Inspection on 02/05/07 for Maple Lodge Care Centre

This inspection was carried out on 2nd May 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

Maple Lodge Care Centre 30/04/08

Maple Lodge Care Centre 23/11/06

Maple Lodge Care Centre 06/07/06

Maple Lodge Care Centre 14/02/06

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Maple Lodge Care Centre (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ Lead Inspector Jo Bell Key Unannounced Inspection 2nd May 2007 09:30 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 Maple Lodge Care Centre DS0000066447.V333672.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. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Lodge Care Centre Address (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ 01748 834029 01748 831008 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Susan Margaret Alderson Care Home 60 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (50) Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 50 (OP), up to 10 (DE(E)) and up to 10 (MD(E)) up to a maximum of 60 Service Users The Category MD refers to one named Service User Date of last inspection 23rd November 2006 Brief Description of the Service: Maple Lodge is a large care home providing nursing and Social care for up to 60 elderly people. There is a separate 10-bedded unit providing nursing care for people suffering from dementia. The home was purpose built in 1991 and comprises three single storey wings with level access by wheelchair users throughout. The fees vary from £455£600. There are additional charges for chiropody, hairdressing, papers and toiletries. The home is located near the Garrison base of Catterick and has extensive grounds to the rear with car parking at the front. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Wednesday 2nd May 2007. Prior to the visit a pre-inspection questionnaire was completed and surveys from seven people who use the service, and seven relatives were completed, along with one comment card from a GP. One inspector spent six hours at the home. During part of this time three people were observed over a one hour period using a type of observational assessment for people with communication difficulties. Areas observed included how staff interact with people, the type of activity people participate in and how happy or sad they are in their environment and in daily life. This took place on the dementia unit over a lunch time. Throughout the visit observations of care practices, discussions with people who use the service, their relatives and staff took place. Documentation relating to individual care plans, medication and health and safety issues were looked at. The quality assurance system, recruitment, finances and the running of the home was discussed with the manager who was available along with the deputy during the visit. Overall the home has improved, the standard of care was good and people like living in the home. All key standards were assessed during this visit. What the service does well: What has improved since the last inspection? Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 6 The standard of care provided has improved, generally people have their needs assessed and documented and staff are aware of how individual needs can be met. Some redecoration to individual bedrooms has taken place, with more planned. The security of the medication and sluice rooms has improved which minimises the risk of harm to people. People are able to express their views through an improved quality assurance system. Staff have a greater understanding of meeting nutritional needs which has been helped by introducing a new assessment form. Many aspects of fire safety have been addressed, including new fire doors, smoke detectors, and a fire risk assessment has been completed. Areas of the kitchen have been thoroughly cleaned to ensure cross contamination is minimised and the choice of food available has improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People who use the service experience good quality outcomes in this area. Individual needs are comprehensively assessed prior to admission to ensure needs can be met. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager of the home visits people in their own home or in hospital to carry out a detailed assessment of individuals needs to ascertain if health, personal care and mental health needs can be met by the staff in the care home. Three of these assessments were checked and all were found to be comprehensive and completed appropriately. One person spoken with said they remember someone asking them lots of questions. This assessment takes place alongside an assessment carried out by the care manager. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 9 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 &10 People who use the service experience adequate quality outcomes in this area. A good standard of care is offered and people are treated in a dignified manner, though aspects of medication and some of the documentation need improving. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The standard of care provided by the staff has improved since the last visit. People were observed in the communal areas looking clean and well cared for and staff were ensuring that privacy and dignity was maintained. Three care plans in the nursing and residential area of the home were checked and two care plans in the dementia unit were looked at. One man had moved to the home a few weeks ago to be with his wife. He said ‘staff are really good’, and the rapport between himself and the staff was evident. However, there were no specific care plans in place and it was unclear as to the individual needs of this person. New documentation in the care plans is being introduced which staff are receiving training in. Risk assessments for nutrition, moving and Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 10 handling and the prevention of pressure sores were in place and staff spoken with had a good understanding of the action to take when someone was underweight or had a pressure sore. Input from a range of healthcare professionals was evident, this included the hospital dietician, GP, district nurse and the community mental health team. One person spoken with said she had seen the chiropodist and the dentist and optician could be accessed when needed. The home is aware of how to deal with accidents and incidents and prompt reporting of these takes place. Two people discussed how they receive their medication on a morning, and part of a medication round was observed. The home have a policy in place regarding medication and staff receive training in this area. However there are aspects which need to be improved. The medication room is now secure and appropriate cupboards are in place to store medication. Three medication charts were checked and these were completed satisfactorily. The controlled drugs are recorded and stored correctly. At present stock balances take place randomly, on some charts the amount of tablets were recorded on others it was absent. In one cupboard lots of medication which should have been disposed of was stored, which had built up over a few weeks. One bottle contained a mix of all medication that had been refused (called cocktail of tablets), each tablet should have been disposed of at the end of each medication round in the appropriate container. Staff need to ensure they do not give prescribed build up drinks to other people in the home from another persons supply, for example Calogen. The medication issues were discussed with the deputy of the home who was unsure as to the correct method for storing and disposing of medication. It was felt that a visit from a pharmacy inspector would help clarify these issues and they could advise on how to make the home’s medication system more robust. This will have a positive effect on the outcome for people in the home, because any risk from poor medication practices will be minimised. Overall, the care is good and how staff deal with people going in and out of the bathroom and receiving personal care has improved. Staff are much more aware of how to address people and ensure their dignity is maintained. This was confirmed through observation and through positive comments received by relatives in the surveys they completed. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 11 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 & 15 People who use the service experience good quality outcomes in this area. People are encouraged to participate in a range of activities, and independence is promoted. Mealtimes are an enjoyable experience for people and they have a range of communal areas to dine in. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has an activities organiser who splits her time between working as a carer and carrying out activities throughout the home. There are a range of activities that include trips out, entertainers coming into the home, arts and crafts, quizzes and games. One man was enjoying spending time in his room watching the snooker. A game of dominoes took place with one person who had a relative visiting, she confirmed how much she enjoys playing a range of games and she never gets bored. Activities normally take place during the afternoon. One lady was having a one to one chat with a carer and people were asked what they would like to participate in. The pre-inspection questionnaire confirmed the activities available. These are recorded and discussed at residents meetings. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 12 Staff are aware of how to promote autonomy, this has improved since the last visit. Two ladies spoken with said they can get up and go to bed when they want, one person said she had already had two baths this week. One relative said she is able to come to the home at any time. This was also confirmed in the visitors book. During lunchtime in the dementia unit a focused observation of three people took place over a one hour period. Two people had positive experiences, although one was asleep for much of the observation. Staff interacted well with these people at lunchtime, though a better explanation of the choice of food would have improved the experience for one person. A relative was visiting during this time and clearly the person was pleased to see them, her husband had also joined her from the nursing/residential unit. On one occasion a member of staff sat down to talk to one person but ran out of conversation after a couple of minutes, this could have been a more positive experience for this person. The quality of food provided has improved. During the morning people are offered fruit, or biscuits with their tea and coffee and on an afternoon a selection of cakes are available. The dining rooms are pleasant with suitable furniture and crockery provided. Staff ask people the day before as to what food they would prefer. The manager is in the process of obtaining individual menus and stands to put on each table, this will remind people what food is being offered. Portion sizes are good and a range of deserts are available. One man said how much he liked the roast beef and vegetables at lunchtime and observations showed people enjoying their food. Assistance was given where necessary in a dignified manner and the cook is aware of how to puree food correctly. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 13 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 & 18 People who use this service experience good quality outcomes in this area. People are able to voice their opinions and action is taken when a complaint is made. The risk of harm is minimised through robust adult protection procedures been in place. This judgement has been made using available evidence including a visit to the service. EVIDENCE: People in the home are able to share their views and opinions with staff in the home. This can be done through the formal complaints procedure or informally at the resident’s meetings, or in one to one discussions with the deputy or the manager. One formal complaint has been made since the last visit. This was investigated by the manager and appropriate action was taken. One relative said she would be happy to discuss any concerns with the staff. The surveys received confirmed that people would know who to go to when making a complaint. In discussions with people in the lounge they were quite vocal in knowing how to raise concerns. The risk to people of harm is minimised through the home having a safeguarding adults procedure, mandatory training takes place in this area and both the manager and staff spoken with had a good understanding of the different types of abuse and the action to take if an allegation has been made. A whistle blowing procedure is available and the manager is aware how to make a referral to the adult protection team and how to put someone on the Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 14 protection of vulnerable adults list. All staff have a vulnerable adults check prior to being employed. People in the lounge looked relaxed and comfortable, one man said he felt very safe here and he had no concerns about how he was being treated. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. Much of the environment has improved, and it is kept clean and well maintained although some aspects still need attention. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The environment is pleasant and is kept clean and reasonably well maintained. The home has views across fields and has a seating area and grounds for people to spend time in. The fence at the front of the building is partly broken and in parts is loose. This needs to be addressed to ensure it is safe. Outside the home there are emergency lights, however there are no other lights which makes it difficult for people to see where they are going when it is dark, this could pose as a hazard and action needs to be taken. The home carry out routine maintenance and since the last visit some rooms have been redecorated, and people are now involved in the colour scheme when Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 16 redecoration takes place. One person chose blue paint and matching curtains and a carpet. The bathing facilities were discussed and in the nursing/residential area a new bathroom is been designed. Currently there is one other bath available, and whilst staff are able to use one of the four ensuite bathrooms it would be beneficial if this room was completed. This was highlighted at the previous visit. The home has sufficient communal areas which are kept clean and free from unpleasant smells. The conservatory area in the nursing/residential area is not currently being used. Some people spoken to said it gets too hot in there, and the manager discussed future plans for this area. People were observed wearing clean and well ironed clothes, the laundry area was checked and found suitable to meet the needs of the people in all areas of the home. Infection control training has taken place and staff are aware of hand-washing techniques. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience good quality outcomes in this area. Staff are appropriately trained in sufficient numbers to meet the needs of the people in the home. This judgement has been made using available evidence including a visit to the service. EVIDENCE: People in the home are cared for by enough staff, this was observed in the nursing/residential and in the dementia unit. A new nurse has been employed in the dementia unit and there are enough care staff in all areas to meet individual needs. The surveys returned confirmed that no concerns needed raising regarding the staffing levels. The call bell system was being used and this was answered in a prompt manner. People spoken with confirmed that staff attend to them when needed and they do not have to wait a long time for attention. Staff have a range of skills and qualifications. Dementia training takes place and some staff have completed an NVQ level 2 in care. Due to the location of the home (near the army barracks) some staff work in the home for a short time then may leave. The registered manager is supernumerary and there is a deputy who runs the nursing/residential unit. Staff are given induction training which is equivalent to Skills for Care. This covers a range of care practices and health and safety issues. One member of staff confirmed she had undertaken this training, and an induction manual was Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 18 available. This training will help staff meet individual needs and promote a good standard of care. People in the home are cared for by staff who are recruited effectively. Three files were checked and these all contained written references, a police check and a protection of vulnerable adults check. The manager confirmed that any gaps in the references are followed up with a telephone call (this needs to be documented), and people are only employed when all checks are completed. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience adequate quality outcomes in this area. Generally health and safety needs are met though some work remains ongoing to ensure the safety of all people in the home. Improvements have been made in the quality assurance systems which means people can air their views and opinions. This judgement has been made using available evidence including a visit to the service. EVIDENCE: People in the home feel well cared for and the experienced registered manager is keen to run the home in the best interests of people using the service. Currently the manager is completing her NVQ Level 4 in management. The quality assurance system has been developed and questionnaires are sent to people to ascertain their views regarding the care they receive, the food and Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 20 the environment. An audit system is in place which looks at a range of practices in the home. The manager is aware of the policy that highlights what the quality assurance system is and confirmed that both residents and staff meetings take place. People are encouraged to deal with their own finances, a bank account is available with individual records maintained. One lady said she pays for the hairdresser and the chiropodist out of her money, other people have relatives to deal with finances. A certain amount of money is kept on behalf of each person, though individual receipts are kept this money is stored together. The amount was checked and there was a small discrepancy between the amount stored and the records. This was discussed with the financial administrator. People are able to keep money in a locked space in their own rooms and keys are made available following a risk assessment. Health and safety in the home was checked and discussed with the maintenance person, all safety checks are carried out and records are available. Evidence of certificates are available in the pre-inspection questionnaire. Water temperatures are well maintained which reduces the risks of burns and scalds for people. Some people had bed rails fitted, staff need to be aware of the risk of rolling over the top of the bed if an air flow mattress is used on top of a normal mattress as the gap at the top is reduced. The maintenance person was going to seek advice on the correct measurements to ensure no-one was being put at risk. Many aspects of fire safety previously identified has been addressed, all of this work needs to be completed as soon as possible in line with the fire officer. Staff receive mandatory training in fire safety, moving and handling, infection control and first aid. Three files were checked and these were all up to date, with evidence of further training planned. Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 21 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 x x 2 Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 All people using the service must have completed care plans to ensure staff are aware of each individuals needs. Medication must be disposed of in line with current guidance to minimise risk of mistakes (action to be taken following pharmacy inspection) The bathing area in the nursing/residential area must be completed to ensure there is more choice for people when bathing. Sufficient outside lighting must be made available to ensure people are safe when outside in the dark. The amount of money maintained on behalf of people must tally with the records and the amount kept. All work relating to fire safety must be completed as soon as possible in line with the fire officers guidance. Staff must be aware of the necessary height gap needed when using bed rails and a DS0000066447.V333672.R01.S.doc Timescale for action 12/05/07 2. OP9 13 02/06/07 3. OP19 23 02/07/07 4. OP19 23 02/06/07 5. OP35 16 12/05/07 6. OP38 23 02/07/07 7. OP38 37 12/05/07 Maple Lodge Care Centre Version 5.2 Page 23 pressure relieving mattress. (in line with MHRA guidance) Regular checks need to take place to ensure people are not at risk of rolling over the top of the bed rails. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP28 Good Practice Recommendations Consideration should be given to repairing/replacing the fence outside to ensure it is safe. More staff should try to complete an NVQ Level 2 in care Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Maple Lodge Care Centre DS0000066447.V333672.R01.S.doc Version 5.2 Page 25 - 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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