Inspection on 22/03/07 for Elgin Lodge

This inspection was carried out on 22nd March 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elgin Lodge 02/03/06

Elgin Lodge 07/12/05

Elgin Lodge 14/02/05

Elgin Lodge 30/06/04

Elgin Lodge 22/02/04

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

CARE HOME ADULTS 18-65 Elgin Lodge 25 Elgin Drive Wallasey Wirral CH45 7PP Lead Inspector Debbie Corcoran Key Unannounced Inspection 22nd March 2007 10:00 Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 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 Elgin Lodge DS0000018884.V331658.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 Adults 18-65. 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. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elgin Lodge Address 25 Elgin Drive Wallasey Wirral CH45 7PP 0151 639 3074 0151 6393074 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) Pinpoint Developments Limited Mrs Jane Richardson Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Service may accommodate 1 named service user over pensionable age as agreed in variation received 06/06/06. This variation will cease to apply when/if the service user leaves the home. 2nd March 2006 Date of last inspection Brief Description of the Service: Elgin Lodge is registered to provide care support and accommodation for eight adults with a mental disorder. Bedrooms are situated on two floors and comprise of six single and one shared bedroom. Four of the bedrooms have en suite facilities and several rooms have views across the river Mersey. The home is a two storey detached property set in a residential part of the Wirral on New Brighton promenade. The home is within a five-minute drive of Liscard town centre, which has a good selection of shops, banks and a post office. A local bus service is within easy reach of the home. The fee for staying at Elgin Lodge is £346.92 per week. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was not announced beforehand. During the visit the majority of the residents were met and spoken with and a number were spoken with on a one to one basis. Members of the staff team were also spoken with. A sample of resident’s records were looked at. Other records looked at include staff files, staff training records and health and safety records. A tour of the home was carried out which included all areas. The manager returned a questionnaire on the service to the Commission and a number of residents returned questionnaires on the quality of the service provided. Some of the information contained in these has been used to inform the findings of this inspection. What the service does well: The manager ensures that new residents are only admitted to the home when an assessment of their needs has been carried out. This is to ensure that the person’s needs can be met at the home. Residents are provided with a signed statement as to the terms and conditions of their residency. The residents were positive about all aspects of the home and were complimentary about the staff team. One resident commented that the “staff are experienced”. Another resident described staff as “really nice” and “helpful”. Each resident has a detailed care plan. The care plans include information on the service user’s likes, dislikes, strengths and needs and include goals for supporting the person to develop their skills and aim for a more independent lifestyle. Residents are contributing to decision making in the home and are making choices with regard to their daily routines and residents meetings take place. Residents are supported to use local community facilities and public transport on a regular basis and there is a clear emphasis on the residents using and developing their daily living skills and increasing their independence in line with their individual needs. Residents are well supported with their health care needs and are supported to see a GP, nurse or other relevant health professionals when appropriate. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 6 Staff have been provided with good training opportunities. These include training in topics relating directly to the needs of the residents for example in mental health issues and in health and safety related topics, for example fire safety and first aid. 50 of staff are qualified to a National Vocational Qualification (N.V.Q) level 2 in care. The home environment is presented as clean, well maintained and the décor and furnishings and fittings are of an appropriate standard. Health and safety procedures are in place so as to ensure the home environment is safe to residents, staff and visitors. The manager of the home has been in post for 13 years and the home is well run and well organised. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are assessed before moving to the home in order to ensure their needs can be met at the home. EVIDENCE: There has been one new resident admitted to the home since the last inspection. The records for this person were looked at in order to assess the home’s referrals and admissions procedures. It was evident that an assessment of needs had been attained from the referring agency before the person moved to the home. The residents needs were also assessed by the manager of the home prior to the person moving in. This is to ensure that the person’s needs can be appropriately met at the home. Residents have a signed statement as to the terms and conditions of their residency at the home. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care which clearly reflects their needs and choices and residents are making decision about their life and the running of the home. Where a resident is thought to be at risk of harm information on this, and how to manage it, is recorded in their care plan. Resident’s confidentiality is protected by the arrangements for storing information. EVIDENCE: A sample of resident’s records were examined in order to assess the care planning in place for residents. Care plans are comprehensive and are also easy to read and follow. The care plans provide information on meeting the resident’s needs in areas such as; their mental and psychological health, occupation, culture, spirituality, social, emotional, educational and recreational needs. The care plans examined had been signed as agreed by the resident concerned and had been reviewed and updated on a regular basis. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 10 Where a service user is involved in activities which pose a risk to their safety then this is recorded in the person’s care plan along with information on what steps need to be taken to prevent the risk from occurring. Many of the staff have worked at the home for a significant period of time and therefore they have had the opportunity to build relationships with the residents and to get to know the residents well. The manager gave a good example whereby the staff team have supported one of the residents with a particular issue and this appears to have been dealt with sensitively and with thought for the best outcome for the resident concerned. During discussions with residents they were positive about their support. Residents confirmed that they are making their own decisions as to their routines and are supported to manage their own matters when possible. For example to manage their own money or their own medication. Residents have the opportunity to attend residents meetings whereby they can discuss the running of the home with staff on a more formal basis. Care plans indicate that the residents are encouraged to maintain their independence as much as possible. All personal and confidential information is stored appropriately and staff are aware of their responsibilities in this area. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to develop their independent living skills, to develop and maintain relationships and to be involved in local community activities. Residents are included in decision making on the running of the home. Residents are provided with a varied diet of home cooked food and are supported to use and develop their own cooking skills. EVIDENCE: The residents care plans include a good level of information on how to support the person with using and developing their independent living skills. From discussions with residents it was clear that this is in line with their individual needs. Residents confirmed that they are making choices and they gave examples such as choosing their daily routine as in when to get up, when to go to bed, their meals, how to spend their day and this will include going outside of the home on their own if they have the skills to be able to do this independently or with staff support when required. All residents are given their Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 12 post directly. Residents are encouraged to manage their own medication when possible and to manage their own money when possible. Residents are also supported to use and develop their daily living skills and are actively included in household tasks such as stock checking food supplies, preparing shopping lists, maintaining their own room and laundry as appropriate to their needs. Residents are encouraged to make choices about the running of the home. Residents are able to express their needs and preferences and contribute to changes at the home and have the opportunity to do this on a day to day basis through discussions with staff and on a more formal basis through residents meetings. The manager reported that she is looking to develop the residents meetings to be more regular and to encourage greater participation from residents. Relationships are encouraged and this was confirmed during discussions with residents and in the residents care planning. Visitors are welcome to the home at all reasonable times. Residents gave good feedback on their support with pursuing leisure and social activities. Residents are going out and using community resources independently when they are able to and with support from staff when needed. Residents said that they have the chance to do some activities in the home for example, games, art and films and there are occasional trips out organised and regular walks and shopping trips. The approach to activities appears quite relaxed and low key and this seems to suite the residents. A record of activities is kept and this shows that residents are given the opportunity of being involved in an activity on a regular basis. The activities appear to organised around the needs of the individual resident and their needs and wishes. Residents are provided with information on local activities and events. In order to assess the meals and food provided the menus were checked, the kitchen was checked including food storage and health safety in the kitchen, and a number of the residents were asked to comment on the food. In addition to the main kitchen residents have a kitchen area in the dinning room where they can make their own snacks and drinks. The menu was varied and appetising and all feedback on the food and meals was positive. Residents are actively encouraged to get involved with meal preparation and cooking and other tasks within the kitchen. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being well supported with their personal, emotional, physical and health care needs and medication is well managed. EVIDENCE: The resident’s care plans include a good level of information on how to support the person with both their emotional and physical health and well being. During discussions with the residents they felt that staff support them well. When asked if staff were respectful of their privacy residents said that they were. The manager described how residents are supported to be independent with personal care needs and discussed some of the practices in place which staff adopt in order to ensure the privacy and dignity of those residents who do require support with personal care. This was confirmed during discussions with residents. Resident’s care plans and other relevant records show that the residents are well supported in remaining healthy. This was confirmed during discussions with residents and in questionnaires returned to the Commission. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 14 Residents are supported to see a GP or nurse when appropriate and feedback from residents was that staff are good at responding to their health care needs. Medication is appropriately stored, recorded and administered. The majority of medication is provided in blister packs and medication storage was found to be well organised. Medication was examined for two of the residents and was found to be in good order. Staff who are responsible for admninistering medication have been provided with training in this. Residents are encouraged to manager their own medication when this is appropriate and a risk assessment is carried out to ensure that residents who do manage their own medication are able to do this safely. Information on the medication which residents are prescribed and side effects of these is kept for reference. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place for dealing with complaints and residents know how to make a complaint. Systems are in place to deal with an allegation of abuse and protect residents. The system for recording resident’s monies needs to be developed to provide greater accountability for resident’s monies. EVIDENCE: The home has a complaints procedure which is time scaled appropriately and includes contact details for the Commission. A copy of the complaints procedure is available to residents and is on display in the main hallway. Residents who were asked bout complaints said that they would let staff know if they were not happy about something and that there concern would then be dealt with. There has been one complaint made to the home since the last inspection. Records showed that this had been made by one of the residents. The complaint had been taken seriously, had been investigated and the complaint was responded to appropriately. Policies and procedures are in place for the protection of residents. There was a copy of Wirral’s adult protection procedures available and home’s own procedure which is very good and provides clear instruction and guidance to staff on dealing with an allegation of abuse and limits of their responsibility in this. All staff have undertaken an adult protection course with Wirral Social Services. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 16 A record of key events is maintained for example incident reports and accident reports. These were checked and found to be maintained appropriately and there were no areas of concern identified. Residents manage their own money when possible. Only a small number of residents require support with managing their money. The records were checked for these residents. The manager was advised that the current system for recording resident’s monies was not appropriate as it did not give an indication of source of money in and out and residents were not being asked to sign for receipt of their money. The current system would also make it difficult account for the resident’s monies and to audit these. The registered person is therefore required to develop the current system. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, clean well maintained home environment. However, the health and comfort of residents may be compromised by the current designated smoking area. EVIDENCE: The communal areas of the ground floor comprises of one large open plan lounge and dinning area, kitchen and shower room. Resident’s bedrooms and bathrooms are located on the ground and first floor. Each resident has there own bedroom and a sample of these were checked and found to be well presented and furnishings and fittings were of a good standard. The home is appropriately presented and well maintained. The only areas of concern with the home environment are firstly, there is only one lounge and this is used by both people who smoke and non smokers. The responsible person must consult with residents and provide alternative arrangements to this. Secondly, an exterior adjoining garden wall looks like it may present a Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 18 hazard and the registered person should seek professional advice as to the safety of this. The home has health and safety practices and procedures which are aimed at ensuring the home is safe and clean and as free from hazards to the health and safety of service users and staff. There are sufficient domestic staff employed and the home was presented as clean and hygienic throughout. Policies, procedures and practices are in place for hygiene practices and the control of infection. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by appropriately qualified, trained and supported staff. Staff numbers are appropriate to ensure that the resident’s needs are being met effectively. EVIDENCE: Staff and residents were seen to be warm and friendly with each other throughout the visit. Residents were positive about the staff and their feedback included the following “staff are kind and thoughtful” and “staff keep me informed with important issues”. One relatives feedback was that “all the staff are very pleasant”. Staff are provided with training as appropriate to meet the needs of the service users. Staff training includes training on topics such as supporting people with mental health needs, supporting people with challenging behaviour, the prevention of abuse, medication, food hygiene, fire safety, infection control and first aid. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 20 There are 6 members of care staff on the staff team. Of these 3 have attained a National Vocational Qualification (N.V.Q) in care and 2 were reported to be in the process of undertaking the award. The home is therefore meeting the target for 50 of care staff to have attained a relevant qualification. Staff turnover is low and therefore many of the staff have been supporting the residents for a significant period of time and have had the opportunity to get to know the residents well. Discussions with residents indicated that staff are supporting the aims and objectives of the home in encouraging service users to make choices, develop their independent living skills and use their local community. There have been no new members of staff since the last inspection and therefore the home’s staff recruitment and selection procedures could not be practically assessed on this occasion. Robust recruitment and selection procedures which aim to protect residents were in place at the time of the last inspection. Staff are provided with the opportunity of supervision meetings whereby they meet one to one with the manager. For some staff supervision meetings are regular and for others they are not. All staff should have equal opportunity of supervision and this should be in line with the national minimum standard of six times per year. Staff also attend staff team meetings. However, these should take place more frequently so as to ensure that staff members have a regular forum to discuss issues that may effect the service provided to residents and the implementation of polices, procedures and practices within the home. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and is run in the best interests of the residents. The health, welfare and safety of residents and staff is promoted and protected. EVIDENCE: The manager was proficient in responding to all matters and was able to produce all information required during the visit. The manager has been managing the home for the past 13 years. The home is well managed in the best interest of the residents. Along with residents contributing to daily decision making in the home residents are also invited to comment on the home through residents Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 22 meetings. The home is visited by a representative from the organisation on a monthly basis and reports of these visits are forwarded to the Commission. The home has numerous policies and procedures in relation to the health and safety of service users and staff and staff are provided with training in core health and safety related skills. Fire safety and health and safety practices are adopted. Records of fire and health and safety checks were checked and found to be up to date. However, the manager was advised to review the frequency of checks on hot water temperatures. Risk assessments are in place for safe working practices and these are regularly reviewed. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 X 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 17 (2) Schedule 4 13 (4) (a) Requirement Timescale for action 22/04/07 2. YA24 3. YA24 23 (2) (b) The registered person must develop the system for recording and accounting for resident’s personal monies. The registered person must 29/04/07 review the arrangements for designated smoking areas in the home. The registered person must seek 29/04/07 professional advice on the safety of the exterior boundary wall and take appropriate action following this advice. 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. 2. Refer to Standard YA36 YA33 Good Practice Recommendations The manager should review the frequency of staff supervision meetings and ensure equality of opportunity for staff supervision. The manager should ensure that recorded staff meetings take place on a regular basis. Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI Elgin Lodge DS0000018884.V331658.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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