Inspection on 24/05/05 for H.C.S. (Enfield) Ltd (Southbury Road)

This inspection was carried out on 24th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

H.C.S. (Enfield) Ltd (Southbury... 18/11/08

H.C.S. (Enfield) Ltd (Southbury... 05/06/08

H.C.S. (Enfield) Ltd (Southbury... 22/10/07

H.C.S. (Enfield) Ltd (Southbury... 19/04/07

H.C.S. (Enfield) Ltd (Southbury... 25/04/06

H.C.S. (Enfield) Ltd (Southbury... 06/09/05

H.C.S. (Enfield) Ltd (Southbury... 16/06/04

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

CARE HOME ADULTS 18-65 H.C.S. (Enfield) Ltd 20-24 Southbury Road Enfield Middlesex EN1 1SA Lead Inspector Teferi Degeneh Announced 24 May 2005 @ 09:25 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. H.C.S. (Enfield) Ltd Version 1.10 Page 3 SERVICE INFORMATION Name of service H.C.S. (Enfield) Ltd (Southbury Road) Address 20-24 Southbury Road, Enfield, Middlesex, EN1 1SA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8364 6923 Mr Michael J. Crausaz of H.C.S. (Enfield) Vacant Post PC Care Home 12 Category(ies) of LD, LD(E) registration, with number of places H.C.S. (Enfield) Ltd Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Five specific service users who are currently resident in the home and are over 65 years of age may remain accommodated in the home. This condition must be reviewed at such times as any of the specified service users vacate the home. Date of last inspection 1 February 2005 Brief Description of the Service: Southbury Road is a care home managed by HCS (Enfield) Ltd and the registered provider is Mr Crausaz. The service is registered to provide 12 places to younger adults with a learning disability. The home was originally established to provide support to older people with a learning disability but over the years the service has been extended to younger adults with a learning disability and high physical care needs. The home currently has 5 service users who are over the age of 65. The home consists of a group of terraced houses, which were knocked together. All the service users have a large single bedroom. The home has a lift to the first floor. The service users with higher physical care needs have bedrooms on the ground floor. There is one assisted bathroom on the ground floor. There are two dining areas and service users can either eat at a table in the large kitchen area or there is a small separate dining area where a few of the more independent service users choose to eat. There is one lounge where service users choose to sit in two groups. Most of the service users have a TV and a music system in their room. There is a conservatory at the rear of the house, which acts as another sitting area and as a smoking area. There is a very pleasant garden with some sensory features. The staffing consists of 5 care staff working on a morning shift and 4 on a late shift. The night shift is covered by two waking night staff. The home also has a domestic who works five hours a day from Monday to Friday. The home has a cook who works three hours a day from Monday to Friday. H.C.S. (Enfield) Ltd Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection is the outcome of discussions with various people and the assessments of a number of documents between 9:25 am and 5:25 pm on 24th May 2005. The acting manager, Ms Aisha Capina, and the manager of another home owned by the same Company (HCS (Enfield) Ltd, Ms Christina Physentzou were present throughout the inspection. An assistant to the director of the company and the assistant manager of the home were briefly available during the inspection. Seven service users and two members of staff were spoken to individually. A discussion was also held with a group of six members of staff. Two visiting relatives were kind enough to give their views. The inspection was ca Seven relatives, twelve service users and three care managers and health professionals completed and returned feedback cards the Commission for Social Care Inspection. A number of staff and service users’ files were examined. Records such as rotas, menus, service users’ finance, health and safety, and medication administration sheets were also assessed. Direct and indirect observations of the care provided to service users and the standard of the premises and facilities were undertaken. What the service does well: Service users’ care plans and risk assessments are reviewed and social and leisure activities that meet the needs of service users are provided. The home’s complaints procedure and policies and procedures on the protection of vulnerable adults from abuse are presented in detailed and appropriate formats suitable to the needs of service users. The premises and facilities are clean, tidy and accessible. Service users are satisfied with the food provided at the home. The staffing level is appropriate to the number and needs of service users. H.C.S. (Enfield) Ltd Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. H.C.S. (Enfield) Ltd Version 1.10 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 Standards Statutory Requirements Identified During the Inspection H.C.S. (Enfield) Ltd Version 1.10 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 standard(s) 2, 4 and 5 Even though systems are in place to ensure that full assessments are completed and prospective service users and their representatives have an opportunity to visit the home before admission, service users’ health, safety and well-being is at risk due to the failure of the home to develop a service user plan based on the assessed needs of service users. The home is poor in operating in compliance with its conditions of registration (i.e. client category) and its implementation, admission policies and procedures. Service users have been admitted outside the category of registration without ensuring that their needs can be met and the admission to the home is legal. Service users are not clear about the terms and conditions of service and service users do not know their rights and responsibilities while living at the home. EVIDENCE: The files of a service user recently admitted contained a copy of full assessment completed by a care manager. Information regarding new service users’ health needs have been obtained from health professionals. However, evidence was not available to confirm that service plans have been developed based on the assessed needs. Indeed, one service user with a diagnosis of dementia has been admitted against the conditions of registration of the home. Discussions with the responsible individuals and an assessment of the records showed that no plans have been put in place regarding administration of medication and personal care of a recently admitted service user. Prospective H.C.S. (Enfield) Ltd Version 1.10 Page 9 service users have visited the home before admission. Two visiting relatives and a service user spoken to confirmed that they had visited the home before a service user was admitted. Feedback cards returned to the CSCI showed that service users, health professionals and relatives are satisfied with the care provided by the staff. A number of the staff have worked at the home for many years and have attended training programmes in areas such as manual handling, communication, medication administration, protection of vulnerable adults from abuse, and dementia. At the last inspection the registered person was required to ensure that service users’ terms and conditions are signed on their behalf by a representative. This has not yet been complied with. A new service user has not been given a contract which details terms and conditions of service. H.C.S. (Enfield) Ltd Version 1.10 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 standard(s) 6, 7 and 9 Satisfactory procedures and practices are in place to ensure that care plans and risk assessments are reviewed and service users’ needs are met. EVIDENCE: It was evident from the records seen that annual reviews have taken place for each service user and social workers and relatives have been involved. Key workers also regularly review and update care plans. The files examined showed that risk assessments have been completed and reviewed. The people in charge said that reviews are undertaken on a monthly basis for service users with high risk and on a six monthly basis for those with a low risk. Service users can move freely about in the home. The service users spoken to and feedback from the relatives and care managers confirmed that service users are happy and well cared for. The staff demonstrated satisfactory knowledge and experience of ensuring service users’ right to make decisions about how they would like to live and supported. None of the service users are able to look after their own money. The home has supported service users with claiming their benefits and opening bank accounts. Personal allowances are kept in a cash box and monitored and audited by the person in charge and by an internal auditor. Six cash boxes, receipts and records were checked and found to be in order. A discussion with the people in charge and an assessment of the cash boxes revealed that a large sum of money was cashed for a service H.C.S. (Enfield) Ltd Version 1.10 Page 11 user and was kept in the home. The risk of cashing too much money at a time from the post office and transporting it to keep at the home was discussed during the inspection. H.C.S. (Enfield) Ltd Version 1.10 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 standard(s) 12, 13, 15 and 17 The home provides social and leisure activities that meet the needs of the service users. There is a friendly and welcoming environment to enable service users to see visitors at the home. The food provided at the home is good and meets the expectation of service users. EVIDENCE: Programmes of activities were displayed in the home. Each service user has a plan of activities provided by the staff. Discussions with the people in charge indicated that some service users attended part time day activities. The home is currently looking for a suitable day centre for a new service user who came from another local authority. None of the service users have either a paid or unpaid job. Two relatives stated in feedback cards that the home has not done enough to stimulate service users. However, a number of relatives, professionals and service users were satisfied with the social and leisure activities provided by the home. The staff were observed playing games and watching television programmes and videos during the inspection. Feedback cards received from relatives and discussions with service users indicated that friends and relatives visited the home. The relatives seen during this inspection H.C.S. (Enfield) Ltd Version 1.10 Page 13 said the staff welcomed them in a friendly manner and offered them hot drinks. They said they were able to see and talk to service users in private. Letters and feedback cards completed by relatives confirmed that the food provided at the home was satisfactory and service users are provided with nutritious meals. A four-weekly rotating menu was available for inspection. The staff confirmed that service users are consulted about the menu. The lunch provided on the day of the inspection did not reflect the menu. However, the staff stated that service users chose to have a different meal on that day. It was clear from discussions with service users that they were able to eat their meals at tables of their choice and that they were happy with the food. H.C.S. (Enfield) Ltd Version 1.10 Page 14 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 standard(s) 18, 19 and 20 The registered provider has done well in ensuring service users have health care that meets their needs. The system of storing, administering and recording medication is satisfactory to ensure health care needs of existing service users are met. New service users’ health and welfare are at risk due to lack of full information on how and when to administer medicines that they bring to the home with them when they are admitted. EVIDENCE: Service users were observed to be well presented and content. Records, appointment letters and discussions with the people in charge confirmed that service users have seen opticians, dentists and chiropodists. All service users are registered with their own general practitioner. It is stated elsewhere in this report that despite the availability of comprehensive assessments, service plans have not been developed for new service users. All service users spoken to said they are happy with the way they are treated. A feedback obtained from a health professional stated: “The service users seem happy and comfortable”. Medication is administered by trained and experienced senior staff on shift. On the day of the inspection the medication and medication administration records were in order. As per the last requirement, the registered provider has developed guidelines when PRN medication should be administered. However, medication guidelines have not been developed for a H.C.S. (Enfield) Ltd Version 1.10 Page 15 new service and the home did not know when and if to administer a PRN medication to the service user. H.C.S. (Enfield) Ltd Version 1.10 Page 16 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 standard(s) 22 and 23 There are clear policies and procedures in place to enable service users to complain and to be protected from abuse and neglect. The staff have received training on abuse and service users feel that they are safe and their well being is respected. EVIDENCE: No complaints have been recorded since the last inspection. Service users and visitors who completed feedback cards confirmed that they are aware of the homes complaints procedure. The complaints procedure includes a format with pictorial illustrations and bigger fonts suitable for people with sight or reading difficulties. There is a policy on the protection of vulnerable adults from abuse. The registered provider has obtained a copy of the local authority’s policy and procedure on the protection of vulnerable adults from abuse. The training records and staff files indicated that the staff have attended training on abuse. During a group discussion the staff demonstrated their understanding of how to protect service users from abuse. They gave satisfactory explanation of what abuse is and how to deal with abuse. Discussions revealed that the staff are aware of the home’s whistle blowing policy. As stated elsewhere below, a member of staff has been suspended while an investigation is undertaken following the home’s disciplinary procedures and the policies and procedures relevant to the protection of vulnerable adults. H.C.S. (Enfield) Ltd Version 1.10 Page 17 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 standard(s) 24, 26 and 30 The home’s cleanliness and facilities are satisfactory for the service users to live with comfort and safety. EVIDENCE: The home is located near local amenities including a supermarket. Each service user has a single bedroom that meets their needs. Service users have personal items such as a television set and a musical system in their bedrooms. The premises are accessible to people with a physical disability. The registered provider has redecorated the conservatory as required at the last inspection. The home has been visited by an environmental health officer who made requirements that need to be complied with. The home was clean, tidy and free from offensive odours. Satisfactory policies, procedures are in place to prevent infections and communicable diseases. The washing machine, which incorporates a sluice function, has appropriate programmes to wash various materials at various temperatures. H.C.S. (Enfield) Ltd Version 1.10 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34 and 35 The staff morale is low and the inspector is of the view that service users’ health and safety is compromised by staff’s account of a system which encourages them to return to work when sick. EVIDENCE: It was evident from staff files that they have attended various training programmes including manual handling, medication administration, the protection of vulnerable adults from abuse, dealing with challenging behaviour, infection control, first aid, basic food hygiene and fire safety. During group discussions the staff demonstrated satisfactory knowledge and experience of supporting service users with respect and dignity. The staff were also observed interacting appropriately with service users. The service users spoken to and the feedback received from relatives and visitors were positive about the staff. From the staff files and discussions it became clear that only one member of the fourteen currently employed staff is undertaking training to achieve NVQ level 2 Qualification in care. The staff files, which were assessed, did not contain terms and conditions of employment. The people in charge said that terms and conditions were being reviewed and would be issued to the staff. Six staff spoken to said they like their job but they are unhappy with the changes proposed to their terms and H.C.S. (Enfield) Ltd Version 1.10 Page 19 conditions of their employment. The staff said that the policy of the home not to pay for sick leave for the first three days meant that they had to come to work even if they were not fit enough. They said they worked at as a team but their morale is low. It was apparent on the day of the inspection that two student nurses were on work placement at the home. However, there was no evidence to suggest that the home was clear about the students’ duties and responsibilities while on placement. Also evidence was not available to confirm that the students have undergone a satisfactory CRB check. H.C.S. (Enfield) Ltd Version 1.10 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 Despite previous requirements, the registered provider has done little to employ a permanent manager who makes application to CSCI for registration and who ensures leadership, good management approach and continuity of service. Service users are yet to benefit from the home’s system of quality assurance. The home is clean and comfortable for service users to live in. However, service users’ health and safety is still at risk as requirements made by the environmental officer are yet to be complied with and local the fire authority is yet to visit the home. EVIDENCE: At the last inspection the registered provider was required to ensure that the acting manager applies to the CSCI to be registered. It was mentioned in the last report that the acting manager was sick and had not been at work for six weeks. On returning to work, the acting manager was suspended on issues that are currently under investigation. In the meantime, the registered provider has temporarily employed an acting manager who has already started H.C.S. (Enfield) Ltd Version 1.10 Page 21 work. The acting manager is supported by deputies and the operations director who visits the home regularly. The system of quality assurance is yet to be fully implemented. Questionnaires have been developed for service users. The people in charge said similar questionnaires would be prepared for and administered to visitors. The home was clean and tidy and there was sufficient evidence to confirm that fire extinguishers, fire alarms, the gas boiler and emergency lights have been tested and the lift serviced. Records showed that fire drills have taken place monthly. An environmental health officer visited the home on 15/3/05 and identified areas such as food hygiene, waste oil disposal, clinical waste and reporting accidents that need to be addressed by the registered provider. Four incidents and accidents have been recorded since the last inspection. No concerns have been noted in a recent report of the home by an occupational therapist. The people in charge were unable to provide evidence that the fire safety officers have visited the home. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 H.C.S. (Enfield) Ltd Score Standard No Version 1.10 Score Page 22 1 2 3 4 5 x x 2 3 2 22 23 ENVIRONMENT 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 2 x H.C.S. (Enfield) Ltd Version 1.10 Page 23 No 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 3 Regulation Requirement Timescale for action 30/6/05 2. 3 3. 5 4. 7 5. 20 9(1)(2)(3) The registered person must 12 apply for a variation of conditions of registration in respect of the service user with dementia currently at the home. 15(1)(2) The registered person must ensure that each service user has a a care plan based on their assessed needs. 5(1)(b) The registered person must ensure that the service users terms and conditions are signed on their behalf by a representative. (The previous timescale of 31/3/05 not met). 13; 20; The registered person must 25 develop a policy and procedure which ensure that only a limited amount of money can be cashed at one time and kept at the home. The staff must not cash and keep at the home money beyond the amount agreed by the registered person and, as appropriate, by service users and their representatives. 13(1)(2) The registered person must ensure that a service plan which includes guidelines of medication administration are developed when a new service user is Version 1.10 30/6/05 31/7/05 30/6/05 30/6/05 H.C.S. (Enfield) Ltd Page 24 6. 34 18; 19 7. 34 13(3)(4) (5); 19 19(1)(2) (3) 8. 34 9. 37 9(1)(2) 10. 39 24(1)(2) 11. 42 17(2)(b); 23(5) 12. 42 23(4) admitted. The registered person must ensure that medication is administered to a new service user as prescribed by their doctor. The registered person must ensure that each member of staff has terms and conditions of employment issued and available in their files. The registered person must ensure that staff do not come to work when they are sick and are not fit enough to work. The registered person must ensure that appropriate checks including a satisfactory CRB are undertaken and work duties and responsibilities are specified for all students on work placement at the home. The registered person must ensure that a manager is appointed to run the home and that an application for registration is submitted to the CSCI by this individual. The registered person must consult service users and visitors about the quality of services and facilities provided at the home. The feedback obtained through the quality assurance must be summarised with action plans and made available to all stakeholders including the CSCI. The registered person must comply with the requirements made by the environmental health officer on 15/3/05. A copy of an action plan regarding the requirements made by the environmental officer must be sent to the CSCI Inspector. The registered person must arrange for the local fire authority to visit the home and to act upon any advice given. Version 1.10 31/7/05 30/6/05 30/6/05 31/8/05 31/8/05 30/6/05 15/7/05 H.C.S. (Enfield) Ltd Page 25 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 32 Good Practice Recommendations The registered person should ensure that at least 50 of care staff achieve a care qualification equivalent to NVQ Level 2 by 2005. H.C.S. (Enfield) Ltd Version 1.10 Page 26 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 H.C.S. 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