Inspection on 31/07/06 for Appletree Care Home

This inspection was carried out on 31st July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Appletree Care Home 28/02/06

Appletree Care Home 01/12/05

Appletree Care Home 05/11/04

Appletree Care Home 19/07/04

Similar services:

Ann Charlton Lodge

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

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

CARE HOMES FOR OLDER PEOPLE Appletree Care Home Frederick Street Meadowfield Durham DH7 8RT Lead Inspector Mr Leonard Hird Unannounced Inspection 31st July 2006 09:30 X10015.doc Version 1.40 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 Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 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 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. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletree Care Home Address Frederick Street Meadowfield Durham DH7 8RT 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) 0191 3783152 0191 3789080 Maria Mallaband Care Homes Limited Shannette Isobell Render Care Home 48 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (38), Physical disability (15) of places Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical Disability: Up to 15 persons with a physical disability (over the age of 55 years) may be accommodated, commensurate with the home’s statement of purpose. Dementia: Up to 17 persons with dementia (over the age of 60 years) may be accommodated, commensurate with the home’s statement of purpose. 24th April 2006 2. Date of last inspection Brief Description of the Service: Appletree Residential Care Home is currently registered to provide care for up to a maximum of 48 older people in three different registration categories of Older Persons, Physical Disability and Dementia. There are limitations as described above regarding the maximum numbers of residents who can live at the home in each category. The home is owned and managed by Maria Mallaband Care Homes Limited. Appletree Residential Care Home is located off the A690 Durham to Crook road in the village of Meadowfield some 3 miles from the centre of Durham City and is on a regular bus route. It is a large modern two-storey building with the benefit of two passenger lifts to the first-floor and the Acorn suite. All bedrooms are single accommodation with the benefit of en suite facilities. There are a number of different communal lounges and dining areas throughout the home. The home has a well-kept enclosed garden space for the use of residents and visitors. The weekly fees to stay at Appletree Residential Care Home are currently £419 to £445. Car parking spaces are located to the front of the home for the use of relatives and visitors. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection of Appletree took place on the 31stJuly between 10 00 and 1430 hrs as well as the 17thAugust between 0930 and 1430 hrs. The inspection process considered all of the Key standard areas as identified by the Commission for Social Care Inspection within the Care Homes for Older People National Minimum Standards. These Key standards are: Choice of Home (NMS 3), Health and Personal Care (NMS 7, 8, 9 and 10), Daily Life and Social Activities (NMS 12, 13, 14 and 15) Complaints and Protection (NMS 16 and 18), Environment (NMS 19 and 26), Staffing (NMS 27, 28, 29, 30,) and Management and Administration (NMS 30, 31, 33, 35 and 38). The Commission for Social Care Inspection received some 12 written responses from residents in response to the Commission for Social Care Inspections survey ‘Have your say about Appletree’. Verbal comments were received on the days of inspection from residents, relatives, and visitors. Comments were also received from members of the care and ancilliary staff, the Registered Manager, as well as the companys area manager. What the service does well: Appletree was generally clean, tidy, well decorated and comfortably furnished in a pleasant and homely way. Residents in both of the units spoken with were positive in their comments about the home ‘the home was meeting my needs’, ‘all of the staff look after us well’ ‘they look after me when I’m not well’ Relatives spoken with were very positive in their comments about the care been offered to their family members, in particular one family commented that, ‘their family member had improved beyond recognition since coming to the home’. Residents, relatives and visiting professionals made positive comments about the helpfulness of the care staff. The health and safety of residents was being well managed and staff had received appropriate training to enable them to look after the residents. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 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 the following standard(s): NMS3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The Registered Manager at Appletree had ensured that prior to the admission of a resident to Appletree both the Local Authority’s Social Care and Health Team and the staff at the home had carried out assessments of need. EVIDENCE: Both the Local Authority and the home had carried out assessments of needs prior to admission. Where the Local Authority had undertaken an assessment of need a copy of the documentation had been maintained along with the homes on the residents file. Residents spoken with indicated that they thought the home was meeting their current needs. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 9 All of the written responses received from residents replying to the Commission for Social Care Inspection’s questionnaire ‘Have your say about Appletree Care Home’ indicated that residents had received enough information about the home before moving in. One resident commented that, they had received information from both social services and the home itself before moving in, another resident commented, that they had read an inspection report before coming in to the home, whilst another commented, that they had visited the home before moving in. A relative spoken with commented that, ‘they had received enough information about Appletree for their family member and themselves to make decisions about the home. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 10 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 the following standard(s): NMS 7 NMS 8 NMS NMS9 and NMS 10 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service Individual resident’s health, personal and social care needs were being set out in their care plan. The homes medications policies, procedures, guidance and training programme enabled care staff to dispense medication to residents safely. Residents were able to make decisions about how they could lead their lives and were treated with respect and dignity. EVIDENCE: Residents living at Appletree had individual plans of care in place and information was being maintained about the individual residents health and personal care needs on these plans. Care plans reviewed during the inspection-contained information about personal care, bathing, mobility and health requirements. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 11 Assessments of risk were included in the plans and took account of the individual residents views e.g. whether to self-medicate or not. No residents were self-medicating at the time of the inspection. Staff had reviewed individual residents care plans on a regular basis and this was being recorded appropriately. The Local Authority’s reviewing team on residents living at Appletree had undertaken annual reviews. Where any changes to a residents care plan had been required following a review the home had responded appropriately. Records were maintained by the home of the individual residents health needs as well as when GPs and other health professionals had visited their patients at the home. From the results of a multi disciplinary care team survey initiated by the home and from those who had responded to it, it was confirmed that residents were seen in the privacy of their own rooms, when necessary. Care staff had undergone training in first aid and the safe handling and administration of medication. Records of this training were being maintained on staffs training files. Written comments received from residents indicated that, ‘they always received the medical support they needed’. Residents written comments also indicated that, ‘they received the care and support they needed’. A relative commented verbally that, ‘the home always kept them informed as to the health of their relative’’. Another relative commented that, ‘care staff at the home kept them in touch by regular phone contact as they lived outside of County Durham.’ It was observed during the inspection that members of staff were working in a respectful, positive and friendly manner with the residents. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 12 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 the following standard(s): NMS12 NMS13 NMS14 and NMS15 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service The routines of daily living and activities available at Appletree were varied and flexible and generally meeting the needs of the residents. The independence and personal choices of residents at Appletree were being encouraged by the home. The food in the home is of good quality and meets the dietary needs of residents. EVIDENCE: Records were being maintained of activities undertaken by residents in the home. Residents were been encouraged to socialise with friends and family. The homes Registered Manager confirmed in the pre-inspection questionnaire sent to the Commission for Social Care Inspection that regular visits were Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 13 undertaken by members of the clergy and that a Holy Communion service took place on a weekly basis. The home had employed an activities organiser for 24 hours per week and this member of staff had started to develop an activities programs for the residents. The home had recently introduced a newsletter for both residents and relatives to read. A resident commented verbally that ‘they had enjoyed the recent summer fayre at the home’. Written comments received from residents confirmed that there were activities taking place in the home. One resident indicated in these written comments that they had taken part in activities such as cake decoration, beauty sessions, and trips to the shops and pub. Relatives visiting the home spoke well of the homes visiting policy and a relative commented that, “ I have found the staff at Appletree to be courteous at all times and very helpful’. Visiting professionals had commented in the homes quality assurance survey that, staff had a pleasant attitude. Though menus were being displayed in the home they were difficult to read and understand. The cook confirmed that the home was catering for residents with special diet requirements and records were being maintained of this. It was also confirmed by the cook, that there were no outstanding requirements from the last environmental health officer’s inspection. Verbal comments received from residents about the food ranged from ‘the meals were good ’ ‘ I always get what I want ’ to ‘I dont like some of the food’. Records were being maintained of the choice of food being made by residents as well as records of the homes menus. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 14 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 the following standard(s): NMS16 and NMS18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service The corporate complaints and adult protection policies and procedures currently being used in Appletree provide for a safe environment for residents to live in. EVIDENCE: Appletree had appropriate corporate policies and procedures provided by Maria Mallaband Care Homes Limited in place for the Protection of Vulnerable Adults. From discussions with staff it was confirmed that they were aware of the importance of acting quickly in cases of suspected abuse and that they would follow the homes policy and procedures. Staff had received training on dealing with the Protection of Vulnerable Adults in the care home environment, and records were being maintained of this training. Staff confirmed in discussions that they had received training in how to deal with the Protection of the Vulnerable Adult. Where the Protection of Vulnerable Adults procedures had been used records were being kept of the outcomes of these investigations. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 15 Appletree had appropriate corporate policies and procedures in place for residents and their families on how and who to complain to if they needed to. Information on how to complain was being displayed on the notice board in the home as well as being contained in the residents guide to the home. A written comment received from a resident in response to the Commission for Social Care Inspection’s survey ‘Have Your Say About Appletree’ stated that, ‘if I was not happy about things I would speak to the manager’. Another indicated that, ‘they knew how to make a complaint and that they would go to the office if necessary. Relatives spoken with during the inspection confirmed that they were aware of how to complain on behalf of their relative if they needed to. Records were being maintained of complaints received by the home and how they had been dealt with. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 16 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 the following standard(s): NMS19 and NMS 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service Appletree was generally clean, pleasant and hygienic and providing a safe and comfortable environment for its residents to live in. EVIDENCE: Appletree generally had a well-maintained environment and ensured that aids and equipment required by residents to meet their care needs had been made available. It is a pleasant, safe place to live with all of the residents’ rooms having ensuite facilities that meet the national minimum standards. The physical layout and design of the home currently meets the needs of the residents. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 17 Appletree meets the requirements of the Disability Discrimination Act. Maintenance work undertaken on the homes equipment and facilities by the home’s handyman as well as by outside contractors had been recorded appropriately. Appletree was generally clean, tidy and free from unpleasant odours. There were a number of carpets, corridor areas and communal areas that required refurbishing or redecorating, particularly in the Acorn Suite. The registered manager, as well as the company’s area manager confirmed that all of these areas would be refurbished and redecorated by the end of September 2006. There were appropriate systems in place for infection control. The homes infection control policies and procedures were written in accordance with relevant legislation and professional guidance. Written comments received from residents indicated that ‘the home was fresh and clean’. A visiting relative stated that, their relatives room was always tidy and clean. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS27 NMS28 NMS29 and NMS30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service Appletree through Maria Mallaband Care Homes Limited’s corporate recruitment and employment procedures had not ensured that only suitably qualified care staff were being employed at the home. Staffing levels at the home were sufficient to meet the current assessed needs of residents. Appletree through the corporate training programs provided by Maria Mallaband Care Homes Ltd was ensuring that staff had been trained to meet the needs of the residents. EVIDENCE: Appletree used the corporate recruitment procedure provided by Maria Mallaband Care Homes Limited and this document clearly defined the process to be followed when recruiting staff. This process had not been followed when the overseas staff who were found to be working at Appletree had been recruited. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 19 The company had not undertaken an enhanced criminal bureau records check or a POVA 1st check on these overseas staff prior to them commencing employment at the home. It is acknowledged that Maria Mallaband Care Homes Limited had through their agents undertaken previous employment checks on their overseas staff as well as ensuring there had been a police check completed in their native country prior to an offer of employment. However, once this failure had been identified in the recruitment process the company immediately ensured that all of the overseas staff underwent an enhanced criminal bureau records check. It was confirmed by the companys area manager, that those overseas staff currently employed at the home would be supervised at all times in the working environment. All other staff whom had been recruited to work at Appletree had undergone the appropriate checks prior to their employment. The Registered Manager confirmed that it was the companys policy that all visiting professionals had appropriate checks in place to ensure the protection of the residents. From a review of the staff rota provided it was noted that care staff were being deployed in sufficient numbers as to ensure that the current needs of residents were being met. Residents on the whole indicated in their written responses that staff were either always or usually available when they needed them. One resident commented that the girls were very good and very caring another commented, ‘the girls were very busy’. Staff spoken with during inspection confirmed that in their opinion staffing levels had improved since April 2006. Staff had received appropriate induction training and there were ongoing training programmes operating in the home e.g. working with Dementia, first aid, infection control and moving and handling. There was a commitment to training for care staff at the home and currently 12 of the 29 care staff had qualified at NVQ level 2 in care or above. The home currently had a further 13 care assistants undertaking the NVQ level 2 in care course, and the homes Registered Manager indicated that it was Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 20 hoped all of these members of the care staff would have successfully completed the course by the end of November 2006. Records were being maintained of all training being given in the home and individual records of training were being kept on the staffs files. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 21 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31 NMS 33 NMS 35 and NMS 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service Appletree had an established management structure that ensured the home was promoting the health, welfare and safety of residents and staff. EVIDENCE: The Registered Manager had the appropriate qualifications and experience to run the home. Formal supervision sessions were being given to all members of the care staff, ancillary staff and management team. Records of staff supervision sessions were being maintained securely and staff confirmed that they had received copies of their supervisions. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 22 Full staff meetings were regularly been held as well as separate meetings for members of the senior and assistant care staff teams. Minutes were being kept of these staff meetings and where issues had been raised, particularly in the area of communications between the night and day staff home the senior management team had sought to address the problems. From discussions with staff it was confirmed that they were aware of the management structure within the home and outside of the home. Staff spoken with indicated that they felt morale and staffing levels had improved over the past few months’. Residents and relatives meetings were being held and minutes were being kept of these meetings. The responses to points raised by residents and relatives during these meetings from the manager were also being kept. Appletree had initiated a quality assurance survey of visiting professionals to the home as well as a twice yearly quality assurance survey of residents and their relatives. Appletree is the subject of a regular monthly audit visit by the company’s area manager. Appletree was the subject of regular financial audits undertaken by the company. Checks were regularly undertaken to ensure the building is safe, included in these checks are; checks of portable electrical appliances, water temperatures and assisted bathing equipment. Regular fire training, fire alarm tests and fire drills had been undertaken at the home and records were being maintained accordingly. Records were also been were being maintained of when equipment had been serviced and who had undertaken and completed the work e.g. the handyman or external companies. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 Schedule 2. Requirement The Registered Manager must ensure that all staff prior to being employed at the home have had the appropriate, employment and criminal records bureau checks carried out on them thereby ensuring they are suitably qualified to work with the residents. Timescale for action 30/09/06 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. 2 Refer to Standard OP4 OP15 Good Practice Recommendations It is recommended that when annual reviews have been undertaken and completed the home confirms in writing that it still can meet the needs of the resident. It is recommended that the home develop a more user friendly menu that is suitable for all of the different residents living at the home. Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 Appletree Care Home DS0000061010.V303234.R01.S.doc Version 5.2 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. 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!