Inspection on 06/06/06 for Holmwood House

This inspection was carried out on 6th June 2006.

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

Holmwood House 22/07/09

Holmwood House 25/07/07

Holmwood House 10/02/06

Holmwood House 07/09/05

Holmwood House 22/03/05

Holmwood House 13/10/04

Holmwood House 12/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Holmwood House Channels Hill Westbury On Trym Bristol BS9 3EU Lead Inspector Vanessa Carter Key Unannounced Inspection 09:00 6 and 8th June 2006 th 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 Holmwood House DS0000020280.V295079.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. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Channels Hill Westbury On Trym Bristol BS9 3EU 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) 0117 9500810 0117 9508070 Mr Ghassan Al-Jibouri Mrs Serena Hogg Lucas Reynolds Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 41 Patients over 50 years of age sickness, injury and infirmity Staffing Notice dated 10/07/1998 applies Manager must be a RN on part 1 or 12 of the NMC Register Date of last inspection 10th February 2006 Brief Description of the Service: Holmwood House is registered to provide nursing care for up to forty-one people who are fifty years and over. The Home is a classically styled property, located in its own grounds, surrounded by residential housing and near to the local shopping centre. There are local shops, public houses and restaurants located within walking distance of the home. There are single and double rooms located on all three floors and a lift provides access to all floors. The home is near to major roads and bus routes. The mission statement describing the aims of the Home was displayed in the entrance hall. Prospective residents are able to find out about the home, the services and facilities it has to offer by requesting the homes brochure or ‘residents information pack’. The weekly fees range from £459 – 600 per week and additional charges are made for podiatry and hairdressing services. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. Evidence was gathered from a number of different sources: - Information taken from the pre-inspection questionnaire - Directly speaking with residents and some visitors during the visit - Case tracking a number of residents - Speaking with care and ancillary staff - Speaking with registered nurses - A tour of the premises - Examination of some of the homes records - Observations of staff practices and interaction with the residents. The home manager was present during the inspection and assisted in the inspection process The overall analysis is that the home is a good place in which to live and to work. There were no protection issues, or concerns regarding health and safety. What the service does well: What has improved since the last inspection? The improvements in the homes care planning processes mean that residents will receive a better standard of care and their care needs will be met. Improvements have been made in the appearance of the home with a programme of both interior and exterior decoration being underway. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 6 The safety of residents who require the use of bed rails at night time, has been enhanced as the home now provide appropriately sized equipment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 7 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 Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 8 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, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and their admission processes, ensure that placement is only offered to those people whose needs can be met. EVIDENCE: The Statement of Purpose has been updated to incorporate the necessary changes in staff. A copy of the document is located in the main entrance of the home, and is provided for any prospective new resident. Some of the residents have a “Residents Information” pack – this is also due to be reviewed and updated. All newly admitted residents will be provided with a statement of terms and conditions. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 9 The home manager undertakes pre-admission assessments for any new residents. The majority of residents come to the home directly following a stay in hospital. One visitor said they had visited many other homes in the local area, and had chosen Holmwood House to look after their relative. The home has a comprehensive assessment tool to enable the manager to determine that the home is able to meet the person’s needs. The records of the most recently admitted person were inspected, and provided a clear insight into the residents needs. The assessment along with information obtained from the hospital, evidenced how the home judged it could meet that persons needs. The home offers placement to older people who need assistance with personal care and nursing tasks. It is only able to accommodate people with low to moderate levels of dementia and confusion. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 10 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, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that because of the homes care planning processes, they will be well looked after in all respects and their needs will be fully met. EVIDENCE: The care planning files of three residents were examined. The care plans on the whole were well written and detailed the needs of the resident and what actions the care staff were to take. Each plan required minor improvements that were discussed with the manager during the inspection. Residents care plans have been reviewed on a monthly basis, but the home need to evidence who has been involved in that process (resident and/or their representative). Residents are registered with a number of different health centres and GP practices. Where possible, residents are encouraged to retain the services of their family GP. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 11 Records are maintained of all contacts with GP’s and any other healthcare professionals. Monthly observations to monitor healthcare are undertaken but noted to be sporadic at times. There is a lack of good reliable recordings of residents’ bowel function, and this has the potential to place a resident at risk from poor health. This has been referred to again under standard 37. Marked improvements have been made to the quality of the wound care planning documentation - those examined gave clear instructions for staff to follow and provided evidence of progress or deterioration. Photographs of wounds were improved but could be of a better quality. Relatives said their family member was well looked after and they were always kept informed of any changes, or significant events. One GP responded via a comment card that “they were satisfied with the overall care provided to residents” and that any advice given is acted upon and that staff have a clear understanding of each residents care needs. The home has sound procedures in place for the ordering, receipt, storage, administration and disposal of medicines. Signage was in place where oxygen cylinders are stored and upon advice, a more visible sign was placed on a resident’s bedroom door. The home does not store any more than one months supply of medications. During the course of the inspection, the staff team were seen going about their duties in a kind, friendly and courteous manner. They were heard being respectful and in general, using first names to address each resident. One resident said that they were helped with personal care tasks in privacy, but the staff encouraged them to “do for themselves” where possible. The person was satisfied with this level of support. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 12 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, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered choice and a well balanced diet, and can participate in a range of activities. Visitors are encouraged and can participate in their relatives care as much as they are able. EVIDENCE: The home has a weekly plan of activities and this is displayed around the home. There was a mixed response from the residents about what happens during the day. One resident said they liked to pass the time of day reading quietly whilst another said, “the girls do their best”. It was evident that residents can choose to participate or not in the activities. One resident enjoyed visits from the church member, another said they liked to have a sit outside and enjoy a cigarette. Those resident’s who were able to, were seen moving independently around the home using their walking aids, whilst others were asked where they wanted to spend their time. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 13 Two visitors said they visited every day. One said that they pleased they were able to participate in the activities in the home and therefore keep involved in the care of their spouse. The home has a four-week menu plan. There is a choice of two main meals at lunchtime and residents were heard being encouraged to make choices about what they wanted to eat. The dining tables have been moved out of the conservatory are as it is now “too hot”. Cold drinks were provided with the meal. A number of residents need to be assisted with feeding and this was undertaken sensitively and in an unhurried manner. On day one of the inspection there was choice of cottage pie with fresh vegetables, or omelette, followed by apple pie and brandy sauce or custard. The meals looked appetising and were attractively served. Residents made positive comments regarding the meals. The chef explained that all dietary needs can be catered for, and that he will visit any new resident who has specific needs. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by staff who will safeguard and protect them, and will ensure that any concerns they have are appropriately addressed. EVIDENCE: The home has a complaints procedure and this is displayed in the main reception area of the home, and is included in the residents information pack. CSCI have not received any complaints. The manger has handled any complaints made to her appropriately and has kept records to show how any concerns have been handled. This means that residents and their relatives can be assured that any concerns they have will be listened to and acted upon. There have been no referrals made under protection of vulnerable adults procedures. The home manager has previously demonstrated a good knowledge of the procedures to take, should any concerns be raised. The home has a copy of the Bristol City Council “No Secrets” guidelines. Discussions with some of the staff evidenced their knowledge of adult abuse issues and an awareness of their responsibilities if they witness any bad practice. The manager stated that she will be attending Bristol City Council Adult Protection training, along with the deputy manager and some of the care staff, once dates have been confirmed. Other staff have attended training sessions in the past. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 15 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, 20, 21, 22, 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. Residents live in a home that is safe and comfortable but provision of lockable facilities in their rooms, would ensure that their belongings are safe. EVIDENCE: Holmwood House is a period property, situated within it’s own large gardens. The gardens are established, well maintained and provide a safe and quiet space for residents to relax in. The front entrance is secured with a keypadded lock, and leads into a pleasant reception area. It has retained the period wood- panelling, has seating areas for visitors and residents, a pay phone, and is the main thoroughfare for the home. The reception area is also the living place for the homes cat and caged bird. A staircase leads off the reception area to the first floor. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 16 The communal areas are all on the ground floor. There are two linked dining rooms, one conservatory overlooking the rear gardens, and two separate lounges. Each of the rooms is equipped with comfortable furniture. Both lounges are nicely decorated. The home has an ongoing programme of refurbishment and the exterior of the property is currently being painted. There are a number of toilets and bathrooms located throughout the home in sufficient numbers to meet the needs of the residents. There are specialist bathroom facilities to enable those residents with mobility difficulties, or who are frail, to be assisted to have a bath. The manager hopes to have one of the baths replaced with a shower room, and this would enhance the facilities provided for the residents. The home has an abundance of moving and handling equipment. The home has 31 bedrooms, ten of which are for shared occupancy. The bedrooms are located on the three floors and a lift makes them all accessible rooms. Most of the bedrooms were viewed. Residents are encouraged to bring in small items of their own furniture to make their rooms familiar and more homely. A number of the bedrooms have ensuite facilities and those that don’t, have a vanity unit. Each bedroom is provided with its own commode, with two for shared rooms. Residents have been asked whether they wish to have a door lock fitted to their bedroom door, as this is currently not available in the home, but this has not been taken up. The resident themselves or a relative have signed to say they do not want this facility. The manager must ensure that each new resident is given the opportunity to have one installed, if they so wish. However, in order for residents to be able to keep their personal possessions secure, the home must provide a lockable drawer with a key – the timescale for the home to achieve this has been extended. The home was clean and tidy and any unpleasant odours, noticed during the inspection, dissipated quickly. The home has a number of housekeeping staff who have been employed at the home for many years. One staff member stated that bedrooms are “deep cleaned” in between residents. The laundry room consists of two commercial washing machines and two large tumble driers, and this is adequate to meet the needs of residents. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements must be made with the recruitment and vetting procedures to ensure that residents are only cared for by people who are suitable, and have the necessary skills. EVIDENCE: The home employs eight registered nurses, 22 care staff and ten ancillary workers. There has been only minimal staff turnover and no use of agency staff. The home is currently in the process of recruiting a second chef and have a vacancy for a handyman. This means that the residents will be cared for by staff who are familiar with their needs. 50 of the care staff have obtained an NVQ Level 2 in Care qualification, and a number are working towards a level 3. Examination of the personnel files of newly recruited care staff showed that the home is failing to consistently apply safe vetting procedures and sound recruitment practices. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 18 All care staff are required by law to have a satisfactory protection of vulnerable adults (POVAfirst) check before they take up employment. The home records showed that a number of staff had commenced work at the home prior to a POVAfirst check having been received, whilst some overseas staff had provided “to whom it may concern” references, and there was no evidence how these had been authenticated. For those staff who had started work before these checks, the necessary documents had been obtained in retrospect. This is not acceptable and has the potential to place residents at risk of being cared for by unsuitable people. The staff have received training in a wide range of relevant topics with some training being tailored to match the needs of specific residents. The manager has already arranged forthcoming training courses on Parkinsons and dementia care. The deputy manager is to undertake a project as part of her NVQ studies about staff training and will undertake an overview of the training needs of each staff member. The aim of this exercise is to highlight those areas where staff training is required. The home currently does not have a training plan and the manager is not allocated a training budget. It will be a focus of the next inspection, the outcome of the deputy managers training review, and plans for how any skills gaps are to be met. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 19 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, 32, 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. Residents live in a home that is well managed and run with their best interests in mind. EVIDENCE: The manager is a registered nurse and has been at Holmwood House for two years. She previously worked as the registered manager at a sister home. She has already completed the Registered Managers Award, and continues to demonstrate her commitment to the responsibilities of being the registered manager. She has a good awareness of the each resident’s specific needs, and the skills and shortfalls of the staff team. She cooperated during the inspection process and discussed areas where she still feels the home needs to improve. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 20 Staff spoke very positively about the manager’s management style - “she puts her heart and soul in to the job”. Staff said they felt well supported and able to express their opinions. Staff meetings are held on a regular basis – the manager is addressing the fact that not all staff attend meetings. The manager was observed to interact well with residents, relatives and staff during the course of the inspection, giving clear instruction and guidance to the staff team. A deputy manager supports the manager in her role – she has just started the registered managers award. The home does not currently have any formal quality assurance and monitoring systems in place, however an identified representative does visit the home on a monthly basis. This was discussed with the manager during the inspection, and it is expected that procedures will be put in place to capture the views and opinions of residents, relatives, and the staff team, and resulting from this there is an annual development plan. The homes policies and procedures manual is dated several years previously – this must be reviewed to ensure it up to date with current legislation. Petty cash is held for some residents, at families request and the home has a good accounting system in place to evidence transactions in and out of their accounts. A sample were checked and found to be correct. The manager explained that where possible, they prefer to invoice the families for additional services such as hairdressing and podiatry. Staff confirmed that they have formal supervision and the records were seen. The manager completes all formal supervision sessions, but the long-term aim is that supervisory arrangements will be split between the deputy, and the manager. As referred to earlier in the report some of the recordings about resident’s healthcare needs were not consistently maintained. This was particularly so in respects of bodily functions. The manager must ensure that staff record the necessary information for each residents state of health to be monitored. All other home records were well maintained. There were no current health and safety issues. The fire logbook evidenced that tests and checks of the system are taking place at the appropriate intervals. The workplace fire risk assessment is November 2005. Staff confirmed that they have had fire training and have participated in fire drills. The home has a number of hoists, and specialist bathing equipment, and these were last serviced in February. The manufactures guidelines, recommend that these are serviced on a six monthly basis. The manager has stated that all service contracts are up to date. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 21 A number of residents have side rails installed in order to maintain their safety whilst in bed. Where these are in place a risk assessment has been undertaken and, the appropriate type of equipment has been installed. At the last inspection this had not been the case. The manager must ensure that this safe working practice continues. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 22 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X 3 3 2 3 Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 23 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 OP24 Regulation 23(2) m Requirement Resident to be provided with a lockable drawer in their bedroom for storage of personal effects. (The previous timescale of 10/06/06 will not be met, therefore an extension has been granted.) Timescale for action 31/08/06 2. OP29 19 Robust recruitment and vetting procedures must be followed at all times. Effective quality assurance and monitoring systems must be in place to ensure the service remains appropriate to the residents needs. Accurate records regarding a resident’s healthcare must be maintained. 08/06/06 3. OP33 24 08/12/06 4. OP37 17 08/08/06 Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 24 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. 2 Refer to Standard OP7 OP8 Good Practice Recommendations When care plans are reviewed, a note should be made of who is involved in the process. Wound care photography could be improved to make monitoring easier. Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Holmwood House DS0000020280.V295079.R01.S.doc Version 5.2 Page 26 - 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!