Inspection on 12/12/06 for John Darling Mall

This inspection was carried out on 12th December 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

John Darling Mall 24/10/07

John Darling Mall 04/11/05

John Darling Mall 05/08/05

John Darling Mall 09/12/04

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

CARE HOME ADULTS 18-65 John Darling Mall Selborne Drive Eastleigh Hampshire SO50 4SE Lead Inspector Ms Sue Kinch Unannounced Inspection 12th December 2006 12:30 John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 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 John Darling Mall DS0000040678.V323250.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service John Darling Mall Address Selborne Drive Eastleigh Hampshire SO50 4SE 023 80613101 023 80611497 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) Hampshire County Council Wendy Frances Burkill Care Home 24 Category(ies) of Physical disability (24), Physical disability over registration, with number 65 years of age (2), Sensory impairment (1) of places John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th November 2005 Brief Description of the Service: John Darling Mall is a purpose built unit for up to 24 service users who have physical disabilities. The service users are mainly there for short breaks or in preparation to moving to more independent living. There are, therefore, both long and short-term service users in residence. Assessment and rehabilitation facilities are also available. The building is single storey, split into four units with a central communal area and some smaller communal lounges. There is a central dining room, and each unit has its own kitchenette and dining area. John Darling Mall is close to local shops, pubs and other amenities that are accessible to service users. Weekly fees are £868.00 but charges are based on individual financial assessments. Information about the home is available in welcome packs provided in each room. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the home this year and all key standards were assessed. It was unannounced and was completed by one inspector and took 10 hours, over two days - 18th and 28th December 2006. Four service users were spoken with in detail. Three others were spoken with more briefly and six staff members and the manager were also spoken with. Care practices were observed. A partial tour of the home was made separately with some of the service users, staff and the manager. The shared areas and some bedrooms were seen. Some of the homes records, policies and procedures were also viewed. Information was also received from the manager who submitted a pre inspection questionnaire. What the service does well: What has improved since the last inspection? What they could do better: Attention is needed to the fabric of the home, which is showing signs of wear and tear in places. A plan of redecoration and further refurbishment is needed to offer service users a more homely and brighter environment. Three shower areas need attention to reduce the risk of infection. Although the home has a clear plan for maintaining a safe environment an improvement plan needs to be developed for the home, which includes the environment. Variable comments were made by service users about the food and included some very positive comments such as ‘lovely’ and ‘good choice’ but also comments that the ‘quality is variable’ and ‘ could be improved’. The provision of food for people with special diets needs more rigorous attention to ensure that their needs are met. Some service users would also like an increase in mental stimulation and this must be documented more comprehensively in care plans and provided for less independent service users. Sufficient staff need to be deployed to meet those needs. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are confident that their needs are known by the home at the point of admission. EVIDENCE: Staff spoke of admissions to the home and the varying needs of people that services are provided to as the home supports people who are waiting for re housing, provides short-stay respite care and responds to emergencies. One staff member said that they felt that the home responded well to the varying demands although this can be difficult at times if the home has not been given enough information before the person is admitted. Two of the service users spoken to about admissions thought that their needs were being met and that systems were in place for updating John Darling Mall about their needs. One service user thought that this had happened through social services. Another service user had told the home of changes before coming in and felt that staff knew the care needs. One member of staff said that the district nurses often knew who was coming in to the home for respite care, and that information and equipment was obtained from them. A sample of care plans for respite service users were viewed and had been updated. Service users are provided with documentation about the service and a file of this information is provided in rooms. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from involvement in care planning. These plans reflect changing needs and include support to be provided as a result of risk assessments but would be improved by addressing mental and social stimulation in more detail. EVIDENCE: Although not all service users spoken to said they were aware of care plans, four were viewed during the inspection and there was evidence that all had recently been reviewed by the key-workers and shared with the service users who had signed them. One member of staff said that any differences in views about care needed is recorded .The example given was when a service user did not wish to be hoisted but not using would put the service user and carer at risk. The issues then would be discussed as they arise. Care plans included the abilities of service users and were cross-referenced to appropriate risk assessments where necessary. Several for moving and handling were noted. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 10 Others seen in the sample viewed related to independent use of the community and self-medication. There was evidence of risk assessments being updated. From conversation with service users and consideration of their care plans much of the key information was recorded. One person said that it was ‘a reasonable documentation of what I need’. One area concerning the special diet of a resident needed to be developed as discussed with a member of staff and the manager on the first day of the inspection. Lack of staff support with the menu had led to a plan that did was not sufficient to meet that persons needs. This was amended before the start end of the second day of the inspection giving more details of how staff should provide support. Service users asked thought that it was possible to make choices and decisions during their stays. Comments were received, however, about there not always being enough to do or staff support to go out in the community. Staff and residents referred to insufficient key worker time available for this. Some service users are more independent than others but how social and mental stimulation is to be addressed was not sufficiently covered in the care plans for those needing more support. Staff said that they actively use the care plans and one shift-leader said that they were referred to each shift so that staff could be up to date with current needs. The care plans were kept in a locked office, which staff use and were held by the desk where staff members plan their work. The same shift leader explained the system for ensuring that the service users identified needs are met on a day-to-day basis. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to maintain and develop their independence and engage in social and recreational activities but this could be developed and improved for some service users who need more mental stimulation based on their individual wishes. Service users would benefit from being consulted about the menu and special dietary needs being routinely catered for. EVIDENCE: Mental stimulation and activities were discussed with some of the staff and service users individually. Various comments received suggested that insufficient attention is given to it. One person said that going out once a week was not enough, that there were usually people to talk to but the staff were usually too busy. Another said that the Thursday trip is often cancelled due to lack of interest or lack of staff to support it. It was cancelled on the second day John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 12 of the inspection. One comment was that although those able to go out alone can, others had to rely on key-workers for this and little time is available for this. Another said that staff support was needed sometimes to gain confidence in going out. Comments were also received about the weekly activities: bingo, arts and craft, a quiz and the bar being open every other Friday. Some service users appreciate these activities but leave others dissatisfied. Two said that they would not mind paying to go out. In a conversation with one member of staff comments were received that the social needs of a younger service user were not addressed during a respite stay. Another member of staff said that for a while support with activities was offered in the afternoon once a week. A record of this was held until 25th August 2006 but staff became busier with the service users in rehabilitation and this has now stopped. A discussion was held with the manager about the need to develop a more person centred approach to mental stimulation. Little information was recorded about this in care plans. The manager said that the draft service review discussed at previous inspections had not been implemented. It had proposed providing more and planned activities and programmes for the longer-stay service users receiving the rehabilitation/re-enablement service. There was verbal evidence from service users and staff about support with social and family relationships. These were spoken about sensitively and staff have assisted with a range of issues such as marital relationships, coping with disability and other personal issues. Responsibility is encouraged and independence promoted. Service users are encouraged to retain responsibilities for aspects of their lives that they are used to having control over, such as finances, cleaning, cooking, shopping and making arrangements. Key-workers plan assistance for those needing it. Comments about the food were varied. Some liked the choices on offer, the level of variety and the quantity. Others were less satisfied making comments about the taste, quality and presentation varying, a lack of choice and dietary needs not always being met. The food records were viewed to consider the food provided for one person on a special diet. There was insufficient evidence that this person’s dietary needs were met, that a real choice was still offered for that person or that adequate guidance was provided to staff for supporting this person. Staff had addressed this by the second day of the inspection. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that personal support is provided individually and health needs are met. The home has systems in place to offer service users safeguards in medication practices. EVIDENCE: Personal care needs are addressed in the care plans according to the varying needs of those requiring support. Moving and handling assessments and health risk assessments were noted and guidance is recorded for staff to follow. Equipment needed was also noted in the care plans sampled. One service user said that they were happy with the level of assistance for bathing, and washing. Privacy and dignity is maintained and staff members usually know how to give the support required. Another confirmed that support was given at an appropriate pace. A third said that their personal care needs were met and that support was received with health care. One person did comment that occasionally help was not always immediately available when needed. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 14 Staff said that they assist with appointments and meeting health needs. Independence is promoted where possible but help is given such as overseeing the self-administration of medication and liaising with the district nurses. Records are held of the appointments with health professionals. Service users are encouraged to administer their own medication where possible. Two service users spoken to about this confirmed that they had been provided with lockable storage for this. In the one file sampled in respect of this a self-medication risk assessment was in place. Medication is stored securely in the home with additional security for controlled drugs. Records are held of medication given and these had been completed adequately where sampled. A system is in place for identifying who should have medication and lists of medication are held. Changes of medication were recorded. Trained staff members administer medication. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An effective complaints procedure means that any service users concerns are followed up. Service users benefit from systems in place for adult protection. EVIDENCE: The home has a complaints procedure, which is clearly written and made available in private rooms although two of the four people spoken to said that they were not aware of it. However, the home promotes a positive culture in which service users say that they feel able to raise issues with staff and management if needed. One service user was not confident that an improvement in one area could be sustained. Another thought that they would be listened to and a third felt able to raise issues. The fourth service user thought that the management were approachable. The manager said that three complaints had been received since the last inspection. These have all been responded to but further information detailing action taken in the home should be recorded. The home has an adult protection policy and induction records showed that all new staff members have received adult protection awareness training. Four staff completed this in March 2006. Most others had completed training in 2003– 2004 and further refreshers were advised. Adult protection was discussed with a member of staff who was aware of procedures to follow should an allegation be made. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from further attention to the fabric of the home, which is showing signs of wear and tear, to ensure that it’s upkeep and adequate infection control is maintained. EVIDENCE: John Darling Mall was purpose built for people with physical disabilities and has been suitably adapted. More individualised adaptations are provided as needed. The mall itself has dimmed lighting and comments were received about this from a staff member. The manager was advised to consider this in the homes risk assessment. Although no accident had been recorded the home does accommodate people with sight impairments. Service users rooms are in four sections each with shared facilities including adapted kitchens. Use of these kitchens varies but unit two has damaged and stained worktops which need replacing damaged drawers and the tiles need to John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 17 be cleaned. Carpets in some of the shared areas were stained and some of the ceilings marked. The home is cleaned sufficiently but the decorative standard is deteriorating with marked walls in places and damaged doorways. The manager said that there was no specific plan to address this. Service users did not comment on the décor and those asked said that they were comfortable. The home has an infection control policy and staff members have access to necessary equipment needed to safeguard themselves and users. There is a regularly used maintenance book. However the home is in need of some improvement. Three bathrooms are in need of attention to the base and surround of the showers. The cracked, stained or marked tiles increase risks of infection. Specific plans are not is place to address this. One of the shower areas also overflows causing a problem with drying and the smell of dampness. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with well, recruited, supported and trained staff but a review of staff levels is needed to ensure that mental stimulation and activity is developed. EVIDENCE: The home has a large number of full and part-time staff, which is supplemented by bank or agency staff depending in the numbers and needs of the service users. This was reflected in the rotas and numbers of staff on duty. The manager said that they were unable to recruit to a vacant post but that bank or agency staff filled the hours. One staff member felt that the service was very flexible and needed to be in order to meet the varying needs of respite, emergency and rehabilitative care. Senior staff are usually on duty leading the shifts and have handover sheets to aid organisation. Changeovers are planned into the shifts. Most of the comments from service users about the staff were positive. One person commented on feeling respected, and that dignity was maintained when support received. Another said that staff were ‘pretty good’ but were John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 19 ‘sometimes feeling understaffed, too busy and unable to give the attention needed’ and there were times when they had to wait too long. Another said that they were polite and helpful and ‘nothing was too much’. However in other sections of this report comments are made about lack of stimulation and lack of staff to support this. A review of staffing should follow a review of the needs of service users to provide them with a more person centred service. Recruitment practices reflect national guidance and appropriate records had been sent from the head office. One piece of information was missing from the records sampled but there was evidence that it had been obtained by the organisation. The importance of training is recognised and starts with induction of which records are held and is followed up by probation reviews after 6 months. Annual appraisals take place. Staff meetings are held weekly. Staff spoken to confirmed that they were receiving training and supervision regularly by management and senior staff. There is a mixture of external and internal training. Training records are held and plans are in place for 2007. Staff are encouraged to complete NVQ assessments and over fifty percent of permanent staff have been assessed at level two or above. Service users asked felt that staff had the skills to assist them. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users would benefit from a review of the service taking their wishes into account and development of a service plan. Service users benefit from attention being given routinely to health and safety by management. EVIDENCE: The manager has worked in the home for a number of years and has both the experience and qualifications to manage the home. Staff and service users said that the management staff were approachable and offered support. The management recognises that a quality assurance system needs to be developed as there is no current clear system for this and it is a while since the service users have been consulted about the services at John Darling Mall. The manager stated that there was no current improvement plan and possible developments identified following the previous review of the service had not John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 21 been implemented. However, some feedback is obtained from service users about each stay. Of the two service users asked, one service user had been asked about their stay at the end of it. Another had completed a form. The management needs to ensure that any improvement plan includes action to ensure that the social needs of service users are met. The home has various health and safety procedures in place and staff were able to describe elements of this. Regular in house training is provided to cover some of the health and safety issues in the home following elements covered in induction. One member of staff is identified as the health and safety representative and another said that the management are very good on health and safety, which they see as of paramount importance. Staff gave evidence of procedures being implemented in the home. The management reported that regular checks and servicing takes place and samples of records of these were viewed and in place during the inspection. This included: up to date staff fire training; and checks of the fire system; gas safety, and a risk assessment. John Darling Mall DS0000040678.V323250.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 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 YA6 Regulation 15 Requirement Timescale for action 28/02/07 2 YA12 3 4 YA17 YA24 5 YA30 6 YA33 The registered manager must ensure that care plans include more detailed guidance to staff about meeting social needs. 12 The registered manager must 16(n)(m) ensure that mental stimulation and activity meets service users needs. This is an amended requirement from the inspection of 22/7/04 and 9/12/04. 12,16(2)(i) The registered manager must ensure that food provided meets the needs of service users. 23 The registered manager must (2)(b)(d) ensure that sufficient plans are in place to improve the environment including damaged doorways, redecoration and stained carpets. 13(3)(4)(c) The registered manager must ensure that the bathrooms and kitchens do not put service users at risk of infection. 18 The registered manager must ensure that staff levels are adequate to meet the needs of service users at all times including social and activity DS0000040678.V323250.R01.S.doc 28/02/07 28/01/07 28/02/07 28/03/07 28/02/07 John Darling Mall Version 5.2 Page 24 needs. 7 YA39 24 The registered manager must ensure that quality assurance and improvement plans are in place and in progress. 28/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA17 Good Practice Recommendations It is recommended that menus be revised periodically with the service users. John Darling Mall DS0000040678.V323250.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI John Darling Mall DS0000040678.V323250.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. 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