Inspection on 24/07/07 for Kitnocks House Nursing Home

This inspection was carried out on 24th July 2007.

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

Kitnocks House Nursing Home 25/07/08

Kitnocks House Nursing Home 22/11/06

Kitnocks House Nursing Home 13/01/06

Kitnocks House Nursing Home 21/07/05

Kitnocks House Nursing Home 18/01/05

Kitnocks House Nursing Home 07/07/04

Kitnocks House Nursing Home 08/01/04

Kitnocks House Nursing Home 22/07/03

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

CARE HOMES FOR OLDER PEOPLE Kitnocks House Nursing Home Wickham Road Curdridge Hampshire SO32 2HG Lead Inspector Ian Craig Unannounced Inspection 10:00 24th July 2007 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 Kitnocks House Nursing Home DS0000012130.V341439.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. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kitnocks House Nursing Home Address Wickham Road Curdridge Hampshire SO32 2HG 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) 01489 798244 01489 799411 kitnocks@zoom.co.uk Kitnocks House Limited Mr Anthony Nicholas Murdoch Care Home 62 Category(ies) of Dementia (62), Dementia - over 65 years of age registration, with number (62), Mental disorder, excluding learning of places disability or dementia (62), Mental Disorder, excluding learning disability or dementia - over 65 years of age (62) Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Dispensation has been given to 4 named service users in the LD category to remain accommodated in the home. 22nd November 2006 Date of last inspection Brief Description of the Service: Kitnocks House is a care home providing nursing and accommodation for 62 persons with mental health difficulties, from the age of 18. It is situated in the rural area of Curdridge, between the local villages of Botley, Wickham, and Bishops Waltham. The registered provider is Kitnocks House Ltd. Kitnocks is a converted Edwardian building, originally refurbished and opened as a 32-bed nursing home in 1993. It was further extended in 1994 and in 2007 an extra 13 beds and communal areas were added. All bedrooms are single with the exception of 6 double bedrooms. There is a passenger lift. The home is set in large grounds. Flexi paving is provided so that the grounds may be accessed and enjoyed with minimal risks to service users. Residents must meet the National Health Service clinical eligibility criteria for continuing care before they can be admitted. The home’s weekly fees range from £596.00 to £1930.00. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection consisted of a tour of the premises, examination of records, policies and procedures. Discussions took place with the manager and one staff member was interviewed. Survey forms were received from 3 community mental health professionals who have responsibilities for the supervision of residents. A survey form was also returned from a residents’ relative. Three relatives of residents were interviewed during the inspection. Several residents were spoken to and two of these were interviewed. Staff and residents were observed carrying out various duties. The inspection lasted approximately 6.5 hours. What the service does well: The home’s physical environment is clean, well maintained and of a high standard, reflecting a commitment to promoting the dignity of the service users. Care is provided to residents in conjunction with the plans of the community mental health services. There is effective liaison with community medical teams and hospital consultant psychiatrists specialising in the care of older persons, adults with mental health and learning disability needs. Medical staff are also involved in reviewing the residents’ physical needs. Each resident’s medical needs are formally reviewed each week by a consultant. The home works closely with health professionals and provides a clinical report for the medical teams every 3 months. The home caters for people who have complex and multiple mental health and physical health needs. Records and discussions with the manager show that the home carries out comprehensive assessments of needs for those referred for possible admission to the home. Information is also obtained from relevant health and social services professionals regarding the needs of those moving into the home. Each resident has a care plan setting out health and social needs. Medication procedures are well documented with exception of recording of when medication ‘as required’ should be dispensed for night sedation. Residents have opportunities for taking part in activities both inside and outside the home, although two relatives of residents expressed the view that this could be improved. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 6 The home’s complaints procedure is displayed in the home. Trained nursing staff are on duty at all times and the home deploys sufficient care and domestic staff. Staff recruitment procedures are thorough and show that all required checks are carried out. Training and support is provided to the nursing and care staff. The manager and staff are committed to ongoing learning. The manager’s academic interests are reflected in the home having an ‘openness’ to training and development. The manager is motivated to maintaining and improving the service as well as being receptive to the findings of the inspection. Relatives described the manager and administrator as approachable and helpful. What has improved since the last inspection? What they could do better: Whilst much of the emphasis and expertise of the home is on health needs, there is scope to develop practices that promote the rights, choices and involvement of the residents. For instance, residents are not offered, or assessed as capable of, having a key to their bedroom door. Residents are not involved in devising and reviewing their care plans. Procedures for dealing with challenging behaviour need to be reviewed for one person. The home’s Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 7 management and staff need to have a greater awareness of the rights of residents in dealing with challenging behaviour. Guidelines need to be recorded of the circumstances when medication ‘as required’ is needed for night sedation. 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. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that it only accommodates those whose needs it can meet by carrying out a thorough and excellent assessment of need prior to the person moving in. EVIDENCE: Each person referred to the home for possible admission undergoes an assessment of his or her needs, which involves the manager visiting the person and completing an assessment pro forma. From this information, the manager devises and records a daily routine for the person which gives an indication of whether the person’s needs can be met, the level of input of staffing and supervision, which in turn provides guidance for the level of funding required. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 10 In addition to this, the home obtains copies of relevant social and health care assessments from referring agencies such as hospitals and community teams. The home also devises its own report about the person’s situation and needs. These were seen to be comprehensive and included details about mental health needs and any status under the Mental Health Act 1983. Prospective residents have an opportunity to visit the home to see if it meets their preference. Information about the home is also provided to prospective residents and their relatives. This was confirmed from discussion with the manager and was verified by two relatives. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst each person’s health and personal care needs are set out in a plan, improvements are needed to ensure that residents are involved in care planning and the decisions being made about them. Greater attention is needed in promoting residents’ rights and privacy. EVIDENCE: Assessments of need and care plans were examined for 4 residents. These are comprehensive and include the following: • Life history • Physical profile • Client contact Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 12 • • • • • • • • • • • • • Full assessment summary Wound care plan Lifting plan Mental health, including details of assessments by medical services, risks and symptoms Social and leisure needs Personal care including, catheter and colostomy care Risk assessments Individual activity plan Plan to control pain Barthel assessment Waterlow assessment Weight charts Reviews Daily running records are also well maintained and are signed and dated by the member of staff completing them. Care plan procedures for dealing with challenging behaviour are recorded. It was noted that for one person these need to be recorded in greater detail as the behaviour as described by a member of staff was not fully reflected in the plan. For this same person, it was also identified that a review of the plan for dealing with the behaviour is needed for the following reasons: • The intervention as recorded is restrictive to the person’s liberty • The intervention has not been agreed with the client • The intervention has been agreed by a doctor but not by any other agencies, although the manager stated that the person’s care manager has been made aware of the procedure. The Commission have since been informed that procedures for dealing with challenging behaviour have been agreed by the consultant psychiatrist, care manager, advocate and the resident. Correspondence was sent to the Commission clarifying another intervention similar to the above for the same person. The process of devising care plans is not carried out with the resident and there is no evidence of individual residents agreeing to their care plan. Records and discussions with staff, the manager and relatives show that each person’s health care needs are addressed. Each person has a weekly medical review by a doctor. Medical advice and procedures are included with case records including dealing with neurological conditions and speech and language therapy reports. The home is also actively involved in multi agency planning meetings, including those as required by mental health procedures. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 13 The home’s medication procedures were examined. Staff record a signature each time medication is administered. Recording and safekeeping of controlled medication meets pharmaceutical guidelines. Where medication ‘as required’ is administered the home has written guidelines of what symptoms indicate the need for the medication. This includes medication for behaviour, anxiety and neurological conditions. There are two exceptions to this, where night sedative medication ‘as required’ is prescribed for two people. A record was not made of the circumstances that indicate that staff should administer the drug, which is needed for consistency. It was noted that the medication has not been administered and the manager stated that following a medication review the drug will no longer be prescribed. For this reason, a requirement has not been made regarding the lack of details of when night sedation is needed. Observation showed that residents have a choice about how they spend their time and that there are opportunities for activities. The provision of privacy for residents was discussed with the manager. Residents are not offered a key to their bedroom door. Whilst it is acknowledged that many residents are not able to use a door key, this is not the case for each person. It was suggested that the home assesses each person’s ability regarding a key to their bedroom door and offers a key to those capable of handling a door lock and key. A record of this process should be maintained. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a good range of activities in the home and in the local community. EVIDENCE: Residents were observed taking part in a variety of activities in the home. These included watching television, playing sports, reading and talking to visitors. The home employs an activities coordinator from 1pm to 5.30pm from Monday to Friday. This person was observed playing football with one person and talking to other residents. Another person is employed for two afternoons a week for conversation and activities. Another female staff member provides 18 hours of activities a week primarily for the women residents. An external Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 15 health support worker takes 7 residents to community activities on a one to one basis, such as working at an allotment and visiting local facilities. Relatives confirmed that they are able to visit at any reasonable time they wish. Residents are also able to go out with relatives subject to risk assessment. Regular entertainment is provided by visiting musicians. A resident described how she has a daily newspaper and that she likes to read magazines. Feedback from the relatives of 2 residents described how they would like to see more activities for the residents. The home’s 6-week menu plan shows a varied, nutritious and balanced diet. Special diets are catered for, such as vegetarian. Residents stated that they are satisfied with the food although one person stated that he/she does not like all of the meals. A relative of a resident described how a special diet is provided, that the meals always look appetising and that his/her next of kin has benefited from this. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home listens to the views of service users and relatives and provides a complaints procedure. Whilst staff are trained in dealing with challenging behaviour incidents are not always dealt with in accordance with the rights of the individual. EVIDENCE: The home’s complaints procedure is clearly displayed in the entrance hall. Relatives stated that they would know what to do if they had a complaint and that they felt comfortable approaching the home’s staff and management if they have any matter they wish to discuss. The home has policies and procedures for dealing with any suspected abuse. A staff member stated that she has not had specific training in adult protection procedures but that there are team discussions on the subject. The manager stated that there are presentations in adult protection from a training provider. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 17 The home also has a ‘whistelblowing’ procedure to encourage staff to report any poor practice. Staff receive training in dealing with challenging behaviour entitled, ‘non aversive intervention.’ Reference has already been made in the Health and Personal Care section of this report, highlighting that details of challenging behaviour need to be recorded in more detail and that interventions that restrict the liberty of the individual should be preferably agreed with the client and by a multi agency review. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s physical environment promotes the dignity of the residents being clean, well maintained and decorated and furnished to a high standard. EVIDENCE: The home has been recently extended to accommodate a further 13 residents in a purpose built annexe. All areas of the home seen are clean with rooms and communal areas decorated in a variety of different pastel colours. Furnishings are in good Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 19 condition and the home is carpeted in most areas. Paintings, prints and other items are used to create a stimulating environment. These include large antique and modern prints and paintings, as well as displays of photographs of the surrounding area and its people from Edwardian times. Close attention to detail has been given to the environment. For instance, room numbers are displayed outside each bedroom on artistically painted plates and each person has their name typed and placed in a brass bracket outside their bedroom door to identify their room. Residents were observed using the numerous sitting areas around the home, including the lounges and outside areas. One resident was sat at a table in the garden with his/her relatives. There is ramped access to the garden and paths are made of a soft rubber material to help prevent any injury to the residents. Each of the residents spoken to stated that they like the facilities of the home. There are several lounges and dining areas and an activities room. Four bathrooms have specialist facilities for bathing those people who have mobility needs. The home is clean and there is an absence of any unpleasant odours. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well-trained and motivated staff supplied in sufficient numbers. Residents are protected by the home’s staff recruitment procedures. EVIDENCE: One staff member is on duty for every 4 residents. Four registered nurses are on duty from 7am to 8 pm each day and two from 8pm to 7am overnight. This was evidenced from observation, the staff rota and discussions with the manager. Discussions with residents and residents’ relatives showed that they consider the staffing levels to be sufficient. In addition to the nurse and care staff, the home employs staff for cleaning and catering as well as for the purposes on engaging residents in activities and conversation. Staff were observed providing care to residents in a sensitive manner. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 21 The home has developed links with various establishments such as community and hospital services as well as universities, which have been used to create a learning environment for the staff. The manager’s own academic interests and openness to learning have also enhanced this. A registered nurse described how she has developed skills in tutoring care staff and nursing students by attaining an NVQ assessor’s qualification and completing a ‘mentorship’ course. Staff have access to a variety of training courses and the home has regular learning sets when relevant subjects are discussed. Staff appraisals are carried out and newly appointed staff have an induction programme. The home’s recruitment procedures include completion of the required checks such as with the Nursing and Midwifery Council (NMC), Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) list as well as obtaining 2 written references for each person. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst the residents would benefit from the management acknowledging the rights of the people who live at the home, the manager is committed to developing and improving the service for the benefit of the people who live there. EVIDENCE: Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 23 The manager is a registered nurse and regularly updates his training in various subjects related to the running of the home, the management of the staff and the care of the residents. He liaises with teaching establishments to foster a work environment that has learning as significant interest for all staff. As well as reading about subjects related to the care of the residents he is also actively involved in his own research about mental health care. The staff and relatives described him as approachable and always willing to listen to any concerns. During the inspection he showed an ‘openess’ to any suggestions about improving the service. The views of relatives are sought via a questionnaire, which is sent out on an annual basis. The home carries out several audits including medication. An annual development plan is devised which has an action plan for the completion of set works. A local authority receiver deals with each person’s finances. Records of any transactions involving the home are maintained with any amounts spent recorded alongside a date. The home carries out its own audit of the accounts. Health and safety procedures were examined. Staff receive training in first aid, moving and handling and food hygiene. The home’s equipment is serviced and tested by suitably qualified persons. Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 24 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 4 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 4 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 Requirement Residents must be involved in the assessment and care planning process. Timescale for action 23/10/07 2 OP7 15 Where staff deal with challenging 23/09/07 behaviour the written care plans must be expanded to include the details of the behaviour. Where the intervention to deal with challenging behaviour involves a restriction of the person’s liberty this must be reviewed and agreed by a multi agency approach and, if feasible, should include the consent of the resident. Residents should be offered a key to their bedroom unless a risk assessment indicates other wise. The decisions made must be recorded. 23/09/07 3 OP7 15 4 OP10 12 23/10/07 Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations Kitnocks House Nursing Home DS0000012130.V341439.R01.S.doc Version 5.2 Page 27 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. 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