Inspection on 29/11/05 for 115 Gough Road

This inspection was carried out on 29th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

115 Gough Road 26/03/08

115 Gough Road 26/01/07

115 Gough Road 05/07/05

115 Gough Road 29/11/04

115 Gough Road 06/05/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

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Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

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10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Gough Road, 115 Edgbaston Birmingham West Midlands B15 2JG Lead Inspector Kerry Coulter Unannounced Inspection 29th November 2005 10:40 Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 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 Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gough Road, 115 Address Edgbaston Birmingham West Midlands B15 2JG 0121 446 6744 0121 446 6289 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) Sense West Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (5) registration, with number of places Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: 115 Gough Road is a large detached Victorian house situated in a quiet residential road in Edgbaston. Public transport is close by and the home is approximately two miles from the city centre of Birmingham. Gough Road currently accommodates five male service users. The accommodation is spacious and includes a large reception hall, lounge, dining room, kitchen, office/meeting room, laundry and a ground floor bedroom with ensuite facilities. Four further bedrooms, (one of which is ensuite), two bathrooms and a toilet are situated on the first floor. The home has a second floor, which is inaccessible to service users, and provides a storage area and a staff sleeping in room. The garden has been developed so that the top area includes a large patio area which is accessible to service users and contains garden furniture and a range of plants. The lower part of the garden is extensive. The home provides care and support services to five adults with learning disabilities and a sensory impairment. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted by one Inspector. This was the second of the statutory inspections for this home for 2005/2006 and not all of the National Minimum Standards were assessed. To get a full picture of the home it is advised to read this report in conjunction with the report from July 2005. At this inspection time was spent observing care practices, interactions and support from staff. Some of the service users do not have verbal communication and their ability to communicate to the inspector their views of the home was limited. A tour of the home was made. Service user care plans, risk assessments and a number of Health and Safety records were inspected. The Inspector had the opportunity to talk with several members of staff, the Manager and Deputy Manager. During this visit the Inspector did not have opportunity to speak with relatives and other professionals. What the service does well: What has improved since the last inspection? A new manager has been appointed. Staff meetings are held, it was observed from the minutes that meetings had been held more frequently since the new manager had commenced work in the home. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 6 Progress towards completing satisfactory risk assessments has been made. Staff have obviously worked hard to ensure each risk assessment is directly cross-referenced to the element(s) of the care plan to which it relates. Progress has also been made to ensure that where needed, the assessments are specific to the service user rather than being generic documents. The home now has two new vehicles, this provides more flexibility for activities. A full review of activity time-tables has taken place since the last inspection to ensure activities on offer are what the service users enjoy. 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. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 5 Progress has been made towards service users having the information they need to make an informed choice about where to live and having individual contracts about the terms and conditions of their stay at the home. EVIDENCE: The home does not have any service user vacancies. Previous inspections have evidenced that full assessments have been completed for current service users and that the admission procedure for prospective service users is satisfactory. Requirements were made at the inspection in July 2005 to further develop the Statement of Purpose and Service User Guide to ensure they contain all the required information and are in a format suitable to the needs of the service users. Progress has been made, it was observed that the Manager is near to completing the revised Statement of Purpose. The Manager also stated that the Service User Guide had been updated and a copy obtained on CD Rom format. Unfortunately the Manager was unable to locate this. He will need to ensure the Guide is located and a copy made available to each service user. Previous inspections have required that people who live at the home must be provided with an individual contract and terms and conditions of residency. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 9 The Manager stated that progress was being made towards achieving this and was able to provide blank copies of terms and conditions that have recently been developed. These now need to be completed and a copy provided to service users. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 and 10 In general there is a clear and consistent care planning system in place to provide staff with information they need to meet service user needs. Service users are supported to take responsible risks, but some work needs to be done on the ways in which risks are assessed and how this information is presented. Confidential information about the service users was appropriately handled within the home. EVIDENCE: The care plans for one service user were sampled. They included detailed personal profiles, personal goals and aspiration, specific information on service user communication needs and independence and life skills. The plans sampled were up to date, detailed, informative and included behaviour management guidelines. Staff at the home seek input from other health and social care professional to assist in meeting individual need. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 11 Requirements were made at the inspection in July 2005 in regard to service user risk assessments. Sampling of risk assessments shows that progress has been made towards meeting requirements. The majority of assessments were up to date with the exception of a manual handling assessment dated 2003. One service user had new behaviour management strategies in place but the risk assessment for exhibiting challenging behaviour had not been reviewed at the same time to see if any changes were necessary in light of the new guidelines. Staff have obviously worked hard to ensure each risk assessment is directly cross-referenced to the element(s) of the care plan to which it relates. Progress has also been made to ensure that where needed, the assessments are specific to the service user rather than being generic documents. Risk assessments are not always clear in detailing the actual level of risk. Discussion with the Manager and observation of meeting minutes indicates that a senior manager from SENSE is leading a project on updating the risk assessment forms to include the level of risk. Service users individual records are stored securely. Staff are mindful of issues discussed in the presence of service users, and were not observed to breach confidentiality. The home uses accident books that are compliant with the Data Protection Act. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Arrangements are in place so that service users experience a meaningful lifestyle to include participation in a wide range of activities. EVIDENCE: Each person who lives at the home has a schedule of activities. The activities on offer are varied and include swimming, shopping, rock climbing, ice-skating and massages from a visiting therapist. At the last inspection it was identified that where activities had been cancelled it was not always possible to track the reason why. Records sampled at this inspection showed that fewer activities are cancelled and the majority of records show the reason why. The home now has two new vehicles and discussion with the Manager and Deputy Manager indicate that this provides more flexibility for activities. In addition, a full review of activity time-tables has taken place since the last inspection to ensure activities on offer are what the service users enjoy. An audit of activities completed for November indicates a level of 82 of activities had occurred, this is an increase on previous levels. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service user personal care needs are met. Practices relating to the storage and administration of medication are generally satisfactory but improvements to auditing of stock and written medication protocols must be introduced. EVIDENCE: Information on the support required by individuals for their personal care was observed to be recorded in their care plan. Sampled care plans included information on gender specific support. During the inspection personal care was offered sensitively as required by the individual. In general the procedures for medication administration are satisfactory. Medicines were seen to be stored appropriately in a secure location. The majority of medication is dispensed from a blister pack but Paracetamol is retained in the manufacturers packaging. Since the last inspection the Manager has obtained an audit form to ensure stocks held in the home tally with medication administered. This form now needs to become a working document, regular auditing will identify any discrepancies. Protocols are available for the administration of ‘as required’ medication. Some of the protocols were undated, therefore it was not possible to establish that the guidelines were current. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 In general the home is run in a way that keeps service users safe but adequate steps have not been taken to protect service users from the recent behaviour of one service user. EVIDENCE: Although behaviour management guidelines had been recently reviewed there were no guidelines for staff regarding one service users recent behaviours of pushing other service users off the toilet. Discussion with staff and examination of records did not identify any tangible way in which this had been explored or addressed. These incidents had not been reported to the CSCI as required by regulation, despite one service user having been scratched causing bleeding. Pro-active strategies need to be included in the plan to ensure other service users are protected from this behaviour. Since the last inspection an incident occurred in the home that was reported under adult protection procedures. The procedure followed by SENSE managers has been in line with the Birmingham Multi Agency Adult protection guidelines. The file of one recently recruited staff evidenced that a robust recruitment procedure had been followed. The financial records of one service user were sampled, receipts were available for all expenditure. Staff were observed to do a financial handover at the change over of shifts to ensure monies held tallied with records. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Several maintenance matters required attention to ensure the home presents as a homely and comfortable environment for the people who live there. EVIDENCE: The premises are not owned by SENSE, the landlords of the property are Moseley and District Churches Housing Association (M&D). During this inspection representatives from M&D were completing an environmental audit of the home. It was identified at the last inspection that the kitchen area was starting to look worn in appearance. Worktops had some chipped areas and the area to the back of the sink required resealing. The rear kitchen, where most of the food is stored had some missing drawer fronts and one jammed drawer. Temporary repairs have since been completed and the Manager stated that refurbishment of the kitchen was planned for early in 2006. Although it is not that long since the dining room has been repainted the walls were observed to be quite stained from drink splashes. Staff said they had tried hard to remove the stains but the paint was not of a washable type. This room will again need repainting but consideration should be given to using a washable paint. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 16 Other minor repairs that were needed included repairing a hole in the wall in the first floor bathroom, repainting above the cistern shelf in a first floor bathroom, repairs to the fire door closure in the dining room and cleaning inside the window of the ground floor bedroom where there was a lot of condensation forming between the window and protective screening. One service user had an armchair in his room that was missing a cover. The chair was very stained, staff said that they did not have a cover for the chair. The chair will require deep cleaning and a new cover, or alternatively a new chair must be provided. This inspection was carried out following a recent episode of snow. Of concern was the cold temperature in some areas of the home, particularly the lounge area. One member of staff said that the home was often quite cold. It was not possible to measure the temperature at this inspection but the Inspector felt very cold despite wearing both a top and jacket. The room is quite large in size but is served by only one radiator that although switched on was not giving out much heat. An immediate requirement was made to ensure that the home was maintained at a comfortable temperature. It is recommended that the Manager ensures a daily log of temperatures is maintained to identify if there is a reoccurring problem with temperatures in the home. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 and 36 The staff team is committed and motivated to support the service users. Staffing levels are adequate but service users are not always supported by staff who know them well. There is a continuous training programme in place for staff, and this should be developed further to ensure staff receive all mandatory training. EVIDENCE: The staff on duty were observed to support service users competently with patience and respect. Service users were supported by staff to undertake independent living skills at their own pace. Discussion with the Manager indicates that more than 50 of staff have now achieved an NVQ in care, this meets the National Minimum Standard on qualifications for care staff. Most staff have received the training they need but not all staff have had medication, infection control, food hygiene and first aid training/ refreshers. Two staff require refresher training on the use of physical intervention (NCI). The home has recently had a period of staff shortages and the use of agency staff has therefore increased. The home currently has 4.5 day vacancies and a waking night vacancy. One new member of staff has recently commenced work and two new casual staff have been recruited. One member of staff from another SENSE home has recently commenced work in the home for a three month period whilst vacancies are recruited to. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 18 The organisation needs to ensure the current use of agency staff is further reduced to ensure service users are supported by people they know well. The Manager said that recruitment meetings are being held two weekly with senior managers to track recruitment issues and progress across all of the Birmingham SENSE homes. Staff meetings are held, it was observed from the minutes that meetings had been held more frequently since the new manager had commenced work in the home. The frequency of supervision from managers was assessed for three staff. The frequency of supervision has now increased and monthly supervision has taken place with staff. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 Work practices generally promote and protect service user’ welfare, health and safety but attention is required to a fire door and temperature in the home. EVIDENCE: A new Manager has recently commenced work in the home. Discussions indicate that he has previous relevant experience in care. An application for registration as manager must now be made to the CSCI. Fire records indicated that an engineer has serviced the fire extinguishers, fire alarms and emergency lighting. Staff test the smoke detectors weekly and the emergency lighting monthly to make sure they are working. Regular fire drills take place to make sure that all service users and staff are aware of the procedure to follow if there was a fire in the home. The fire risk assessment showed what action has been taken to ensure the risks of there being a fire are minimised. A Corgi registered engineer has tested the gas equipment and stated that it was in a satisfactory condition. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 20 Staff test the fridge and freezer temperatures regularly to make sure that food is being stored at the correct temperature. As recorded earlier in this report the home was quite cold on the day of the inspection. The home needs to be kept warm to ensure the general health and well being of service users. Repair to the fire door closure were observed to be required in the dining room. This appeared to be an ongoing problem and had reported as requiring repair but staff did not know when repair was scheduled. In the bathroom the water at the sink tap was extremely hot, presenting a risk of scalding to service users. Staff had placed a warning sign above the tap and reported the problem but again did not know when repairs were scheduled. Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X 2 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 2 X 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Gough Road, 115 Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000016712.V269564.R01.S.doc Version 5.0 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 YA1 Regulation 4 Requirement The homes statement of purpose must include the following information: The fire precautions and emergency procedures. The arrangements for dealing with complaints. Outstanding requirement from 31/3/04. The homes service user guide must include the following information; Summary of statement of purpose. Outstanding requirement from 31/3/04. The home must ensure that each service users has a signed contract. Outstanding requirement from 31/3/04. Risk assessments require further development to ensure they detail the level of risk. Outstanding from 30/8/05. Service user risk assessments must be reviewed every six months or following a critical incident. Medication: A system for the auditing of non blistered medication DS0000016712.V269564.R01.S.doc Timescale for action 30/12/05 2. YA1 5 30/12/05 3. YA5 5 30/01/06 4. YA9 13(4) 30/01/06 5. YA20 13(2) 30/12/05 Gough Road, 115 Version 5.0 Page 23 stocks must be introduced. Outstanding from 30/8/05. Protocols for ‘as required’ medication must be dated to show they are current. The behaviour of one service user pushing other service users off the toilet must be explored and addressed. Proactive strategies need to be developed. Accidents and incidents must be reported to the CSCI as required under regulation 37. A planned schedule of repairs is required for: - repainting of dining room -hole in bathroom wall -repainting above cistern lid in bathroom - cleaning inside of window of ground floor bedroom and addressing condensation problem - armchair in bedroom requires repair/replacement. The registered provider must ensure that all parts of the home are maintained at a comfortable temperature close to 21°C. The registered provider needs to ensure the current use of agency staff is further reduced to ensure service users are supported by people they know well. Ensure staff have received all mandatory training to include refresher training. Outstanding from 31/4/04. An application to register a manager for this home must be made. Ensure the water at sink tap in first floor bathroom is reduced to 43°C. DS0000016712.V269564.R01.S.doc 6. YA23 13(6) 15 30/12/05 7. 8. YA23 YA24 13(6) 37 23(2) 30/11/05 02/01/06 9. YA24 23(2)(p) 30/11/05 10. YA33 18(1)(a) 30/01/06 11. YA35 18(1)(c ) 28/02/06 12. 13. YA37 YA42 8,9,10 13(4) 30/01/06 05/12/05 Gough Road, 115 Version 5.0 Page 24 14. YA42 13(4) 23(2) The dining room fire door closure requires repair to ensure an effective smoke seal. 05/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Gough Road, 115 DS0000016712.V269564.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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