.R01.S.doc 31/08/06 31/08/06 30/09/06 31/08/06 31/08/06 31/08/06 31/08/06 31/12/06 30/09/06 Apple Orchard Version 5.1 Page 28 These roles must have job descriptions and a clearly identified area of responsibility. (Requirement carried forward from last inspection) 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 YA19 YA37 Good Practice Recommendations The home should consider recording health appointments on separate sheets for each health professional The manager and Providers should develop a structured improvement plan for the home and the manager be provided with regular and supervision and support. Apple Orchard DS0000016365.V291575.R01.S.doc Version 5.1 Page 29 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.V291575.R01.S.doc Version 5.1 Page 30 - 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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