Inspection on 09/10/07 for Ardgowan House

This inspection was carried out on 9th October 2007.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ardgowan House 15/09/08

Ardgowan House 12/01/07

Ardgowan House 03/07/06

Ardgowan House 16/01/06

Ardgowan House 22/07/05

Ardgowan House 28/02/05

Ardgowan House 02/09/04

Ardgowan House 27/02/04

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

CARE HOME ADULTS 18-65 Ardgowan House 4 Middle Street Newsham Blyth Northumberland NE24 4AB Lead Inspector Karena M. Reed Key Unannounced Inspection 9th October 2007 11:15 Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 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 Ardgowan House DS0000000521.V352422.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 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. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ardgowan House Address 4 Middle Street Newsham Blyth Northumberland NE24 4AB 01670-367072 01670 367072 deborah.jobson1@btinternet.com 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) Mrs A Jobson Mrs A Jobson Care Home 13 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (7), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (5) Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2007 Brief Description of the Service: Ardgowan House is a large, detached house with a small front and very large back garden. The home is registered to provide personal care to twelve adults with mental health problems and one adult with a learning disability. Five of the places are for people over sixty-five years of age. Nursing care is not provided. The home is situated in a residential area on the outskirts of Blyth. It is close to local shops and pubs. The town centre and coast are also close by. Each person has their own bedroom and they share communal areas that include a dining room/combined lounge, separate lounge, conservatory and a quiet room. A passenger lift is not available but some bedrooms are situated on the ground floor of the property. There are two bathrooms, two shower rooms and sufficient lavatories for the needs of residents. A bathroom and shower room are fitted with equipment to assist physically dependent people. A Statement of Purpose and service user guide are available for prospective residents and their relatives to give them information about the services provided by the home and the relevant charges. Fees payable for living at the home at the time of inspection in October 2007 are £383. Additional charges are payable for hair dressing, personal toiletries, private chiropody, holidays and outings. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • • • • • Information we have received since the last inspection on January 12th 2007. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The provider’s view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The visit • An unannounced visit was made on October 9th 2007 During the visit we: • • • • • • Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at other records that must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last inspection. We told the provider what we found. 13 surveys were sent to residents, 0 were returned. 10 surveys were sent to care professionals and GPs, 0 were returned. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans must be updated at least 2-3 monthly to ensure the correct amount of care and support is provided to residents. Staff must receive accreditted training in the Safe Handling of Medication for the safety of residents. Staff must receive training about the ageing process to help understand the changing needs of residents. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 7 Food must not be stored on the floor in the kitchen in the interests of hygiene. Vetting procedures must be more robust to protect residents. The management team must promote a more open and inclusive atmosphere for staff and include them in the running of the home. The daily register must be kept up to date. The position of the nurse call system must be reviewed to ensure the safety of residents. Care plans must be used as working documents and kept accessibly for all staff. The use of skimmed milk should be reviewed for the nutritional value to residents. Residents should continue to be consulted about the running of the home and their lives. 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. The summary of this inspection report can be made available in other formats on request. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 8 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 Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 People who use the service experience good quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. Information is available to give to prospective residents before they move in to help them decide if they want to live at the home. The home collects enough information about the needs of prospective residents before they move in to help ensure staff are aware of the amount of care and support needs of the resident as they settle in. Staff receive training to give them the knowledge and insight to help understand the needs of residents and to provide the necessary levels of care and support to individual residents. Residents and their relatives are very welcome to visit the home to assess its suitability. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Home’s Statement of Purpose and service user guide were examined and they contained the necessary information as required by the Care Homes Regulations 2001 they were interesting and easy to read. Records for four of the residents showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. The resident and relevant people who knew them were involved in the initial assessment. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender, cultural, religious/spirituality, educational and social histories, preferred daily routine and preferences. It also looks at mood, speech, behaviour, mental health, risks, sexuality and living skills. This information and the care manager’s assessment of the resident’s care needs were used to ensure all the needs of the resident could be met by staff. The records contained a range of information. Staff receive training so that they know how to meet the needs of the residents. Staff have received the necessary statutory training: Fire Training, Food Hygiene, First Aid, Protection of Vulnerable Adults and National Vocational Qualifications. Staff have also received training about; Podiatry, low vision, falls awareness, risk assessment, mental health, diabetes and epilepsy awareness. Residents have the opportunity to visit the home as often as they need in order to decide if they want to live there. A resident may come for meals, have overnight stays and be introduced to other residents at the home at a pace suitable to the individual. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 People who use the service experience adequate quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. There are arrangements in place to ensure that residents’ health and social care needs are met. There is a system of reviewing the changing care needs of residents but it is out of date. Residents are supported by staff but care plans do not show the amount of care and support that staff are providing to residents. Residents are encouraged to be involved communicate and make their views known. in decision-making and to Staff support residents to take risks as part of independent living. Information about residents is handled appropriately, and their confidences are kept. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 12 EVIDENCE: Information was available about residents but the files needed organizing to make sure the information was up to date and relevant to the current care and support needs of all the residents. There are detailed assessments in the residents’ care plans but the care plans were not available to staff to use daily as tools to work with residents. Care and support needs are documented but they do not give clear instructions to staff on how to support people that require support with tasks. Care plans are not being updated three monthly or earlier if required if a resident’s care and support needs change. Residents care records showed that they have access to external health care services. GPs and Community Psychiatric Nurses were regularly consulted for advice and treatment. Records show residents are assisted to access chiropody, dental and optical services at least annually or as often as required. Residents are asked individually and consulted about decisions involving themselves and the running of the home. Meetings are held regularly with service users about the running of the home. Service users spoken to stated that they were involved and consulted about decisions involving themselves. The home supports residents to remain independent and take risks in order to live a more fulfilled lifestyle and up to date risk assessments were present in residents care records. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience good quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. Residents are encouraged to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents enjoy appropriate leisure activities. Residents are encouraged to have appropriate personal, family and sexual relationships. Residents’ rights and responsibilities are recognised in their daily lives. Residents are offered a healthy diet. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 14 EVIDENCE: The residents spoken to confirmed that residents are involved in the running of the home and involved in making decisions about their life. Residents’ records and residents meeting minutes provided evidence that all residents are consulted and asked their opinion and encouraged to make decisions. Residents all pursue their own individual hobbies and interests. Some residents attend drop in centres and day centres during the week, some residents are retired and enjoy a more leisurely lifestyle . One resident visits Newcastle to go to a specialist music shop to purchase his classical Cds. Residents also enjoy meals out at a pub in the town centre. They are looking forward to the parties and festivities arranged by the home at Christmas. Within the home residents usually enjoy quizzes, keep fit, beetle drives, karaoke, video nights and playing bingo. Residents care plans and case records detail any family involvement. Conversation with residents also provided evidence that residents are encouraged to maintain contact with family and friends, staff providing the necessary levels of support for them to do so. Residents are asked individually daily what they wish to eat. A light snack is available at lunch times and a cooked meal is served in the evening. On the day of inspection lunch was fish fingers and beans or sandwiches. The evening meal was pork chops, potatoes and vegetables or a filled jacket potato and Angel Delight or fruit and ice cream. Long Life Skimmed milk is used by the home and this should be reviewed as the nutritional content may not benefit all residents. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19.20,21 People who use the service experience adequate quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. Residents do receive some support in the way they prefer and require. There are arrangements in place to ensure that service users’ health care needs are met. Some systems are in place for residents to retain and administer their own medication where appropriate. The home is becoming better equipped for the ageing and incapacity of residents. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 16 EVIDENCE: Four care plans and case records were inspected. The daily records detailed the care and support required for different needs. They reflected the changing needs of service users due to becoming older. The care plans did not accurately record the needs and the care and support provided by staff. The home also respects the wishes of the individual when dealing with their ageing. Records showed when residents had seen health professionals e.g. doctors, community nurses, psychiatrists and psychologists. Records also showed when residents had seen opticians and dentists. Training records showed staff members receive training about medication before they are able to administer it to residents however it should be from an accreditted training provider and not just the home’s own medication training. A new medication cupboard has been obtained for the storage of the medication. No resident administers their own medication currently. A system could be put into place to oversee the medication of residents if they should retain and administer their own medication. The environment is becoming better equipped for the ageing of residents and some areas have been adapted. Staff have received some training to give them more insight into the ageing process, however a more specialist course about the needs of residents as they become incapacitated due to illness and older age would benefit the staff team. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience adequate quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. The complaints procedure is ayailable so residents can bring any matters of concern to staff or people outside of the home. Residents are quite well protected from abuse. EVIDENCE: There is a complaints procedure if complainants are not happy with the homes investigation and response. The home keeps a record of complaints. One complaint has been received since the last inspection regarding the management of the home. It is in the process of being addressed. Staff have received training about Protection of Vulnerable Adults and Prevention of Abuse. Staff files did not contain evidence of the most recent previous employer supplying a reference to comment about the suitability of an applicant for a position in the home. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience good quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. Residents live in a homely, comfortable and safe environment. There is a quite a good standard of hygiene around the home. EVIDENCE: There is a programme of redecoration and improvement around the home. Since the last inspection some bedroom carpets have been changed. A new medication cupboard has been purchased. Some bedrooms have been decorated. The sitting room is to be decorated. The home is clean, well decorated and well maintained. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 19 There is a good standard of hygiene around the home apart from there was not enough storage space in the kitchen for foods and some items were stored out of cupboards on the floor. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 People who use the service experience adequate quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. The numbers and skill mix of staff meets residents’ needs. Systems are in place to ensure residents are in safe hands. The home’s recruitment and vetting procedures are not fully robust in order to protect residents. Staff are trained to meet most of the care needs of residents. . EVIDENCE: Examination of staff rotas and discussion with the person in charge and members of the staff team showed that the numbers of staff are as follows: 8.00am- 4.00pm Ardgowan House 2 support staff DS0000000521.V352422.R01.S.doc Version 5.2 Page 21 4.00pm-10.00pm 2 support staff 10.00 pm - 8.00 am to following day 1 sleep in staff member and 1 waking staff member. These numbers include the manager. Staff members carry out cooking and cleaning with the help of residents where possible. At least five residents are now over the age of sixty five, so staffing levels should continue to be reviewed to ensure the needs of residents can be met as individually as possible. The necessary checks are being carried out prior to the workers being appointed apart from the references for some newly appointed staff were not from the most recent employer. Staff files did not contain staff photographs. CRB checks are carried out before a person is appointed to work with residents. There are thirteen members on the staff including a manager and deputy manager. Eleven staff members have achieved NVQS at various levels 2 and 3. Residents have increased care and support needs as they become older, staff have not had specialist training about the ageing process. Staff have received Fire Training, Moving & Assisting, Food Hygiene, First Aid, Protection of Vulnerable Adults and National Vocational Qualifications. Staff have also received training about; infection control, podiatry training, risk assessment, diabetes awareness, person centred planning, epilepsy awareness. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 People who use the service experience adequate quality in this outcome area. We have made this judgement using a range of evidence including a visit to this service. Residents’ benefit from quite a well run home. Residents and staff do not all benefit from the ethos, leadership and management approach of the home. There is an out of date system to review the quality of care provided by the home. There is quite a good standard of record keeping. The health, safety and welfare of residents are not always promoted and protected. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 23 EVIDENCE: Discussion and observation showed that the management are starting to put the needs of the residents first and there is a less institutionalised environment. The manager must promote an atmosphere of confidence amongst the staff team to ensure that they may feel listened to and able to bring any matters of concern to the manager, proprietor of the home. Some residents living at the home have lived there for several years and the manager has respected the rights of individuals to remain at the home as their needs have changed. The environment has been adapted and staff have been equipped with better training opportunities to meet these different needs of residents. This is a continual process due to these different, individual needs. Documents detailing fire safety, risk assessments in the environment, water temperatures and statutory records were all up to date and well recorded apart from the daily register did not record the absence from the home of a resident who was away overnight. The newly installed nurse call system is not placed in an accessible position for residents or staff. It is not placed by the bed but rather by the door so a resident would have to make their way to the door to call for attention. In the bathroom the pull cord is not by the bath but again by the door so it would be difficult to call for attention easily. The use of the monitor must be reviewed in the resident’s bedroom so privacy can be respected and promoted. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 3 4 3 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 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 2 3 2 3 x 2 2 x Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 14(2)(a) 15 (2)(b) Requirement Timescale for action 01/12/07 2. YA18 15(2)(b) 3. 4. YA20 YA21 13(2) 18c (i) Care staff should have access to the care plans which must be up to date and accurately record the care and support needs of residents. Care plans must be reviewed at 01/12/07 least 3 monthly and be used as working tools by staff to ensure all the care and support needs of residents are met. All staff must receive accreditted 01/02/08 training about the safe handling of medication. Training about the ageing 01/02/08 process must be provided to staff. THIS REQUIREMENT REMAINS OUSTANDING. 5. 6. YA30 YA34 16(2)(g) 13(6) 7. YA38 12(5)(a) Foodstuffs must not be stored on the floor. References must be obtained from the most recent previous employer when recruiting new staff. The manager must try to create a more inclusive and open environment for the staff team so any issues about the running DS0000000521.V352422.R01.S.doc 15/11/07 15/11/07 15/11/07 Ardgowan House Version 5.2 Page 26 8. YA41 3(d)(e) of the home can be brought to the manager’s attention. The daily register must be completed accurately. The position of the nurse call system pull cords must be repositioned in the interests of safety. 15/11/07 9 YA42 13(4)© 01/03/08 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. 3. 4 YA17 YA33 Refer to Standard YA6 YA8 Good Practice Recommendations Residents’ files should be weeded to make sure relevant up to date information is available. Residents should continue to be consulted about the running of the home.. The use of skimmed milk should be reviewed. Staffing levels should continue to be reviewed. Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Ardgowan House DS0000000521.V352422.R01.S.doc Version 5.2 Page 28 - 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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