Inspection on 07/11/06 for Brigstock Manor

This inspection was carried out on 7th November 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

Brigstock Manor 04/11/08

Brigstock Manor 17/02/06

Brigstock Manor 11/07/05

Brigstock Manor 11/01/05

Brigstock Manor 19/04/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Brigstock Manor 129 Brigstock Road Thornton Heath Croydon Surrey CR7 7JN Lead Inspector Michael Williams Key Unannounced Inspection 7th November 2006 11:00a 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 Brigstock Manor DS0000043307.V314560.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. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brigstock Manor Address 129 Brigstock Road Thornton Heath Croydon Surrey CR7 7JN 020 8684 1912 020 8684 3585 ann.denman@croydon.gov.uk 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) London Borough of Croydon Ann Elizabeth Denman Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age (0) of places Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2006 Brief Description of the Service: Brigstock Manor is a large residential establishment registered with the CSCI, the Commission, to provide personal care for up to 26 elderly service users on a permanent basis, and it has 7 respite, short stay beds. The home is owned and run by the London Borough of Croydon. The home is situated on a busy main road in Thornton Heath and is therefore close to public transport. The stated philosophy of the home is to provide a caring and homely environment for our service users and to endeavour to treat everyone equally regardless of their disability, gender or ethnic origins. Accommodation is on three floors, with the ground floor being used for respite care. Communal areas comprise small lounges and dining rooms with kitchenettes on each floor. There are bathrooms and toilets on each floor and other facilities include laundry, kitchen administration offices. The home has a large, enclosed garden to the rear and parking space to the side of the premises. Fees as 7th November 2006 were £465. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 11am and included a tour of the premises; meetings with service users, with relatives and with a range of staff, the person in charge. Nine replies were also received to the Commission’s questionnaires circulated to these people. The site visit included examination of a sample of the statutory records. This inspection was also used to monitor compliance with previous requirements. What the service does well: 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 6 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 Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 7 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): NMS 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are being assessed prior to admission so as to assure prospective residents that all their health and social care needs can be met when they are admitted. Whilst intermediate care is not provided respite care is available and again the Commission was able to confirm that suitable arrangements are in place to assess the needs of short-stay residents prior to admission to ensure that even in the short term their needs are clearly identified. EVIDENCE: The residents were the first to contribute to this section of the report and several said they were very pleased with the service they received in arranging for their admission, the admission process itself and the information provided as well as organising of their affairs including transport, medication, money and clothing. The home will be proud to hear that several short-stay residents said they look forward to staying again next year. The information pack provided to each new residents, including the Service User Guide is well presented and includes all the information a new resident might expect Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 8 including details of activities, religious observance, how to complain, fire safety, their contract, and the Commission’s latest report. A very god effort by the home. The commission cross-checked the details provided by residents by examining the Service User Guide and talking to the person in charge as well as checking a range of records including the complaints record, care plans and menus. Areas of strength are residents’ very positive opinions about their own admission arrangements plus the well presented information given to new residents and as no matters requiring improvement arise this section, about choice on admission, is assessed as good. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 8 9 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Plans are in place for each service user. This means their health and personal care needs are clearly set out and there are action plans to ensure their personal goals can be fully met in this care home. Medication can either be administered by the care staff or staff will support service users to hold and administer their own medication in order to maximise their independence. Service users are treated with respect and dignity. EVIDENCE: A plan of care is drawn up with each service user setting out their individual social and health care needs so that staff can use this plan as the basis for the care they deliver and these care plan include assessment of any risks to the resident’s health or their safety. The home is promoting and maintaining service users’ health by ensuring they have access to health care services to meet their assessed needs and in doing so the home is supporting service users to make decisions about how their health will be managed. Each resident’s case file includes details of all professional contacts including doctors, nurses, chiropodists, and so forth. Daily notes record how health care Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 10 is being monitored and additional records such as weight, food and fluid charts are kept if needed. The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service users who wish to be responsible for their own medication so that they may do so safely - for example when residents manage their own diabetes including daily insulin injections. A resident was hoping for a more flexible diet even though diabetic and it is recommended that the home consult the Diabetic service to see how this can be safely managed by the home. This may include more frequent blood testing of the resident so as to balance diet and insulin. A detailed check of the procedures for handling medication, including the storage, recording and administration of medicines, identified no problems. When providing personal care staff are ensuring service users’ privacy and dignity is being maintained at all times so that service users feel their right to be treated with respect is upheld. It was noted that staff knock the door before entering rooms and ask the opinion of residents when the occasion suggests they should - such as turning down the television volume and so forth. The service user guide also indicates the respect and dignity are core elements of the care that will be provided. Areas of strength are the good management of health and social care and the effective management medicines, and as matters requiring improvement arise this section, about health and social care, is assessed as good. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 13 14 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable setting for service users to engage in social and cultural activities as they choose and in accordance with their expectations of the home, including ay expectations in respect of their diversity. The staff assist and encourage service users to lead as fulfilled lives as they wish or their frailty allows. Service users are encouraged and given every opportunity to maintain contact with family and friends and the community. A full and wholesome menu is available for all service users to ensure their health and well being and to provide them with a diet that suites them including those who wish for meals from other cultures/nations. EVIDENCE: The daily routines in this home are reasonably flexible, within the constraints of a large service. Service users are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so and so it was noted on the day of the inspection that there were a wide range of visitors including family and friends, and church visitors as well as professional health carers. The visitors’ book, a required record, confirms this social and professional contact with the wider community including a number of entertainers. Service users are in general receiving a wholesome, appealing and well balanced diet in a Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 12 congenial setting in accordance with their recorded requirements and preferences. Most of the residents attested to the quality of the catering in this home but a small number hoped for a better service, in particular the way in which food is cooked was not to their liking – they said, in their opinion, the cooks lacked experience cooking “ good English food” whilst another wanted “more Continental and Caribbean meals”. Both points of view were discussed in detail and it is a recommendation of this report that these individual residents are consulted about their wishes and preferences; this may include making special provision not only for minority ethnic groups but indigenous English residents as well. It is however also noted that the cooks do consult residents about their choices and are prepared to provide specialist meals and did so on the day of inspection. Despite these few reservations about meals, in general the residents said they were very happy in this care home. This reflects the quiet, tranquil atmosphere evident during this visit. There is ample space for residents to sit where and with whom they please. Staff were with them throughout the day and often engaging them in some activity or conversation. It was also pleasing to hear residents in the various lounges supporting each other and chatting about their news and views – clearly a group of residents who are getting on well together. One aspect of care that did however disappoint and annoy some residents was the dependency of some service users - the effect was that that those will full mental capacity found little companionship with those losing their mental faculties. One resident in particular would like to move but has no friends to assist her in doing so. A recommendation is made to provide advocacy where residents do not have independent personal support. Some residents have visual and hearing impairment and no specialist hearing devices are available for example in communal areas to enable residents to join in conversations and hear the television so a recommendation is made to consult the RNID and RNIB who can supply suitable equipment. In respect of diversity, the person in charge advised the inspector that all residents use English as their language of choice although one or two are not English by birth. Other aspects of diversity were discussed such as the accommodation of residents who may sensory or mobility problems – the home seeks to meet such needs whenever possible, as it is registered to do so, and will be following suggestions about hearing aid devices for use in communal areas. Matters of sexuality diversity were also discussed and the person in charge said all residents are treated with tolerance and forbearance whatever their lifestyle or sexual orientation. Areas of strength are open and welcoming atmosphere of the home, the satisfaction of almost all service users and the social activity available to the that wish to participate. No matters requiring improvement but a number of recommendations are made about meals, advocacy and hearing and visual support so this section, about daily life and social activities, is assessed as good. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for service users and their representatives to either complain or compliment the service. Effective procedures are in place to deal with complaints. Service users confirm that with these arrangements in place they are confident their opinions and concerns are dealt with in a professional and thoughtful manner. Arrangements are also in place to protect the vulnerable service users. EVIDENCE: No formal complaints arose during the course of the inspection but several critical observations were made by some residents about meals; lack hot water for baths; companionship and excessive use of temporary staff. These comments were passed on to the person in charge and noting that the residents did not want their comments to be regarded as complaints but as suggestions for improvements. In contrast many people complimented the home and staff team. One complaint was recorded but the file containing the record of complaints was rather full, so it was not easy even for the home’s staff to identify and count recent complaints – a simpler record is suggested. The compliant recorded appears to be dealt with a professional manner but is not yet fully resolved. The service user guide provides information to residents about how they may complain and the home appears to be very receptive to any concerns the residents or their representatives may raise. In respect of the protection of vulnerable persons from abuse staff were clear about reporting untoward incidents to managers and external agencies such as the local Social Service Department or the Commission’s inspectors. The procedures for protecting vulnerable service users is satisfactory; the home Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 14 has a copy of the local authority’s procedures for dealing with allegations of abuse but no such issues have arisen since the previous inspection. Areas of strength are manner in which complaints are dealt with and the procedures for protecting residents and as matters requiring improvement arise so this section, about complaints and protection, is assessed as good. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained and comfortable environment. This is a purpose built, but rather aged, care home and is subject to ongoing refurbishment. It was clean and comfortably warm at the time of inspection. EVIDENCE: This local authority care home is now rather old and showing its age and is in need of regular maintenance to keep it in good working order. Two toilets were leaking; kitchen equipment not working; the water heating has broken down recently and the supply of hot water to a pair of bedrooms is intermittent. All these matters are being attended to; for example engineers were on site to fix the toilets and the potato peeler during then inspection. The residents have commented upon the hot water supplies but they have been assured these matters are being addressed as soon as practicable. Despite these shortcomings, the communal areas are pleasantly decorated. The individual rooms, though not spacious, are adequate and are fitted standard bedroom furniture and fittings. Minor points noted include an old metal bed-frames and worn furniture in some locations, such as the arms of Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 16 chairs in bedrooms and minor damage to walls. This is a large care home but the small units make it a homely environment for the small groups of service users. The home was generally clean and tidy at the time of inspection Areas of strength are homeliness of the units and matters the ongoing need for maintenance are already known to the home so this section (which intends demolishing this building and building a new under the ‘new for old’ programme. So this section about environment, is assessed as adequate. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 28 29 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and the skills mix appeared adequate for the current care needs of service users so as to ensure their wide range of social and health needs could be met. A great number of temporary staff including agency staff are still being employed in the home, Despite the problem of temporary staff the service users appear ‘safe in their hands’ as required by the standards in this section. EVIDENCE: There were 29 residents in the home and there were 4 carers plus two senior staff who can assist in the care of residents as required; plus the person in charge and there were numerous ancillary staff, including the Activities Lady, cooks, cleaners and maintenance personnel. Staff records are now being transferred to the home as required by Regulation but this transfer was not complete by the time of this inspection. Two requirements are re-stated - to employ adequate numbers of permanent staff without unreasonable delay because agency are still employed regularly in this home and secondly to ensure all staff records in respect of staff recruitment are available for inspection by Commission. If the home wishes to keep staff records in the head office it must seek the consent of the Commission to do so and agree the arrangements for the Commission to examine these centrally held records. Whilst interviewing staff it was apparent that they are well informed about their duties and are highly regarded by the service users. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 18 The home is still using too many temporary agency staff; for example on the day of inspection three of the four care staff were temporary agency staff and of those three only one was a long-term contract placement with the home. Several residents were critical of this and commented upon in their feedback to the Commission. The Commission is aware that the programme of ‘new for old’ means that staff will need to be redeployed around the care homes as they are demolished and rebuilt but wherever possible staff must not be temporary if it will affect the continuity of care. Staff induction and training is satisfactory but there was no evidence in the staff files that staff are receiving regular supervised. Areas of strength are the kindliness of staff, their induction and ongoing training whilst matters requiring improvement are the need for a stable staff team and they need regular supervision; so this section, about staffing, is assessed as only adequate. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31 33 35 36 37 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. With a ‘people centred’ approach it was clear that this home is being run in the best interests of the service users and certainly the service users thought so. The manager is registered with the Commission as a person competent to run this care home in accordance with its stated aims and objectives, the national minimum standards and in the best interests of the service users. The home is well managed; including finances and medication for example, and is safe for service users. EVIDENCE: Service users throughout the home were full of praise for the home, its staff and management team. This is a competently run care home. The manager is registered with the Commission and has many years experience in running care homes. The home is managed so as to ensure the health and well being of the service users. Record keeping is proficient. A wide range of records were Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 20 checked, including the Visitors’ book, menus and other kitchen records; staff files; residents care files; cash handling records; the Service User Guide; fire and accident records and the record of complaints. All are maintained to an acceptable standard, so administration in this home is clearly satisfactory. Quality monitoring is based upon the views of service users this home is being run in the best interests of the service users. The home is ensuring that in so far as it is reasonably practical to do so, the health, safety and welfare of service users, and staff, is being promoted and protected and on this occasion no matters of safety need to be addressed. In respect staff supervision, it has been noted under the previous staff heading that there was no record of staff supervision in the staff files checked and the person in charge did not produce any evidence to demonstrate that alls staff receive individual supervision six times per year so a requirement is made to this effect. It is noted that the registered manager has been on leave for some period and this may have affected the programme of staff supervision. Areas of strength are the overall management of the home and the high regard in which management and staff are held by residents; although one matter requiring improvement is staff supervision this section, about the management of the home, is assessed as good. Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 2 3 3 Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP27 Regulation 18(1)(b) Requirement Staff: The person in charge advised the inspector that the home still has many staff vacancies and is reliant upon temporary agency staff. The home is required to employ staff who are not temporary in sufficient numbers to meet the needs of service users. The CSCI acknowledges that an action plan is in place to address this requirement within a reasonable timescale. This requirement is outstanding from 30/08/06. Records: Staff records need to contain the details listed in the Regulations and Schedules including details of police and POVA [Protection of Vulnerable Adults List] checks. The registered provider must seek the agreement of the Commission if they wish to hold any records in its head office. This remains an outstanding requirement from 30/03/06. DS0000043307.V314560.R01.S.doc Timescale for action 30/03/07 2. OP37 17 07/11/06 Brigstock Manor Version 5.2 Page 23 3. OP19 23(2)b Premises: The building and equipment used by staff and residents must be maintained in good working order including the hot water system and toilets. Staff: supervision must be provided for all staff six times each year. 28/02/07 4. OP36 18(2) 30/12/06 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. Refer to Standard OP22 Good Practice Recommendations Sensory impairment: The home is recommended to consult the RNID and RNIB in respect of aids and adaptations that may assist residents maintain their independence; in particular hearing devices that may assist residents in communal areas. Meals: It is recommended that the home consult those residents, including ethnic minority and indigenous English, who have requested improvements in the meals about their specific wishes and preferences for meals and the manner in which they are prepared and served. 2. OP15 Brigstock Manor DS0000043307.V314560.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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