Inspection on 31/01/07 for Dunsfold

This inspection was carried out on 31st January 2007.

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

Dunsfold 15/09/08

Dunsfold 27/11/07

Dunsfold 09/06/06

Dunsfold 08/12/05

Dunsfold 07/07/05

Dunsfold 24/01/05

Dunsfold 18/05/04

Dunsfold 20/10/03

Dunsfold 19/05/03

Dunsfold 17/12/02

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

CARE HOMES FOR OLDER PEOPLE Dunsfold West End Road Herstmonceux East Sussex BN27 4NX Lead Inspector Phil Hale Key Unannounced Inspection 31st January 2007 9.30 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 Dunsfold DS0000021089.V331076.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. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunsfold Address West End Road Herstmonceux East Sussex BN27 4NX 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) 01323 832021 Mr Paul Hughes Mrs Indra Hughes Mr Paul Hughes Care Home 20 Category(ies) of Dementia (20) registration, with number of places Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty (20) Service users must be aged sixty-five (65) years or over on admission Service users with a senile dementia type of illness only to be accommodated 9th June 2006 Date of last inspection Brief Description of the Service: Dunsfold is registered to provide a home for twenty older people with dementia. The home is a large detached property situated in the small village of Herstmonceux. The home is set within its own grounds and is approximately half a mile from the main road, which includes local amenities such as shops and local transport links. Resident accommodation consists of twelve single rooms and four shared rooms. Some of the room sizes are below the New National Minimum Standard and there is not level access throughout the home although the home is exempt from these regulations as it was first registered before April 2002. Communal areas comprise of a lounge, dinning room and library/second dining area. There are three bathrooms and five additional toilets in the home. The home welcomes pets and some residents keep cats in their rooms. The external grounds include a large rural garden, and a large parking area, including courtyard tables/chairs. An alarmed gate separates the garden from the road and allows residents freedom of movement as well as ensuring their security. The home does not provide level access internally or externally and there are some steps out to the garden from some exits. The home is better suited for those without mobility needs particularly as upstairs rooms are only accessible by stairs. Information on the range of fees charged was confirmed in the pre-inspection questionnaire prior to the inspection with fees approximately ranging from around £366 to £410 per week with extra changes for personal items. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection carried out by two Inspectors on 31 January 2007 beginning at 9.30am and ended at about 2.30pm. It included a review of information contained in the Commission records, a site visit, a meeting with the owners, including the registered manager, informal interviews with staff and residents and observation of routines. This was a key inspection, being the second one since April 2006 and so followed up on the requirements made at the last inspection carried out in June 2006. There were eighteen residents at the home on the day of the site visit. What the service does well: What has improved since the last inspection? What they could do better: Inspectors concluded that staff, on the day of the site visit, were relatively young and inexperienced and needed some close guidance and support to improve the way they provide care. Some improvements are needed to the recording of information, primarily ensuring that all documents are signed and dated and the care plans being more specific in describing what actions staff need to take to meet the needs of residents. With the level of dementia of many of the residents, activities have to be more individual and recognise that concentration is limited. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 6 Ways of providing more opportunities for choice also need to be identified and carried out. The home would benefit from a better maintenance system to enable staff to identify and pass on any such issues. 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. The summary of this inspection report can be made available in other formats on request. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 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 Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there was evidence of some good information being obtained about residents, improvements are required. EVIDENCE: At the previous inspection the service user guide did not include all the necessary information, as the last inspection report was not included. This has been rectified. This information is available by the main entrance to the home and so is available for all visitors. Three new residents arrived at the home in January 2007. A number of preadmission assessments were seen. These provide a good pen picture of the needs of the resident and confirmed that the home could meet their needs. For example, one provided some history of the person, a daily plan and the fact that the person was at risk of falls. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 9 However, much of the information was not signed and dated, so it was not possible to confirm that the information was gained prior to the person’s arrival at the home and who completed the assessment. An issue identified since the last inspection was that a resident had deteriorated and the Community Nursing Team carried out an assessment of need. The conclusion was that the person needed to be transferred to a care home with nursing. Therefore Dunsfold was unable to meet this person’s needs and there was a delay in the transfer taking place. At the time of this inspection, Inspectors did not identify any resident whose needs the home may not be able to meet. One resident was poorly and in bed. Community Nurses were supporting the service to meet this person’s needs. Intermediate care is not provided. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although care planning has improved since the last inspection, with evidence of regular reviews, there remains a need for the care plans to more clearly identify what action staff need to take to meet the needs of residents. EVIDENCE: A relatively new care planning system has been introduced. A number of care plans were seen and these were generally good with evidence of being regularly reviewed. For example, one care plan showed that the person’s care needs had been reviewed monthly and indicated that these needs had changed in recent months, with the person needing more assistance. The nature of the deterioration and how the person’s needs should be met were documented. There continued to be some gaps in the care planning and so it was not always possible to clearly identify what action staff need to take to meet needs. For example, one resident had a leg ulcer and it was not clear how this was being treated and what action the care home staff needed to take. Therefore, although there have been improvements since the last inspection, there remains a need for further work to be carried out on the care planning system. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 11 This is necessary to ensure that staff are fully aware of the needs of residents and what action they need to take to meet their needs consistently. Records indicated that residents are weighed weekly in order to monitor any weight loss. Healthcare support is obtained when necessary. Due to the level of dementia of most of the residents, it was not possible to gain information from, and the views of, residents. Therefore Inspectors spent time observing daily routines to see how care is delivered. The staff team on the day of the inspection was relatively young and inexperienced and there were times when this showed. Whilst in the main staff interacted well with residents and ensured their needs were met, there were a couple of incidents that indicated staff needed further training or advice on how to provide care. For example, a wheelchair was used to assist in the moving of residents to the dining area for breakfast. Footplates were not used and the person tilted back at one point. Staff found it difficult to find and fit the right foot plates once Inspectors had intervened. There are policies and procedures in place for the storing, administrating, disposal and receipt of medication. The medication administration records were viewed and were completed correctly. The midday medication round was observed and good practice was seen in the individual administering of medication. The storage of the medication was seen to be secure and was closed whilst the medications were dispensed, thus ensuring the safety of the residents. The home would benefit from seeking advice from the Pharmacist regarding the identification of medication in tablet form. At the previous inspection some issues were identified regarding the privacy and dignity of residents. Inspectors at this inspection concluded that, in the main, residents were treated with dignity and their privacy maintained. However, one resident was in the lounge in the morning read for breakfast but without her dress on. Inspectors pointed this out to staff, but this was not rectified until after breakfast. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities need to improve to ensure they are more individually tailored to the needs of each resident. Choice needs to be improved as well. EVIDENCE: There was some evidence of a number of activities being available, with these being recorded on an activity sheet. However, on the day of the inspection, the television was on all day and at one point music was playing and the television remained on. The owners recognised that the television should have been switched off whist the music was on. One resident regularly asks for drinks of water, as he cannot remember when he last had a drink. At one point staff introduced a game of dominos as a useful diversion and to positively engage with this person. A couple of other residents joined in and even though this was short-lived, was a good way of providing some useful activity. One resident was walking up and down in the communal areas for most of the inspection. It would have been useful if staff had tried to engage him in an activity, but this was not done. Staff were observed explaining to residents what they were doing when they were assisting them. For example, one member of staff was heard to explain to a resident that they were assisting them to the dining room for breakfast. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 13 Whilst there were examples of choice being provided, there were also examples where this was limited. For example, there was little or no choice available at breakfast with this being one type of cereal and marmalade sandwiches. Residents were also not offered a choice of tea or coffee. The owners stated that choice should be provided each day for breakfast. Choice is provided at lunch time. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is easily available and a complaint raised since the previous inspection had been dealt with appropriately. EVIDENCE: The service has a complaints procedure which is made available to all residents, relatives and other stakeholders through the Statement of Purpose and the service user guide, both of which are available by the front door. There has been one complaint recorded since the last inspection. There was evidence that this had been investigated by the owners and a letter sent to the complainant. An adult protection matter was identified in August 2006 and investigate by the local Social Services Department. This was related to poor manual handling and attitude of staff. It was recommended that ongoing manual handling training was necessary to ensure that all staff are able to safely assist residents. It also resulted in a resident being identified as needing nursing care and she subsequently moved from Dunsfold to a care home with nursing. Inspectors observed some issues related to the way that staff assisted resident to move. There is a need for regular training and guidance in how to assist resident to move, for example, to be assisted out of a chair, within the care home. Dunsfold DS0000021089.V331076.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home is fairly clean and tidy, there is a need for a clearer maintenance system to be implemented as Inspectors identified a number of issues that needed to be rectified. The layout of the lounge is much improved. EVIDENCE: The major change to the environment since the last inspection has been the alterations to the seating in the lounge. Although chairs remain mostly around the edge of the room, the chairs have been removed from the central area resulting in a much more open feel to the room. It also enables greater movement within the room. All residents can now see the television, whereas before some chairs had their backs to the television and to other residents. One Inspector toured most areas of the home. Some bedrooms have been redecorated and generally the home is well decorated and maintained. However, there is a need for a thorough clean of the premises. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 16 Some furniture in the lounge was in need of replacing as the cover of the padding was torn resulting in the padding being accessible. This is an infection control issue as well as residents being in danger of potentially consuming the padding. Two zimmer frames were seen in one bedroom and it was uncertain who they belonged to. Some maintenance issues were identified by Inspectors and passed to the owners. These include a stained commode in a bedroom, a broken radiator guard, a broken bed headboard and a couple of light bulbs that did not work. A maintenance book would be helpful in order for staff to report all maintenance issues and for them to be completed in a methodical manner. An Occupational Therapist had assessed the building some months ago and the owners confirmed that all recommendations have been completed. Dunsfold DS0000021089.V331076.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Inspectors concluded that there were sufficient staff on duty to meet residents’ needs. Recruitment processes are fully completed and a good range of staff training has been carried out in the last year and some good training opportunities planned for the future. However, staff were relatively young and inexperienced and need close guidance and support to ensure they are able to consistently meet the needs of residents. EVIDENCE: On the day of the inspection there were three care staff, a domestic member of staff and a cook on duty. Therefore, there were sufficient staff on duty to meet the needs of residents. Staff recruitment files were checked and the necessary recruitment procedures are carried out. Evidence of staff receiving relevant training was found through interviewing a number of staff. New staff confirmed that they are completing an induction into the service and the needs of residents. One confirmed that she had received fire and medication training and a first aid course is to be arranged. She had also completed some manual, handling training. Another confirmed that she had received fire training from the owner and health and safety training. She was due to complete some manual handling training in about a month’s time. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 18 Subsequent to the inspection visit, the owners provided a training matrix which showed what training all staff had received in the last year. All staff, apart from those recently recruited, had received adult protection and fire safety, infection control, and food hygiene training in the last year. The vast majority had received manual handling training September 2006. Most staff have been booked onto some training courses at Sussex Downs College in February and March 2007. These include caring for those with confusion, activities and reminiscence and effective communication. Whilst recognising that staff have completed manual handling training in the last year, Inspectors were concerned that they observed staff supporting and assisting residents in an inappropriate and potentially unsafe manner. Close guidance needs to be provided to staff to ensure they put the theory of how to assist residents into practice. Further training may need to be provided, based on the individual needs of residents in the care home to ensure they are supported in a safe way. Dunsfold DS0000021089.V331076.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements to the management and systems in the home since the last inspection. However, staff need clearer supervision and guidance to ensure residents’ needs are met in a safe way. EVIDENCE: One of the owners became the sole registered manager in the last year. As reported at the last inspection, this has resulted in clearer lines of management and responsibility. Whilst the manager is a qualified nurse, he does not have the necessary management qualification and needs to complete this if he is to remain the registered manager. However, the owners are considering employing a manager, to allow the owners to take a lesser role in the day to day running of the care home. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 20 Although some auditing mechanisms have been introduced, there is a need for these to be more robust in order that the service can identify there own strengths and weaknesses and put in place clear actions to make the necessary improvements to overcome the areas that need to improve. As reported elsewhere in the report, staff were well meaning but lacked experience and therefore need some guidance in how to provide effective care. Although there was some evidence of supervision taking place for staff, this was not occurring as regular as it is needed. For example records showed that one member of staff received supervision in May and September of last year, but that was all. Examples were found of supervision records not being completed. It was good to see evidence, from staff meeting minutes, that staff are being challenged about the manner in which care is provided and records maintained. For example, the minutes of one staff meeting remind staff that they need to be careful about the wording in care plans. The issues raised in the last inspection report were also discussed with staff. Some staff meetings are used as group appraisal meetings. It was noted that a photo of a resident was undated and needed to be updated. A range of health and safety certificates were seen during the inspection including fire hazard analysis, bacteriological analysis and servicing of the hoists etc. Environmental Health Officers had inspected the care home in the last few months with no requirements made in relation to health and safety and two recommendations related to food safety. The owners were aware of the need to work on these recommendations. The last electrical check was completed in August 2001 and recommended that it be carried out again in 5 years time, and so this needs to be arranged. Similarly the annual gas certificate ran out a few days prior to the inspection and the owners were aware of the need to have this renewed. Issues regarding manual handling have been identified in other areas of this report. These are seen as health and safety issues and a requirement has been made. Dunsfold DS0000021089.V331076.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 3 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 22 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 OP3 Regulation 14 Requirement That pre-admission assessments must be signed and dated, by the person who carries out the assessment. That care plans must more clearly identify what action staff need to take to meet the needs of residents. A similar requirement has been made in previous inspection reports. That activities must be individually tailored to meet the needs of each resident to provide a stimulating and interesting environment. That residents must be consistently provided with greater opportunities for choice, such as meal times. That the maintenance issues identified at the inspection visit must be rectified and an ongoing system introduced for staff to identify any future maintenance matters, to ensure that the premises remain safe for residents. That the chairs in the lounge, DS0000021089.V331076.R01.S.doc Timescale for action 01/04/07 2. OP7 15 01/04/07 3. OP12 16(m) & (n) 01/04/07 4. OP14 12(2) 01/04/07 5. OP19 13(4)(a) 01/04/07 6. Dunsfold OP19 13(4)(a) 01/04/07 Page 23 Version 5.2 7. OP31 9(2)(b)(i) 8 OP33 24 9. OP36 18(2) 10. 11 OP38 OP38 23(4) 13(5) which have arm rests that are splitting, must be replaced, to ensure the safety of residents and to prevent cross infection. That the Registered Manager Commences and Completes a relevant management qualification. That a robust quality assurance system must be introduced to identify areas of strengths and weaknesses and put this information together in a report for the Commission, residents and other stakeholders, to inform them how the service is improving. That all staff receive regular supervision, at least six times each year, to provide an additional mechanism to monitor their practices and to provide effective guidance, to ensure the quality of the care provided by staff is good and meets the needs of residents. That the service must obtain a new gas certificate and electrical certificate. That the Registered Person must review how all staff assist in the moving and handling of residents and provide updated training and guidance, to ensure that residents are transferred and assisted safely. A similar requirement has been made in previous inspection reports. 01/12/07 01/07/07 01/04/07 01/04/07 01/04/07 Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 24 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 OP37 Good Practice Recommendations That photographs of residents are regularly updated. Dunsfold DS0000021089.V331076.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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