Inspection on 20/12/05 for Holmers House

This inspection was carried out on 20th December 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

Holmers House 16/06/09

Holmers House 15/09/08

Holmers House 24/06/08

Holmers House 27/06/07

Holmers House 21/08/06

Holmers House 14/09/05

Holmers House 25/01/05

Holmers House 03/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmers House Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU Lead Inspector Nichola Cahill Unannounced Inspection 20th December 2005 09:50 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 DS0000022979.V275001.R02.S.doc Version 5.1 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. DS0000022979.V275001.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holmers House Address Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU 01494 769560 01494 446790 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) www.heritagecare.co.uk Heritage Care Mrs Helen Brooks Care Home 48 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places DS0000022979.V275001.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 48 older people, some of whom may have dementia, and/or a physical disability 14th September 2005 Date of last inspection Brief Description of the Service: Holmers House is a purpose built residential home, registered to provide care for up to 48 elderly persons within the category of old age and dementia type illness. The home is owned and managed by Heritage Care. Accommodation is provided in single rooms. The home is divided into smaller units, each with its own sitting room, dining room and kitchenette. There are safe accessible gardens to the rear and side of the property and car parking to the front. The home is situated in a residential area of High Wycombe, which has all the amenities of a large market town and has good commuter links. Public transport is accessible to the area. There are leisure facilities nearby and there is a large national department store and national chain supermarket in the same area as the home. Service users are registered with GP Practices and all service users have access to local NHS Services through GP referrals. Community Nurses visit the home and provide support to the home as needed. DS0000022979.V275001.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the annual unannounced inspection visit carried out by Nicky Cahill (lead inspector) and Gill Gentles (inspector) on 20th December 2005. The inspection commenced at 09.50 and was carried out over a period of three and half hours. The inspection consisted of viewing documents regarding the health and well being of service users, staff recruitment and the day-to-day running of the home. During the tour of the building staff and service users were spoken to regarding care issues. A full feedback of the inspection findings was given to the manager, Helen Brooks and a senior member of the care team. What the service does well: Information is available regarding the services provided by the home. This will ensure that service users are able to make an informed choice regarding their admission to the home. A pre-admission assessment is carried out prior to admission to the home. This will ensure that the home is able to meet the individual needs of service users. The routines of daily living and activities made available are flexible and varied. Visitors to the home are welcomed at any time and service users are supported in maintaining contact with relatives, friends and the local community. Service users receive a varied, appealing and nutritious diet, which is suited to their individual requirements. A comprehensive complaints procedure is in place. This allows service users and other visitors to the home to air concerns and complaints and know that they will be addressed appropriately. The location and layout of the home are suited for its stated purpose; it is accessible, safe and reasonably maintained. The home meets the collective needs of the service user group for which it is registered. A thorough recruitment procedure is in place ensuring the protection of service users. DS0000022979.V275001.R02.S.doc Version 5.1 Page 6 According to the small number of records viewed it would appear that staff are appropriately trained to meet the needs of the service user group. Staff receive regular supervision and are therefore supported in their individual roles. The health and safety of service users is protected by the homes safe working practices. What has improved since the last inspection? What they could do better: Service user care plans do not provide adequate information regarding the current and ongoing needs of service users. Shortfalls in information do not ensure that the service users needs are appropriately met. Through discussions with the manager it was confirmed that strategies are in place for the protection of vulnerable adults from abuse. However, the homes record keeping does not evidence that service users have been safeguarded against the risk of harm. Some areas of the home were not clean and free from offensive odours; this detracts from an otherwise clean and hygienic environment. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose. However, due to the manager’s secondment to another of the organisations homes recently it would appear that the home is presently not able to meet some of the minimum standards expected. This does not ensure that the needs of the service user group are appropriately met at all times. Records required by regulation for the protection of service users are not up to date and accurate and do not safeguard the service users interests. DS0000022979.V275001.R02.S.doc Version 5.1 Page 7 The arrangements for health and personal care do not always ensure that the privacy and dignity of service users is respected at all times. 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. DS0000022979.V275001.R02.S.doc Version 5.1 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 DS0000022979.V275001.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Information is available regarding the services provided by the home. This will ensure that service users are able to make an informed choice regarding their admission to the home. A pre-admission assessment is carried out prior to admission to the home. This will ensure that the home is able to meet the individual needs of service users. EVIDENCE: The home has a comprehensive information pack, which is supplied to any service users or representatives interested in admission to the home. This pack includes a statement of purpose, which was reviewed in August 2005, a service users guide, terms and conditions of residency, which has been developed with Bucks Social Services, colour brochures, the service users charter and information regarding making complaints. Pre-admission assessments were viewed for four service users. Assessments had been carried out by one of the homes deputy managers and were completed appropriately. DS0000022979.V275001.R02.S.doc Version 5.1 Page 10 DS0000022979.V275001.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Service user care plans do not provide adequate information regarding the current and ongoing needs of service users. Shortfalls in information do not ensure that the service users needs are appropriately met. Service users are assisted in accessing the services of external health care professionals. Service users health needs are appropriately met. The arrangements for health and personal care do not always ensure that the privacy and dignity of service users is respected at all times. EVIDENCE: Five care plans were viewed during the inspection process. Care plans were of a poor quality and did not contain details of the service users current and ongoing needs. One care plan included a monthly review sheet, which had not been completed on a monthly basis. One personal care chart did not have an entry after June 2005. Two care plans contained a completed pre-admission assessment, an incomplete personal planning proforma, a list of personal possessions and an incomplete personal care chart. A daily log was kept of significant events for DS0000022979.V275001.R02.S.doc Version 5.1 Page 12 each service user. However, daily logs were hard to follow and did not reflect actions taken after significant events had been recorded. Concerns regarding the content of information recorded within the daily care logs and the serious implications that this may have for service users were discussed with the homes manager. This is discussed within standard 18 of this report. It was noted during the tour of the home that care staff did not access care plans until the end of their shift, thus not ensuring that any updates were noted. The home has a ‘handover’ book, which is kept in the main office. This file contained information regarding individual service users and significant events, however, did not correspond with the individual care files. The home has received requirements on a number of occasions regarding the quality of care planning at Holmers House; however, there is little evidence of improvement in this area. A further requirement has been made and The Commission reminds the manager that failure to comply with requirements made may result in enforcement action. It is a requirement that service users health, personal and social care needs are set out in an individual plan of care which has been developed in consultation with the service user or a representative. The manager must ensure that care plans are reviewed appropriately and that care plans are utilised by care staff. The use of the daily handover book must cease and all information must be recorded within the service users individual care file. It was noted that although care plans did not identify the current and ongoing needs of service users the daily handover book did confirm that service users were receiving visits from external health care professionals. General Practitioners, district nurses and CPN’s are regular visitors to the home and will support staff in meeting the health needs of service users. Several concerns were noted during the tour of the home with regard to the privacy and dignity of service users. It was noted that one service user had chosen to visit another in his bedroom. This was clearly not an agreed arrangement with both parties. Staff were asked to intervene and allow the one service user quite time in his room. This request was met with a negative response. An inappropriate incident was witnessed within one of the homes communal areas. The response from care staff asked to respond to this incident was worryingly. A number of other incidents were witnessed at a time of day were staff were clearly available to respond. It is a requirement that the manager ensures that the privacy and dignity of service users is respected at all times. Staff must adopt a more understanding and proactive approach in dealing with incidents which may compromise privacy and dignity of service users in their care. DS0000022979.V275001.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15. The routines of daily living and activities made available are flexible and varied. Visitors to the home are welcomed at any time and service users are supported in maintaining contact with relatives, friends and retain community links. Service users receive a varied, appealing and nutritious diet, which is suited to their individual requirements. EVIDENCE: From observations made during the inspection visit service users are afforded the opportunity to get up and go to bed at a time of their choosing. The home has a relaxed atmosphere. Service users are able to participate in activities provided by the home. A list of activities for the Christmas period was posted at the front entrance of the home. Many photographs were displayed around the home of other activities throughout the year. It was confirmed by visitors to the home that they are welcomed at any time. The home has recently lost its full time cook and is presently reliant on the services of the two kitchen assistants. Service users are still provided with wholesome and nutritious meals. Menu’s were available for inspection and DS0000022979.V275001.R02.S.doc Version 5.1 Page 14 were displayed on the walls of each individual unit. It was noted that the menu’s displayed were typed in small print which was not suitable for the need of the service user group. It is recommended that the menus are displayed in a more appropriate format to ensure that service users a fully informed of the choices of meal available. DS0000022979.V275001.R02.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 A comprehensive complaints procedure is in place. This allows service users and other visitors to the home to air concerns and complaints and know that they will be addressed appropriately. Through discussions with the manager it was confirmed that strategies are in place for the protection of vulnerable adults from abuse. However, the homes record keeping does not evidence that service users have been safeguarded against the risk of harm. EVIDENCE: All service users and representatives are supplied with a copy of the complaints procedure and a free post comment card. This allows for concerns and complaints to be made in confidence and will ensure that they are addressed appropriately. The complaints records showed that no complaints had been received by the home since 21st March 2005. One serious concern noted during the inspection of the homes care plans and other related documentation was that the correct procedures did not appear to have been followed when an Adult Protection issue had been highlighted. The failure to report under the interagency guidelines could have serious implications for those service users and relatives involved. This was discussed at length with the homes manager and a senior member of the care team, who confirmed that reported incidents had been followed up, however, had not been documented appropriately. DS0000022979.V275001.R02.S.doc Version 5.1 Page 16 It is a requirement that the manager ensures that service users are safeguarded from abuse and that the correct procedures are followed in the event of any disclosure or incident noted by anyone working in or visiting the home. The home must ensure that all records are completed promptly and that the appropriate agencies are notified. All staff must receive refresher training in this area to ensure that correct action is taken in the future. It is a requirement that the home provide The Commission with a copy of the investigation and outcome of the incidents noted during the inspection visit. An up to date copy of the homes policies and procedures regarding adult protection has been forwarded to The Commission since the inspection visit. DS0000022979.V275001.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. The location and layout of the home are suited for its stated purpose; it is accessible, safe and reasonably maintained. The home meets the collective needs of the service user group for which it is registered. Some areas of the home were not clean and free from offensive odours, this detracts from an otherwise clean an hygienic environment. EVIDENCE: Holmers House is a purpose built residential home, registered to provide care for up to 48 elderly persons within the category of old age and dementia type illness. The home is owned and managed by Heritage Care. Accommodation is provided in single rooms. The home is divided into smaller units, each with its own sitting room, dining room and kitchenette. There are safe accessible gardens to the rear and side of the property and car parking to the front. The home is situated in a residential area of High Wycombe, which has all the amenities of a large market town and has good commuter links. Public transport is accessible to the area. There are leisure facilities nearby and there DS0000022979.V275001.R02.S.doc Version 5.1 Page 18 is a large national department store and national chain supermarket in the same area as the home. It was noted during the tour of the home that there was a strong odour of urine in the ‘Mimosa’ unit. Some of the bedroom areas had stained carpets and an over powering unpleasant odour. The dining area floor was sticky and unclean. Discussions with one housekeeper would confirm that these areas had been attended to prior to the inspection visit; however, cleaning in this area was unsatisfactory. It is a requirement that the manager must address the issues regarding the unpleasant odours within some areas of the home. If deemed appropriate to eradicate such odours carpeting and other flooring must be replaced. A suitable cleaning regime must be carried out in all areas of the home to ensure cleanliness throughout. Other areas of the home visited were clean, pleasant and free from any odours and an appropriate cleaning regime had been followed. DS0000022979.V275001.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29, 30 A thorough recruitment procedure is in place ensuring the protection of service users. According to the small number of records viewed it would appear that staff are appropriately trained to meet the needs of the service user group. EVIDENCE: Five staffing files were viewed during the inspection. Information was found to be in order. Of the training files viewed it would appear that most training was up to date. However, the manager is reminded that all certificates must be available as evidence of attendance to all training for all staff. DS0000022979.V275001.R02.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 37, 38. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose. However, due to the manager’s secondment to another of the organisations homes recently it would appear that the home is presently not able to meet some of the minimum standards expected. This does not ensure that the needs of the service user group are appropriately met at all times. Staff receive regular supervision and are therefore supported in their individual roles. Records required by regulation for the protection of service users are not up to date and accurate and do not safeguard the service users interests. The health and safety of service users is protected by the homes safe working practices. EVIDENCE: DS0000022979.V275001.R02.S.doc Version 5.1 Page 21 The manager, Helen Brooks, is qualified, competent and has 25 years experience in the care of older people and children. Ms Brooks is a trained nurse and has achieved her registered managers award and a certificate in care management. The Commission were notified that Ms Brooks had been seconded to another of the organisations homes for a period of three months; during this period the two deputy managers in post would run Holmers House on a day-to-day basis. It was confirmed during the inspection visit that Ms Brooks was visiting the home at least once per week. Concerns were raised during the inspection regarding adult protection issues, the upkeep of care plans and negative reactions of the staff team when requests were made. It was noted that, with the exception of the ongoing care planning requirements, the home had historically been well managed, however, this was not evident at this inspection visit. It is a requirement that the manager returns to Holmers House to resume the responsibility of the day-to-day running of the home. Records viewed during the inspection would indicate that staff receive regular supervision and are therefore supported in their individual roles. The manager is reminded that supervision notes are confidential and must be filed in a suitably locked facility at the earliest convenience. Records required by regulation for the protection of service users are not up to date and accurate and do not safeguard the service users interests, such records are as follows; • Care plans – as previously discussed within this report. • Adult protection documentation – as previously discussed within this report. • Team meeting minutes indicated that these were not held as frequently as they should. According to records viewed ‘Willow’ had only held two meetings in 2005, one on 22.02.05 and the other on 25.07.05. Team leader meeting minutes did not indicate that the manager had attended. It is a requirement that all staff attend regular meetings and that minutes are available for inspection purposes. • Accident and incident reports had been completed, however, concerns were noted regarding the number of falls, which were reported as ‘found on floor’. Thirty-nine falls had been recorded for November and twenty four for December up until 20th. The home are commended that they record all incidents, however, it is unclear how falls are audited. Since the inspection visit the manager has carried out an audit of falls during a three-month period. Action has been identified to ensure that any issues directly related to the cause of any falls for individual service users have been addressed and the appropriate professional advise sought. The following health and safety documentation was viewed; DS0000022979.V275001.R02.S.doc Version 5.1 Page 22 • • • • • • A summary of the nurse call out system was available, which showed the times that this was utilised by service users, the date and area of the call made. COSHH data was in place for products used within the home. Pest Control records were in order. Water treatment records were in order. Hoist servicing was up to date and in order. Fire records were up to date and in order. DS0000022979.V275001.R02.S.doc Version 5.1 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 3 2 3 DS0000022979.V275001.R02.S.doc Version 5.1 Page 24 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 OP7 Regulation 15 Requirement It is a requirement that service users health, personal and social care needs are set out in an individual plan of care which has been developed in consultation with the service user or a representative. The manager must ensure that care plans are reviewed appropriately and that care plans are utilised by care staff. The use of the daily handover book must cease and all information must be recorded within the service users individual care file. It is a requirement that the manager ensures that the privacy and dignity of service users is respected at all times. Staff must adopt a more understanding and proactive approach dealing with incidents which may compromise privacy and dignity of service users in their care. It is a requirement that the manager ensures that service users are safeguarded from abuse and that the correct procedures are followed in the DS0000022979.V275001.R02.S.doc Timescale for action 20/03/06 2 OP10 12 21/12/05 3 OP18 13 21/12/05 Version 5.1 Page 25 event of any disclosure or incident noted by anyone working in or visiting the home. The home must ensure that all records are completed promptly and that the appropriate agencies are notified. All staff must receive refresher training in this area to ensure that correct action is taken in the future. 4 OP17 13 It is a requirement that the home provide The Commission with a copy of the investigation and outcome of the incidents noted during the inspection visit and an up to date copy of the homes policies and procedures regarding adult protection. It is a requirement that the manager must address the issues regarding the unpleasant odours within some areas of the home. If deemed appropriate to eradicate such odours carpeting and other flooring must be replaced. A suitable cleaning regime must be carried out in all areas of the home to ensure cleanliness throughout. It is a requirement that the manager returns to Holmers House to resume the responsibility of the day-to-day running of the home. It is a requirement that all staff attend regular meetings and that minutes are available for inspection purposes. 31/01/06 5 OP26 16 31/03/06 6 OP38 8 28/02/05 7 OP37 21 31/01/06 DS0000022979.V275001.R02.S.doc Version 5.1 Page 26 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 OP15 Good Practice Recommendations The routines of daily living and activities made available are flexible and varied. Visitors to the home are welcomed at any time and service users are supported in maintaining contact with relatives, friends and community links. Service users receive a varied, appealing and nutritious diet which is suited to their individual requirements. DS0000022979.V275001.R02.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000022979.V275001.R02.S.doc Version 5.1 Page 28 - 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!