Inspection on 23/08/05 for Milestone

This inspection was carried out on 23rd August 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestone 27/02/08

Milestone 23/05/07

Milestone 26/06/06

Milestone 16/12/05

Milestone 19/01/05

Milestone 16/07/04

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

CARE HOME ADULTS 18-65 Milestone 1 Milestone Court Wales Close London SE15 2SL Lead Inspector Lisa Wilde Unannounced 23 August 2005, 10:00am rd 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Milestone Address 1 Milestone Court, Wales Close, London, SE15 2SL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7639 8628 Turning Point London and S.E. Region CRH Care Home PC Care Home Only 14 Category(ies) of MD Mental Disorder registration, with number MD(E) Mental Disorder over 65 of places Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2005 Brief Description of the Service: Milestone is registered to provide accommodation and care for 14 men who have a forensic mental health background. The home is purpose built and divided into two blocks. The first block has accommodation and facilities for six service users and the second block has 8 self-contained flats. The communal areas are accessible to all service users, including potential wheelchair users. The home is located off the Old Kent Road close to Peckham and New Cross. There are nearby facilities and services including public transport, shopping, leisure, health and social care support. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in August 2005. The Registered Manager was on leave at the time and as this had been the case at the previous inspection, the inspector decided to announce the next inspection to ensure the Registered Manager could be present. The inspector checked the communal areas of the building, the records and spoke with the deputy manager, staff and the service users who were available in the home. The service users who spoke with the inspector said that they were generally happy at the home and they had no problems. The inspector found that there had been improvements in some areas since the last inspection, with some requirements having been met but that a number of requirements were still outstanding from the last inspection or inspections prior to that. The Registered Individuals must ensure that an action plan is sent to the Commission that specifies how all requirements will be met within the established timescales otherwise consideration may be given to enforcement action to ensure compliance with the regulations and National Minimum Standards. What the service does well: Based on the standards assessed at this inspection the home showed that: • • service users’ are being given enough information to make an informed choice about where they live and can understand what they can expect from the home once they move there. new service users who come to this home know that their needs will have been assessed prior to them coming to the home, that their established goals and needs will be addressed in care plans and that risk will be assessed and minimised. service users are provided with a well balanced and nutritious menu that they have chosen and which is flexible to their changing needs. service users control and administer their own medication when they have been assessed as capable of this by their consultant and their wider care team. the home’s communal areas are clean, spacious and comfortable. the health, safety and welfare of service users are promoted and protected. • • • • Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 5 The home’s Statement of Purpose and Service User Guide make sure that service users’ are being given enough information to make an informed choice about where they live and can understand what they can expect from the home once they move there. Service users are not being given complete information in the most up-to-date form in their licence agreements which means that they may not be aware of their full rights and entitlements while living at the home. EVIDENCE: There was a previous requirement that the registered provider must produce an updated Statement of Purpose and Service Users’ guide for Milestone. These must be made available to all current users at the home and other interested parties/agencies. There was also a previous recommendation that the statement of purpose and service user guide be kept as two separate documents. The guides have been separated into two documents. There was a previous requirement that the registered person must ensure that references to the old legislation and regulatory authority within the existing license agreements are either removed or updated to reflect the new arrangements. This work had not been done and the requirement is repeated (See Requirement 1) There was a previous requirement that the registered provider/manager must develop and agree with each prospective service user, a written and costed Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 9 contract/statement of terms and condition between the home and the service user. The user should also be given a copy of this agreement. This work has been done but not consistently across all service users. Some had different versions of a licence agreement, some didn’t have all areas completed within the document. (See Requirement 2) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 Practice has improved considerably in this area and new service users who come to this home know that their needs will have been assessed prior to them coming to the home, that their established goals and needs will be addressed in care plans and that risk will be assessed and minimised. The more long-term service users have not yet had their care files revised in line with this improved way of working. EVIDENCE: There were previous requirements that the registered provider and manager must develop and agree with each user, an individual plan describing the services and facilities to be provided by Milestone and how these services will meet current and future changing needs; Photographs of each user must also be on individual files and a full auditing of all files, including archiving outdated information must be completed; Care plans should also be re-written following a CPA review to reflect changes in care needs; Care review notes must be signed and dated; Service users must agree and sign risk assessments and action plans. The inspector viewed a random sample of six files and found that the care plans for the newer service users were completed in more detail with more thorough action plans than longer term service users. In addition the newer service users had pre-admission assessments whereas the longer-term Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 11 service users didn’t. The deputy manager stated that practice in these areas had improved over the past couple of years. There was a previous requirement that the registered provider and manager must ensure that risk assessments must contain information that forms part of the overall multidisciplinary joint assessment and CPA care planning. These must be kept under regular review. As stated above from the files it appears that recent practice does cover these areas whereas the older files did not contain as much information. One requirement is made for all areas of assessment, care planning and review. (See Requirement 3) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The system of food provision has changed very recently and the service users are still adjusting to the new procedures. Service users are provided with a well-balanced and nutritious menu that they have chosen and which is flexible to their changing needs. Service users have not yet been made aware of their ability to opt out of the communal food programme when they are aiming to develop their life skills in order to move-on from the home. EVIDENCE: There was a previous requirement that the registered provider must ensure that service users receive training in food hygiene matters. The deputy manager stated that this has not occurred yet. The system of food provision at this home has changed in the last month. A cook is now employed and food is provided to service users in the dining area. This has led to service users receiving a better quality and quantity of food but minutes from the service users meeting showed that there although most service users prefer having their food provided there is some dissatisfaction from some service users with not having their food money given to them each week. The home is continuing to consult with the service users in their meetings about the issue of food and the menus. The deputy manager stated that should a service user wish to develop their skills in the area of cooking and been deemed ready for this by Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 13 the staff team then they would be supported to move towards doing their own budgeting, shopping and cooking. This is currently not explicitly stated in policy and service users have not been made aware of this. (See Requirement 4) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Service users do control and administer their own medication when they have been assessed as capable of this by their consultant and their wider care team. Service users are not being protected by the home’s procedures and practice when dealing with medication in the area of stock control and checking. In addition the staff team as a whole is not adequately trained to safely administer medication. EVIDENCE: There was a previous recommendation that with their agreement, service users be weighed regularly. Records showed that this now occurs. There was a previous requirement that the registered person must ensure that all staff responsible for the handling and administration of medication receive accredited training. This has not occurred yet as the pharmacist has not yet organised the training. (See Requirement 5). The inspector examined the stock of medication held in the home and the administration records. The medication file was not locked away but held openly in the main reception (but was put away on the day of the inspection). Some service users are self-medicating and the deputy manager stated that their stocks are randomly checked by staff. The records of these checks are kept in their daily notes but should be recorded on their medication Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 15 administration sheets on addition. Of the four medications randomly checked two did not tally with the records. There were no gaps in the recording of medication administration. (See Requirements 6, 7 & 8) There was a previous requirement that the registered provider must ensure that the requirements and recommendations made in the pharmacist inspector’s report of the July 2004 inspection are fully complied with by the given timescale and that The registered provider must ensure that the requirements and recommendations made in the pharmacist inspector’s report of the July 2004 inspection are fully complied with by the given timescale. The deputy manager did not have a copy of the pharmacists report and did not know if these requirements and recommendations had been met. The requirement is therefore repeated. (See Requirement 9) There was a previous recommendation that the registered provider should ensure that the wishes of service users are recorded- should they become ill or die. The home’s policy and procedure relating to death and dying should also contain guidance for staff about how such issues should be handle. This recommendation had not been met. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Service users are not fully protected from abuse as the staff team are not adequately trained in vulnerable adult issues which means that service users are not being offered support from a comprehensively trained staff group. EVIDENCE: There was a previous requirement that the registered provider and manager must ensure that staff receive relevant training from the local authority in Adult Protection issues. Some staff have attended Protection of Vulnerable Adults training but not all. (See Requirement 10) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 Generally the home’s communal areas are clean, spacious and comfortable. There are some areas of work necessary in service users’ rooms and flats. EVIDENCE: There was a previous requirement that the registered provider must ensure that worn carpets (including that in Flat 8), and stained furniture (including the chairs in Rooms 4 and 6) are replaced. The deputy manager said that the chairs have been replaced but the carpets have not. (See Requirement 11) There was a previous requirement that the registered provider must ensure that service users are provided with lampshades, and curtains are hung correctly on curtain rails. One service user said that this has happened in their flat. The inspector did not view all rooms and flats as not all service users were available. The deputy manager stated that this had occurred. On the day of the inspection the communal areas of the home were clean and free from odours. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 & 35 The staff team is not fully qualified or trained in all required areas and there is not enough evidence of planning in place to assess and develop staff. This means that service users are not being offered support from as effective a staff team as possible. EVIDENCE: There was a previous requirement that the registered provider must ensure that staff receive relevant Sector Skills Council and NVQ training to equipped them with the competencies and qualities required to meet the assessed needs of service users. There is now a new Induction and Foundation pack that staff have just started that is in line with Skills For Care requirements. The deputy manager was not certain how many staff held the NVQ. (See Requirement 12) There was a previous requirement that the registered provider must ensure that staff records listed in Schedule 4 of the Care Homes Regulations are kept at the home or are available at the home within one hour of the commencement of an inspection and evidence that staff have received CRB and POVA clearance is available at the home within one hour of the commencement of an inspection. As this inspection was unannounced there were no records available at the home. The inspector decided to announce the next inspection and will expect these records to be available on that date along with all personnel records. (See Requirement 13) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 19 There was a previous requirement that the registered person must ensure all staff undertake mandatory training in food hygiene and moving and handlingand copies of the staff training and development programme is sent to the Commission. All staff have either undertaken or are booked on the food hygiene course. Staff have not undertaken moving and handling training. The deputy manager was not aware of staff training and development plans. (See Requirements 14 & 15) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Generally the health, safety and welfare of service users are promoted and protected at the home by policy, procedure and staff practice. The home is not doing everything necessary to protect service users safety fully in the area of fire procedures or reporting of incidents to the Commission. EVIDENCE: There was a previous requirement that the registered provider must ensure the COSHH products at the home have detailed information and explanation sheets from the manufacturers and these are displayed in the appropriate places. This has been done. There was a previous requirement that the registered provider and manager must ensure that where reasonable practicable- the health, safety and welfare of service users and staff must be safeguarded. This also includes ensuring service users living spaces are kept clean, hygienic and free from potential hazards. On the day of this inspection the home was clean and free from odours and on the tour of the communal areas no hazards were found apart Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 21 from the area of recording who is in the building. Visitors are asked to sign in but no record is maintained of which service users are in or out. The deputy manager stated that this was too difficult as service users did not tell staff when they were leaving and only had to ring the bell at the gates to be let back in. The inspector acknowledged the difficulty but it is necessary for some record to be maintained of who is in the building in case of fire. (See Requirement 16) There was a previous requirement that the registered provider must ensure that certificates for the safety of the electrical installation of the premises and portable electrical appliances are sent to CSCI Southwark Office on receipt of the draft report. The deputy manager could not find these records and the annual portable equipment testing was due to occur in May but had not. (See Requirement 17) There was a previous requirement that the registered provider must ensure that accidents are recorded on single sheets to maintain confidentiality. This now occurs. On checking the records of the critical incidents the inspector found that some of these, including a significant fire in April 2005 had not been reported to the Commission. (See Requirement 18) Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x x 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x 2 Standard No 31 32 33 34 35 36 Score x 2 x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Milestone Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 23 YES 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 YA5 Regulation 5 (1) (b) (c) Requirement Timescale for action 30/11/05 2. YA5 5 (1) (b) (c) 3. YA6 15 (1) (& (2) 4. YA17 16 (2) (i) The Registered Manager must ensure that references to the old legislation and regulatory authority within the existing license agreements are either removed or updated to reflect the new arrangements.Unmet requirement: Previous timescales 30/10/04 & 30/04/05. The Registered Manager must 30/11/05 ensure that the new licence agreement is signed, dated and on file for all service users and that all required details within the licence are completed. The Registered Manager must 30/11/05 ensure that the assessments, care plans and risk assessments for all longer-term service users are redone to include as much detail as for the more recent service users. The Registered Manager must 31/10/05 ensure that the policy around food specifically states that service users can move out of communal food system when they are working towards developing their practical skills in order to move-on and ensure that service users are made Version 1.40 Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Page 24 aware of this. 5. YA20 13 (2) The Registered Manager must ensure that all staff responsible for the handling and administration of medication receive medication training. Unmet requirement: Previous timescales 30/12/04 & 31/05/05 The Registered Manager must ensure that the medication file is stored confidentiality in the home. The Registered Manager must ensure that the random selfmedication stock checks that take place are recorded on the medication administration sheets. The Registered Manager must ensure that the system for stock checking all medications is operated effectively. The Registered Provider must ensure that the requirements and recommendations made in the pharmacist inspector’s report of the July 2004 inspection are fully complied with by the given timescale. Unmet requirement. Previous timescales 30/10/04 & 31/05/05 The Registered Provider and Manager must ensure that staff receive relevant training from the local authority in Adult Protection issues. Unmet requirement. Previous timescales 30/10/04 & 31/05/05 The Registered Individuals must ensure that worn carpets (including that in Flat 8) are replaced. Part of an unmet requirement. Previous timescales 30/10/04 & 30/04/05 The Registered Individuals must ensure that 50 of staff hold the NVQ Level 2 in Care (or 31/12/05 6. YA20 13 (2) 7. YA20 13 (2) Immediate (Met during the inspection) 30/09/05 8. YA20 13 (2) 30/09/05 9. YA20 13 (2) 30/09/05 10. YA22 18 (1) (c) (i) 31/12/05 11. YA24 16 (2) (c) 31/12/05 12. YA32 18 (1) (c) (i) 31/12/05 Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 25 equivalent). 13. YA34 17 (2) The Registered Individuals must ensure that all staff personnel records are made available for inspection at the home at the next announced inspection The Registered Individuals must ensure that all staff undertake moving and handling training The Registered Manager must ensure that a copy of the staff training and development programme is sent to the Commission. Unmet requirement. Previous timescale 31/05/05. The Registered Manager must ensure that some record is maintained of which service users are in the building for use in case of fire. The Registered Manager must ensure that certificates for the safety of the electrical installation of the premises and portable electrical appliances are sent to the Commission. Unmet requirement. Previous timescale 31/03/05 The Registered Individuals must ensure that copies of critical incidents are sent to the Commission at the time of the event. 31/12/05 14. 15. YA35 YA35 18 (1) (c) (i) 18 (1) (c) (i) 31/12/05 31/12/05 16. YA42 23 (4) (c) (iii) 30/09/05 17. YA42 13 (4) (a) & (c) 30/09/05 18. YA42 37 30/09/05 19. 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. Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 26 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH 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 Milestone G52-G02 S7104 Milestone V244203 230805 Stage 4.doc Version 1.40 Page 27 - 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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