Inspection on 31/08/06 for Beech Tree House

This inspection was carried out on 31st August 2006.

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

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

Other inspections for this house

Beech Tree House 19/08/08

Beech Tree House 30/01/06

Beech Tree House 13/07/05

Beech Tree House 18/01/05

Beech Tree House 03/08/04

Beech Tree House 10/03/04

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

CARE HOMES FOR OLDER PEOPLE Beech Tree House High Street Keinton Mandeville Somerton Somerset TA11 6DZ Lead Inspector Jane Poole Key Unannounced Inspection 09:30 31st August 2006 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 Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Tree House Address High Street Keinton Mandeville Somerton Somerset TA11 6DZ 01458 223369 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) Mr John Whitehouse Mrs Estelle Louise Josephine Whitehouse Mrs Estelle Louise Josephine Whitehouse Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. registered for 16 persons in categories OP and DE (E) Date of last inspection 30th January 2006 Brief Description of the Service: Beech Tree House is a care home, providing personal care, for 16 older people with dementia care needs. Situated in the village of Keinton Mandeville, the property was built around 100 years ago and extended to accommodate 14 people when it became a care home about 18 years ago. Recently a further extension has provided two additional en-suite rooms that meet modern environmental standards and have been registered with CSCI. Accommodation is on the ground and first floors with the majority of bedrooms on the ground floor. The home is secure and the old house retains many of its original features, which give the home a domestic and homely feel. The house has a large, wellmaintained garden and a mini-bus is available to transport service users. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 6 hour period by one inspector. The inspector was given unrestricted access to all areas of the home, was able to speak with service users and observe care practices. All records requested were made available. 6 service users, 4 relatives/visitors and 2 professionals completed questionnaires prior to the inspection. The atmosphere was calm and relaxed and the inspector was made to feel welcome in the home. What the service does well: The home provides care for older people who have a dementia. All prospective service users have a pre admission assessment before being offered a place at the home. This ensures that the home is able to meet their needs. Once someone moves to the home a full care plan is created. This is a comprehensive document and gives details of not only a persons needs but also their likes and dislikes. The home encourages families to complete a brief life history about the service user to enable staff to learn about the important people in a person’s life and significant events and interests. There is evidence that the service users living at Beech Tree House are able to access appropriate health care services and staff assist people to attend appointments outside the home if necessary. Service users stated verbally and in questionnaires that they felt that staff listened to them and acted on what they said. Complaints are taken seriously and fully investigated. Service users and relatives were very complimentary about the staff. There is a strong commitment to staff training and currently 80 of the care staff team have a National Vocational Qualification in care at level 2 or above. All areas seen by the inspector were pleasantly furnished and decorated in domestic style. Bedrooms are very personal to the individual and service users are encouraged to bring small items of furniture, pictures and ornaments which creates a very homely feel. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 6 The home was clean and fresh on the day of the inspection. What has improved since the last inspection? What they could do better: A recommendation of the last inspection was that all electric storage heaters be risk assessed and action taken to minimise risks. These assessments have been carried out and the proprietor is confident that they do not pose a significant risk to service users. These risk assessments must to be reviewed before the winter months and regularly thereafter. Currently 15 of the 16 service users use one bathroom on the ground floor as it is the only bathing facility that has been adapted to meet the needs of the current service user group. The home should look at ways that other bathrooms could be made accessible to service users, particularly those people whose private rooms are on the first floor. Outside the home there is a large attractive garden. Three people spoken to stated that they would like to make better use of the garden. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 7 Menus are available on the notice board in the main hall but service users would be better informed if the menu of the day was more clearly displayed. 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. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 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 Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 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, 2, 3, 4 & 5. Overall quality in this outcome group is good. All prospective service users have their needs assessed by a senior member of staff at the home before moving in. Prospective service users and/or their representatives are able to visit Beech Tree House before making a decision to make it their home. Intermediate care is not provided at the home. EVIDENCE: The homes statement of purpose is regularly reviewed and up dated to ensure it reflects the current facilities and services offered by the home. The weekly fee at the home ranges from £400.00 to £475.00, this does not include personal items and services such as toiletries, newspapers and hairdressing. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 10 All 6 service users who completed a questionnaire prior to the inspection answered YES to the question “Have you received a contract?” The inspector was able to see copies of signed contracts during the inspection. In addition to the contract each service user, or their representative, receives a letter detailing the room that they will occupy and a service user guide. The homes statement of purpose states that ‘all prospective service users will be assessed by either the proprietors or the deputy manager to ensure that the home is suitable to meet their needs.’ The inspector viewed the personal files of 3 service users, all contained pre admission assessments. Some files also contained full assessments completed by professionals outside the home. Service users spoken to stated that they had been able to visit the home prior to making a decision to make it their home. The terms and conditions state that the first 4 weeks of a service users stay is a trial period for both the service user and the home. There appears to be good communication between staff and management and appropriate training is available to ensure that staff are able to meet the needs of the service users. The home has built up professional relationships with local health and social care professionals who offer advice and support. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 11 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, 8, 9 &10. Overall quality in this outcome group is good. Care plans in the home are comprehensive and give clear guidelines to enable staff to assist service users in their chosen way. Service users are able to access a range of healthcare professionals in line with their individual needs. EVIDENCE: The inspector viewed the care plans relating to three service users. All were comprehensive and contained details of needs, likes, dislikes and preferences. In addition to the basic care plan there were assessments in respect of mental health needs, nutrition and moving and handling. A senior carer reviews the care plan with service users on a monthly basis and there was evidence that the plan is updated when needs change. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 12 All service users are registered with local GP’s and other healthcare professionals appropriate to their individual needs. There was evidence that service users are able to access, chiropodists, opticians, district and community psychiatric nurses. The home has recently sought support from a consultant psychiatrist to better meet the needs of one service user. The home asks that family or friends accompany service users to attend appointments outside the home but if this is not possible staff support service users to attend these appointments. Service users are weighed regularly and records showed that all service users are maintaining a stable weight. All 6 service users who completed comment cards prior to the inspection answered ALWAYS to the question “Do you receive the medical support you need?” There was evidence that the privacy and dignity of service users is respected. Staff were seen knocking on the doors of personal rooms before entering and toilet and bathroom doors were always kept closed when in use. Both professionals who completed comment cards stated that they were always able to see service users in private. No service users currently living at the home administer their own medication. Staff have received training in this area from the dispensing pharmacy and also are supervised and assessed on a regular basis by the manager or deputy. All medication is securely stored and Medication Administration Records are well maintained and correctly signed. There is a policy on the covert administration of medication that seeks agreement from the service users advocate and the relevant health care professional. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 13 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, 13, 14 & 15. Overall quality in this outcome group is good. There are organised activities in the home everyday. Service users are able to have visitors at any time. The home has changed the menus and is now providing a greater amount of fresh and home cooked foods. EVIDENCE: Service users spoken to stated that there were no fixed routines in the home and that they are able to choose what time they got up and when they went to bed. There are some organised activities in the home every day, which are facilitated by the care staff. On the morning of the inspection 15 of the 16 service users were in the main lounge and a member of staff was doing some quiet activities on a one to one basis. It was noted that there was very limited social interaction for those not directly involved in the activity. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 14 When someone moves to the home staff request a brief life history of the person. Many of the service users are unable to give a history of themselves and therefore the home rely on relatives to provide this. This information is kept in care plans and enables staff to identify activities that may be interesting for the individual. For example one of the newer service users has always enjoyed painting and the staff are hoping to encourage them to continue this hobby. The home should look at expanding these life histories to include activities that service users have enjoyed during their time at the home. Service users are encouraged to bring personal possessions, including photographs to the home and again this gives an indication of peoples tastes and interests. 5 of the 6 people who completed questionnaires answered USUALLY to the question “Are there activities that you can take part in?” Everyone spoken to stated that they could have visitors at any time and that they were able to go out with friends and family. All four relatives/visitors who completed comment cards prior to the inspection stated that they were always made welcome in the home and were always able to see their relative/friend in private. The home also has a minibus for trips out. One person who completed a questionnaire prior to the inspection stated that they particularly enjoyed trips out. One person living at the home goes to church on a regular basis. The home also organises visiting speakers and entertainers for service users. A recommendation from the last inspection was that the home review the meals to ensure that there was not an over use of tinned and processed foods. The home have embraced this recommendation and with the advice of a dietician have devised a new four week menu that gives a wide range of home cooked foods. The deputy stated that they are now using a lot more fresh fruit and vegetables. Everyone spoken to stated that they enjoyed the food in the home and that they received ample portions. The main meal of the day is at lunch-time and the cook gave evidence that alternative meals are always offered to service users who do not like the meal offered. The majority of service users asked in the morning did not know what was for lunch. Menus are available on the notice board in the main hall but service users would be better informed if the menu of the day was more clearly displayed. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 15 Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 16 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 & 18. Overall quality in this outcome group is good. The home has measures in place to minimise the risk of abuse to service users. Complaints are fully investigated and action taken to address any shortfalls identified. Service users are comfortable to express any worries or concerns and feel that they are listened to by staff. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse, making a complaint and whistle blowing. Staff spoken to on the day of the inspection were aware of the ability to take serious concerns outside the home. Since the last inspection the home have received one complaint. There is evidence that this complaint was fully investigated and as a result of the investigation one of the policies has been changed to ensure that a high quality of care is further promoted for service users. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 17 Service users who were able to express an opinion stated that if they were unhappy with anything in the home they would be comfortable to share their concerns with a member of staff. All 6 people who completed a questionnaire answered YES to the question “Do the staff listen and act on what you say?” Beech Tree House cares for older people who have a dementia. Doors are locked by an electronic keypad and the codes are clearly marked beside the doors. Service users are aware of this restriction when they move to the home. All new staff are checked against the Protection Of Vulnerable Adults register before commencing work and undergo an enhanced Criminal Records Bureau check. The home does not act as a financial appointee or power of attorney for any service user. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25 & 26. Overall quality in this outcome group is adequate. Beech Tree House provides a comfortable homely environment for service users. Bedrooms are comfortably furnished and reflect the tastes and needs of the individuals. Risk assessments in respect of storage heaters have not been reviewed. EVIDENCE: Beech Tree House is a large older style house that has been extended to provide accommodation for up to 16 people. There are 14 single rooms and one double. 12 rooms have en-suite toilet facilities. Bedrooms seen by the inspector were comfortably furnished and decorated. All had been personalised to reflect the tastes and needs of the individuals. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 19 Personal accommodation is arranged over two floors with the majority of rooms being on the ground floor. Since the last inspection a stair lift has been installed to assist service users to access the upstairs bedrooms. All communal areas are located on the ground floor and are accessible to all. There are two lounges and a dining room. All areas are pleasantly furnished and decorated in domestic style. Outside there are attractive gardens. Three service users stated that they would like to use the garden more often, however staff stated that it was only safe for service users to access the grounds with supervision due to its uneven nature. The home has four bathrooms, two on each floor. Only one bathroom on the ground floor has been adapted to meet the needs of service users. One person currently living at the home is able to use an unassisted bath, meaning that 15 service users share one bath. This includes people whose personal rooms are on the first floor. The proprietors are planning to turn one of the unassisted bathrooms into a shower room which will give greater choice to service users. Various other aids and adaptations have been fitted in the home to assist service users to move around independently. These include hand-rails and raised toilets. A call bell system has been fitted throughout the home. In one room it was noted that the pull cord for the emergency bell could not be accessed from the bed. This was discussed with the deputy manager who informed the inspector that the call bell was not used due to the ability of the service user. Assurances were given that all staff were aware of service users who are unable to use the call bell system. Bedrooms doors are colour coded to assist people to identify their personal rooms. There is some signage in the home. The home is heated by a combination of oil fuelled central heating and some electric storage heaters. A recommendation of the last inspection was for storage heaters to be risk assessed and appropriate action taken to minimise risks. The manager has carried out risk assessments and is confident that they do not pose a risk to any service users. There is no evidence that these assessments have been reviewed. All areas seen on the day of the inspection were clean and fresh. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 20 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, 28, 29 & 30. Overall quality in this outcome group is good. There is evidence that the home operates a robust recruitment procedure which minimises the risks of abuse to service users. There are good training opportunities in the home for all staff. EVIDENCE: The home employs 10 care staff and 2 ancillary workers. 80 of the care staff team have a National Vocational Qualification in care at level 2 or above. (Figures taken from pre inspection questionnaire) The home supplied duty rotas with their pre inspection questionnaire. Throughout the day there are a minimum of two members of the care staff team on duty. At peak activity times, such as first thing in the morning there are additional staff on duty. Overnight (9pm to 7am) there is one member of staff on duty and another person providing sleep in cover. The managers’ hours and all ancillary hours are in addition to this. All 4 relatives/visitors who completed comment cards answered YES to the question “In your opinion are there always sufficient numbers of staff on duty?” Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 21 Service users spoken to were complimentary about the staff saying that they were very kind and hard working. Staff have received training in statutory subjects such as manual handling, 1st aid, fire safety and infection control. Many staff have also undertaken training in oral health, caring for people who have a dementia and the management of aggression. Some new staff have not yet received training in the care of people who have a dementia but it was apparent that the home have a strong commitment to providing training opportunities for all staff. Two professionals who completed comment cards prior to the inspection stated that staff demonstrated a clear understanding of the care needs of service users. One person commented “I have been most impressed with the manner in which staff have cared for the residents I have placed at the home.” A relative commented that “the staff are fantastic.” The inspector viewed the recruitment files of two members of staff and found that they gave evidence of a robust recruitment procedure. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 22 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, 35, 37 & 38. Overall quality in this outcome group is good. The home is effectively managed taking into account the views of service users and their representatives. EVIDENCE: The registered manager and joint proprietor of the home is Mrs Estelle Whitehouse. Mrs Whitehouse has many years experience in caring for older people and holds the Registered Managers Award (NVQ level 4) At the time of this inspection the registered manager was not available and the home was being managed by the deputy manager. The deputy was extremely professional and knowledgeable. All records requested were made available Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 23 and she was able to demonstrate a good knowledge of both staff and service users. Everyone asked stated that the management of the home was open and approachable. There are systems in place in respect of quality control, there are regular safety checks, monthly care plan reviews with service users and 6 monthly questionnaires for service users and their representatives. All accidents are recorded and these records are audited on a monthly basis. Equipment in the home is regularly serviced by outside contractors. A fire log is maintained that shows that all staff have received training in fire safety, alarms are tested on a weekly basis and emergency lighting is tested every month. The majority of radiators in the home are of the cool wall type which prevents the risk of burns to service users. As previously mentioned there are some electric storage heaters in the home. Risk assessments have been carried out and the proprietor is satisfied that no further safety measures need to be put in place in respect of these. These risk assessments need to be regularly reviewed. All records requested were made available and all seen were well maintained and appropriately stored. Up to date certificates for registration and insurance were on display. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 3 3 2 x 3 2 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 2 Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 OP38 Regulation 13 (4) [a][c] Requirement The manager must ensure that risk assessments in respect of electric storage heaters are regularly reviewed and action taken to minimise or eliminate any identified risks. Timescale for action 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP12 OP15 OP20 OP22 Good Practice Recommendations The manager should ensure that there are suitable opportunities for social interaction for people who do not wish to take part in organised activities. The manager should ensure that the days menu is clearly displayed for service users. The manager should ensure that service users are able to safely access the gardens. The manager should ensure that bathrooms are appropriate to the needs of service users. Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Beech Tree House DS0000016082.V295512.R01.S.doc Version 5.2 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. 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