Inspection on 16/12/05 for Autumn House Nursing Home

This inspection was carried out on 16th December 2005.

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

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

Other inspections for this house

Autumn House Nursing Home 18/09/07

Autumn House Nursing Home 14/08/06

Autumn House Nursing Home 12/07/05

Autumn House Nursing Home 24/01/05

Autumn House Nursing Home 21/07/04

Autumn House Nursing Home 02/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Autumn House Nursing Home 37 Stafford Road Stone Staffordshire ST15 OHG Lead Inspector Lynne Gammon Unannounced Inspection 16th December 2005 09:00 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 Autumn House Nursing Home DS0000022309.V272658.R02.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 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. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Autumn House Nursing Home Address 37 Stafford Road Stone Staffordshire ST15 OHG 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) 01785 812885 01785 615506 Waverley Care Homes Limited Mrs Lesley Barbara Powell Care Home 67 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (31), Physical disability (31), Physical disability over 65 years of age (31) Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 1 Physical Disability (PD) - minimum age 50 years on admission Nursing Care 31 Physical Disability (PD) - Minimum age 60 years years on admission - Nursing Care 4 Physical Disability (PD) - Minimum age 50 years on admission Personal Care 12th July 2005 Date of last inspection Brief Description of the Service: Autumn House is a care home providing personal care, nursing care and accommodation for up to 67 elderly service users. The home is registered with the Commission for Social Care Inspection to care for service users with the following needs: - dementia, mental disorder (excluding learning disability or dementia), old age, (not falling within any other category) and physical disability. The home is owned by Waverley Care Homes Limited who also own the other care home located on the site. The home is located on the outskirts of the town of Stone in Staffordshire. Amenities, including those in Stone town centre are situated within walking distance. The home consists of two floors, the ground floor is home to service users requiring personal care and the first floor is dedicated to those needing nursing care. There is a passenger lift installed serving both floors. Most bedrooms have en-suite facilities, with some double rooms available. There is a patio area with tables and chairs and a substantial car-parking area at the front of the home. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection on the 16th December 2005 at 9.30am using the National Minimum Standards for Older People as the basis for the inspection. The total time spent for the inspection, including pre and fieldwork, amounted to 11 hours. The inspection included a tour of the home, inspection of records, observation and discussions with service users and staff. Since the last inspection on 12th July 2005, no complaints nor any incidents or reports of abuse of any kind had been received. Two requirements against the regulations were outstanding from the last inspection report. What the service does well: The staff within the home were committed to providing a very good service to the service users. Overall, the home was well maintained and exceptionally clean, warm and bright. The choice and quality of the food was praised by a number of service users who spoke to the inspector and efforts had taken place to improve the range of activities in the home. There was a lot of enthusiasm from staff about meeting the social needs of the service users in addition to their nursing and personal needs. Visitors were welcomed and staff were friendly and open towards them. There was very good interaction between staff and service users, and service users were generally, very happy and complimentary about all the staff and the care provided to them. Staff and service users were able to play a part in the running of the home through regular meetings where views were listened to and taken into account. No complaints or allegations of abuse had been received by the home or the Commission for Social Care Inspection. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Nine requirements were raised as a result of this report and were as follows: • • To amend the Statement of Purpose to include all elements of Schedule 1 of the Care Homes Regulations 2001. Care records to reflect the individual care needs of each service user with involvement from the service user or their representative and appropriate risk assessments to be carried out and reviewed monthly for each service user as required. A service user’s individual condition must be appropriately documented and reviewed, involving other professionals as necessary. To make good the upstairs sluice window. To replace the fridge in the dining room on the 1st floor and for food in the fridge to be labelled. For the kitchen sink in the 1st floor serving area to be resealed. Door wedges to be removed and retainer door guards put in place that meets the requirements of the Fire Authority to ensure the safety of the service users and staff. All staff files to be audited to ensure they contain all required elements under Schedule 2. The registered person must not employ a person to work in the home until the completion of a satisfactory Criminal Records Bureau check has been obtained. • • • • • • • Three recommendations were also raised as a result of this report and were as follows: • • • Service users to be offered meals at reasonable times of the day giving acceptable time lapses between each main meal. For all care staff to receive formal supervision sessions at least 6 times per annum. For the window openers identified to be missing in the small lounge to be replaced. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 7 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. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 8 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 Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 9 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): 1 The Statement of Purpose required further amendments to provide prospective service users and their families with the necessary details to inform their choice about the home being an appropriate place to meet their care needs. EVIDENCE: One of the inspectors examined the Statement of Purpose and a couple of omissions were identified in that it did not specify that care was offered to members of both genders, the age range accepted or the number of rooms actually being used to accommodate the service users (i.e. how many single and how many shared rooms). The telephone number for the Commission for Social Care Inspection was also incorrect and it is a requirement of this report that the Statement of Purpose is amended to include all elements of Schedule 1 of the Care Homes Regulations 2001. At a later date following the inspection, the registered manager identified a problem in updating the Statement of Purpose which required the Commission to resolve. Therefore, it remains a requirement for the Statement of Purpose to be updated but it has been agreed that this may take some time before it is completely accurate. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. Care planning processes did not provide staff with sufficient information to understand the needs of the service users and would benefit from being more organised, detailed and individually personalised. EVIDENCE: The care records inspected on the nursing floor revealed to the inspector the need for greater clarity with regard to individuality. Service user’s care records inspected did not demonstrate their actual state of health at the present time. Greater explanation of the service users condition must be explained, reviewed and documented in the records. Relatives’ signatures were not evident in all care records; their preferred involvement must be documented within the file. On the residential floor, it was evident that efforts had been made to improve the monthly review and recording within the care plans following the previous inspection but more work was required to ensure that all relevant risk assessments were undertaken, documented and reviewed, particularly in relation to falls. Evidence was seen of service users having regular access to other health professionals including the GP, district nurses, physiotherapist etc. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 11 It is a requirement of this report that care records reflect the individual care needs of each service user which are drawn up in conjunction with the service user or representative and appropriate risk assessments are carried out and reviewed monthly for each service user as required. It is a further requirement that a service user’s individual condition must be appropriately documented and reviewed. Advice from professionals should be sought as necessary. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 All of the key standards were reported upon satisfactorily in the report of the previous inspection of 12/07/05 and the home had continued to improve the range of activities to meet the needs of the service users. Overall, service users were supported and enabled to make their own choices and decisions over their lives. EVIDENCE: The home employed three part-time activity organisers and the inspector spoke with one of these who provided an activity log showing a record of the activities undertaken by each service user. This record and discussion with the activity organiser evidenced that a range of activities had taken place since the last inspection including: trips to Trentham Gardens, a concert in Stone, chair aerobics, arts and crafts, bingo (one service user acted as the Caller), visits to the home from local primary school children singing carols, and individual activities for those who were bed bound. Service users also told the inspector about their recent activities, which they had undertaken for Christmas and in the main reception area in the home, a collage made by the service users was hung in ‘pride of place’. Another service user informed the inspector that she led painting/craft sessions for service users, which were supported by the staff Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 13 in the home, and she explained how much she enjoyed organising these for the other people in the home. There were a number of examples of how the home met individual choices, however, one inspector noted that a service user on the nursing floor was being offered breakfast far too late in the morning and discussions with them identified as not having their individual choice met. It is a recommendation of this report that service users are offered meals at reasonable times of the day giving acceptable time lapses between each main meal. The registered care manager informed the inspectors that a ‘No Smoking’ Policy had been developed and would be implemented throughout the home from January 2006. The home had four service users who were smokers and discussions had taken place with them about the implications of the policy for them. The registered care manager confirmed that a number of options were being considered to support these service users to smoke outside undercover, or to offer assistance to give up smoking as one service user had requested. The inspector considered this to be a positive move in supporting service user’s choice. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Service users were satisfied that their complaints were taken seriously and acted upon. Service users were supported and enabled to participate in the electoral process if required. EVIDENCE: Discussions with service users and examination of records evidenced that service user views were taken into account and any minor grumbles resolved as quickly as possible. Service users confirmed that they were able to vote in national and local elections and were supported by staff as required. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 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): 19, 21, 22 and 25 Satisfactory lavatory and washing facilities were in place to meet the needs of the service users. Specialist equipment was used to support service users to promote their independence. Some environmental issues remained outstanding. Hygiene standards were very good. EVIDENCE: Both inspectors had a tour of each floor within the home. Toilets and bathrooms throughout the home were found to be very clean and tidy. The sluice window on the 1st floor identified at the last visit remained broken, and it is a requirement that this is replaced and a recommendation that the window openers identified to be missing in the small lounge be replaced also. Specialist equipment and environmental adaptations were evident throughout the home to meet the needs of the service users and included grab rails, handrails, ramps, a lift, hoists and pressure mattresses. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 16 In each bedroom radiators were guarded and a fire/smoke alarm was in place. Corridors were free from obstruction and well lit for the safety of service users. The registered care manager and the service users confirmed that some bedrooms had been redecorated and service users had been offered a choice of colour for their rooms. Some rooms had also been fitted with new carpeting with two further bedrooms planned to have new carpet early in the New Year. The dining room on the residential floor had recently been redecorated and was very homely and bright. Outside each door on the residential floor were individual Christmas stockings, which evidenced the effort that staff had made to make Christmas as homely as possible for the service users. On the nursing floor in the dining room, a few items were identified that required attention. These were: • • • • The sink unit needed resealing to maintain an adequate hygiene standard. The fridge temperatures should be recorded The fridge’s integral freezer door was broken off and this required defrosting whilst a replacement fridge is organised. Unlabelled food was identified within the fridge. It is a requirement of this report that the fridge in the dining room on the 1st floor be replaced and for food placed in the fridge to be labelled. It is also a requirement that the kitchen sink in the 1st floor serving area is resealed. It is recommended that the windows identified at the visit and within the report conform to recognised standards. During the tour of the environment, it was observed that door wedges were still being used to prevent fire doors from closing and this had been raised at the previous CSCI inspection and the fire safety inspection in June 2005. It is a requirement of this report that these are replaced with retainer door guards that meet the requirements of the Fire Authority to ensure the safety of the service users and staff as a matter of urgency. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 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): 27 and 29 Staffing levels were sufficient to meet the needs of the service users. Staff files and recruitment procedures were not robust enough to ensure the protection of service users. EVIDENCE: There were 34 service users on the nursing floor and 33 service users on the residential floor. The registered care manager, also the Director of Care Services was on duty all day and on the nursing floor, there were two registered nurses on duty plus one senior carer and five care assistants in the morning, and one registered nurse and six carers plus a cadet until 8.00 p.m. On night duty, there were one registered nurse and four carers. These staffing levels were deemed satisfactory for the number of nursing clients living in the home. On the residential floor, the residential care manager was on duty all day, plus three senior carers, two care assistants and one cadet in the morning, two senior carers, two care assistants (one off duty at 5.00 p.m.) and one cadet until 8.00 p.m. and two senior carers on night duty. These staffing levels were also deemed satisfactory for the number of residential clients living in the home. In addition to this, the home employed a wages clerk, a secretary, a cook, two kitchen assistants, two laundry assistants, two orderlies, two domestics on Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 18 each floor and a domestic supervisor, plus three maintenance people and three part-time activities co-ordinators. Inspection of staff files evidenced that they were still lacking some of the required elements as set out in Schedule 2 of the Care Homes Regulations 2001 e.g. proofs of identity. More seriously, the inspector was concerned to discover that a recent new member of staff had not been subjected to a POVA or CRB check prior to commencing employment in the home. Discussions with the registered care manager confirmed that this had been an oversight and would be rectified immediately. However, it is a requirement of this report that existing staff files are audited and any gaps identified and corrected as a matter of urgency and a further requirement that the registered person shall not employ a person to work in the home until the completion of a satisfactory Criminal Records Bureau check has been obtained. It was noted that a significant amount of work had been undertaken regarding recruitment processes and the inspector was shown a new recruitment document that had been developed recently which included a checklist to ensure staff files contained the required elements. These should help to progress the above requirement more effectively. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 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): 31, 32, 33, 36, 37 and 38 The registered care manager was an experienced professional and of good character, and provided an open, accessible leadership style for the benefit of staff and service users. Consultation with service users enabled on-going quality assurance and records held were accurate and secure. Staff supervision took place but needed to be more frequent to enable staff to have formal, one-to-one sessions with their manager. The health, safety and welfare of service users and staff were not being fully protected. EVIDENCE: The registered care manager, Mrs Lesley Powell, (Director of Care Services), was a qualified nurse and very experienced in managing her responsibilities and staff to meet the needs of the service users in the home. She had worked at Autumn House since 1991, apart from a two-year break where she qualified as a teacher in Health and Social Care and taught NVQ Level 4 in care and the Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 20 Registered Manager’s Award. The inspector witnessed very good relationships between the manager and the service users and it was clear that she knew them well. Quality assurance was maintained and included regular cheese and wine evenings for the service users and their relatives who were encouraged to raise any issues or concerns with the registered care manager or any member of staff during the evening. Formal meetings used to take place but the manager informed the inspector that these were not well attended and service users and their relatives preferred a more informal approach. Regular staff meetings took place for all groups of staff and were evidenced with detailed minutes. Staff supervision records were examined and confirmed that formal supervision sessions did take place for staff, however it is recommended that these be increased to a minimum of six times per annum to ensure staff are appropriately supervised. Individual and home records were seen to be held securely and up to date for the protection of service users. A number of areas were identified by the inspectors regarding the health, safety and welfare of the service users and staff whilst carrying out a tour of the home. These have been identified in the report under the ‘Environment’ section. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 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 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 2 X 3 3 X X 3 X STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 1 Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 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 OP1 Regulation 4 (1)(c) Requirement To amend the Statement of Purpose to include all elements of Schedule 1 of the Care Homes Regulations 2001. Care records to reflect the individual care needs of each service user with involvement from the service user or their representative and appropriate risk assessments to be carried out and reviewed monthly for each service user as required. A service user’s individual condition must be appropriately documented and reviewed, involving other professionals as necessary. To make good the upstairs sluice window. To replace the fridge in the dining room on the 1st floor and for food in the fridge to be labelled. For the kitchen sink in the 1st floor serving area to be resealed. Door wedges to be removed and retainer door guards put in place that meets the requirements of the Fire Authority to ensure the DS0000022309.V272658.R02.S.doc Timescale for action 30/04/06 2. OP7 15 (1)(2) 31/03/06 3. OP8 12 (1) 31/03/06 4. 5. OP19 OP38 23 (2)(b) 16 (g) 31/03/06 31/03/06 6. 7. OP38 OP38 16 (j) 23 (4) 31/03/06 31/03/06 Autumn House Nursing Home Version 5.0 Page 23 8. 9. OP29 OP29 19 (1)(b) (i) 19 (1)(b) (i) safety of the service users and staff. All staff files to be audited to 31/03/06 ensure they contain all required elements under Schedule 2. The registered person shall not 16/12/05 employ a person to work in the home until the completion of a satisfactory Criminal Records Bureau check has been obtained. 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. Refer to Standard OP14 OP36 OP38 Good Practice Recommendations Service users to be offered meals at reasonable times of the day giving acceptable time lapses between each main meal. For all care staff to receive formal supervision sessions at least six times per annum. For the window openers identified to be missing in the small lounge be replaced. Autumn House Nursing Home DS0000022309.V272658.R02.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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