Inspection on 29/09/08 for Gate Cottage

This inspection was carried out on 29th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate Cottage 11/10/06

Gate Cottage 14/02/06

Gate Cottage 01/09/05

Gate Cottage 06/01/05

Gate Cottage 15/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gate Cottage Bazehill Road Rottingdean Brighton East Sussex BN2 7DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gwyneth Bryant     Date: 2 9 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Gate Cottage Bazehill Road Rottingdean Brighton East Sussex BN2 7DB 01273301890 01273300071 info@gatecottageresthome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Brenda Georgina Sodeau Type of registration: Number of places registered: Mr Michael Martin Sodeau,Mrs Brenda Georgina Sodeau care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The number of service users accommodated must not exceed eleven (11). The service users accommodated will be aged sixty-five (65) years or over on admission. Date of last inspection Brief description of the care home Gate Cottage is registered to provide care and accommodation for up to eleven older people who do not have high dependency needs. The home is located in a quiet residential area of Rottingdean and it is close to public transport, local shops, amenities and the seafront. The home is an attractive two-storey property built on a slight incline and comprises of eleven single en suite rooms, lounge and dining area, a conservatory and very pleasant garden areas. A lift is available to the first floor. The Care Homes for Older People Page 4 of 29 Over 65 11 0 Brief description of the care home property is furnished and maintained to a very high standard and provides a very warm, caring and friendly environment for residents. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was carried out on 20 September 2007 and an Annual Service Review undertaken on 7 January 2008. This was an unannounced inspection and took place in just under seven hours. The purpose of the inspection was to check compliance with key standards. There were eleven people in residence on the day of which four were spoken with. The Deputy Manager, a carer, the cook and the Registered Provider were also spoken with. A number of documents and records were viewed; including personnel files, medication charts and care plans and a tour of the premises was also carried out. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how Care Homes for Older People Page 6 of 29 well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was provided a little later than when we asked for it but the information included in this report as necessary. The current fees as from April 2008 are from 575 to 680. Additional charges are made for dry cleaning, toiletries, hairdressing and newspapers. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the pre-admission process to ensure the home can meet assessed needs. Evidence: Pre admission assessment sheets were viewed and in the main included most of the required information in relation to care needs. However, they did not show how the home will meet needs in particular for those people who have dementia type illnesses or specified social needs. For example, two people with dementia have been admitted but not all staff have received training in dealing with this condition and neither do care plans to include direction to staff. One persons assessment say they need social interaction and to be encouraged to join in activities. However, due to limited staff numbers this person was observed to be left unsupervised in the lounge for approximately 45 minutes. It is important that the home demonstrates it can meet assessed needs. Care Homes for Older People Page 10 of 29 Evidence: Discussion with the Deputy Manager found that new residents have flowers put in their room and a welcome card detailing meal times, however this is not recorded. It is important to record both positive and negative aspects of the service to ensure all staff are aware of what to do when new residents are admitted. Following the site visit the Deputy Manager confirmed that no resident was admitted with a dementia type illness but the condition became apparent following admission. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to all aspects of the care planning process and the recording of medication. Evidence: Five care plans were viewed in conjunction with related documents such as daily notes, risk assessments and medication administration records (MAR). While care plans identified most care needs not all had been updated to show the changes identified in the daily notes. One care plan had not been signed and dated, therefore it was not clear who had made the entries nor when. It is important to provide a means of identifying the assessor and to show when the next review is due. The person admitted for respite did not have a care plan at all therefore it is not possible to show that all needs have been identified nor how they will be met. Staff spoken with were knowledgeable about the needs of residents and residents spoken with said they felt well cared for. However, improvements need to be made to record keeping to ensure all staff are able to deliver consistent care. On viewing daily notes, it was found that they were variable as some staff were writing -(name) fine- or - usual routine. Some Care Homes for Older People Page 12 of 29 Evidence: notes were more informative but most were task orientated such as -bathed- or -eye drops given-. Daily records are a good source of evidence to show that care is being provided, as detailed in the care plan, however terms such as - (name) had a quiet morning- is not helpful or adequate. Daily records when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs. It is also important to ensure that that daily notes provide information on following up any events. For example, one person had been aggressive but subsequent notes did not mention this, nor was there a record of a request for an assessment by an appropriate healthcare professional although the Deputy Manager said this had taken place. It was of concern that two care plans indicated that the residents mental health needs had increased and therefore need to be reassessed by an appropriate healthcare professional. The daily notes showed that one person had left the home but there was no evidence of additional safeguards put in place to ensure it doesnt happen again. Basic risk assessments had been carried out and these need to be expanded to include clear direction to staff in reducing the risks. The risk assessments also need to be thoroughly reviewed when residents needs increase, in particular for those who have begun to have falls or spend most of the day either sitting down or in bed. On the day of the site visit some residents were unable to have their 8am medication as the medication provided by the pharmacist was incorrect. It is good to note that the Deputy Manager checks all incoming medication thoroughly and takes appropriate action to ensure residents are not given incorrect medication. Information in the AQAA showed that staff have been trained in safe handling in medication and this was confirmed by the Deputy Manager, however, the MAR charts were not clear with gaps in the records, signatures overwritten, inappropriate use of code letters and signatures scribbled out. It is of particular concern that signatures are overwritten as this indicates that staff are signing for medication prior to administration, hence the need to scribble out the signature or overwrite it with a code letter to indicate that the person refused the medication. One daily note showed that a tablet was missing from the blister pack but there was no further information to showed if the matter was reported to the person in charge or investigations made. This should have been carried out as due to the errors in medication recording it may be that the person had already been given the tablet but it had not been properly recorded. It is important to follow good practice in all aspects of the handling and recording of medication to ensure it is clear whether or not medication has been given. Following the site visit the Deputy Manager confirmed that all risk assessments have been reviewed and an alarm fitted to the front door to alert staff if residents leave the home. Care Homes for Older People Page 13 of 29 Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to the activity programme but the arrangements for visitors and respecting privacy and dignity are good, as are meals. Evidence: The home maintains an activity record to show which residents take part in individual activities however, there is no system for ensuring that all residents have a range of chosen leisure opportunities as most activities are for individuals. The Registered Provider takes some people out for drives and on outings throughout the year but again there is no evidence to show that all residents are encouraged to make use of this facility. In order to ensure all residents have the opportunity to partake in chosen activities a daily programme of activities needs to be devised, made available to residents and be based on their preferred choices. One person spoken with said how much they enjoyed the arts and crafts and they felt that they could not paint, however the inspector noted that the paintings they had done were very good. This person said that it was very encouraging to sit round the table with others and this was what inspired them to try painting. This is a very positive outcome and indicates the value of providing group activities. One residents assessment showed that they should be encouraged to join in activities Care Homes for Older People Page 15 of 29 Evidence: and to have good social interaction but on the day this did not happen. Discussion with the Deputy Manager found that it was due to lack of staff as at the time staff were engaged in completing domestic type tasks. There is an open house policy with visitors welcomed at all times and residents spoken with confirmed that they have regular visitors and go out with them. Menus were viewed and found to be well balanced, nutritious and varied with choices offered at each mealtime. Residents spoken with spoke highly of the food and said that they were lucky to have such good cooks. One person said that they felt the food was almost too good as they were putting on weight. A discussion with the cook found that she was knowledgeable about special dietary requirements such as for those residents who are diabetic. Residents spoken with said that staff always treated them well and with care and kindness. Throughout the inspection staff were seen to treat people with respect and in ways that promoted dignity. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for dealing with complaints are good but improvements need to be made to Safeguarding Adult systems to ensure alerts are made when required and that all staff are trained in the area. Evidence: The AQAA showed that there are detailed policies and procedures for dealing with both complaints and Safeguarding Adults. Neither the home nor the CSCI have received any complaints. Not all staff have been trained in Safeguarding Adult procedures and this needs to be addressed to ensure they are clear in what they need to do in the event of an allegation. It was of concern that one person had left the home on more than one occasion and neither the CSCI nor Social Services had been notified of these incidents. As part of the Safeguarding procedures vulnerable adults are at risk if they leave the home and therefore the guidance needs to be followed. Care Homes for Older People Page 17 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and provides a safe, comfortable and attractive place in which to live. Evidence: A tour of the premises was carried out and a random selection of individual bedrooms inspected. Generally all parts of the home are well maintained and attractively decorated. Information in the AQAA and brief discussion with one of the Registered Providers found that there is a refurbishment programme in progress. Under this programme new call bells, kitchen, boilers and cookers have all been provided, with plans in place to replace carpets, bedding and curtains in individual rooms. Conservatory used as store room and for filing cabinets but Deputy Manager explained that it was not currently safe for residents due to the high step down from the dining room and this was due to be addressed under the maintenance programme. It would be good to see this prioritised to enable residents to enjoy looking at the garden during the winter months as the gardens are well maintained and attractive. During good weather residents said they go into the garden for walks as all parts of it are accessible. Although all bedrooms have full en-suite facilities, most residents use the communal bathroom and the hot water delivery temperature was just over 48 degrees. As the risk assessments state that water temperatures are controlled to reduce the risk of Care Homes for Older People Page 18 of 29 Evidence: scalding this needs to be addressed to ensure water is delivered at a safe temperature. This was discussed with the Deputy Manager who said that residents do not bathe alone but she agreed to get the water temperature adjusted on the day. Staff have been trained in infection control and were seen to working in ways that reduced any risks. The laundry was viewed and was found to be very clean and tidy with machines that wash at temperatures that reduce incidence of contamination. Care Homes for Older People Page 19 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements need to be made to staff deployment, and staff training but recruitment practice is good and ensures service users are protected. Evidence: As the Deputy Manager has been running the home on a day to day basis her time for caring duties has been reduced and staff numbers have not been increased to fill this shortfall. There are two carers on each daytime shift, in addition to the Deputy Manager and one staff member at night. Given that some residents needs have increased and the Deputy Manager is now managing the home a review of staffing levels needs to be carried out based on the needs of residents. As care staff also carry out some domestic tasks and do the laundry this further impinges on the time available for giving direct care to residents. Cooks and domestic staff are employed in addition to maintenance people and gardener. It was of concern that one person had not been trained in fire safety but the Deputy Manager confirmed that it was part of the induction process however this same person had not been trained in manual handling and this needs to be addressed to ensure neither they nor residents are at risk. Although some residents have dementia type illnesses and present challenging behaviour not all staff had been trained in these matters and this also needs to be addressed to ensure staff have the skills to provide Care Homes for Older People Page 20 of 29 Evidence: good quality care. Following the site visit the Deputy Manager has confirmed that all staff have since received training in dementia care. The recruitment records for the last three people to be recruited were viewed and all had provided the required documentation prior to employment and all had been inducted in line with the Skills for Care Guidance. Of the 11 care staff 9 have at least National Vocational Qualification at level 2 in care. Care Homes for Older People Page 21 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures all aspects of the welfare, safety and health of people living in the home are protected and promoted but improvements need to be made to the management arrangements. Evidence: Currently the Registered Manager is on long term sick leave and the Deputy Manager has been in charge of day to day management for approximately a year. The Deputy Manager is a qualified nurse and is due to complete the Registered Managers Award by the end of 2008 therefore she has the qualifications to manage the service. However, the CSCI was not informed of the change in management and this needs to be addressed to ensure it is clear who is responsible for the home. The Deputy Manager also carries out care duties and this impinges on her management time. Information in the AQAA did not indicate that all safety checks are carried out on electrical and gas appliances and systems. However, on the day of the site visit the Registered Provider confirmed that new boilers and a new cooker had been installed so Care Homes for Older People Page 22 of 29 Evidence: they do not currently need the annual check. In addition the electrical systems are part of the refurbishment programme so these will be checked as part of that process. The AQAA also showed that all policies and procedures were reviewed in 2008 as part of the quality monitoring process. Emergency lighting, water delivery temperatures and fire alarms are tested regularly and records were available to demonstrate this. Accident records are appropriately maintained and ideally should be collated and examined as part of the quality monitoring process. Some surveys had been sent to residents and their families as part of the quality monitoring process and outcomes were all positive. The lack of a clear quality assurance programme is evidenced by the number of shortfalls found at this site visit. Therefore a detailed quality monitoring system needs to be devised and implemented. As part of the quality monitoring process the Registered Provider needs to make unannounced monthly visits to the home and ensure subsequent reports are available for inspection. The home does not handle the finances of any service users and if service users need something the money is taken out of petty cash, receipts obtained and the home is reimbursed by relatives. Correction fluid and tape had been used on a number of documents including care plans and this needs to cease to ensure all records pertaining to the running of the home are accurate, clear and up to date. Care Homes for Older People Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 13(2) That all medications administered are correctly signed for by staff. 11/10/2006 2 27 18(1)(a) The home ensures that 11/10/2006 adequate staff are on duty to meet the current needs of service users. That the home expands its quality assurance programme to include written feedback from service users, relatives and visiting professionals. 11/01/2007 3 33 24(1) Care Homes for Older People Page 24 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 That the pre-admission document be revised to include information as to how the home will meet assessed needs. To show how the home will meet assessed needs. 29/12/2008 2 4 18 That no one is admitted to the home unless it can be demonstrated that staff have the skills and training to meet assessed needs. To ensure the home can meet the needs of those who need specialist care. 05/11/2008 3 7 15 That all service users whose physical or mental health needs have significantly increased by reassessed as required by the relevant placing or healthcare authorities. To ensure the home can continue to meet service users needs. 29/12/2008 Care Homes for Older People Page 25 of 29 4 7 14 Risk assessments 29/11/2008 undertaken for those at risk of falls, going out alone, leaving the home unescorted and tissue breakdown must include direction to staff in the management of the risk and be regularly reviewed. To ensure service users are not at risk. 5 7 15 That all service users have a 29/12/2008 care plan and that care plans are regularly reviewed and accurately reflect service users current care needs and include direction to staff in meeting needs. To ensure service users needs are met in a consistent manner. 6 8 12 That care plans inlcude healthcare needs of service users. To ensure service users healthcare needs are met. 29/11/2008 7 9 13 All staff who administer medication have their competence assessed and that all medication administration records are clear accurate and up to date. To reduce risk of medication errors. 29/11/2008 8 12 16 That a daily programme of activities based on service users preferences be devised and implemented. 29/12/2008 Care Homes for Older People Page 26 of 29 To ensure all service users have the opportunity to have a good quality life. 9 18 13 That Safeguarding Adult alerts are made as required. To ensure appropriate safeguards are in place. 10 18 18 That all staff are trained in Safeguarding adults procedures and that it is followed in practice. To ensure service users are not at risk. 11 27 18 That a review of staffing levels is carried out. To ensure there are sufficient staff to meet service users needs. 12 30 18 That all staff are trained to 29/12/2008 meet service users needs, in particular for manual handling, challenging behaviour and dementia care To ensure staff have the skills to meet service users needs. 13 31 8 That either the current registered manager gains the appropriate qualifications or the person who is in day to day charge of the home submits an application to registered with the CSCI. 29/01/2009 29/11/2008 29/12/2008 05/11/2008 Care Homes for Older People Page 27 of 29 To ensure it is clear who is in charge of the home on a day to day basis. 14 33 24 That a detailed Quality monitoring systems be introduced and fully implemented. To ensure any shortfalls are quickly identified and actioned. 15 33 26 That the Registered Provider 05/11/2008 make monthly visits to the home and make the subsequent reports available for inspection. To ensure the service is monitored. 16 37 17 That the use of correction fluid/tape ceases. To ensure all documents are clear and accurate. 29/10/2009 29/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 19 That daily notes accurately reflect the current condition of service users and how they spent their day. That the conservatory is made available for use by service users. Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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