Inspection on 19/04/06 for Ashgate House Nursing and Residential Home

This inspection was carried out on 19th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashgate House Nursing and... 10/05/07

Ashgate House Nursing and... 05/09/06

Ashgate House Nursing and... 22/01/06

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

CARE HOMES FOR OLDER PEOPLE Ashgate House Nursing and Residential Home Ashgate Road Chesterfield Derbyshire S427JE Lead Inspector Ivan Barker Unannounced Inspection 19th April 2006 08:50 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 Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashgate House Nursing and Residential Home Address Ashgate Road Chesterfield Derbyshire S427JE 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) 01246 566958 01246 566216 Ashgate Care Limited Gary Foley Care Home 34 Category(ies) of Dementia (29), Dementia - over 65 years of age registration, with number (29), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (29) Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration of the MD category is to Room 18 - Single Room, Room 19 - Double Room, Room 20 - Double Room. A total of 5 places. 22nd January 2006 Date of last inspection Brief Description of the Service: Ashgate House is situated on the western outskirts of Chesterfield, within the area of Ashgate, Chesterfield. It is a large converted building, rather than purpose built. The bedrooms are of various sizes and situated on the ground and first floor. The lounges and dining room are located on the ground floor. The company applied for and was granted a variation in the registration. The home now provides accommodation for 29 older people with Dementia and has accommodation for 5 older people with Mental Disorder and is registered to provide personal and nursing care. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Only a limited number of the National Minimum Standards were examined at this inspection (with emphasis on several of the ‘key standards’), and the previous requirements. The persons present at the inspection was: Ms A Hoskin acting manager. Within this inspection, which occurred over a four-hour period, the inspector toured the building, examined requirements relating to the previous inspection, spoke with service users, and staff and examined some documentation. The registered manager named on page four has being Mr G Foley, was no longer in post and Ms A Hoskin was operating in an acting role. What the service does well: What has improved since the last inspection? What they could do better: There are issues around the keeping up to date of care plans. If the records are not up to date then the care delivery could be compromised. There is also the need to provide a stimulating environment for the service users. There are cross infection and hygiene issues, minor repairs, training issues, quality monitoring, staff recruitment, management issues and the provision of evidence which needs to be addressed. Whilst the inspector accepts that the registered person is the person responsible under the Care Standards Act, for meeting the requirements, it is Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 6 also the responsibility of the staff, who should be accountable for their own actions. The registered person needs to raise this matter with the staff. 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. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 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 Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 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): Standards 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Accurate assessments will ensure that the home has sufficient information to be aware of the service user’s needs prior to admission. EVIDENCE: The acting manager undertook an assessment of the service user, prior to admission. The home also obtained the assessments, prior to admission from Care managers and Nursing staff from the hospitals. These assessments provided the basis for the completion of the care plans, which contained the assessments detailed in Standard 3. The acting manager advised the inspector that the home did not admit service users requiring intermediate care. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 9 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): Standards 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Inaccurate care plans will not contribute to the delivery of care, and may place the service users at risk. The system for the administration of the medication was adequate. There was a secure environment for the medications. There were no omission within the medication administration records and these factors will contribute to the medications being administered in the correct manner. EVIDENCE: On examination of the three care plans of the three service users who were being case tracked, the plans were drawn up using information from the assessments prior to admission. The inspector found that two of the care plans had not been re-evaluated on a monthly basis. The other care plan was to a lady who had only been admitted on the 15th April 06, therefore the monthly review was not applicable. On discussing the shortfall with the acting manager, she examined the documents and referred to a white board displayed within Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 10 the office. The board contained the names of all the service users and the date of when the care plans should be next reviewed. This information was available to the staff and would provide an easy reference point, rather than staff having to check every file. However clearly this information was not being used, as the care plans had not been reviewed. Should the care plans not be an up to date record, then errors in the delivery of care may occur. Inaccurate care plans will not contribute to the delivery of care, and may place the service users at risk. The acting manager agreed to discuss this matter with the members of staff. Risk assessment were included within the documentation and included moving and handling and pressure area risk assessments. On examination of the storage, administration and disposal of medication the inspector found that the home was using the Boots system of storage and administration. The medication records were up to date, with no omissions in the record keeping. Any medication entries, which were hand-written, had a signature. The service users, who were receiving personal and nursing care, had their medication administered by the qualified nurse. The inspector spoke with the service users who were being case tracked and also 3 other service users. However because of their mental capacity, he was only able to establish that they were ‘happy’ with the care and service provision. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 11 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): Standards 12, 13, 14. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There was insufficient activities and stimulation to enhance the service users quality of life. EVIDENCE: The shortfall in activities was raised within the last inspection in February 2006, and had a current timescale of the 30/06/06. The acting manager advised the inspector that she was still examining the introduction of an activities programme, and there was an advertisement placed in the job centre for an activities co-ordinator. She went on to explain that some staff did sit and spend time with service users, on a one to one basis, but accepted that this was dependent on the time available and the individual qualities of that member of staff. Within the care plan there was an assessment under the heading of ‘working and playing’. This listed the individual interests. The inspector discussed the option of including more information, for example the person’s current mental and physical capacity to undertake should activities, as some service users had a limited attention span. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 12 The acting manager advised the inspector that service users allowed visitors to visit in either the communal lounge, or their bedroom. She also advised the inspector that some relatives and visitors took the service users out on the home. The acting manager advised the inspector that for the majority of service users, the members of the family handled the financial affairs. A debit and credit system was also operated within the home for some service users. Service users brought personal possession into the home. The service users rights to exercise choice and controls over their lives are restricted by the service users own mental capacity. The inspector observed that staff did hold discussions with the service users regarding some choice. For example; a member of staff offered a service users an option by asking, ‘would you like a cup of tea or coffee’. On other occasions instructions were offered, for example, ‘its lunch time, can you come into the dining room for your lunch’. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 13 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): Standards 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. As far as could be established the home had a complaints procedure in place, but evidence was not available how effective the procedure was, as there was no record of recent complaints. The majority of staff had received training, on Adult Protection, which if implemented should make them more aware of Adult Protection issues and how to act should an allegation occur. Some staff still required training in Adult Protection. EVIDENCE: The complaints procedure was displayed and available to the service users and relatives. On discussing complaints with the service users, they informed the inspector that they were ‘happy’ with their care. No complaints were addressed to the inspector, at the time of this visit. On examination of the complaints book, the last entry was in 2004. The Commission had received no complaints since the last inspection. Regarding Adult Protection training, the acting manager was able to evidence that the majority of staff had attended training in 2004. However the 6 staff Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 14 appointed since had not received any training, except briefly as part of their induction. The acting manager advised the inspector that she was on the Training for Trainers course on Adult Protection, from Derbyshire County Council. She would produce a training programme for the 6 staff, as part of her last exercise practical assessment, on the course. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 15 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The environment, monitored at this inspection, had not been maintained to the required standard to provide a safe, well-maintained environment for services users. EVIDENCE: A locum inspector undertook the previous inspection in February 06, Mr Barker’s last inspection occurred on the 15 April 2005, since this date there has been a considerable amount of investment within the furniture, fittings and décor. The ground floor communal areas and some corridors and bedrooms have been redecorated. Floor covering in the communal areas have been replaced, and new furniture provided for the communal areas. The inspector monitored the previous requirements from the last inspection, which referred mainly to lack of cleaning and untidiness within several areas of the home. The acting manager advised the inspector that the housekeeper Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 16 team had been increased and the staff had been reminded about leaving the rooms untidy. On touring the building, at this inspection, the following was found: There were some shortfalls found these were that: Within room 26 there was a damaged wall, with flaking plaster and paint. Within room 29 (a toilet), the toilet seat was missing. Neither of these repairs was recorded within the maintenance book. Within rooms 20 and 27 and on a shelf in the sluice room, there were faecal stained commode pans, which had not received adequate cleansing. This was clearly a hygiene and cross infection, and health and safety risk. The sluice disinfector machine was found to be fully operational. On raising this issue with the acting manager she requested that the staff immediately cleaned the commode pans. Within room 33, there were numerous piles of boxes, clothes, books, cases, as well as the expected furniture. Over half of the area of the room was cover with items. When this was discussed will the acting manager she informed the inspector that the lady had brought into the home a considerable amount of her belongings. Whilst the inspector accepted that it is beneficial to the lady to bring items into the home, it was not acceptable for the items to be stored in such a way that creates a health and safety risk to the lady and the staff, in the event of the items falling, or blocking a means of escape, and being a potential fire hazard. The acting manager agreed to discuss with the lady and her family the implications, as discussed and to find ways of providing better storage facilities within the lady’s room and the home. On the door to bedroom 20, there were keypads on both sides of the door. The room had no service users residing in it at the time of the visit. The acting manager advised the inspector that the lock fitting company had fitted the device to the wrong door and the handyman was this afternoon going to remove the device. The important of maintaining the ‘fire integrity’ of the door, when the lock was removed, was emphasised by the inspector. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 17 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): Standards 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The company, at the time of inspection, were unable to provide evidence that the recruiting system was adequate to protect the service users. However agreement has been reached that they provide this evidence as a matter of urgency. EVIDENCE: The previous requirement relating to be employment of sufficient housekeeper staff had been addressed. There were two housekeepers employed. 1 member of staff worked 30 hours per week. The other member of staff worked 27 hours. The rota indicated that one member of staff was on duty for four days a week and three days a week had two staff on duty. The number of care staff on duty at the time of inspection was 1 qualified nurse (the acting manager) and 2 care staff. The acting manager and the staff advised the inspector that there should have been 3 care staff on duty today, but one member of staff had phoned into the home. The rota indicated that she had been marked absent for duty. On examination of the rota the following was indicated. Am shift. 1 RGN or RMN and 3 care staff. Pm shift. 1 RGN or RMN and 3 care staff. Night shift. 1 RGN or RMN and 2 care staff. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 18 Caring for 19 service users receiving nursing care and 2 receiving personal care. A total of 21 service users. The rota also showed that on one shift a week the staffing levels were 2 nurses and 2 care staff rather than 1 nurse and 3 care staff. The acting manager identified that on that day she was able to undertake some ‘managerial’ tasks, rather than providing ‘hands on’ care, as a nurse. The acting manager discussed the possible re deployment of staff, examples given were that the ‘heaviest’ work was in on an Am shift, and the lightest work was with the 3 staff on duty at night. The introduction of a twilight shift was discussed with the inspector. The proposal being that the night shift for one member of staff, be reduced by a number of hours, with these hours being used during busier times of the day. The inspector advised the inspector that he would be satisfied with a reconfiguration of staff, so long as the needs of the service users were being met and there was sufficient staff over a 24 hour period to met the service users’ needs. On examination of the 3 staff files, 2 did not contain evidence that a CRB check had been undertaken. The acting manager identified that she had found a file containing CRB document, which had been kept by the previous manager. She provided a list which she had drawn up which indicated which staff had a CRB document within the file and which staff had no documentation. On examination of this list, the inspector established that one of the care staff on duty today, was listed as having no CRB check. The inspector spoke with this individual, who confirmed that she had received a copy of her CRB, and her copy was at her home. On further analysis of the rotas it was established that for the next days, the staff on duty had CRB checks. It was agreed that should this member of staff provide a copy of her CRB, before the commencement of her duty, she would be allowed to work at the home. The acting manager advised the inspector that she was of the opinion that some of the CRB documentation may be stored at the head office. She advised the inspector that following the inspection she would contact head office and the individuals who were listed as not having a CRB check and she would confirm to the inspector that all staff had a CRB check. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 19 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): Standards 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The management of the home does not comply with the requirements of the Care Homes Act, as no registered manager is in post, and regulation 26 visit were not evidenced. Quality assurance systems were not in place that should assist the manager and director to measure the home against expected outcomes. EVIDENCE: On arrival at the home, Ms A Hoskin advised the inspector that the registered manager had left this post, and she was the acting manager. She advised the inspector that the Director of the company had written to the Commission within the last two days to advise the Commission of the situation. The inspector had not seen this letter, prior to this inspection. The acting manager Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 20 then explained that she intended to make an application for the registered manager position. On requesting to see the Regulation 26 reports, which should have been completed by the director, the acting manager advised the inspector that no copies were available. The inspector was aware that the director did visit the home on a frequent basis, but there was no formal record to indicate that he had complied with Regulation 26. During the verbal feedback part of the inspection, the inspector spoke with Mr Rosenburgh, Director, via the telephone. Mr Rosenburgh advised the inspector that the Regulation 26 documents were completed and kept at head office, and he would fax the last report to the Commission. The inspector reminded him that copies should be available on site for inspection. Mr Rosenburgh also assured the inspector that he had a record at the head office that would indicate that all staff had had a CRB check, and he would fax a copy of this to the Commission. The acting manager advised the inspector that since her appointment to the post, she had been evaluating the care and service provision and up dating the director, in writing, of her findings. However she was unable to provide evidence that formal quality assurance monitoring had occurred, for more than a year. On discussing the previous requirement of staff supervision, the acting manager informed the inspector that this issue had not been acted upon, however as she had recently taken over in the position of acting manager, she planned to start the supervision and every member of staff was to have received supervision by the timescale of the 30th June 06. Regarding service users monies the home operated a debit and credit system, which was documented in a small accounting book. The concerns of health and safety and cross infection have been addressed in other section of this report. Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP12 Regulation 16 (2) (m) 18 (2) Requirement Activities and stimulation must be provided for service users. (Previous requirement, timescale still relevant) All staff must receive regular supervision and appraisal. (Previous requirement, timescale still relevant) The registered person must ensure that care plans are reviewed on at least a monthly basis and reflect the current care needs and the care to be delivered. The registered person must ensure that all staff receive training on Adult Protection. The registered person must ensure that the home is maintained to an adequate standard, with repairs and redecoration, and reduces the possible risk of infection. The registered person must ensure that all staff have all the required checks prior to commencing employments and that these documents are kept on site for inspection. DS0000066966.V290154.R01.S.doc Timescale for action 30/06/06 2. OP36 30/06/06 3. OP7 12 19/05/06 4. 5. OP18 OP19 18 13 & 23 19/06/06 19/07/06 6. OP30 19 19/05/06 Ashgate House Nursing and Residential Home Version 5.1 Page 23 7. 8. OP31 OP33 8 24 9. OP31 26 The registered person must ensure that a registered manager is in post. The registered person must ensure that a quality assurance system with a systematic cycle is in place and being operated. The registered person must provide evidence of visit covered by regulation 26, and provide written evidence of these visits. 19/07/06 19/07/06 19/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Ashgate House Nursing and Residential Home DS0000066966.V290154.R01.S.doc Version 5.1 Page 25 - 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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