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Inspection on 13/07/05 for The Firs Residential Home

Also see our care home review for The Firs Residential Home for more information

This inspection was carried out on 13th July 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service provides accommodation which is spacious but gives residents the opportunity in live in small homely living units. All bedrooms are for single occupancy and all are provided with ensuite facilities which include private showers. The home has a clear staffing structure and staff are clear about their roles and responsibilities. The home encourages residents to use local community resources and also seeks guidance and support from clinical specialist services in relation to the care of older people suffering from dementia.

What has improved since the last inspection?

Since the previous inspection, the level of activity provided to residents has increased and a staff member has been allocated additional hours to ensure that this service is provided. This improvement in services has been much appreciated by residents. Additionally the owning organisation and management of the home have ensured that all staff providing services to residents accommodated on the special needs unit have received appropriate training in the care of older people with dementia and evidence clearly showed that they were willing to look at alternative ways of working to endeavour to meet the complex individual needs of this resident group.

What the care home could do better:

The home should endeavour to provide each newly admitted resident with a care plan from which staff can work and ensure that the individual needs of people are met. Care plans seen were limited in their content and provided very little information from which care staff could draw the relevant information. Care Plans are a working document which should indicate the assessed needs of each person in relation to activities of daily living and should also indicate the preferences and preferred daily routines of each person. The increased provision of care for residents with special needs has been in existence for approximately one year. It has become clear through inspection that the level of staffing provided on this unit is not sufficient to ensure that the needs of residents currently accommodated are met. The home needs to increase the level of care staff available on this unit by one thus ensuring that there is one senior carer and three care staff on duty throughout the waking day.

CARE HOMES FOR OLDER PEOPLE The Firs Residential Home 186 Grange Road Felixstowe Suffolk IP11 8QF Lead Inspector Jane Higham Unannounced 13th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Firs Residential Home Address 186 Grange Road, Felixstowe, Suffolk, IP11 8QF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01394 283278 01394 284504 None Anchor Trust Mrs A P Houston CRH 40 Category(ies) of OP - 20, DE - 20 registration, with number of places The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08 December 2005 Brief Description of the Service: The Firs Residential Home for Older People was built in 1991 on the land adjacent to a former local authority home. The home offers accommodation and care for up to forty service users, within four individual living units, each accommodating ten people. The two living units situated on the first floor of the home are allocated for older people with a diagnosis of dementia, therefore presenting more complex individual needs. The home is owned and adminstered by Anchor Homes Trust, a non profit making organistion which provides housing and resdiential care throughout the cournty. Twelve of the forty beds are offered on a private basis and the remaining twenty-eight beds are block purchased by Suffolk Social Care Services. The home is situated in a quiet road in a residential area of Felixstowe. There are several local shops close by and a superstore a short distance away which includes a pharmacy, post office and local GP practice. The home is purpose built and offers a high standard of accommodation on two floors. The home has one room which is allocated for respite care. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of The Firs, a forty bedded residential home for older people situated in a residential area of the coastal town of Felixstowe. The home is administered by the Anchor Trust and the building leased by the Trust from Suffolk County Council. The home is registered to accommodate forty residents. Twenty people are accommodated in the special needs unit on the first floor of the building and the remaining twenty residents are accommodated on the ground floor. Twelve beds are allocated for privately funded placements and the remaining twenty-eight are block purchased by Suffolk County Council. This was the first scheduled inspection in the inspection year 2005/2006. The Inspection took place on 13 July 2005 over a period of 4 hours and 25 minutes. On the day of the inspection, the Registered Manager was in attendance. During the inspection feedback was sought from the Registered Manager, residents and staff and an environmental tour of the building was undertaken. Care Plans of the two most recently admitted residents were examined as were required records, policies and procedures. Requirements made following the last inspection of the home were revisited and progress and/or compliance was assessed. What the service does well: What has improved since the last inspection? Since the previous inspection, the level of activity provided to residents has increased and a staff member has been allocated additional hours to ensure that this service is provided. This improvement in services has been much appreciated by residents. Additionally the owning organisation and management of the home have ensured that all staff providing services to residents accommodated on the special needs unit have received appropriate training in the care of older people with dementia and evidence clearly showed The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 6 that they were willing to look at alternative ways of working to endeavour to meet the complex individual needs of this resident group. 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 Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3,4. Prospective residents can expect to be provided with appropriate information about the service which will assist them in deciding if they wish to live there. Prospective residents can also expect to receive a full assessment prior to admission in order to confirm that the home is able to meet their individual needs. Once living in the home, residents can expect to be cared for by staff who have received appropriate training. Following admission residents can expect to be provided with a placement contract and a copy of the terms and conditions. EVIDENCE: Information in relation to the recent admission of two residents was examined during the inspection. The home was able to evidence that in both cases the prospective service user’s needs had been assessed by a named assessor, ie a social worker, and a copy of the written assessment of need had been provided to the home on which a decision could be based on whether the home would be able to meet the needs of the prospective resident. Both residents had been living at the home for approximately two weeks and one resident had already been provided with a placement contract and a copy of the home’s terms and conditions of residence. In addition to the pre-admission The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 9 assessment carried out by a member of social care services, the Manager, or other senior member of staff also visits the prospective resident and carries out their own pre-admission assessment, taking into consideration the needs of the existing resident group. The home was able to evidence that it has provided staff with appropriate training in the care of older people with dementia to ensure that staff working on this specialist unit carry out their duties in an informed manner. It was noted that all private rooms had been provided with name plaques to assist residents with poor orientation to find their own rooms. The home has a Statement of Purpose which has recently been amended to reflect the increase in the service provision for people with dementia. All residents are provided with a copy of the home’s Statement of Purpose and a copy is also available in the entrance hall of the building. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Residents who have recently been admitted to the home can not necessarily expect to have their care needs set out in an individual care plan. However they can expect to have their health care needs met and to be enabled to access community health services. Residents will be protected by the home’s revised policies and procedures in relation to the safe keeping and administration of medication and will be treated with respect by staff members. EVIDENCE: Care planning documentation in relation to the two most recently admitted residents who had been at the home for two weeks, was examined. In the case of one resident, information with regard to individual assessed needs was very limited. It was identified that care staff might have difficulty in ensuring the care offered to this person was appropriate due to the limited information available. In the case of the second resident, a care plan had not been produced and staff were making a decision on the care required based on limited information contained within the pre-admission assessment. Care Plans are a working document and should be commenced when the prospective resident is admitted to the home. The home is able to evidence that it monitors the physical and mental health of all residents and enables them to access The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 11 community health resources. On the day of the inspection several residents were being visited by the district nursing services. In response to two incidents where residents have not been given their appropriate medication, the home has reviewed and revised its procedures in relation to the administration and safe keeping of medication. It was agreed that in order to ensure that practices in relation to medication are appropriate and secure, the pharmacy inspector from CSCI would carry out an audit within the near future. The manager confirmed that she would welcome this additional safety check. Throughout the inspection, staff members were observed to interact well with residents in a manner which upheld both their dignity and privacy. All bedrooms are for single occupancy and have the benefit of ensuite facilities and therefore provide maximum privacy to all occupants. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Residents living at the home can expect to be provided with a programme of activities which suit their needs and preferences. They can also expect to be enabled to maintain contact with family and friends and to be provided with meals which are of a good standard. EVIDENCE: A programme of what activities available to residents was displayed on the notice board within the main hallway of the building. Since the previous inspection, two days a week have been allocated to an existing staff member to provide activities to residents. Activities being offered included cooking, a beauty afternoon, aromatherapy bingo and a coffee morning. A record of activities is maintained for each resident and showed what activities service users had been involved in. A resident spoken to at the time of the inspection stated that they never got bored, as there was more than enough activity available. Another resident was observed assisting a member of the care staff by drying dishes on the unit kitchen. During the inspection several, family members visited the home and were made very welcome. The Manager advised that since the previous inspection a local housing committee had become involved in fund raising for the home. On the day of the inspection, preparations were under way for the home’s forthcoming summer fayre. Menus of meals provided were not examined on this occasion although residents The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 13 spoken to confirmed that all meals were of a good standard and very enjoyable. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents can expect to be provided with sufficient information which will enable them to raise any concerns they may have with either the management of the home, the owning organisation or other agencies such as the Commission for Social Care Inspection. EVIDENCE: The home was able to evidence that it has a complaints procedure, which is issued by Anchor Homes Trust, a copy of which is displayed within the main hallway of the home and therefore available to all staff, family members and visitors to the building. The procedure is also included as part of the Statement of Purpose and Service User Guide, a copy of which is provided to each resident. Since the previous inspection, the Commission received one complaint in relation to the home. This was in relation to the omission of a particular resident’s medication. Following the investigation, the complaint was found to be substantiated and an action plan was submitted by the home in order to ensure that these matters were addressed satisfactorily. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 Residents accommodated at the home can expect to be provided with a homely environment in accommodation that is both spacious and appropriate to meet their needs and which is maintained in a safe and satisfactory manner. Some issues in relation to infection control practices require addressing by the service provider. EVIDENCE: The Firs consists of a fit-for-purpose building which provides accommodation which is appropriate for the care of older people and people suffering from dementia. Accommodation is provided on two floors, each consisting of two units. Each unit has ten bedrooms, all of which have ensuite toilet and shower facilities. Additionally, each unit has its own small lounge, with a dining, sitting and kitchen area where light snacks and drinks can be made. In addition to the ensuite bathroom facilities each unit is provided with a communal bathroom, with assisted bathing and WC. There is a large communal lounge on each floor where residents can meet together and where larger functions can be held. The home is sited in pleasant gardens, including a secure garden, where residents with dementia can wander unassisted. Whilst accommodation is on two floors both can be accessed via a stairway or passenger lift. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 16 On the day of the inspection, a selection of residents bedrooms were seen. These were very spacious, pleasantly decorated, comfortably furnished and had been made to look very homely by the occupants and their families with the addition of personal belongings and small items of furniture. Communal areas were again comfortably furnished in a domestic style and were maintained to a satisfactory standard of decorative order and repair. It was noted during the inspection that skirting boards in some bedrooms were being replaced as part of a planned maintenance and renewal schedule. Aids and adaptations to assist mobility were provided throughout the home and new signs, which included residents names and a symbol, had been provided for all bedrooms doors to help residents find their way back to their own room. On the day of the inspection three issues relating to hygiene control were noted: * An unpleasant odour was noted in the main entrance hallway. * A tablet of used soap was found in one of the communal bathrooms. * Filled urine bottles had been left on the desk in the main office awaiting awaiting dispatch to the surgery. However, it was noted that in response to a requirement made at the previous inspection, the home has purchased a new laundry bin system comprising of three washable bags which each have lids. This piece of equipment ensures the effective and safe storage and transfer of soiled laundry In summary the home provided very pleasant and spacious accommodation for residents which provided maximum privacy but enabled residents to be independent and have a choice about where and with whom they socialised. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Whilst residents accommodated on the residential unit can be assured that their needs will be met by an appropriate level of staff, residents accommodated on the special needs unit can not be afforded this guarantee. However, residents accommodated on the special needs unit can expect to be provided with care by staff members who have received appropriate training to meet their complex and individual needs. EVIDENCE: At the time of the inspection, the manager was in attendance and residents were being cared for by two senior members of staff, one allocated to each unit and supported by six members of care staff. During the night period, the home is staffed by one senior, supported by two carers. The upper floor of the home is allocated to the care of older people with a diagnosis of dementia and one senior and two carers are allocated exclusively to this unit. Recent behavioural problems exhibited by a resident had necessitated an additional carer to be in attendance on the special needs unit. This has now been withdrawn since the person concerned was admitted to hospital. However, it has highlighted that the current level of staffing provided on the special needs unit is not adequate to meet the fluctuating and complex needs of this service user group. To ensure the safety and well-being of all residents accommodated on the special needs unit the level of staffing needs to be increased to four members of care staff in addition to the attendance of the senior member of staff, allocated to that unit. The home was able to evidence that since the increase in the number of residents being accommodated on the special needs unit, staff have received appropriate training in the care of older The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 18 people with dementia via a six part training course accredited by the University of Bradford. Additionally the Deputy Manager has undertaken training in Dementia Care Mapping and the Registered Manager has obtained a qualification in dementia care accredited by the University of Sterling. The home was able to evidence that good practices in relation to the care of older people with dementia has emerged from this training. Feedback gained from residents was very positive in relation to the staff. They described staff as very helpful and kind. Interaction between staff and residents was observed to be good. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 Residents can expect to live in a home that is effectively managed by a person who is qualified and experienced to carry out this role. They can also expect that staffing structures in place provide a clarity to the roles and responsibilities of all levels of staff. Residents can expect the owning organisation’s quality assurance systems to be monitoring the standard of care and accommodation provided to them and that the environment they live in is safe. At the time of the inspection, residents could not necessarily be assured that they would be provided with mobility equipment which is appropriate to their individual disabilities. EVIDENCE: The home is able to evidence that appropriate and qualified management is in place. The Commission are aware that the Manager of the home is currently spending one working day a week in another Anchor Trust home in southern England that is without a manager. There is a clear staffing structure which The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 20 includes a senior staffing level who have additional responsibilities and are allocated extra hours to attend to administrative duties. On the day of the inspection, the home was being visited by a representative of the owning organisation for the purposes of quality assurance in compliance with Regulation 26 of the Care Homes Regulations 2001. Reports produced from these visits are provided to the Commission. The home was able to evidence that it provides a safe environment for residents. Records examined evidenced that fire alarms are tested on a weekly basis as are emergency lighting units. The owning organisation has employed a falls co-ordinator who has been consulted in relation to the provision of hip protectors for residents who may be at risk. It was noted during the inspection that one resident who was having respite care was provided with a zimmer frame which was clearly inappropriate to her height. This caused the service user to feel unsafe when walking. The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 4 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 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 1 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x x x 2 The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The Registered Persons must ensure that each resident is provided with a care plan which sets out in sufficient detail how that persons assessed indivdual care needs will be met. The Registered Persons must ensure that the unpleasant odour detected in the entrance hallway of the home is identified and eliminated. The Registered Persons must ensure that tablets of soap are removed from communal bathrooms and liquid soap is provided. The Registered Persons must ensure that urine samples waiting for collection are stored in a safe and appropriate manner. The Registered Persons must enusre that the number of care staff available to provide direct care to residents accommodated on the special needs unit is increased to four. This is in addition to the Senior member of care staff available on that unit. The Registered Persons must ensure that residents are Timescale for action Immediate 2. 26 16(2)(k) Immediate 3. 26 13(3) Immediate 4. 26 13(3) Immediate 5. 27 18(1) 31.08.05 6. 38 13(5) & 13(4)(c ) Immediate Page 23 The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 provided with appropriate walking aids which are suitable for their indiviudal mobility needs and stature. 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 None Good Practice Recommendations The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Firs Residential Home I54-I04 S24387 Firs Felixstowe V242618 050713 Stage 4.doc Version 1.40 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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