Inspection on 16/11/05 for Ashclyst

This inspection was carried out on 16th November 2005.

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 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

Ashclyst 15/12/08

Ashclyst 23/06/08

Ashclyst 25/06/07

Ashclyst 03/05/06

Ashclyst 04/05/05

Ashclyst 25/10/04

Ashclyst 22/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ashclyst 23 Park Lane Winterbourne South Glos BS36 1AT Lead Inspector Wilfried Maxfield Unannounced Inspection 16th November 2005 09:30 Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashclyst Address 23 Park Lane Winterbourne South Glos BS36 1AT 01454 250946 0117 970 9301 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) Aspects and Milestones Trust Mr Ian John Knowles Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 4 residents aged 19 - 64 years Date of last inspection 4th May 2005 Brief Description of the Service: Ashclyst is based in a modern 4 bedroom detached bungalow. Accommodation is on 2 floors. Bedrooms are en suite. Communal areas consist of a lounge and dining area/kitchen. Bathroom and toilet facilities are situated on both floors. The home is located in a somewhat remote, almost rural position on the outskirts of Winterbourne. Residents rely on the local bus service to be able to reach local amenities. The homes own minibus as well as taxis are used to get to local, as well as destinations further a field. Ashclyst is registered to provide accommodation, personal care and support for up to four people with learning disabilities. It may accommodate up to 4 residents aged 19 - 64. This range is reflected in the ages of residents currently supported at the home (30 - 40). Their needs include communication, behavioural and mental health requirements. Ashclyst is operated by the Aspects and Milestones Trust. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The purpose of the visit was to monitor the progress to the requirements from the last inspection in May 2005 and review the standard of the care provided to the residents at Ashclyst. The Registered Manager was not present during this visit. Instead the homes Deputy Manager supported the inspection process. Outside of the customary parameters of an unannounced inspection, a large proportion of time focused on the physical conditions of the premises including bedding, furnishings and fittings. Concerning this, an additional visit was necessary to inform the Registered Manager of a number of ‘Immediate Requirements’. A letter was issued to inform the Provider about a number of specific concerns. Details of these can be found in the relevant sections of this report. The inspection provided good opportunities to observe and have some, however limited, contact with residents. One member of staff was interviewed. The total number of hours for this inspection was 9 hours. What the service does well: What has improved since the last inspection? There has been little progress to the requirements since the last inspection, and whilst there was evidence that some areas have improved (see below) there is still work to be completed for the home to demonstrate full compliance to the National Minimum Standards and the Care Home Regulations to ensure that this is a well managed home. The practice of carrying soiled laundry through the dining room has now stopped. Staffing levels in the home meet the assessed needs of the persons accommodated. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 6 A review of nutritional guidance by a dietician now better ensures a continuous/consistent supply of nutritious balanced meals and more awareness of the need for good hydration. What they could do better: The health and welfare of the residents living in the downstairs bedroom would be greatly improved if the home replaced the damaged bed immediately. The health and welfare of the residents living in the second bedroom downstairs and both bedrooms upstairs would be greatly improved if the mattresses on their beds would be replaced immediately. The health and welfare of residents and their general sense of well being would be much improved if the home tackled the sources of offensive odours and replaced the carpets in the first bedroom downstairs and the second bedroom upstairs. Continence management would be greatly improved if adequate laundry and sluicing facilities were available at the home. The quality of care at the home could be greatly improved if the home kept to agreed quality assurance protocols. A continence management assessment required after the last inspection was not sent to the Commission. The health and safety of residents would be better protected if the home stored substances hazardous to health in lockable facilities. The health and safety of residents and staff would be better protected if combustible materials were not stored in cavities of the home. The identities and privacy of residents would be better protected if confidential documents were stored properly. The health and safety of residents would be better protected if the staff team would fully comply with the organisations medication policies and procedures. Residents would benefit if the home would conduct an urgent investigation into the cause of members of staff ignoring the home’s policies and procedures on the administration and storage of medicine. Residents would benefit if the homes building maintenance needs were better managed and more promptly seen to. The quality of life and residents general well being could be greatly enhanced if improvements were made to the physical environment. This includes furnishings as well as full re-decoration of the entire home. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 7 Residents and the staff team would feel better supported if the Registered Manager ceased to be in a dual role for the trust and was more fully able to concentrate on the needs of the home this includes documenting on the roster the hours actually worked in Ashclyst. 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. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. The home can evidence that it is able to meet the assessed needs of residents. EVIDENCE: Findings relating to essential documents are in line with the outcomes of the last inspection. The Statement of Purpose and Service User Guide have been sent to the Commission after recent inspections and placed on file. There was good evidence that these documents are regularly updated. The statement of purpose includes details on the admission process and that visits would be tailored to suit the individual to enable them to make a decision on whether to move to the home. The new Service User Guide has been available in a pictorial format for some months and is seen to have had a positive impact on communicating with residents. The home has full occupancy and many of the residents have been living in the home for a number of years. It was evident that the home would liaise with the placing authorities prior to making a decision for an individual to be admitted to the home. This would include a full care plan and an assessment being obtained from the placing social worker. It was evident that the home would complete an assessment of need prior to an individual moving to the home. Less evident was a re-assessment and review of residents changing needs. However, the home can demonstrate and evidence that it is able to deliver assessed needs on a day-to-day basis. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 10 Two licence agreements were scrutinized and found to include all the specifications listed NMS (National Minimum Standard) 5. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 10. The home showed convincing evidence that its emphasis on the person centred planning approach leads to positive outcomes for its residents. This includes supporting user participation and enhancing residents preferred lifestyles. EVIDENCE: A sample of two of the resident’s plans of care was inspected. Due to the complex communication needs of each of the residents their respective plans have been developed with their involvement using non-verbal means of communication. Methods of communication are an important issue at Ashclyst since individual residents needs and abilities vary and are particularly intricate. Individual care plans reflected that residents were assisted in making choices in their daily lives. The current documents have been compiled using the Person Centred Planning tool and have been regularly updated. The Residents and their families were involved in this process as much as possible and photographs were being used to assist in communicating every day activities as appropriate. This was well assessed and examples of support to provide Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 12 individual residents with the information, assistance and communication needed to make decisions about their own lives were also well documented. Residents at the home are not able to deal with their own finances and the staff team manage these, when no relative is available. Records were inspected and found to be correct. All of the residents have their own bank account. There was good evidence of regular consultation with residents. Residents are involved in decisions regarding the daily running of the home whenever possible. This often involved the use of pictorial systems to display every day tasks. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 17. The home enables residents to maintain appropriate and fulfilling lifestyles in and outside the home. EVIDENCE: In line with previous inspection findings the home was able to demonstrate that residents are encouraged to participate in a range of activities. These were seen to be domestic activities including cookery, gardening and cleaning. The home also offered arts and craft activities as part of the residents’ weekly schedule. All of these programmes were set up to enable residents to develop practical skills. All of the residents attend Resource and Activity Centres during the day. Links with the local community were generally maintained through attendance at Resource and Activity Centres. Each Service User had been on holiday during 2005. Families were able to visit whenever they wished. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 14 The home produced evidence to show that a dietician had been consulted in order to review and develop individual residents diets. A recommendation was made in the last two reports for the home to review the menu using appropriate nutritional guidance or assessment by a dietician to ensure a continuous/consistent supply of nutritious balanced meals. This recommendation has now been implemented. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. The residents receive sensitive and flexible support and care. The staff team needs reminding about the importance of following the homes medication policy and procedures. EVIDENCE: The staff team provides flexible personal support. Each resident has a key worker, who relates closely to him and offers support in maintaining as much independence as possible. Routines in the home are flexible but of necessity, have to fit with day centre timetables. During the inspection of the premises items of prescription medication were found left in parts of the home. This was immediately discussed with the deputy manager and the home advised to conduct an investigation into the reasons for this breach of medication policy and procedure. This is made a requirement in the relevant sections of this report. With the exception of the above, medication was stored appropriately. The Medication Administration Records confirmed that normally, correct procedures were followed in the home. Care plans that were in place detailed a personal care statement relating to bathing. Care documentation included visits to the specialists and health care Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 16 professionals. The recording of health care interventions, including medical and general health review sheets were seen to be of a good standard. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The homes complaints and POVA (Protection of Vulnerable Adults) procedures are robust and sound. EVIDENCE: A copy of the homes complaints procedure was available at the home. Details of how to contact the Commission in case of a complaint and a procedure, which is in a user-friendly format, is accessible to Service Users and their representatives. There was no record of a complaint in the home’s complaint book since the last inspection. The home has a policy on abuse and local joint policies and guidance between South Gloucestershire Council and the local authority. Good evidence was provided that the Trust systematically trains its entire staff group on this topic. Staff members regularly take part in the organisations ‘Vulnerable Adults Alerter’ training. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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, 26, 27, 28, 30. Concerns about the quality of beds, management of odour and efficient maintenance and renewal of the furnishings and fabric need urgent attention. Continence management equipment is poor. The home is in need of a thorough refurbishment. EVIDENCE: Consistent with the findings of the last inspection the home fails to achieve some of the basic environmental standards and currently can still not be termed ‘homely and safe’ without some major reservations. In spite of clear advise in the last inspection report Ashclyst is also still not free from offensive odours. In the opinion of the inspector and after an extensive tour of the premises the home does currently fall short of the above criteria and needs to be completely refurbished and redecorated. As in the last report, this is again required as a result of this inspection. A number of ‘Immediate Requirements’ were issued immediately after this inspection and brought to the attention of the provider: 1. The bed frame in the downstairs bedroom was damaged. The home was advised to urgently replace this bed. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 19 2. The mattress in the second bedroom downstairs and both mattresses in the bedrooms upstairs were heavily stained and smelled. In order to combat the effects of incontinence they had been covered with unsuitable heavy-duty plastic sheets. The home was advised to urgently replace these mattresses with the type seen in the first bedroom downstairs. 3. Carpets in the first bedroom downstairs and the second bedroom upstairs needed replacing in order to tackle sources of offensive odour. 4. In total, a list of 15 maintenance tasks was compiled with the Registered Manager and entered into the maintenance log on the 17th of November 05. The home needed to ensure that these tasks were completed within one month. At the last inspection two requirements were made with regards to infection control measures and the need for an urgent re-assessment of the homes continence management protocols and handling procedures. A small hand written note was found at the home, which detailed some outcomes of a meeting with an infection control expert nurse. A requirement in the last report to forward any expert assessment to the Commission was ignored by the home and is therefore made again. All of the residents have continence management needs and staff explained how time consuming and labour intense this task was. In spite of this the home still prefers to use domestic style appliances which, considering the considerable demands made on them, seem hardly suitable for this task. Again, there was evidence that members of the team were still not using the temperatures recommended for contaminated clothes. The home is advised that the minimum recommended temperature for foul laundry is 65 degrees Celsius. In addition, the home has no sluicing facility although in the opinion of staff this would improve infection control measures considerably. A requirement is made in the relevant sections of this report. The previously common practice of carrying large amounts of contaminated laundry through the dining room to reach the utility room has now stopped. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 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): 31, 33, 34. Irregularities over the staff duty roster need urgent attention. However, there was good evidence that an effective staff team supports the residents. EVIDENCE: There was good evidence that the home had overcome past staffing difficulties and was enjoying a period of stability. However, there were concerns over the duty roster being a reliable source of information after it became doubtful whether the roster was actually worked. A requirement is made for the home to be mindful of the necessity to operate a roster of person’s working at the home, and a record of whether the roster was actually worked. A core group of staff have worked for the home for many years and are very familiar, knowledgeable and supportive of the home’s aims and values. The staff team understands how these values translate into policies and procedures and how to implement these in practice. It was apparent through discussion with the Deputy Manager that the home follows clear and robust recruitment procedures. An appointment is only made subject to references, CRB, POVA, and medical checks. Staff documentation available for inspection at the home was not scrutinised as part of this inspection. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41, 42. Leadership and direction of the home are currently affected by the homes manager’s functions outside the home. Health and safety concerns include the storage of hazardous substances as well as the home taking unnecessary fire risks. EVIDENCE: The Registered Manager has been acting in a dual role for the Trust for some time. The additional duties of acting Area Manager have engaged him outside the home’s tasks and responsibilities for substantial parts of his working week. Concerns about this had already been raised in the last inspection report including comments about this almost certainly affecting the aims and purpose, leadership and direction of the home. There was good evidence that the current situation was still affecting the management of the home negatively. This was discussed with the Registered Manager who gave assurances that this arrangement was about to cease and that he would be working at Ashclyst full time very soon. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 22 Scrutinising the homes duty rosters it was noted, that the record available did not show the hours the manager actually worked in the house. The manager is reminded that Schedule 4. 7 is very specific about the required content of duty rosters. During the inspection a great number of substances hazardous to health were found in various places around the home. Lockable facilities were found open. The home needs to provide evidence that staff understand and are able to comply with COSHH regulations. A staff-training refresher is urgently recommended. When inspecting the premises, unlocked storage space in close proximity to the stairways was found full of discarded documents. In addition to this practice increasing the risk of fire these records were also seen to contain private and confidential information about residents currently living at the home. The home is reminded of the criteria set out in NMS (National Minimum Standard) 10.3, 41.3 and Regulation 17 of the Care Home Regulations when storing individual records. Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X 1 3 3 X 1 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 2 X 2 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashclyst Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 3 1 X X 1 1 X DS0000003390.V261932.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard 26 26 Regulation 16 16 Requirement The home to replace the bed in the downstairs bedroom. The home to replace the mattress in the second bedroom downstairs and both bedrooms upstairs. Carpets in the first bedroom downstairs and the second bedroom upstairs need replacing in order to tackle sources of offensive odour. Continence management needs better facilities including laundry and sluicing appliances. A professional continence management assessment required after the last inspection to be send to the Commission. The home needs to provide evidence that staff understand and are able to comply with COSHH regulations. The home needs to take adequate precautions against the risk of fire. The home to conduct an investigation into the cause of members of staff ignoring the home’s policies and procedures on the administration and DS0000003390.V261932.R01.S.doc Timescale for action 01/01/06 01/01/06 3 24, 26 16 01/01/06 4 5 30 30 23 23 01/03/06 01/01/06 6 42 13 01/03/06 7 8 42 20 23 13 01/03/06 01/03/06 Ashclyst Version 5.0 Page 25 storage of medicine. 9 10 11 24 24 31, 33, 38 23 23 18 The home needs premises need to be well maintained on an ongoing basis. The home is in need of refurbishment and complete redecoration. The staff team to benefit from the registered manager being more regularly available for the needs of the home. The duty roster needs to document the hours actually worked. 01/01/06 01/03/06 01/02/06 12 33 Schedule 4 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Ashclyst DS0000003390.V261932.R01.S.doc Version 5.0 Page 27 - 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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