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Inspection on 22/11/06 for Lady Spencer House

Also see our care home review for Lady Spencer House for more information

This inspection was carried out on 22nd November 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is clean and comfortable and provides a homely environment for its` service users. Bedrooms are decorated and furnished in a way that promotes individual choices and preferences. Staff records indicate that the staff are receiving one to one supervision every two months with a member of the management team. Service Users all have a detailed assessment carried out by a senior member of staff. This ensures that their needs will be fully met. A `Suggested Care` document is also completed for all service users. This adds an important element of personal choices and preferences to each service users care. Each service user does have a summarised care plan in their file that is updated every six months. These plans give a clear picture of the service users` needs.Some of the service users kept the key for their own bedrooms, and the staff were seen to be knocking on doors before entering, and generally treating service users in a respectful way

What has improved since the last inspection?

There was a Statement of Purpose and a Service User Guide in place that had recently been reviewed. These are detailed documents that include information relating to all aspects of care provided, and facilities available within the home. Services such as chiropody, that are not included in the initial fees, were all detailed within this document. It also contains a summary of the complaints policy and the fire procedure. All staff have had an Enhanced CRB check carried out on them.

What the care home could do better:

Records relating to the administration of medications were noted to have several errors in the last two weeks. In particular three out of four service users` controlled drug records were found to be incorrect when checked against stocks. Some staff clearly had a poor understanding of the omission codes used on the Medication Administration Sheets. The submission of Regulation 37 notices to CSCI was rather sporadic and the content often insufficient. The absence of a registered manager for the past year indicates that the smooth running, and administrative functions of the home may have been compromised. The filing and storage of all archived documentation at the sister home caused some difficulties for the inspector during the inspection, as it made the `paper trail` of individual service users difficult to follow. It is hoped this will improve when the recently advertised administrators` post is filled. The manager must ensure that when appointing new staff, appropriate references are obtained. If information indicates staff maybe unsuitable, further references should be requested. Care Plans do not always give clear instruction of how the care and management of the individuals` should be carried out in order to maintain continuity of care.

CARE HOMES FOR OLDER PEOPLE Lady Spencer House 52 High Street Houghton Regis Bedfordshire LU5 5BJ Lead Inspector Mrs Louise Trainor Unannounced Inspection 10:00 22 November 2006 nd 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 Lady Spencer House DS0000014923.V315353.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. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Spencer House Address 52 High Street Houghton Regis Bedfordshire LU5 5BJ 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) 01582 868516 01582 868516 Resicare Homes Limited Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24), of places Physical disability over 65 years of age (24) Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: Lady Spencer House is a residential home for older people, specialising in the care of people with mental and physical disabilities. The home was situated within walking distance of the centre of Houghton Regis, and also provided easy access to the town’s amenities. It is a modern, purpose built house and with three floors, it offered accommodation of 24 single rooms. The communal space included 2 comfortable lounges, one with a small conservatory attached, for service users to sit together, and the staff are able to spend time with them, paying attention to all individuals. A lift was used for access to the first and the second floor. A number of toilets and washing facilities were located throughout the building, allowing easy access. The parking space behind the building and a small garden was sufficient for staff and visitor’s cars. Fees for this service range from £425.00 - £495.00 per week. Lady Spencer House DS0000014923.V315353.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 for this home. It was carried out on the 22nd of November 2006, between the hours of 10:00 hours and 18:00 hours by Regulatory Inspector Louise Trainor. On arrival there was no manager present and the trainee manager was on sick leave. Following a call from a senior carer, the deputy manager, from the sister home, and the owner, who is also the manager from the sister home, arrived. They assisted, and were available for discussion throughout the day where necessary. During the inspection a full tour of the building took place. The care of three service users picked at random by the inspector was tracked. This involved assessing the care documentation against the care provided to them, and seeking their views on the care they receive which was done through informal interviewing and observations. In addition two care staff were interviewed and three other staff personal files were inspected. Care practices were observed on and off throughout the day. The inspector would like to thank all those involved for their support and assistance. What the service does well: The home is clean and comfortable and provides a homely environment for its’ service users. Bedrooms are decorated and furnished in a way that promotes individual choices and preferences. Staff records indicate that the staff are receiving one to one supervision every two months with a member of the management team. Service Users all have a detailed assessment carried out by a senior member of staff. This ensures that their needs will be fully met. A ‘Suggested Care’ document is also completed for all service users. This adds an important element of personal choices and preferences to each service users care. Each service user does have a summarised care plan in their file that is updated every six months. These plans give a clear picture of the service users’ needs. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 6 Some of the service users kept the key for their own bedrooms, and the staff were seen to be knocking on doors before entering, and generally treating service users in a respectful way What has improved since the last inspection? What they could do better: Records relating to the administration of medications were noted to have several errors in the last two weeks. In particular three out of four service users’ controlled drug records were found to be incorrect when checked against stocks. Some staff clearly had a poor understanding of the omission codes used on the Medication Administration Sheets. The submission of Regulation 37 notices to CSCI was rather sporadic and the content often insufficient. The absence of a registered manager for the past year indicates that the smooth running, and administrative functions of the home may have been compromised. The filing and storage of all archived documentation at the sister home caused some difficulties for the inspector during the inspection, as it made the ‘paper trail’ of individual service users difficult to follow. It is hoped this will improve when the recently advertised administrators’ post is filled. The manager must ensure that when appointing new staff, appropriate references are obtained. If information indicates staff maybe unsuitable, further references should be requested. Care Plans do not always give clear instruction of how the care and management of the individuals’ should be carried out in order to maintain continuity of care. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 7 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. Lady Spencer House DS0000014923.V315353.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 Lady Spencer House DS0000014923.V315353.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective service users and their representatives have sufficient information so that they can make an informed choice about where they want to live. EVIDENCE: There was a Statement of Purpose and a Service User Guide in place that had recently been reviewed. These are detailed documents that include information relating to all aspects of care provided, and facilities available within the home. The services such as chiropody, that are not included in the initial fees, were all detailed within this document. It also contains a summary of the complaints policy and the fire procedure. These documents require some amendments with the recent review of the management team. The inspector could not view contracts spontaneously as they are stored at the sister home. However the owner did state that these could be faxed over for viewing if necessary. The inspector did not request this on this occasion as Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 10 various other documentation was being faxed through relating to regulation 37,s and incident forms. At present all archived documentation is filed and stored at the sister home which did present some difficulties during the inspection. A review of this system was discussed with the owner, and the feasibility of moving it on site was a possible option for the future. Service Users all have a detailed assessment carried out by a senior member of staff. This ensures that their needs will be fully met. A ‘Suggested Care’ document is also completed for all service users. This adds an important element of personal choices and preferences to each service users care. Lady Spencer House DS0000014923.V315353.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Policies and procedures relating to the administration of medications’ are insufficient to ensure service users are protected. EVIDENCE: Each service user does have a summarised care plan in their file that is updated every six months. These plans give a clear picture of the service users’ needs, but do not always give clear instruction of how the care and management of the individuals’ should be carried out in order to maintain continuity of care. In addition to the summarised care plan, there is a monthly review sheet in each service user file, however this does not clearly indicate any changes in the overall care each month. During the inspection one particular service user was noted to be in a rather unkempt state. The care plan indicated issues relating to occasional reluctance to accept assistance with personal care, and aggression. However there was no clear plan of action / instruction of how this should be managed with continuity by all staff. There was no evidence in the daily record for this service user to Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 12 identify why personal care had not taken place, or any reference to attempts made to ensure it did take place. Medication Administration Record sheets were checked for this home. These were very difficult to reconcile, because some unused medication is not being returned to the pharmacy, a new delivery is coming in and old stocks are not being forwarded onto the MAR sheets. Therefore it is difficult to ascertain exactly what stocks should be remaining. There appears to be some confusion amongst staff over the use of codes when recording the omissions of medication. One service user had ‘A’ recorded 12 times over the last 13 days. This indicated that the medication had been refused, however these tablets were missing from the blister packs. Although the inspector accepts these may have been refused and destroyed, staff must ensure they insert the appropriate code so that accurate reconciliation may take place. At the time of the inspection the home had four service users receiving controlled drugs. Of these four, only one reconciled correctly with the records. Of the remaining three: one service user that was prescribed Temazepam, had records to show fourteen tablets were remaining, there were actually fifteen. This indicates that staff had signed for giving this medication, when it was not given. Another service users’ records indicated there should have been 290 mls of Oramorph liquid remaining. There was approximately 350 – 400mls in the bottle, indicating also that medication was being signed for, but not given appropriately. Some of the service users kept the key for their own bedrooms, and the staff were seen to be knocking on doors before entering, and generally treating service users in a respectful way. The staff must however, think about the terms of address they use, both with visitors and service users, and understand that these maybe perceived as too familiar and sometimes inappropriate. On arrival too the home, the inspector was greeted with: “Right darling where do you want to go….” This sounded unprofessional and was inappropriate. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Most of the service users indicated they are satisfied with the recreational activities available to them, and appreciate being given the choice of whether to participate. EVIDENCE: The inspector visited both of the lounge areas during the inspection and had the opportunity to observe care practices and talk to service users. Service users in both areas appeared happy and relaxed, and the interactions between staff and service users were friendly and respectful. In the High Dependency lounge there were just four service users. All appeared comfortable and well cared for. There was some ‘old time music hall’ songs playing in the background, and one service user was jovially singing along with them. She told the inspector. “I like it here but I don’t count how long, it’s nice, they don’t force you to do anything, they just help you and keep an eye on you. I love music and used to love reading, but I can’t read any more as I’m going blind. I’m going to have those talking books if I go home.” She also talked about how good the food was how she always has a bath as she hates the shower. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 14 In the main lounge on the ground floor, there were no scheduled activities going on. But service users appeared content. The television was on although no one appeared to be watching it. Service users were chatting amongst themselves, and one service user was doing a ‘word search’ puzzle. Generally there was lots of ‘comings and goings’ in the room as service users were preparing themselves for lunch, which was roast lamb. One lady said. “They’re very good at cooking, I eat anything you know. I get up early and tidy my room as I’ve always done, and I go to bed when I want, I usually go with my friend, she has a room by me”. Service users were clearly comfortable and satisfied with their choices in life. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Evidence suggests that Adult protection issues are managed in a timely and efficient way so that service users are protected. Training is still outstanding for staff on this subject although four sessions have been booked early next month to accommodate all staff. EVIDENCE: There had only been one formal complaint since the last inspection one year ago. This complaint was from a service user, regarding a member of the care staffs’ attitude and behaviour towards her. The member of staff concerned had been suspended, a POVA referral had been made, and a strategy meeting was called. This was dealt with efficiently and effectively, resulting in the dismissal of the member of staff concerned. Training in the Protection of Vulnerable Adults (POVA) remains outstanding in this home. However four sessions have been booked in early December to accommodate all staff. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 16 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, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Overall this home provides a safe, clean, and homely atmosphere for its service users. EVIDENCE: This home was clean and free from any offensive odours. It is decorated in a homely way and is well maintained, and has an ongoing programme for decorating in place. There is a lounge / dining area with an adjoining conservatory on the ground floor, and a lounge for service users with a higher dependency level on the first floor. Service users’ appeared comfortable and well cared for in both. Bedrooms were decorated and furnished individually. Some rooms had furniture that belonged to the service users, and the presence of photographs and personal assets in the rooms made them more personal and homely, reflecting the service users’ families and life history. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 17 Hoists and other moving and handling equipment were strategically placed in the hallway, near to the lounge where it was easily accessible but not obstructing doors or walkways. The temperature in the home was comfortable, however there were two freestanding electric heaters in the main lounge area on the ground floor. These could have presented a trip hazard for service users, and one certainly appeared to obstruct staff when manoeuvring a wheel chair in the lounge. No risk assessment had been carried out prior to using these heaters. The owner was not aware they were in place. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home’s recruitment policies and procedures are insufficient to ensure service users are protected at all times. EVIDENCE: There is a recruitment policy in place, and it is now being adhered to more tightly. Staff that had commenced work in 2004 and 2005 without CRB clearance, have now got certificates in their files to show these checks have been done. There is an established staff team in this home; therefore there are very few staff that have been recently employed. One staff file that was inspected, was for a member of staff that had left the home and returned earlier this year. One of the references obtained, indicated that her tact and attitude towards service users was not always good. There was no evidence to show that further references had been requested, and a complaint had recently arisen relating to these negative qualities. This may have been avoided had further references been obtained. There is a variety of training available for all staff. Staff files indicated that Moving and Handling training, Health and Safety, Food Hygiene and Fire Safety are sessions that are attended by all staff. However during the inspection two staff were observed using a moving and handling sling. This service user did not appear comfortable during this process, as it pulled her up from under her Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 19 armpits. This service user was then wheeled backwards through the lounge. This matter was discussed with the owner during the feedback session, and was going to be addressed immediately. Both of these staff had recently attended moving and handling training. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The management structure of this home is presently under review. The absence of a registered manager for the past year indicates that the smooth running, and administrative functions of the home may have been compromised. EVIDENCE: The home has not had a registered manager in place for over a year. Trainee managers have been placed in the home, but to date none have been put forward to register. This matter was discussed at length with the owner. A senior carer from the sister home was due to commence a trial period as trainee manager at the home. The owner has agreed that if the post progresses satisfactorily, then an application for registration will be submitted to the Commission for Social Care Inspection (CSCI) by the end of January 2007. Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 21 The registration certificates that were on display were out of date. Immediate action was taken to rectify this matter during the inspection. The filing of service users documentation had been allowed to lapse over recent weeks. This was recognised by the inspector to be during the present absence of the trainee manager. However this situation made the case tracking process very difficult, and gave a poor impression of the present process of record keeping and administration within the home. The owner informed the inspector that she is presently advertising for an administrator therefore this problem would be eradicated in the near future. The supervision of staff in this home is good. Staff files that were inspected had records to indicate that the staff receives a 1:1 supervision session every two to three months with a more senior member of staff. The staff that were interviewed also stated that they felt well supported by senior staff. The completion and submission of regulation 37 notices to CSCI are rather sporadic, and the content is often insufficient. The importance of them being submitted in a timely fashion was discussed. Lady Spencer House DS0000014923.V315353.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 2 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 3 1 2 Lady Spencer House DS0000014923.V315353.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 OP1 Regulation 6 Requirement The statement of purpose and the service user’s guide must be reviewed to illustrate accurately the review of the management team at the home. Timescale for action 28/02/07 2. OP9 13(2) 3. OP29 19 The registered person shall make 31/12/06 arrangements for the recording, handling, safekeeping and disposal of medicines received into the care home. Two appropriate, written 31/12/06 references must be obtained for all new staff the home employs. Any missing or adverse references MUST be covered by a third reference or an appropriate risk assessment. (Partially unmet from previous inspection, new timescale applied) The new manager, currently on induction, must apply for registration by the 31/01/07 as discussed during the inspection, if she is to remain in this role by new deadline. 31/01/07 4. OP31 8 Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 24 5 OP38 37(1) & (2) The registered person shall give notice to the Commission without delay of any death, illness or other event in the home that may adversely affect the service users. 31/12/06 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 Lady Spencer House DS0000014923.V315353.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Lady Spencer House DS0000014923.V315353.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. 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