Inspection on 16/08/07 for Green Gables

This inspection was carried out on 16th August 2007.

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

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

Other inspections for this house

Green Gables 22/08/06

Green Gables 27/09/05

Green Gables 11/04/05

Green Gables 18/10/04

Green Gables 24/05/04

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

CARE HOMES FOR OLDER PEOPLE Green Gables Green Gables 2 Woodside Road Low Moor Bradford West Yorkshire BD12 0TX Lead Inspector Pamela Cunningham Unannounced Inspection 16th August 2007 12:30p X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Gables Address Green Gables 2 Woodside Road Low Moor Bradford West Yorkshire BD12 0TX 01274 676231 F-P1274 676231 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) R & N Partners Mr Ian Helstrip Care Home 11 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (10), Physical disability (1) of places Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2006 Brief Description of the Service: Green Gables is situated in the Low Moor area of Bradford on a bus route into the city. The stone built detached house, standing in a large garden with a small area for off road parking, is indistinguishable from other houses in the area. Several local shops and a bookmaker are within walking distance of the home. All but one of the rooms is shared and none have en suite facilities. One of the shared rooms is on the ground- floor; a stair lift provides access to the first floor rooms. Decorations and furniture give a homely feel and people are encouraged to bring some small personal possessions into the home. Two care staff are on duty at all times during the day with one waking and one sleeping person on at night. A cook is employed 7 days a week and tries to include residents’ choices into the weekly menu. At the time of writing this report fees charged for the care provided were between £3700 to £400 per week. Extra charges are made for the following. Private chiropody, hairdressing, newspapers and periodicals. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One visit was made on 16th August 2007. The home did not know that the visit was going to happen. Feedback was given to the provider following the visit The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents, and to see if any improvements had been made regarding requirements made at the last inspection of which there were 14. At the time of writing this report a completed AQAA (Annual Quality Assurance Assessment) had been returned to the Commission so that the information gathered during the inspection could be measured against the information provided by the home. As a result of the information provided five service users relatives were selected to have survey forms sent, however, at the time of writing this report only one survey form had been returned to the CSCI. The AQAA asks about the views of the people use the service. Asks what the home does to make sure equality and diversity are linked in to what they do. It asks about any barriers the home has experienced regarding improvement, and how they give value for money. It also asks for information on what policies and procedures are in place and when they were last reviewed, when maintenance and safety checks were carried out and by whom, menus used, staff details and training provided. In order to find out how well staff knew residents, care plans were looked at during the visit and residents, and staff were spoken to. Other records in the home were looked at such as staff files, training records, health and safety records and accident and complaint records. Survey forms were also sent to relatives and other visiting professionals to find out their views of the care provided. At the time of writing this report no surveys had been returned. What the service does well: This is a well-managed service, which is run in the best interests of the service users. Service users are treated with respect and dignity. The atmosphere in the home is warm and friendly with cheerful and relaxed staff who are focussed on meeting the needs of the service users. Service users are fully assessed prior to admission to Green Gables and confirmation given that the home can meet their needs. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 6 The privacy and dignity of service users is respected. Staff were seen to knock on bedroom doors before entering and related well to the people in their care. Consultations with health professionals took place in private, Service users said they are offered a choice, including the time they get up and go to bed and at mealtimes. Positive feedback from service users was noted. They said they felt the home was run for their benefit, and could certainly plan how they wanted to spend their time. Meals are of a good standard and were spoken about favourably by service users. What has improved since the last inspection? What they could do better: Although it was evident the care was being provided, and the care staff were fully aware of the needs of the people in their care, care plans were not person centred, and plans of care were not always in place where a need had been identified. Plans of care need to be in place to guide the care staff in providing the care needed, so that care needs are not missed. Information about end of life wishes should be identified in the care documentation. Although the senior care staff have received training in the safe handling of medicines and are operating safe techniques, the system in use is not safe. It is not tamper evident, nor are the medications described on the back of the dossette box. Steps must be taken to make sure the system is safe and complies with the British Pharmaceutical Guidelines. Currently there is no activity organiser employed. The provider could make sure some of the staff receive training on activities that suit the elderly so that activities provided are more suitable and more inventive, as one lady said she was bored a lot of the time. Redecoration and refurbishment of the home should continue. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 7 Policies and procedures in the home should be available for the staff to refer to if needed, and be available for review during statutory visits to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission assessment forms were good but these must be completed fully and the information must accurately reflect peoples’ needs to ensure care needs are not overlooked when planning the care. EVIDENCE: The home has produced written information about services provided at Green Gables. Some of it is in large print and is clear and easy to read and should help people decide if they wish to live at the home. There is also information available about Inspecting for better lives. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 10 The manager at the home spends time with prospective residents assessing their needs. This is achieved by talking to the person, and their near relatives, about how they want to live their life, assessing if staff can meet those needs and visits to the home before moving in. Pre admission assessments take place and records regarding these were available for service users admitted prior to 2002. Three of these contained information sufficient to prepare a care plan of needs on admission; however one had very little information recorded about the persons needs. One set of care documentation of a resident who has lived at the home for many years did not contain any pre admission documentation. It is advised therefore that a current assessment of needs is done so that the home has a base line to work from in case of any improvement or deterioration in the person’s condition. All service users have a contract of residency be they publicly or privately funded. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements could be made by including more background information about peoples’ past lives in the care files. It must be possible to follow through the outcome of recorded information. Care files must include information about end of life care. Risks identified through the care planning process should have a plan of care in place to guide the staff on how the risks should be managed and minimised. EVIDENCE: I looked at three sets of care documentation and case tracked one. All people receiving a service were identified by photograph. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 12 Although it was evident the care was being provided, and the care staff were fully aware of the needs of the people in their care, care plans were not person centred, and plans of care were not always in place where a need had been identified. I.e where it was identified a service user recently admitted needed maximum assistance with all care needs, and that the person receiving the care had frail skin, and needed supervision and encouragement to eat and drink, there were no plans of care in place to guide the care staff in providing the care needed. Information in the daily report indicated the person was receiving care from the district nurses to “dress bottom”, however again there was no plan of care in place. There was information in one set of care documentation regarding “do not resuscitate”, following hospital admission when a person receiving care had been diagnosed with a serious medical condition. Staff should be made aware of this, and told what to expect in the event of an emergency situation. Decisions of this kind can only be made following a multidisciplinary meeting in which the persons GP and next of kin are involved. There was also no information about end of life wishes. One care plans however contained very good information on maintaining and promoting in dependence, and about dietary needs, and care plans identified care had been planned either with the person receiving the care, or their relative. The medication system was reviewed. The system in use is a monitored dosage system. All the people receiving care receive their medication from dossette boxes prepared and delivered to the home by the pharmacy the home uses. The medication administration charts were completed, and the staff keep a list of the medication side effects in the drug trolley. However, although the senior care staff have received training in the safe handling of medicines and are operating safe techniques, the system in use is not safe. It is not tamper evident, nor are the medications described on the back of the dossette box. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to choose how they spend their time. A range of activities is available. The meals are of a high standard and mealtimes are relaxed. EVIDENCE: Information provided in the current year AQAA states, “We accept that in moving into our home, clients do not loose their rights to social, culteral and recreational choices and we further accept that whilst some will want an active and organised life-style, others may want an independent and private life style.” Our style of service provision is based on these principles.” This would be acceptable if there was evidence in the care documentation on the likes and dislikes of the people receiving a service regarding social Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 14 cativities. However, there is very little information documented in the care plans. Residents spoken to during the visit talked about the entertainment provided. One lady said “the entertainment suits me, we play dominoes and have sing a longs and listen to music”. Two other ladies in the lounge said they liked doing puzzles, and watching TV and the videos the home provides. One lady said “she had seen some good films, but prefers the old black and white ones”. However another lady in the large lounge said it was a bit boring. “We don’t get much entertainment, only once a month when the music master comes”. She said she is fortunate and goes out with her daughter, and has been away on a 4 day hoiliday. One of the supervisors said the manager is going to make arrangements for certain carers to receive training on entertainment in elderly care homes. This would be seen as good practice as currently the activities are not very inventive. Residents also commented on how good the food was and how they could have a choice. I Inspected the kitchen. It is domestic in style and was very clean. The cook, who has worked at the home showed me the records she keeps, and these were all up to date. Menus which are four weekly are very sunstantial with a cooked breakfast and a hot alternative at lunch and tea time. Fresh fruit and fresh fruit juice is provided, and speacial dites where required. The cook is fully aware of the additives she can use to fortify food and told me there is one person who receives a service who is to be assessed to find out if they have diabetes. She said fresh meat is delivered every two weeks in appropriate sizes which negates the need for handling raw meat. Colour coded chopping boards are in use, however the kitchen would benefit from fly screens being fitted to the kitchen windows and door to prevent food that is being preparded becoming contaminated by flying insects. The manager needs to take advice from the Environmental Health Department regarding this. Food was stored appropriately in the fridge, and there was evidence of whole milk and semi skimmed milk in use. People who receive a service are encouraged to exercise control in their dayto-day lives where possible. There are no specific service user/relative meetings, however one of the supervisors said reviews with residents and relatives take place if concerns are raised. Samples of resident satisfaction surveys were seen, and there were addition questions for those residents who were new to the home. Some of the Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 15 comments were. “I did not choose my room”, and one said “I am not happy with my room”. “I would like more outings”. The supervisor said she was not aware what action had been taken following the comments being made. Samples of resident representative surveys were also seen and the following comments made. “My relative would be more stimulated if offered more activities”. While another said. “I don’t think the home could be made much better. It is a small well run home, very clean good stsaff good food and good surroundings Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaint procedure is clear and easy to follow. People who receive a service are protected from abuse. EVIDENCE: The complaint procedure is displayed in the entrance hall to the home. It is clear and easy to follow. I reviewed the complaint log. There have been no complaints logged since 06/04/2003. This was discussed with the provider during feedback who said they do not document every day grouses, but would certainly document any formal complaint made by either residents or their relatives. Documentation would include the investigation process and the outcome. Staff training was discussed and training files looked at. There was evidence to support staff being provided with training in safe guarding adults, and staff spoken to during the inspection were clear on the action they should take if abuse was either witnessed or suspected. The manager has also completed the training course in elder abuse for managers. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and free from any unpleasant smells, with certain areas having had attention paid to décor. This redecoration programme should continue. EVIDENCE: A tour of the premises identified the home was clean and free from any unpleasant smells. The small lounge looked very homely, with a television, music centre, DVD player, footstools and occasional tables. Fresh fruit was available for the residents. Continence aids were seen on chairs. This gives the impression that Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 18 the residents who use this facility have continence problems. It is advised that the aids be removed from public view and place on chairs when needed. There are handrails at certain places around the home to assist those people with mobility problems. There is also a stair lift to the first floor, however this has no safety straps in place for the safety of the people who need to use it. One of the supervisors said if the stair lift is used, the person using it is supervised at all times. Room one on the ground floor level has been completely refurbished, including having the windows replaced. Room six on the first floor has also been recently redecorated and looks very nice. The two bedrooms, 4 and 6 that have adjoining doors which are fire doors, to the next rooms do not have either smoke seals or intumescent strips fixed to the doors. The provider needs to contact the Bradford Fire and Rescue service for advice regarding this. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who receive a service are in safe hands and are protected by the homes recruitment policy and practices. EVIDENCE: On the day of the visit staff were present at the home in sufficient numbers to meet the needs of the people receiving a service. The manager holds staff meetings every three months where discussions take place on the care of the people who use the service, and any new developments. Residents meetings do not take place at any specific time, however reviews of care take place if concerns are raised. Resident satisfaction surveys are distributed. These were reviewed and the following comments noted. One resident said they did not choose their own room, another said she was not happy with her room, and one said they would like more outings. When the supervisor was asked what action had been taken regarding these comments, she said she didn’t know. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 20 Representative surveys identified the following. One relative said their relative would be more stimulated if offered more activities, which ties in with the comments in the section on daily life and social activities. One resident’s relative however said, “I don’t think the home could be made much better. It is a small, well run home, very clean, good staff, good food and good surroundings.” Training records for staff were looked at. Training the staff have been provided with includes-: Caring for residents with confusion. Manual Handling and Fire Safety Training. Codes of practice. MRSA. Pressure area care. Care of the dying, bereavement and loss. Principles of Palliative care, and Medicine Administration. The company also have training booklets on a variety of subjects including, challenging behaviour which are all in depth and very informative. The manager has also developed and annual training plan. Recruitment documentation was looked at and confirmed the recruitment process used by the home was robust, with all necessary safety checks having been done prior to any new staff starting work at the home. The documentation also identified formal supervision was taking place. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed and run in the best interests of residents. EVIDENCE: The manager is a very experienced person and has successfully completed the registration process with the CSCI. He has also successfully completed the registered managers award. Staff said they felt well supported by him. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 22 The day-to- day management of each shift in the absence of the manager is now clear, and staff left in charge of the home are clear about their responsibilities for other than basic care practices. It is company policy that the manager does not hold any money on behalf of service users. All Health and Safety records were looked at and were in order. Residents or their relatives deal with financial matters. The home will keep small amounts of money in safekeeping for residents and records of all monies received and returned are kept. Information in the AQAA said policies and procedures in place revised and updated by organisation as needed and when laws change, however the senior carer on duty was not able to locate the polices for me to look at. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 x 3 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 3 3 Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation Reg 14 Requirement The Registered Provider must ensure information in the assessments of need must be accurate and provide sufficient background information for all needs to be assessed. (Previous timescale unmet 30/10/06) The Registered Provider must ensure information about care provided must be in sufficient detail to show the outcomes. (Previous timescale unmet 30/10/06) The Registered Provider must a. ensure medication procedures must be safe and in accordance with British Royal Pharmaceutical Society Guidelines, and b b. The system must be tamper evident. (Previous timescale for a unmet 30/10/06) The Registered Provider must ensure care plans include information about end of life care. DS0000001280.V344937.R01.S.doc Timescale for action 30/10/07 2. OP7 Reg 15 30/10/07 3. OP9 Reg 13 30/10/07 4. OP11 Reg 12 30/10/07 Green Gables Version 5.2 Page 25 5. OP12 Reg 16(2)(m) Reg 23 6. OP23 (Previous timescale 31/12/06 unmet) The Registered Provider must make sure adequate and appropriate leisure facilities are provided. The Registered Provider muse ensure privacy can be maintained in those bedrooms with linking doors, (Previous timescale unmet 14/01/07) 30/10/07 30/10/07 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 OP10 Good Practice Recommendations A risk assessment should be done for the gate on the stairway. Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Green Gables DS0000001280.V344937.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!