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Inspection on 22/08/05 for Blyford Residential Home

Also see our care home review for Blyford Residential Home for more information

This inspection was carried out on 22nd August 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The overall feel of the home is pleasant. The maintenance and furnishing of the building is good. Everywhere feels airy, spacious and is clean. The person centred assessments are informative and the life story work is extremely well done. There was a `likes and dislikes wheel` in each record seen that gave very good individual preferences. Meals are well cooked and served with a choice of dishes with extras such as gravy and bread and butter served separately. Residents are encouraged to participate in activities appropriate to their abilities and interests.

What has improved since the last inspection?

The majority of requirements given at the last inspection have been complied with. A lot of work has been concentrated on getting the medication administration practice up to the expected standards. Although there were some issues observed on the day it was clear that there had been improvements made. Old carpets in two residents` rooms have been renewed with vinyl flooring to overcome the problem of frequent soiling and the associated odours. An area of corridor, which had been used to store hoists that made it both unattractive, and a hazard, as a fire exit was blocked, has been converted into a pleasant seating area. Records show evidence of routine monitoring of all residents for their susceptibility to developing pressure sores.

What the care home could do better:

There are several areas of practice that need to be addressed to offer increased protection to residents. Updated training in Protection of Vulnerable Adults should be undertaken urgently by all staff to ensure they are aware of the correct procedures if required. The importance of correctly following Infection Control Policy with regard to managing soiled linen must be emphasised to protect both residents and staff. Further work and training must be done to ensure that administration of medication meets the safe standards required to protect residents. Two of the five visitors comment cards received prior to the inspection said there was not always enough staff on duty. Some staff spoken with also said that there were times when the needs of the residents would be met better and more speedily if there were more staff available. The manager said that an advertisement had been placed to recruit new staff and once there were new appointments the pressure on the rotas should be eased.

CARE HOMES FOR OLDER PEOPLE Blyford Residential Home 61 Blyford Road Lowestoft Suffolk NR32 4PZ Lead Inspector Jane Offord Announced 22 August 2005 nd 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. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Blyford Residential Home Address 61 Blyford Road, Lowestoft, Suffolk, NR32 4PZ 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) 01502 405420 01502 405429 Suffolk County Council Mrs Sharon Jane Hurren Care Home 36 Category(ies) of Dementia Over 65 (DE)E 24, Old Age (OP)12, registration, with number of places Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Rosedene House may accommodate persons of either sex, over 65 years who require care by reasons of old age (not to exceed 12 persons). Woodleigh House and Foxfields House may accommodate persons of either sex, over 65 years who require care by reason of a diagnosis of dementia (not to exceed 12 persons in each house). The total number of service users accommodated in the home must not exceed 36 persons. Date of last inspection 24/11/04 Brief Description of the Service: Blyford is a residential home which was purpose built and is owned by Suffolk County Council. It is situated in a quiet area of Lowestoft, to the north of the town. Although it is some distance from the town centre there are some shops and facilities nearby. The building is single storey and divided into three houses, Rosedene, Woodleigh and Foxfields. Each house offers accommodation for twelve residents in single rooms with en suite facilities. Rosedene is registered to provide for twelve older people who need care, not nursing care, and Woodleigh and Foxfields each offer care to twelve older people with dementia. The houses all have their own front doors, lounges, dining areas and indoor conservatory space. The gardens are attractive, secure and accessible to the residents. There is a day care service within the same building which the residents can attend if they choose. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on a weekday between 10.00 and 17.00. The registered manager of the home was available throughout the day and the inspector spoke with a number of other staff, both care and ancillary, in the course of the day. Files and care plans for five residents, personal records for three staff members, the accident records, the policy folder, duty rotas and menus were all seen. Part of a medication administration round and the lunchtime meal were observed. A guided tour of the building was given but the inspector also had the freedom to visit areas at will. A number of residents and two visitors were spoken with during the inspection. The home felt calm on the day of inspection and residents were occupied with pursuits of their choice. Some urine odours were noted but they were not persistently in the same places, indicating that there were temporary problems that were dealt with as they arose. Staff were observed interacting respectfully and appropriately with residents. Visitors came and went in the course of the day and made use of the various seating alcoves dotted around the building, for privacy with the residents. What the service does well: The overall feel of the home is pleasant. The maintenance and furnishing of the building is good. Everywhere feels airy, spacious and is clean. The person centred assessments are informative and the life story work is extremely well done. There was a ‘likes and dislikes wheel’ in each record seen that gave very good individual preferences. Meals are well cooked and served with a choice of dishes with extras such as gravy and bread and butter served separately. Residents are encouraged to participate in activities appropriate to their abilities and interests. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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 standard(s) None EVIDENCE: Not applicable Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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, 10 People who use this service can expect that their health and social needs will be fully met, an individual care plan developed and that they will be treated with respect. However they cannot be assured that they will be protected by the present medication administration practice. EVIDENCE: Residents’ files had details of the health professionals each resident consulted and records of visits. There was evidence that residents had seen GPs, opticians, district nurses, psychiatrists, chiropodists and specialist nurses such as diabetes and continence advisors. Person centred assessments in the files seen covered a wide range of headings from communication, mobility and sleep to physical care, past medical history, continence, orientation and memory. Each record also had a manual handling assessment and a Braden score, which is used to assess a person’s potential to develop pressure sores. A resident with a score ‘at risk’ would be assessed for use of specialised equipment such as air cushions or mattresses, and some of these were seen in use. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 11 The manager said that risk assessments were done for the use of bed rails to protect residents. Pressure mats were also used in a number of residents’ rooms. A record of the consultation and decision making process should be kept in the residents’ files. The medication policy included guidelines on the acceptability of giving medication covertly. Each resident’s file had a night care plan with details of their usual sleep pattern and interventions if they were having difficulty sleeping. One recorded ‘likes the bedside light left on at night and the door closed’. One file contained a fax from a relative expressing concerns about the resident’s new medication and the effect it was having. There was evidence that the staff contacted the psychiatrist who had prescribed it and it was stopped a few days later on their instructions. The records show the activities that have been undertaken and the daily notes include reference to the residents’ moods and behaviour. Each file seen had a ‘likes and dislikes wheel’ that recorded personal preferences from particular food to favourite pastimes. One ‘wheel’ listed an interest in crosswords and a preferred newspaper. It also said that if the resident became restless ‘music relaxes them’. Staff were seen encouraging residents to eat and expressing concern about people who did not have an appetite. Records were kept in some files of nutrition intake and residents were weighed regularly. Staff were seen knocking on doors prior to entering residents’ rooms. One member of staff spoken with was able to clearly explain how they respected the dignity and privacy of residents as they worked with them by closing doors before starting personal care, ensuring that clothing was correctly worn and asking permission before starting a care intervention. The manager told the inspector that there had been a drug error two days earlier that was being dealt with. The member of staff involved was not allowed to administer medication until the investigation had been completed and an action plan drawn up to address any contributing factors. A copy will be forwarded to the Commission for Social Care Inspection (CSCI). The inspector observed part of the lunchtime drug round. The medication administration records (MAR sheets) had been correctly completed with appropriate codes used and ‘as required’ (PRN) medication doses indicated if there was an option. The controlled drugs (CD) book and store were seen and tallied. The drugs refrigerator was clean and records showed it was maintained at the correct temperature for the storage of medicines. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 12 The practice of the member of staff observed on the day was not safe. Medication was dispensed without reference to the MAR sheets and a number of MAR sheets were then signed at once. It is possible that the member of staff was made anxious by the presence of the inspector but their practice was unsafe and open to errors. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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, 13, 14, 15 People who use this service can expect to be given choices with respect of diet, the way they spend their time, and maintaining contact with family, friends and community if they choose. EVIDENCE: The kitchen was seen on the day of inspection and was clean and tidy with a wide range of dry, fresh and frozen foodstuff all correctly stored and labelled. The cook talked about the menus and the choice of meals that were offered. There is one main cooked meal at lunchtime with a wide selection of other standard options such as jacket potato plus filling, fish dish, omelette or salads. There is also a range of desserts offered. The meal seen looked appetising and was served hot. The residents seemed to enjoy it and at least one had second helpings. Visitors were seen during the day and one said the food was ‘marvellous’. Their relative had not been a resident for long but had gained weight since admission. Their lack of appetite and poor weight had been a source of concern prior to admission. One of the younger residents had, until recently, had their parents alive and the care plan included details of maintaining contact with them. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 14 During the morning residents were observed making use of a variety of areas in the building. Some spent time in their room, some were in one of the lounges watching a video or listening to music, one or two were relaxing in the conservatory and a number were sitting in the garden under sunshades enjoying watching some ducks splashing in water. Later in the day a resident told the inspector that they had played cards and ‘Connect 4’ with the activity carer. They also said that they joined the day centre activities if there was a musical session and enjoyed that, as they liked singing. One resident who ‘likes to be busy’ was carefully filling in a colouring book but said they played the piano sometimes too. The home had recently held a Summer Fete to raise money for some outings. Several residents talked about the success of the Fete and their responsibility in managing a stall. One had received a letter of thanks from the manager, which had pleased them a great deal. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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, 18 People who use this service may not be assured that any complaint will be acted upon, as the complaints policy is not widely known. Although staff can identify abusive situations, the present training may not be adequate to protect residents if a potentially abusive situation needed to be referred for investigation. EVIDENCE: The manager showed a new Service Users Guide, which has been recently compiled in response to a requirement from the last inspection. It was well presented but did not contain a referral to the complaints policy. Three of the five comment cards received from visitors prior to the inspection said they did not know about the complaints policy and one visitor spoken to on the day did not know how or who to complaint to if they needed. The manager talked through a recent incident that involved the Protection of Vulnerable People team (POVA). The incident had been appropriately handled and resolved. It had not involved any staff being investigated. Discussions with staff showed that they were able to recognise potentially abusive situations and were aware of the vulnerability of the residents. However they were less clear on the correct procedure for reporting suspicions. Both staff and the manager recognised the need for updating training in this area to offer full protection to residents. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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, 20, 21, 22, 25, 26 People who use this service can expect to live in a comfortable, purpose built environment that is well maintained and gives access to safe gardens. They cannot be assured that the present Infection Control practices relating to management of soiled linen will protect them. EVIDENCE: The home is single storey and purpose built. It offers domestic style dining areas and kitchens in each of the three units. There is ample attractive corridor space for residents to take exercise in safety, as there is a discreet alarm system in place on the main entrance door to the units. There are rails throughout the corridors for support and frequent seating areas to rest. The décor throughout the home was pleasant and in good order. The kitchen areas had been recently redecorated and tiled with a different colour scheme in each one. Access to the gardens was level and each unit had a safe garden area to use. There was garden furniture available and the planting was colourful. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 17 All the bedrooms were single with en suite facilities but there were assisted bathrooms and toilets in each unit as well. Bath hoists and raised toilet seats were available if required. The water in a bathroom was checked and the temperature was close to 43 degrees Centigrade. Certificates were seen for the maintenance of the heating system, the fire equipment and the emergency lighting. The laundry was visited and the staff member talked to the inspector. The washing machines automatically add detergents so the staff member does not handle cleaning agents. The machines have a sluicing facility and the programme for soiled washing reaches the appropriate temperature to control the risk of infection. However the system of using red bags that disintegrate during washing for sending soiled linen to the laundry is not being correctly implemented. The bags are being filled too full which means there is a risk that the linen is not properly washed. They are also being used for any washing, so that soiled and unsoiled are mixed, which means that they need to be sorted by hand. These are unacceptable practices and put residents and staff at risk. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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, 30 People who use this service can expect to be cared for by staff who have been properly recruited, inducted and trained however they cannot be assured that there will be sufficient staff at all times to meet their needs. EVIDENCE: Three staff personnel files were seen and they all showed evidence of the correct checks being undertaken prior to appointment. Each had two references, an up to date enhanced Criminal Record Bureau (CRB) check and evidence of proof of identity. The files also contained documented evidence of the induction done by the staff member. Training in manual handling, fire safety, first aid and dementia had been done. There were records of more specialised training taking place for continence, medication administration and COSHH guidelines. Rotas were seen and showed that each unit had two carers on duty on the early and late shifts with a team leader overseeing all the units. There was also a ‘float’ carer at busy times working a short shift. Each unit had a waking carer on duty at night and a team leader overseeing all units. During the day there was a rota of domestics, a laundry worker and a handyman. The head cook managed the rotas for the kitchen staff. Two of the five comment cards received prior to this inspection indicated that in the person’s opinion, there was not always enough staff on duty. One visitor spoken with said that it was sometimes difficult to find a member of staff. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 19 Staff spoken with said that as the residents became frailer their needs were greater and that there were times when there did not feel as if there were sufficient staff to meet them. Concerns were expressed that in order for staff to have their correct break periods twelve residents could be in the care of one member of staff for up to an hour. The manager acknowledged that there were times when the ‘float’ carer had been incorporated into the main team to fill a gap in the rota or to cover sickness. A drive to recruit relief staff is underway and the manager is confident that new staff will alleviate the problem. The assessed needs of residents and the numbers and skill mix of staff to meet them must be kept under review. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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) 33, 36, 37, 38 People who use this service can expect that appropriately supervised staff will promote their health and welfare, that their personal records will be kept securely and that their views about the service will be sought periodically. EVIDENCE: Staff files had records of supervision contracts and sessions. Staff spoken with confirmed that they received regular supervision and were able to discuss work related issues and training needs. The files also had Personal Development Plans (PDP) that were reviewed annually. All records were kept securely in the team leaders’ office. Care plans were available for the staff to consult as needed. Staff, visitors and some residents were aware that this inspection had been planned. Five visitors and five residents had completed comment cards prior to the inspection. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 21 Residents’ meetings in Rosedene House take place periodically, chaired by staff members and minutes are taken. There are plans to undertake a residents’ survey soon as the last one was eighteen months ago. There was evidence of good practice in relation to COSHH guidelines with all cleaning agents secured and explicit instructions available in all the sluice areas. COSHH training is updated annually for all domestic staff. Risk assessments were seen in relation to manual handling, water temperatures, waste disposal, spillages, fire risk and allergies to working equipment i.e. latex gloves. Kitchen staff undertake basic food hygiene training routinely and the head cook is studying for an examination in Advanced Food Hygiene. Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 x x 3 1 STAFFING Standard No Score 27 2 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 2 x 2 x x 3 x x 3 3 3 Blyford Residential Home I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 23 None 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 9 Regulation 13 (2) Requirement Medication administration must be carried out by competent staff who adhere to safe practices. An action plan in relation to a recent medication error must be forwarded to CSCI. The Service Users Guide must include a summary of the complaints policy. Updated POVA training for all staff must be undertaken. The Infection Control policy in relation to managing soiled linen must be adhered to. Staffing rotas and numbers of staff must be reviewed in relation to the changing care needs of residents. Timescale for action immediate. 2. 3. 4. 5. 16 18 26 27 5 (1) (e) Reg 22. 13 (6) 13 (3) 18 (1) (a) 30/9/05 30/11/05 immediate. 30/9/05 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. Refer to Standard 7 Good Practice Recommendations The decision to use a pressure mat in a residents room should be explained and recorded in their records. I54-I04 S37146 Blyford V234693 050822 Stage 4.doc Version 1.40 Page 24 Blyford Residential Home Commission for Social Care Inspection 5th Floor, St Vincent House Cutler Street Ipswich IP1 1UQ 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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