Inspection on 21/06/05 for Druids Meadow

This inspection was carried out on 21st June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Druids Meadow 27/07/06

Druids Meadow 25/11/05

Druids Meadow 18/01/05

Druids Meadow 14/04/04

Druids Meadow 02/12/03

Druids Meadow 05/08/03

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Druids Meadow 6 Manningford Road Druids Heath Birmingham B14 5LD Lead Inspector Karen Thompson Announced 21 June 2005 st 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. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Druids Meadow Address 6 Manningford Road Druids Heath Birmingham B14 5LD 0121 430 5421 0121 430 8603 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) Birmingham City Council Mrs Sandra Middleton Care Home Category(ies) of Care Home registration, with number of places Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1.The home is registered to accommodate 45 adults over 65 years who are in need of care for reasons of old age and may include mild dementia. 2.Registration category will be 45(OP). 3. Minimum staffing levels are maintained at 6 care assistants plus a senior member of staff throughout the waking day of 14.5 hours. 4.In addition to the minimum staffing levels above, there must also be 3 waking night care staff plus a senior on waking or sleeping-in duty. 5. Care/shift manager hours and ancillary staff should be provided in addition to care staff. Date of last inspection 18th Jan 2005 Brief Description of the Service: Druids Meadow is purpose built, 45 bedded home for older people. The home offers a service to forty long stay and five short stay residents with a variety of needs. The home is situated on the outskirts of a residential estate in Druids Heath and is close to local shops and amenities with easy access to several public transport routes. The home is a three storey building that offers single bedroom accomodation on each floor. The ground floor has a large dining room, a hairdressers room, two communal lounges,one visitors lounge, the laundry, main kitchen, medical room and office. There are two lounges and kitchenette on the first floor. On the second floor there is also a lounge, dining room and kitchenette. There are bathing/showering and toilet facilities throughout the home that are equipped to enable staff to assist Service users where necessary. To the rear of the home is a large fenced garden and to the front a large car park. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of this report are following an announced inspection. The inspection was carried out over two days and took fourteen hours. Information for the report was gathered from a number of sources: tour of the building, examination of records and documents, lunch and breakfast with service users, talking to 4 members of staff, talking to 8 service users, completed questionnaires from service users, relatives and multi disciplinary health professionals, plus direct and indirect observation. What the service does well: What has improved since the last inspection? The management of medication has improved since the last inspection to a higher standard. The home has reviewed its activity provision but further work is required so service users are getting the activities they want and at the times they want. The home has reviewed staff training needs and now has access to a resource to help meet these needs. Assessment of potential service users coming into the home has improved ensuring that their needs are identified in advance and can be met by the home. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 6 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. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 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 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 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) 1.2.3.4.5 Information provided for service users it is not as comprehensive as it should be to enable residents to make a fully informed choice about this home. The home has accepted a service user outside its registration category, having a detrimental effect on this service user and others within the home. EVIDENCE: The home has both a statement of purpose and service users guide these require further work to ensure that they are fully informative documents. The statement of purpose also needs to state which bedrooms cannot accommodate all the furniture listed in standard 24 due limited space. Not all service users files contained a contract, and those contracts on file did not state who was paying the fees. Service users are admitted to the home following a Social Worker initial assessment and care plan. Service users needs are being met with the exception of one resident who was inappropriately accommodated at the home, a letter of serious concern was sent following this inspection in regards to this one service user. A relative commented “Druids Meadow is very good…….I have no problems…….mum…is very well cared for. Druids meadow has some good carers”. The inspector received positive comments from multi disciplinary health care professionals, these include the flexibility of the staff to ensure that Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 9 service users were treated individually. Since the previous inspection the homes pre admission assessment tool has been improved the home is in the process of trailing it to consider further developments. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 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) 7.8.9.10 The health needs of service users are well met with evidence of good multidisciplinary working taking place. Recording of health and social care needs further development to ensure that comprehensive plans are in place for each service user, so that they receive consistent levels of care. Medication management was good protecting the well being of service users. EVIDENCE: The inspector witnessed good interaction between staff and service users. Feedback from service users included “ staff are very kind, I feel safe here”, “we’re well looked after”. Staff knowledge was good in relation to meeting service users individual needs but this was not always being demonstrated in the care plans. Skin integrity, manual handling and nutritional risk assessments tools were in place but were not being linked into the care plans. Manual handling assessments were not being reviewed monthly. Training is required for staff in regards to skin integrity as these assessments were not being completed accurately thus a false assessment was obtained. No continence assessments were taking being carried out. One service users psychological needs had clearly changed whilst in the home and appropriate health care referrals had been made, but the care plan did not reflect these changes and how these changing needs were going Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 11 to be met whilst an alternative placement could be obtained. Care plans were not being reviewed monthly and service user involvement was not evident. Multidisciplinary health professionals spoke positively about the home and the staffs’ ability to accommodate service users needs. Access to a dentist was discussed with the Care Manager. Not all service users see a dentist for an annual review. The home does have access to dental practices for some service users and can obtain emergency treatment but this comprehensive coverage for all service users is not available. Medication management overall was good. Medication fridge temperature recordings were noticed to be high on several occasions. The home had not taken any action to rectify these. This was discussed with the Care Manager and it was agreed that either the staff had not reset the thermometer or the fridge needed moving from its position next to the window as the high temperature reading coincided with excessively hot summer days. A tub of aqueous cream was found in one of the bathrooms with no name on it or date of opening. The home has a pay phone located in a small private space. Service users clothes were observed to be nicely laundered. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) .12.13.14.15 The home has systems in place to maintain and provide social activities. The level of provision is varied and does not always meet service users expectations. Meals were wholesome and appealing, meeting service users nutritional needs. EVIDENCE: The home has recently reviewed its provision of activities and feedback from service users, relatives and staff in regards to activities was varied, over half of the service users thought that activities provided were inadequate. One comment received by the inspector was in relation to timing of the activities which needs to be considered, “I like activities but they’re doing it at the wrong time, … would prefer them in the afternoon”. Service users were observed reading large printed book’s the inspector was informed that the home has a library service. Service users were observed to be receiving visitors at various times of the day. Service users bedrooms were individual and personalized with their own possessions. The menu’s given to the inspector demonstrated a varied, wholesome and nutritious diet. The inspector sat with service users for two main meals and had of lunch with service users. The meals were nicely presented and service users were assisted discreetly. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 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 standard(s) 16.18 Systems are in place to ensure that Service users are protected and concerns listen to and processed in a sensitive and professional manner. EVIDENCE: The home has a complaints booklet “ Your Right to be Heard”. During the inspection a complaint in relation to a service user on respite at the home was investigated. The complaint was upheld and the management team responded appropriately and will be reviewing staff knowledge about certain aspects of care and the manner in which care is provided. Arrangements for protecting service users within the home were in place. The home has no policy or procedure in relation to physical intervention. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 14 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) 19.20.21.22.23.24.25.26. Only limited progress has been made in addressing outstanding maintenance issues and as a result the building both external and internal in certain areas is showing evidence of wear and tear. EVIDENCE: The Care Manager had drawn up a schedule for maintenance and renewal of the fabric and decoration of the premise for the forthcoming four years. The home has a new maintenance operative and needs to review its schedule in line with this and other work observed to needs replacing or renewing not listed on the schedule. A number of communal rooms and bedrooms were found to have chipped paintwork along the skirting boards, with paint and wallpaper in need of replacing or repainting. Armchairs in the reception area were worn on the arms and needed replacing. The exterior structure of the building is in need of attention, wood structures were observed to have paint peeling and in some cases wood was rotten. Window frames for service users bedrooms were in a poor state of repair. The external perimeter fence was observed to have gaps allowing access into or out of the garden. The home Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 15 has a variety of communal spaces which were accessible for service users. Service users were observed to have the call bell placed within easy reach so they come summon help if required. Bedrooms did not contain all the furniture and fittings stated in standard 24. Service users whose bedrooms are adequate in size need to be asked whether they would like all the furniture stated in standard 24 and documentation in relation to this discussion needs to be kept on the service users file. Commodes in some bedrooms were observed to be in need of replacement. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 16 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) 27.28.29.30 Staffing levels were adequate levels to meet the needs of service users. The manager has a good understanding of the areas in staff training that need improving and has identified a resources to do this to ensure service users needs are met. EVIDENCE: Staffing levels were adequate in the home and almost half of the care staff are trained to NVQ level 2. Not all staff files contained all the information in relation to staff selection and recruitment, the homes manager will need to obtain missing records that are held centrally at the departments Personnel office so all records are available for inspection. Staff require updated training in a number of areas. The home has access to a number of in house training packages and the care manager stated that she would be auditing training needs and making us of this facility to do so. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 17 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) 31.32.33.37.38 This is a well managed home run for the benefit of service users. Systems are in place to protect the health, safety and well being of service users, but they require further work to reduce the risks for service users is necessary. EVIDENCE: The Care Manager has a wide range of experience of working with older people and has just completed her management qualification and is awaiting confirmation as to whether she has passed. The atmosphere in the home was relaxed and friendly. Service users stated they were happy to approach the management team which was confirmed in practice. Service users commented that “staff were kind”. The last staff meeting was March, the home needs to review this frequency and aim for a minimum of four meetings a year. The home has just completed an external quality assurance audit. The homes team manager who visits every month and records are maintain of these visits. The home conducts resident surveys every three months looking Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 18 at specific topics, such as food and activities. Service users money is kept securely with receipts available for auditing. Records that require up dating and reviewing are individual service statements, manual handling, and residential care agreements. The kitchen was clean. Fridge and freezer temperatures were not being recorded consistently which needs to be addressed. The Care Manager was auditing service user falls further work is required so that possible trends and patterns can be easily identified. Risk assessments were in place for fire and premises. Systems for testing water purity were in place but no Legionella testing certificate was found. The lift had been breaking down and work was on going to resolve this problem, the home could not find its current copy of the lift insurance certificate. Hoisting equipment thought out the home was being serviced and inspected. Fire detection and fighting equipment was being serviced and maintained. The home has clinical waste collected but was also unable to find a valid clinical waste contract. Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 19 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 2 2 x 2 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 2 2 2 2 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 2 3 x 3 3 2 2 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 20 yes 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 1,23 & 24 Regulation 4 (1)(2) Sch 1 Requirement The Registered Person must ensure that the Statement of Purpose and Service Users guide is up to date and lists all the information required in Sch 1. If the home is unable to provide all furniture stated in standard 24 due to limitation of space or manual handling equipement then these bedrooms must be identified in the Statement of Purpose. Outstanding requirement 18th Jan 2005 The Registered Person must ensure that all service users are provided with a residential care agreement (contract) at the point of admission including short stay service users. Outstanding Requirement 18th Jan 2005 The Registered Person must ensure that the service users contract states who is paying the fees. The Registered Person must only admit service users whos needs they are able to meet and are within their registration catergory. The Registered Person must Timescale for action 30th Aug 2005 2. 2 5(2)(b) 30th Aug 2005 3. 2 Sch 4 30th Nov 2005 21th June 2005 4. 4 12(1)_ 5. 7 15(1) 30th Oct Page 21 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 15(2) 6. 7 15(1)(2) 7. 7 15(1)(2) 8. 8 12(1)(a)( b) (3) 9. 10. 8 9 12(1)(a) 13(2) 11. 9 13(2) 12. 12 12(1)(a) ensure that individual service statements are developed further to ensure they detail all aspects of health, personal and social care needs. They must also cover their needs over a twenty four hour period and be reviewed monthly. Outstanding requirement 2004 The Registered Person must ensure manual handling assessments are reviewed every month. Outstanding requirement 18th Jan 2005. The Registered Person must ensure that individual risk assessments refer to any concerns with regards to any psychological issues and how any issues around behavioural changes should be addressed. Outstanding requirement 18th Jan 2005 The Registered Person must ensure that assessements are accurately completed in the following : Nutrition (Outstanding requirement 18th Jan 2005) Continence management The Registered Person must ensure that service users have access to a dentist. The Registered Person must ensure that the medication fridge temperature range remains between 2 & 5 c. The Registered Person must ensure that creams are dated on opening and must be discarded after 28 days and stored correctly on opening. Outstanding requirement 18th Jan 2005 The Registered Person must review the provision and timing of the activities provided for service users. 2005 30th Aug 2005 30th Aug 2005 30th Oct 2005 30th Oct 2005 21st June 2005 21st June 2005 30th Sep 2005 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 22 13. 18 14. 19 15. 20 16. 24 17. 24 The Registered Person must ensure that they have a written policy and procedure on physical intervention. This must be in line with current codes of professional practice recognised by relevant professionals. Outstanding requirement 2004 23(2)(b) The Registered Person must resubmit an up to date programme of planned maintenance and refurishement of the premises. 23(2)(b) The Registered Person must ensure that :Torn wall paper in the lounge is repaired or replaced Carpet in the smoking lounges must be replaced. The cupboard in the kitchenette along the first floor must be replaced. That it replaces worn armchairs in the reception area. Window frames that are in poor condition or rotten are repainted or replaced. An action plan must be resubmitted to CSCI indicating when these matters will be addressed. Work outstanding since 18th Jan 2005 inspection. 16(2)( The Registered Person must c)23(2)(b) ensure that net curtains are fitted to service users bedrooms in order to maintain their privacy. Outstanding requirement 18th Jan 2005 16(2)( The Registered Person must c)23(2)(b) ensure that they audit service users bedrooms in relation to those that need re decorating and repair. Some bedroom commode furniture was found to be worn and old and in need of replacing. e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc 13(6)(7) 30th Sep 2005 30th Aug 2005 30th Dec 2005 30th Dec 2005 30th Sep 2005 Druids Meadow Version 1.30 Page 23 18. 19. 20. 21. 25 28 29 30 13(3) 18(1)(a) Sch 2 18(2) 22. 23. 32 37 24(1) 17(2)Sch 4 24. 38 13(4) 25. 38 13(4) Outstanding requirement 18th Jan 2005 The Registered Person must ensure the home has an up to date Legionella certificate. The Registered Person must ensure that 50 of the care staff have an NVQ 2 in care. The Registered Person must ensure that all staff files meet Sch 2 The Registered Person must ensure that staff receive updated training in fire awareness , food hygiene, manual handling, health and safety and first aid. Outstanding requirement 18th Jan 2005. The Registered Person must ensure that staff meetings occur at least four times a year The Registered Person must ensure that it records with regards to individual service statements and manual handling are up to date Outstanding th requirement 18 Jan 2005. The Registered Person must ensure that the temperature for the refrigerators and freezers in the main kitchen are recorded consistently during the day. Outstanding requirement from 18th Jan 2005. The Registered Person must ensure that the monthly audit of service user falls record is robust enough to spot patterns and trends and appropriate action is taken following the fall. The Registered Person must obtain a current Lift insurance certificate The Registered Person must obtain a current clinical waste certificate. 30th Aud 2005 30th June 2006 30th Sep 2005 30th Nov 2005 30th Oct 2005 30th Aug 2005 21st June 2005 30th sep 2005 26. 27. 28. 38 38 13(3) 13(4) 30th Aug 2005 30th Aug 2005 Page 24 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 29. 16 18(1)(a) The Registered Person must 30th Aug review staff training in relation to 2005 monitoring and recording changes in service users social amd helath care needs. 30. 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 Good Practice Recommendations Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Birmingham and Solihull Local Office 45/46 Stephenson Street Birmingham B2 4UZ 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 Druids Meadow e54_S33439_DruidsMeadow_V226249_210605 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. 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