Inspection on 30/11/07 for Elm Tree House

This inspection was carried out on 30th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm Tree House 03/11/08

Elm Tree House 19/02/07

Elm Tree House 11/05/06

Elm Tree House 17/11/05

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE Elm Tree House 37a Ogle Street Hucknall Nottingham NG15 7FQ Lead Inspector Karmon Hawley Unannounced Inspection 30th November 2007 09:30 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 Elm Tree House DS0000064368.V354953.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. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 37a Ogle Street Hucknall Nottingham NG15 7FQ 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) 0115 963 3573 Carisbrooke Healthcare Ltd Elizabeth Pasik Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (17) Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within the total number of beds, a maximum of 17 may be used for the category OP Within the total number of beds, a maximum of 17 may be used for the category DE(E) Within the total number of beds, a maximum of 2 may be used for the category MD(E) 19th February 2007 Date of last inspection Brief Description of the Service: Elm Tree House is a converted family house providing residential care for up to seventeen (17) older people. The home is situated in a residential area near the heart of Hucknall, within walking distance of shops and local amenities. The home is comfortable and homely and has pleasant gardens to the rear. There is a car park available at the front of the building. The home has recently been registered to provide services for people with Dementia and Mental Health Needs. The service’s current certificate displayed in the home is reflective of the current registration. Fees range between £277-£319 depending on dependency levels. Service users are expected to fund additional costs for newspapers, hairdressing and chiropody. This information is made available on the point of enquiry. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took into account previous information held by the Commission for Social Care Inspection, including previous inspection reports, the service history and records of any incidents that had been notified to the CSCI since the last inspection. The site visit consisted of a method called ‘case tracking’, which involves identifying individual service users who live at the home, and tracking the experience of the care and support they have received during the time they have lived there. This enables a judgement to be made about the outcomes for people living in the home. The inspector also spent time with staff and service users talking with them and observing the interaction and support staff offered service users. General records maintained by the home were also looked at to ensure these were maintained and provided positive outcomes for service users. What the service does well: What has improved since the last inspection? What they could do better: Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 6 Plans of care and risk management plans need to improve to ensure that service users complex needs such as behavioural problems are met and service users are protected. Action must be taken to ensure that all medication is stored securely and administered correctly to ensure that service users are protected and receive medication as prescribed. Staff must be respectful towards service users at all times to ensure that their dignity is maintained and they are cared for in a manner, which they deserve. Evidence to show that enough staff are available to care for service users is needed to show that sufficient staff are available to meet their needs. Evidence is needed to show that the home is reviewing and monitoring the quality of the service to demonstrate that the home is run in the best interest of service users. 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. Elm Tree House DS0000064368.V354953.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 Elm Tree House DS0000064368.V354953.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are assured that staff can meet their needs before they decide to move into the home. The service does not offer intermediate care. EVIDENCE: The manager or deputy manager visits prospective service users in the community to carry out a preadmission assessment to see if the staff can meet their needs before a decision to move in is made. Evidence of the preadmission process was seen within two case files seen along with referral information from other services such as the community care assessment completed by the service users social worker. Within one file this was not available, as the service user had been admitted as an emergency. Despite this staff had visited the service user previously and were aware of their needs, on speaking with the service user and their relative they felt that the move to the home had been a relatively smooth transition and stated that they were happy and Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 9 settled and staff were very good, if they did not know anything about them they would tell them. The service does not offer intermediate care. Elm Tree House DS0000064368.V354953.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. Service users are not adequately supported in meeting complex needs and the lack of risk assessments in regard to this could potentially expose others to risk. Service users are not fully protected by the medication procedures in place. Service users are not always treated with respect when staff feel under pressure to completed extra tasks. EVIDENCE: Service users undergo various assessments such as the activites of daily living, manual handling and nutritional needs. Information gained forms the plan of care. Plans of care in place were personalised and reflected service users highlighted needs with the exception of one plan where behavioural issues had not been covered, which may result in inadequate support or assistance being gained by the service user. Risk assessments were in place for highlighted risk to ensure these are managed, however again where challenging behaviour had been highlighted a risk assessment was not in place, which may leave other service users and staff at risk if not managed effectively. A number of care plans and assessments had not been signed and dated by the person Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 11 completing these, which makes it difficult to gain an insight into what are the service users current care needs. Service users spoken with said, “the staff are very nice and caring, they are there if I need them,” and “I am happy here, the staff help me, I am very grateful.” Staff spoken with were able to discuss service users needs and how support is offered. They also understood the processes needed when dealing with challenging behaviour. There was evidence in service users plans of care to show that relevant specialist services such as the doctor, district nurse and community psychiatric nurse is accessed as required. Relevant equipment was also seen to be in place and the manager confirmed that the district nurse following their assessment provided this. An optician was visiting the home on the day of the visit; the majority of service uses were seen during this time to ensure that their optical prescription was up to date. Service users spoken with said that they can see the doctor if they felt unwell. On the morning of the visit medication had been administered to two service users but had not been signed for. The system in use for the recording of medication administered was confusing and staff stated that they had just started on this system as a trial, however they to did not find it user friendly. The pharmacist who supplies the medication was contacted immediately and it was requested that they return to the system that they had previously used. On observing the method used previously there had been no gaps in signing for medication administered. Although this will resolve a number of issues there was no evidence to show that the medication records (at the beginning of the month) had been checked prior to administration, had this procedure been in place the errors detected may not of occurred. There were occasions also where service users had been prescribed creams and gels, there were gaps in signing that these had been administered, this may result in these being administered more times than prescribed or not at all. The cupboard where medication is stored had a lock in place, however if these doors were pulled together and kept in this position a hand could be placed in the cupboard and medication taken out from the bottom shelf. We carried out this procedure whilst visiting to demonstrate that medication is not stored safely. The majority of staff interaction observed was of a positive nature and service users were treated with respect, however on one occasion a service user was not listen to and brushed aside by a member of staff and then referred to as a ‘nuscience’ to an outside visitor, this practice does not respect service users and can have a negative impact on their feelings about their adequacy. This incident was discussed with the manager and staff member concerned and dealt with effectively. Service users spoken with said that staff were respectful and treated them nicely. One service user said that staff do not knock on their door before they enter but this was because they kept it open, they were satisfied with this arrangement. Elm Tree House DS0000064368.V354953.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 good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to maintain social contacts that are important to them and spend private time with their family and friends. Service users are enabled to make their own choices and decisions where able. EVIDENCE: An activites coordinator is employed who carries out activites with service users on a daily basis. Activites such as bingo, dominoes, arts and crafts and trips out are on offer on both a group and individual setting. On the day of the visit service users in the main lounge were seen enjoying music time and dancing with the activites coordinator, they stated that they enjoyed this and had dancing sessions nearly every week. One service user spoke with said, “I enjoy the activites, especially bingo and the dancing sessions, however I don’t tend to join in, I would like more trips out thought,” and “there are not many activites but I do enjoy them.” Another service user said that they enjoyed it when they visited the local town and did their shopping. Both service users and staff stated the routine of the home to be flexible and service users may choose how they spend their time. This was observed during the visit as service users occupied themselves, went out with relatives and went to their rooms when they wanted. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 13 There are no restrictions on visiting so that service users can maintain contacts that are important to them. Visitors may also be received in private should they wish and staff were able to discuss how relationships are enhanced and maintained should a spouse/partner visit, they also discussed that the sexuality of service users would not be an issue to the way in which they care for them. Two service users spoken with offered the following comments: “I often have visitors, they are made welcome, I can bring them to my room if I want to,” and “I have visitors who come to see me, I also go out and spend time with them.” Staff felt that service users are able to make their own choices and decisions about their lives; there was evidence of service users preferences within plan of care. One service user said that they could lock their bedroom door if they wanted, but they chose not to. Another discussed how they spent their day and that they felt they could make their own decisions about their lives. A wholesome and appealing menu was on offer and there was evidence of choices being available at each meal. The lunchtime meal was observed during the visit and service users were seen to have meals of their choice. Service users spoken with offered the following comments in regards to the food provided, “the food is very nice, I get plenty to eat,” “the food is palatable and choices are offered.” One member of staff was observed to assist a service user with their meal standing at the side of them; this may make people uncomfortable and does not afford them dignity. Elm Tree House DS0000064368.V354953.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. Service users are confident that staff will listen to any concerns that they may have and that these will be resolved. Service users are protected from abuse. EVIDENCE: The service has a complaint procedure in place, which is available for service users to view if they need to. The service has not received any complaints since the previous inspection. Staff spoken with stated that they felt they were open and approachable so service users and relatives approached them if there were any problems. Staff were able to discuss how they would handle a complaint should one be received. Service users spoken with said that they would talk with staff if they were unhappy, however they all expressed satisfaction with care received and life within the home. We were unable to ascertain that all staff have a satisfactory Criminal Record Bureau checks in place (a police check to see if an individual has a police caution or conviction). The manager stated that some of the staff also work at the other home owned by the same company and their staff personnel files were there. She stated that these would be forwarded immediately to the CSCI by fax to confirm these were in place. The Commission received evidence of these after the inspection. Both members of staff spoken with confirmed that they had undertaken a criminal record bureau check. Forty five percent of staff have undertaken training in the protection of vulnerable adults, staff spoken Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 15 with were able to discuss what they though constituted abuse and how they would deal with it should they suspect that is was occurring. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment, which is clean and tidy. EVIDENCE: A homely and comfortable environment is on offer for service users and domestic style furniture is in place. The gardens were well maintained for the season and service users were observed to access this area. One service user said that they enjoyed looking out into the garden. Service users rooms were personalised and well maintained and service users were seen to access these, as they required. One service user said that they had brought in some of their own things to make it feel more homely. All areas of the home accessed were clean and tidy. Service users said that staff work hard at keeping the home nice, clean and tidy. Elm Tree House DS0000064368.V354953.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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are not always given the time they need to fully meet their needs due to the impact of staff carrying out multiple tasks. A well-trained staff team supports service users. EVIDENCE: The staff duty rotas showed that there are four members of staff on duty in the morning, two in the afternoon and two during the night. In addition to this there is a cleaner, however they were off sick on the day of the visit and there is no cook in post at the moment, therefore staff on duty were covering both positions. On the day of the visit staff were very busy caring for service users needs, cleaning the home, preparing breakfast and dealing with the outside optician that was visiting. This staffing level impacted upon service delivery and the safe administration of medicines, as one service user was not listened to and ‘brushed’ aside by a member of staff as they were too busy doing other tasks and errors were made in the administration of medication, as discussed in standard 9. Service users spoken with made the following comments: “staff are nice and kind, I don’t see them often but they are there to help if needed,” “I am looked after well and staff are nice and kind,” and “staff are there to help when needed, but I prefer to keep my independence.” On speaking with staff members, they stated that at times it was very stressful when you had a lot of responsibility and additional tasks to perform and this practice detracted from offering service users a quality service and left staff feeling tired and stressed. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 18 There was evidence within staff personnel files to show that new members of staff undergo an induction on commencing employment, so that they are aware of their roles and responsibilities. One member of staff spoken with stated that they had found the staff team very welcoming and the induction useful. Three members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level two and three are working towards this qualification, this will enhance the level of skill and knowledge that they have in caring for the service user group. Four staff personnel files were observed to see if all the documentation required by law was in place and service users are protected from unsuitable employees. All files contained the required documentation such as references and proof of identity. Staff spoken with were able to confirm they had undergone such checks before they had started work. Individual training files and certificates were in place for a number of staff, however again for those staff who also worked at the other home, these were not available. These were faxed through to the commission following the visit. The records seen showed that staff who administer medication have been trained in this area, and 3 members if staff had undertaken training in dementia care needs and a further six members of staff were booked on this course. Staff files reflected that staff training was at a good standard and the majority of compulsory training such as first aid, manual handling and health and safety had taken place. Staff spoken with stated that training was at a good standard and they felt that they had the necessary skills to meet service users needs. Two service users spoken with said that they thought staff must be well trained as they knew how to care for them. Elm Tree House DS0000064368.V354953.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although service users views are gained, these are not fully considered in the quality monitoring of the service. Service users are assured that their personal finances are safe and protected and they may access these at any time. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and is deemed as fit to run and manage the care home. She is currently working between two homes owned by the company. Therefore the deputy manager is acting up as manager when she is not at the home, in view of taking on this role permanently if deemed fit by CSCI. The manager has achieved the registered managers award, which ensures that she has the necessary knowledge and skill to manage the care home. The deputy manager is currently working towards completing the National Vocational Qualification Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 20 level 4, which will offer her further knowledge in managing a care home. Staff spoken with stated that both the manager and the deputy were approachable and listened to concerns. The manager stated that quality assurance monitoring of the service is done in an informal manner; therefore there was no evidence that quality assurance monitoring other than the handing out of service users questionnaires on an annual basis was taking place. Eleven service user questionnaires responses and two visitors responses had been returned, however these were over a year old and therefore not useful in offering up to date feedback about the service. The provider attends the staff meeting to ensure that they remain up to date with events occurring in the home, there was evidence of this in the staff meeting minutes, issues such as the Christmas preparations and any issues with service users needs were discussed at the last meeting. Service users also have a meeting, minutes of these were seen, and issues such as activites had been discussed. Should a service user wish to have money kept in safe keeping this facility is available. The arrangements made for the safekeeping of service users personal allowances are detailed within the plan of care. Four accounts were checked, these demonstrated that two staff sign for all transactions and receipts were available. All four accounts corresponded with the accounting sheet. Evidence was available within staff files to show that staff undergo a supervision session every two months, during this time issues such as training and development and the policies and procedures of the home are discussed. One staff member spoken with said that they felt that they benefited from these sessions as they had a chance to discuss their needs with the manager. During the brief tour of the home no obvious health and safety hazards were observed. Relevant servicing of equipment such as the electrics and gas had taken place. Staff spoken with had a good understanding of risk assessments and the risk of falls within the home. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4,c) 15(1) Requirement Plans of care and risk management plans must be in place for service users complex needs to ensure these are met and service users are protected. All medication administered must be signed for to ensure that accurate records are maintained and service users are protected. All medication must be stored securely to ensure service users are protected. Staff must be respectful to service users at all times to ensure that service users dignity and rights to fair treatment is upheld. Evidence to demonstrate that sufficient staff are available to meet service users needs is required. A business plan is required to demonstrate that quality assurance monitoring takes place and improvements are planned, thus ensuring service users live in a home, which is run in their best interests. Timescale for action 24/01/08 2 OP9 13(2) 30/12/07 3 4 OP9 OP10 13(2) 12(4,a) 26/12/07 26/12/07 5 OP27 18(1,a) 24/01/08 6 OP33 24(1,a,b) 24(2) 24/02/08 Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 23 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 OP7 OP15 Good Practice Recommendations Care plans and risk assessments are dated and signed on completion to ensure up to date information is available. When service users are assisted with meals, staff sit with them and make the occasion a pleasant experience. Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Elm Tree House DS0000064368.V354953.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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