Inspection on 09/06/05 for Blackthorns

This inspection was carried out on 9th June 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 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

Blackthorns 23/05/07

Blackthorns 31/08/06

Blackthorns 18/01/06

Blackthorns 14/03/05

Blackthorns 20/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE BLACKTHORNS 21-29 Dooley Road Halstead Essex C09 1JW Lead Inspector Kay Mehrtens Final Unannounced 09 June 2005 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 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. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Blackthorns Address 21-29 Dooley Road, Halstead. Essex C09 1JW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01787 472170 01787 476342 Runwood Homes Plc Rosalind Garnham Care Home 44 Category(ies) of Dementia - over 65 years of age (23), Old age , registration, with number not falling within any other category (44) of places BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14.03.05 Brief Description of the Service: Blackthorns provide residential care for thirty-nine residents within a four units. The home has a large lounge for all service users and each of the four units has its own communal area. The home is purpose built; recent building work has increased the number of registered rooms to 44. The home also provides accommodation for 5 people on a short-term respite basis. Most of these service users access the day centre located adjacent to the home. The external day care service users access their centre through its own separate entrance. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 9th June 2005, lasting 5 hours. The inspection process included: discussions with the manager, six care staff, fifteen residents, three relatives and two visitors. The premises were inspected, including the grounds. Samples of records and residents’ care plans were inspected. The inspection covered seventeen standards. The home was clean and well maintained. The staff were caring and had a positive approach to the training opportunities provided. The manager approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. There are still some outstanding requirements from previous visits with regard to staffing levels, premises and the failure to provide a Statement of Terms and Conditions for respite residents. The registered person, upon receipt of this report, must address these requirements and they will be monitored. Failure to meet these requirements will lead the commission to seek legal advice regarding enforcement action. What the service does well: What has improved since the last inspection? Care plans have improved since the last inspection. There was good evidence of residents’ involvement in their care plans and reviews. The manager has worked well in improving the organisation and systems with regard to record keeping. There are now good systems in place for monitoring, recording and reviewing residents’ health care, especially following falls and accidents. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 6 The staff have been provided with more opportunities to attend different training courses relevant to the residents’ needs. What they could do better: 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. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 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 standard(s) 2 and 3 standard 6 is not applicable There is insufficient information available for respite residents to inform them of the costs and care provision for their stay in the home. The arrangements for pre-admission assessments are good so staff are aware of residents’ needs prior to their placement. EVIDENCE: BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 9 The inspection again highlighted the shortfall to provide a statement of terms and conditions for those residents receiving respite care. They are not provided with information regarding the rooms to be occupied; the care covered by the fee; the fees payable and by whom; additional charges; contractual rights and obligations and the terms with regard to the period of occupancy. This is a continuing shortfall that must be addressed. The provider did respond to the last inspection, in their action plan, by stating that, “the statement of terms and conditions are currently being reviewed by the operations director and will be put into place for service users requirement respite stays at the home.” The previous timescales were included in the inspection reports of the 20th October 2004 and the 14th March 2005 and the statement has yet to be “put into place”. This issue has been raised at previous inspections and it is a matter of concern that it has not been addressed. Failure to meet this requirement will lead the commission to seek legal advice regarding enforcement action. The manager undertakes the pre-admission assessments on all new referrals. The documentation seen was very detailed and covered all aspects of the residents’ care needs and history. It provided a good picture of the person being assessed and enabled them to feel part of the process, as the information is gathered from the prospective resident, their family and other agencies, as appropriate. The assessments provided good information to enable the development of useful initial care plans and consistent care on admission to the home. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 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 standard(s) 7,8,9 and 10 The care plans and health monitoring have improved since the last inspection and provide staff with good information to meet residents’ needs. EVIDENCE: Three care files were inspected. The inspector discussed the care plan with one of the residents concerned. They were aware of their plan and told the inspector that staff had sat with them, when they arrived, to ask questions about themselves. They appreciated that staff needed to know how to meet their needs and felt part of the process. The care plans had improved since the last inspection. They reflected the information gathered at the assessment stage and the individual needs and wishes of the residents. There was good evidence of detailed information gathering that included the resident and their family. The format used for assessment and planning addressed all the required aspects of care and provided staff with clear actions to meet the identified needs of residents in their care. The inspector was impressed by the work put into one care plan, by a senior member of staff. They had ensured that the immediate needs of a new resident were recorded and shared with the care staff. Once this was in place, the member of staff informed the inspector that they had planned to sit with BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 11 the resident to fully complete the plan and gather more information. The records contained good information regarding the residents’ social history, religious needs and hobbies. Another care plan contained detailed required information for staff to enable them and the resident to communicate effectively. Care files were well organised. Care plans are reviewed regularly with the resident and their family, as appropriate and signed. Residents and their families were pleased with the health care provided at the home. The manager and staff have worked well in addressing the shortfalls identified at the last inspection and as part of a complaint investigation, reported in the last inspection report. All accidents and falls were well recorded and are referred to the commission, as required. The commission did express some concern about a recent increase in the number of accidents and falls over the past months. This was brought to the attention of the manager and the provider. In response to these concerns the staffing levels have been increased for the morning shift and are to be reviewed for the rest of the working day. This inspection, and previous inspections, has highlighted the need for staffing levels to be increased throughout the waking day. The manager has also developed the accident procedures to include a referral to the district nurse or other health professional following any fall or accident. The records examined evidenced these referrals and monitoring of residents by health professionals. Several residents informed the inspector that they felt their health care needs were well met. They felt that the staff were very attentive and responded well to any request to see the nurse or doctor. The staff demonstrated a good understanding and awareness of the individual needs of residents. They were observed to be very gentle and respectful when responding to and listening to comments from residents about their health. Care plans contained required and useful information about residents’ individual health care needs and history. The storage and audit of medication had improved since the last inspection. A senior member of staff had worked well in addressing the shortfalls highlighted at the last inspection. The medication and treatment room was clean, tidy and well organised. The medication round was observed. Senior staff are trained with regard to medication administration and the process was efficient and respectful of residents’ needs and wishes. The inspector observed many instances of care staff interacting with residents in a respectful and appropriate manner that ensured their dignity and confidentiality. This was commented upon by many residents and their families throughout the inspection. They stated that they found the staff to be “respectful, attentive and polite”. Residents that share a room are provided with a screen and informed the inspector that it is used, if they want it to be and their privacy is respected and achieved. One resident told the inspector BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 12 that the staff were gentle and maintained their dignity whilst giving them a wash or a bath. They felt that their personal care needs were dealt with in a respectful way. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 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 standard(s) 12 and 13 The staff provide opportunities for residents to participate in activities in the home, that reflect residents wishes, within the limited budget available to them. Residents are supported in maintaining contact with family and friends who are made welcome when visiting. EVIDENCE: BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 14 The residents are provided with a large communal lounge that is used for musical events and other activities including church services. Some residents enjoyed the church communion that took place during the inspection. They liked the link with their old friends and the local community. Residents are supported in attending worship according to their faith or choice. The care staff continue to raise money to fund activities, entertainment and purchases of activity equipment. The home does not have an allocated activity fund though the provider does employ an activity worker for 17 hours a week. The residents enjoy “visiting” the home’s sweet and toiletries shop that is “open every Wednesday”. The residents clearly enjoyed time sitting and chatting with care staff, generally in the afternoons. They told the inspector that liked the opportunity to do crosswords, watch films and read the paper with the care staff. Some staff were busy working in the enclosed garden of the home, in their off duty time, during the inspection. They had raised money to purchase flowers, garden furniture and other equipment to make this area more enjoyable and accessible for the residents. Whilst their efforts are to be commended, the provision of furniture and facilities that allow residents to access the outdoors must be provided by the registered provider, as stated in National Minimum Standard 19. Regular meetings are held for service users to discuss all aspects of the home. The next meeting is planned for this month and is run by the activity worker. The care staff informed the inspector that she runs these meetings without the manager and other staff present to allow residents to feel able to speak freely. There is information displayed advising service users of an advocacy service, if required. Residents and their visitors informed the inspector that they can visit any time and are always made welcome. They were very complementary regarding the hospitality and kindness shown by the staff when they visit. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 and 18 The home has a good complaints system and there was evidence that complainants are listened to. The manager and staff have a good understanding of the need to protect residents from abuse. EVIDENCE: The manager had acted upon her action plan in response to a previous complaint investigated by the commission. This was reported at the last inspection. The action taken by the manager and staff has led to a marked development in the monitoring of residents’ health care needs and improved contact and advice from health care professionals. The manager responded in an active and positive manner to the requirements raised in the complaint report. This was also evident from the records of complaints received in the home since the last inspection. The records evidence a listening process that includes positive action and approach with the complainant so that complaints are addressed with satisfactory outcomes. The home has clear policies and procedures with regard to the protection of vulnerable adults. There is a good programme of training for staff that includes Protection of Vulnerable Adults. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 19 and 26 The standard of maintenance in the home is poor and provides residents with areas that are unpleasant and not homely. EVIDENCE: The provider has informed the Commission for Social Care Inspection of their intention to refurbish the home. The commission has requested information regarding their plans. The commission, to date, has received no plans. The carpets in the corridor area of Poppy and Primrose units still remain badly stained and in need of urgent replacement. This was raised at the last two inspections. The concerns expressed, at the last inspection, regarding the poor state of the hairdressing room and concern regarding the electrics in this room had not been addressed. No plan for maintenance was available for inspection. The provider had addressed the requirement regarding the rotten window frames. However, the provider’s action plan for the last inspection did not state how the requirements regarding the carpets and hairdressing room were to be addressed. Their response stated that, “Runwood Head office are aware of the BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 17 other maintenance issues raised in this report”. This issue has been raised at previous inspections and it is a matter of concern that it has not been addressed. Failure to meet this requirement will lead the commission to seek legal advice regarding enforcement action. The manager was advised by the inspector to have the electrics in the hairdressing room inspected by a qualified electrician, as a matter of urgency, and to inform the commission of the outcome. The home does accommodate residents with hearing impairment. There is no “loop” provided in the home to assist those residents that use hearing aids. As previously stated in this report, the care staff had purchased garden furniture and flowers for the courtyard area. They were busy ensuring that is was a pleasant area for residents to enjoy. The provider had not provided any funds for the purchase of furniture or flowers for this area. The standard of cleanliness was good. There was good evidence of the provision of infection control equipment for staff in all residents’ bedrooms and bathrooms as well as in the dining and lounge areas. Staff were observed to be following infection control procedures throughout the inspection, at all times whilst administering personal care to residents. Residents were pleased with the laundry facilities in the home. They were also complementary regarding the standard of cleanliness. They told the inspector that “it was a clean place; their clothes were always lovely, clean and well ironed”. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels are not sufficient to meet the needs of the residents. Staff have a positive attitude towards the care of residents and the training provided. EVIDENCE: There was one senior and six care staff on duty for the morning shift. This reduces to five care staff in the afternoon and evening shift. The home is staffed by one senior and two waking night staff during the night shift. The inspector was pleased to note that staffing levels had been increased for the morning shift and part of the afternoon. The staff were also pleased with the extra staffing and stated that it allowed them more time to meet residents’ care needs. This increase was in response to the recent expression of concern, voiced by the commission, following a marked increase in accidents and falls in the home. The need to increase staffing levels has been raised at previous inspections. The provider’s response has been to “review staffing levels”. However, the levels remain insufficient to care for the needs of the resident group, especially as the home is registered to care for people with dementia. The inspector shared her concerns with the manager and requested that the staffing levels remain the same throughout the day. This issue has been raised at previous inspections and it is a matter of concern that it has not been addressed. Failure to meet this requirement will lead the commission to seek legal advice regarding enforcement action. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 19 The staff recruitment records were well organised and all required checks and paperwork had been undertaken by the manager, prior to any staff starting employment at the home. The home uses very few agency staff. The residents’ benefit from a stable, caring and committed staff group. Residents and visitors spoke very highly of the manager and staff at the home. There were several letters of compliment and boxes of chocolates given to staff from happy residents and relatives. The inspector had the opportunity to speak to several residents and visitors during the inspection. Their comments were positive and reflected the good practice observed. Some residents told the inspector that the “staff listen to them…. It is a wonderful place….staff are kind, friendly and respectful”. The care staff informed the inspector that they enjoyed the increase in training opportunities. They stated that they had recently attended several courses with regard to adult protection, dementia care, manual handling, first aid, food hygiene and bereavement care. They are also being supported to attend National Vocational Qualification level 2 though the poor availability of assessors has hindered their progress. The training records were well managed and systems were in place to ensure that all staff receive the statutory training. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 37 The manager is organised and works well with her staff team to provide a positive and caring home for residents. EVIDENCE: The manager informed the inspector that she is soon to recruit a deputy. She stated that this will help her in improving the assessment process and to meeting residents’ needs. The staff felt well supported by the manager and residents were positive in their comments about the manager. It was evident that she is “present” in the home and well known to residents and visitors. She was positive and cooperative throughout the inspection process and keen to improve the standard of care in the home. Standard 33 was not fully inspected. The manager informed the inspector that the home is due to have a quality review by the provider and the contract commissioners in the next month. She hopes to use these reviews to gather information from residents and other parties and form an action plan to address any issues raised. This will be monitored at the next inspection. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 21 Records inspected were well maintained. Requirements highlighted at the last inspection had been addressed. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 3 x x x 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 x 15 x COMPLAINTS AND PROTECTION 1 x x x x x x 3 STAFFING Standard No Score 27 1 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x 3 x BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 23 no 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 2 Regulation 5 Timescale for action The registered person must upon ensure that all service users reciept of receive a statement of terms and this report. conditions. This refers specifically to the respite/short stay service users. This is a repeat requirement for the 3rd time. The timescales for the 20th October 2004 and 14th March 2005 have not been met. The registered person must 11.07.05 ensure that the premises are well maintained and do not present a hazard to service user. This refers specifically to the carpets and hairdressing room. This is a repeat requirement for the 3rd time. The timescales for the 20th October 2004 and 14th March 2005 have not been met. The registered person must 11.07.05 ensure that the needs of people with hearing impairment are met through the provision of a loop system. The registered person must upon ensure that an assessment of reciept of the electrics in the hairdressing this report. room is undertaken. The registered person must upon ensure that the garden, receipt of Version 1.30 Page 24 Requirement 2. 19 23 3. 22 23 4. 19 23 5. 19 23 BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc 6. 27 18 particularly the enclosed courtyard, is kept tidy, safe, attractive and accessible to residents for them to enjoy the sunlight. The registered person must ensure that staff levels are increased to ensure the needs of the service users are met. This is a repeat requirement for the 2nd time. The timescale for 14th March 2005 has not been met. this report. upon receipt of this report. 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 19 22 33 Good Practice Recommendations The registered person should supply an improvement programme for the premises, including the décor. This is a repeat recommendation. The registered person should seek advice regarding wheelchair access throughout the home. This will be monitored at each inspection. The registered person should ensure that the views of family, friends and other stakeholders are sought, with all outcomes made available, as part of the quality assurance process. This will be monitored at the next inspection. BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex CO1 1RJ 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 BLACKTHORNS I56-I05 Blackthornes S17771 V222427 UI 090605 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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