Inspection on 25/11/05 for Druids Meadow

This inspection was carried out on 25th November 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 21/06/05

Druids Meadow 18/01/05

Druids Meadow 14/04/04

Druids Meadow 02/12/03

Druids Meadow 05/08/03

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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 Kings Heath Birmingham B14 5LD Lead Inspector Karen Thompson Unannounced Inspection 25th November 2005 10:00a 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 Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Druids Meadow Address 6 Manningford Road Kings Heath Birmingham B14 5LD 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) 0121 430 5421 0121 430 8603 Birmingham City Council (S) Mrs Sandra Ann Middleton Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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 Registration category will be 45(OP) Minimum staffing levels are maintained at 6 care assistants plus a senior member of staff throughout the waking day of 14.5 hours 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 Care/shift manager hours and ancillary staff should be provided in addition to care staff 21st June 2005 Date of last inspection Brief Description of the Service: Druids Meadow is a 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 accommodation on each floor. The ground floor has a large dining room, a hairdresser’s room, two communal lounges, one visitors’ lounge, a 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 a 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 DS0000033439.V268261.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The findings of this report are following an unannounced inspection. The inspection was carried out over one day. Information for the report was gathered from a number of sources: tour of the building, examination of records and documents, talking to staff and 4 service users, direct and indirect observation. This report should be read in conjunction with the announced inspection report of 21 June 2005. What the service does well: What has improved since the last inspection? What they could do better: There are a number of outstanding requirements in regards to the environment both externally and internally. A number of communal areas and residents’ bedrooms need to be redecorated and refurnished. Activity provision needs to be reviewed. The home needs to review staff training to ensure that the work force have the skills to deliver the care expected of them. Record keeping in respect of care plans needs to be reviewed. The Statement of Purpose and Service Users Guide need to be updated to ensure that residents are fully informed of what they can expect from the home. Fridge temperatures in the kitchenette areas throughout the home need to be recorded to ensure that food is being stored at the correct temperature so there are no ill effects to residents. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 6 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 DS0000033439.V268261.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 Information provided for service users is not as comprehensive as it should be to enable residents to make a fully informed choice about this home. Nevertheless residents move into the home knowing their needs can be met after an assessment has been undertaken. EVIDENCE: The home has both a Statement of Purpose and Service Users Guide. Work is required to ensure that these documents are comprehensive and informative, a matter which is still outstanding from the previous inspection. Not all residents’ files contained a contract. Residents are admitted to Druids Meadow following a social worker’s initial assessment and a visit to the home where staff carry out a pre-admission assessment. One resident commented on their decision to move into Druids Meadow that: “They were kind and helpful and it was easy to make the choice once it came to stay”. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 9 Staff vacancies have impacted on the provision of service delivered to residents. Residents commented however that: “Help is there if I need it and you know that they will come to your aid”, “you get comfort and kindness here”. New staff have been recruited and the home is awaiting final CRB disclosure clearance on those staff. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10 The health needs of residents are well met with evidence of good multidisciplinary work taking place on a regular basis. Planning to meet health and social care needs requires further development to ensure that a comprehensive plan is in place for each resident. Medication management is good, protecting the well being of residents. EVIDENCE: Care plans require further development to ensure that all residents’ needs will be met. The management team at Druids Meadow has been reviewing the care-planning format and are at present piloting a care plan based on the twenty-four hour clock. The inspector viewed a new care plan and this contained more detail about residents’ choices and preferences and how identified needs were to be met. Care plans did not contain nutritional, continence, mental health or skin integrity assessments for all service users. Manual handling risk assessments were in place but these were not being reviewed monthly. Care plans did not detail how the changing mental health needs of residents were being met. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 11 During the inspection the Chiropodist and District Nurse were observed visiting the home. Specialist equipment for pressure area care was delivered to the home during the inspection. Records demonstrate that a variety of health care professionals visit the home. This information was not always easy to track and the home is advised to review how this information is recorded. Overall medication management was good. All staff dispensing medication have received accredited training. The medication room was observed to be warm, the home needs to monitor the temperature of this room to ensure it does not exceed 25°C as this will affect the storage of medication. Although the home is recording the minimum and maximum fridge temperatures, these were observed to be exceeding 5°C on several occasions and the inspector was advised the home was in the process of ordering a new medication fridge. Scheduled medication is recorded appropriately and stored safely but the home needs to carry out a formal count of this type of medication at least once a day. The home has a pay phone located in a small private space. Residents’ clothes were observed to be nicely laundered. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 15 Residents are helped within the home to exercise choice and control over all aspects of their lives. A variety of leisure and recreational activities are available in the home but not necessarily in the quantity desired by residents. EVIDENCE: One resident commented that they could: “get up and go to bed when I want” and staff “ they do what I tell them to do”. Residents are offered a hot drink in the morning by night staff. A resident also informed the inspector that “they will bring you a drink in the night if you need it”. The staff at Druids Meadow have reviewed the provision of activities following the last inspection and were able to demonstrate that a variety of activities and social contact takes place for residents. The quantity of activities however has dropped recently due to staff vacancies. To ensure consistency and continuity for residents the management team have accessed their own casual staff and known agency staff. These staff due to other commitments have not always been available for a full working shift and this shortfall has meant activities have not always taken place. Visitors were observed around the home. The home had an impressive array of prizes for its Christmas raffle and money raised from this will go into the comfort fund for residents. The local community forum has recently made a Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 13 generous donation to the Comfort fund. The management team intends to spend this money on Christmas entertainment and presents for the residents. A priest visits the home regularly. Newspapers are delivered to the home for residents who want them. Residents’ bedrooms were individual and personalised with their own possessions. The menus shown to the inspector demonstrated a varied, wholesome and nutritious diet. The meals were observed to be nicely presented. Residents commented to the inspector, “food is very good here”. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Systems are in place to ensure that residents are protected and their concerns listened to and processed in a sensitive and professional manner. EVIDENCE: The home has had no complaints since June 2005. The home has a complaints booklet “Your Right to be Heard”. Arrangements for protecting residents within the home were in place. The home has produced a policy/procedure in relation to physical intervention since the last inspection and this meets the standard. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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): 19, 20, 24, 26 Limited progress has been made in addressing outstanding maintenance issues and as a result the building externally and internally in certain areas is showing evidence of wear and tear. EVIDENCE: The home since June has made limited progress in addressing maintenance, redecoration and refurbishment issues. Some commodes have been replaced in bedrooms and the kitchenette cupboards have been revamped. As well as bedrooms and communal areas requiring repainting and redecorating, corridors and bedroom doors now require repainting. The exterior structures of the building are still in need of attention and wood surfaces still have paint peeling from them and rotten wood. Window frames for some residents’ windows are in a poor state of repair. Armchairs in some of the lounge areas were worn on the arms and are in need of repair or replacement. Residents were observed to have a call bell placed within easy reach so they can summon help if required. Bedrooms did not contain all the furniture required to meet the standard due to limited space and this needed to be Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 16 reflected in the Statement of Purpose. The home has three bedrooms that can accommodate all the furniture listed in the standard. Residents still need to be asked whether they would like all the furniture listed in the standard and documentation in relation to this discussion needs to be kept on the service users file. Residents have been asked whether they would like net curtains to be fitted to their bedrooms in order to maintain privacy but these have not been supplied yet. The home was clean and had no malodours. Bars of soap were observed in a number of bathrooms and these need to be returned to the residents they belong to and should not be used as communal soap. The home has disinfector sluice machines located in the COSHH room, which was observed to be locked. During the inspection it was observed that in one COSHH room there was no liquid soap or bin to dispose of paper towels or disposable gloves. Staff were placing commode pots in the sluice disinfector but had to leave the room to wash their hands. The management team informed the inspector shortly after the inspection that they had reviewed the systems in place and staff could now wash their hands in this COSHH room. During the inspection it was recommended to the management team that they contact the health protection unit who would carry out an environmental audit for the home and look at logistics as to how to reduce cross infection. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 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): 27, 29, 30 Staffing levels have not always been adequate to meet the needs of both residents and staff. The recruitment and selection procedures ensure that residents are protected. EVIDENCE: Staffing levels have been and are still not always adequate to meet resident’s needs. The home at the time of inspection only had 30 residents and whilst numbers of staff would appear adequate to meet their needs there were issues in regards to levels of deployment of staff. The management team acknowledged that whilst residents basic physical needs have been met, the provision of activities for residents has suffered. The home has recently recruited for two of its vacancies and is awaiting disclosure clearance. Those staff files sampled meet the standard in regards to recruitment and selection. Staff still require updating in a number of training areas. Staff files sampled showed training shortfalls in areas such as fire, food hygiene, manual handling, health and safety and first aid. The management teams believe that training has also suffered as a consequence of staff vacancies. The home needs to carry out an audit of staff training and it is recommended that they produce a training matrix so information on staff training is easily retrievable and staff can identify deficits quickly and respond appropriately. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 18 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): 32, 35, 38 This is a well-managed home run for the benefit of residents. Systems are in place to protect the health, safety and well being of residents, but further work is required to ensure this is comprehensive. EVIDENCE: Residents spoken to during the inspection were happy with the care provided and commented that the staff were kind and helpful. Meetings of residents and staff were taking place and there was an open and honest dialogue between management, staff and residents as to the difficulties they were encountering and what strategies could be put in place to overcome them. Residents’ money is securely stored with records and receipts of transactions. The Comfort fund, which mainly funds residents’ activities, needs to be audited and accounts reconciled. Residents who have run short of money are allowed to borrow from the fund. However systems for such loans and repayments were not clear and this needs to be reviewed. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 19 Not all aspects of health and safety were looked at during this inspection as they were looked at in depth in the June inspection. The kitchenette fridge temperatures were not being monitored or recorded. There was no current lift insurance or clinical waste disposal certificate. Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 20 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 2 2 3 2 X 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 Standard No Score 16 3 17 X 18 3 2 2 X X X 2 X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X x 2 X 2 2 Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP24OP23 OP1 Regulation 4(1)(2) Sch 1 Requirement The Registered Person must ensure that the Statement of Purpose and Service User Guide is up to date and lists all the information required in Schedule 1. If the home is unable to provide all furniture stated in Standard 24 due to limitations of space or manual handling equipment then these bedrooms must be identified in the Statement of Purpose. Outstanding requirement since 18/01/05. 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 since 18/01/05. The Registered Person must ensure that individual service statements are developed further to ensure they detail all aspects of health, personal and social care needs. They must DS0000033439.V268261.R01.S.doc Timescale for action 31/01/06 2 OP2 5(2)(b) 31/01/06 3 OP7 15(1)(2) 30/03/06 Druids Meadow Version 5.0 Page 22 also cover their needs over a twenty four hour period and be reviewed monthly. Outstanding requirement since 2004. The Registered Person must ensure manual handling assessments are reviewed every month. Outstanding requirement since 18/01/05. 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. 4 OP7 15(1)(2) 30/03/06 5 OP7 15(1)(2) 30/03/06 6 OP8 Outstanding requirement since 18/01/05. 12(1)(a,b) The Registered Person must (3) ensure that assessments are accurately completed in the following: - Continence Management - Mental health needs - Nutrition Outstanding requirement since 18/01/05. The Registered Person must ensure that service users have access to a dentist. 31/01/06 7 OP8 12(1)(a) 30/10/05 8 OP8 18(1)(a) Not assessed on this occasion carried forward. The Registered Person must 31/01/06 review staff training in relation to monitoring and recording changes in service users social and health care needs. Outstanding requirement. The Registered Person must review how health professionals’ DS0000033439.V268261.R01.S.doc 9 OP8 12(1) 13(1) 30/03/06 Page 23 Druids Meadow Version 5.0 10 OP9 13(2) 11 OP9 13(2) 12 OP9 13(2) visits are recorded to ensure that treatment prescribed can be monitored and reviewed. The Registered Person must 30/12/06 monitor the temperature of the medication room. If it is found to exceed 25°C, then strategies must be drawn up to reduce the temperature or find alternative locked accommodation for medication. The Registered Person must 30/12/06 ensure that all scheduled medication is counted at least once daily. The Registered Person must 31/01/06 ensure that the medication fridge temperature range remains between 2 and 5°C. Outstanding requirement since 21/06/2005. The Registered Person must ensure that activities provided meet the needs of residents The Registered Person must resubmit an up to date programme of planned maintenance and refurbishment of the premises. The Registered Person must ensure that: - Torn wallpaper in the lounge is repaired or replaced. - Carpet in the smoking lounges must be replaced. - Window frames that are in poor condition or rotten are repainted or replaced. All of the above are outstanding requirements from 18/01/05. - Armchairs, which are worn are repaired or replaced. An action plan must be resubmitted to CSCI indicating when these matters will be 13 14 OP12 OP19 12(1)(a) 23(2)(b) 31/03/06 31/01/06 15 OP20 23(2)(b) 30/03/06 Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 24 16 OP24 16(2)(c) 23(2)(b) addressed. The Registered Person must ensure that net curtains are fitted to service users’ bedroom windows in order to maintain their privacy. Outstanding requirement since 18/01/05. The Registered Person must ensure they audit residents bedrooms in relation to those that need re decorating and repair and submit an action plan detailing when this work will be carried out. 31/01/06 17 OP24 16(2)(c) 23(2)(b) 31/01/06 18 OP26 13(3) 19 OP28 18(1)(a) Outstanding requirement since 18/01/05. The Registered Person must 31/12/05 ensure that bar soap is not left in bathrooms and other communal areas. The Registered Person must 30/06/06 ensure that 50 of the care staff have an NVQ Level 2 in care. Not assessed on this occasion carried forward. 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 since 18/01/05. The Registered Person must audit and reconcile the comfort fund with regard to residents’ loans. The Registered Person must ensure that it records with regards to individual service statements in manual handling are up to date. DS0000033439.V268261.R01.S.doc 20 OP30 18(2) 30/03/06 21 OP35 Sch 4 (9)(a) 31/12/05 22 OP37 17(2) Sch 4 31/01/06 Druids Meadow Version 5.0 Page 25 23 OP38 13(4) Outstanding requirement since 18/01/05. The Registered Person must ensure that the monthly audit of residents’ falls record is robust enough to spot patterns and trends and appropriate action is taken following the fall. Not assessed on this occasion, carried forward. The Registered Person must obtain a current lift insurance certificate. Outstanding requirement since 21/06/05. The Registered Person must obtain a current clinical waste certificate. 30/09/05 24 OP38 13(3) 31/12/05 25 OP38 13(4) 31/12/05 26 OP8 18(1)(a) Outstanding requirement since 21/06/05. The Registered Person must 31/01/06 review staff training in relation to monitoring and recording changes in service users social and health care needs. Outstanding requirement since 21/06/05. 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 OP26 Good Practice Recommendations The Registered Person is advised to contact the Health Protection Unit at Bartholomew House, Hagley Road, Birmingham, to carry out an environmental audit. Telephone number: 0121 224 4670 Druids Meadow DS0000033439.V268261.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 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. 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