Inspection on 20/12/06 for Milton House

This inspection was carried out on 20th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Milton House 14/10/09

Milton House 15/10/07

Milton House 28/06/06

Milton House 04/10/05

Milton House 10/05/05

Milton House 25/01/05

Milton House 08/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Milton House West Street Bridgwater Somerset TA6 3RH Lead Inspector Stephen Humphreys Unannounced Inspection 20th December 2006 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 Milton House DS0000003271.V320231.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. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address West Street Bridgwater Somerset TA6 3RH 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) 01278 422235 01278 451511 Somerset Care Limited Mrs Julie Bohot Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to three persons of either sex, between the ages of 50-60 years, who require general nursing care. Registered for a total of 51 places in Categories OP and PD When the home reaches provision of care for 40 service users requiring nursing care 2 Registered Nurses must be provided at night to comply with the staffing notice in line with Somerset Health Authority. Staffing levels are monitored on a monthly basis to suit the dependency levels of individual service users. Staffing should not fall below 1 - 10 at night and 1 - 5 during the day. 28th June 2006 5. Date of last inspection Brief Description of the Service: Milton House is a purpose built care home situated in the town of Bridgwater, within walking distance of the town centre. It is owned by Somerset Care Ltd. The home is registered with the Commission for Social Care Inspection (CSCI) for 51 people over the age of 60 years; it is a care home providing nursing care for older people and those with physical disabilities. Within the registered numbers the home can provide care for up to 3 people ages 50-60 years who require general nursing care. The accommodation is arranged on two floors with two passenger lifts. All the bedrooms are single. The home has three lounges and a large dining area. A telephone is available for service user use. There is a patio area and a garden, which has been landscaped to ensure safe level access for service users. Car parking space is minimal. The current fees range from: £487 - £577.50 dependent on whether personal or nursing care is required, and does not include hairdressing, newspapers, magazines or toiletries. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second key inspection of Milton House Care Home using the Inspecting for Better Lives methodology introduced by the Commission for Social Care Inspection in April 2006. The inspection methodology used by the Commission for Social Care Inspection enables the inspector to make a judgement on the quality of the service delivery based on the outcomes for service users. Two inspectors visited the care home and assessed all of the key older persons national minimum standards and had detailed discussions with residents, staff and the homes manager. This inspection was unannounced and took place over one day. A tour of the home was made and a selection of service user accommodation was visited. The inspectors were able to speak to service users in their rooms and in the communal areas. A total of eight relatives were spoken to during the day. All the comments received were very positive. One relative commented, “this is the best home, it always smells fresh and the staff are friendly”. The inspectors would concur that the home was free of any malodours and the staff were observed to interact in a sensitive and friendly manner with the service users. The lead inspector for this care home sent out written service user survey questionnaires and comment cards to visiting health care professionals prior to the site visit. Only six completed surveys were received from service users, nine from relatives, and two from visiting health and social care professionals and one from a General Practitioner. Comments from the health professionals were good, indicating a good working relationship with the home. Comments from relatives included “The care is excellent, and the new manager listens”. “ I am welcomed by all the staff every single day”. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 7 The care plans need to be improved to show the links between the identified care needs and how they are being met. The manager needs to ensure the care plans identify fully the specific care needs for service users who are frail and needing high dependency care. Appropriate pain and wound management care plans need to be developed for service users with these care needs. The registered manager needs to ensure that staff completing care plans have identified the care need and appropriate interventions. The care plans need to be completed fully with the care carried out. Risk assessments on service users who have lap straps to aid their safety when sitting in a wheelchair need to be agreed with service user to ensure their safety. 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. Milton House DS0000003271.V320231.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 Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. Quality in this outcome area is good. Prospective service users are provided with information to allow them to make an informed choice. The home takes appropriate steps to ensure the needs of prospective service users can be met prior to a decision being made about admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standards in this section were found to be good at the last inspection. The evidence found at this inspection supports the outcome. The home had an up to date Statement of Purpose displayed in the reception area of the home and the contents were in line with legislation. Prospective Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 10 service users are given a Service User Guide, which assists them to make an informed choice. A copy was given to the inspectors. The guide is informative and easy to read. Service users are assessed prior to admission and evidence was seen in the care plans sampled. The inspectors discussed the referral and assessment of prospective service users with the manager. Referrals were received from social services and private clients. All new residents receive a pre-admission needs based assessment based on the activities of daily living model of care. The inspector was able to review a sample of care plans of recently admitted service users. The care needs assessments were detailed using the activities of daily living model of care however there was no linkage of the care needs to enable a person centred care approach. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Service users cannot be assured that they will have a care plan that reflects all their care needs. Service users needing wound care cannot be assured that their care plan will be a comprehensive record. Service users can be assured they will be treated with respect and dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed six care plans at this inspection. Three care plans of service users who had wounds and three of service users who required high dependency care. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 12 The inspector reviewed the three service users needing high dependency care in detail to assess the level of service delivery. A record of the assessment along with the social workers assessment was filed in the care plan. A detailed plan of care is then made from the identified care needs to make up the care plan. The care plans are now detailed in a computerised system with a paper back up. The computerised system is new to staff and not being used to its capacity. Staff need to become familiar with the system and include more detailed information to ensure the service user care plan is comprehensive. None of the three care plans reviewed of service users with wounds had any specific details of the wound care provided. The inspectors found that a service user had not had any wound care for six days. This was due to the poor information recorded in the care plan. Staff should receive appropriate training in using the new care plan system to ensure all necessary information and records of care delivery are kept up to date. Care plans of the recently admitted service users contained all the necessary information including risk of falls and nutritional needs however the personal and nursing care needs were more task orientated than person centred. There was no clear evidence of relative or representative involvement in the development or evaluations of the care plans. Evaluations appeared to be “no change” which is not specifically outcome related. The inspector was able to observe care staff carrying out some of the personal care needs recorded in the care plans. The service users fluid charts were completed however there was no clear evidence to show that the registered nurses are using the information to evaluate the outcome of the care need. The benefit to service users of having a detailed care plan is that all the identified needs should be linked with appropriate interventions and outcomes. During the inspection the registered nurse was observed to administer medication to a service user. The registered nurse appeared to follow the procedure as it was written. The inspector checked the medication policy including the storage, receipt, administration and disposal of the medicines. A random check of service users medications was carried out. All the medications checked were found to be correct against the medicine administration record. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 13 During the tour of the home the inspectors observed that all service users were well dressed and clean. Staff were observed to speak to service users using their preferred name. Staff were seen to be respectful and providing explanations when assisting the service user. The inspectors were able to conclude from their observation of care practices and the care plans that the service users were not all receiving the care they needed and the care plans lacked detail of specific care needs. Generally service users spoken to said they felt their care needs were met. One relative commented, “Mum has flourished since being here, the care is excellent”. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate Service users benefit from the activity provision and social care, however some service users were unable to access activities and received minimal social care. The opportunities for exercising choice and control appeared limited and service users were not always able to summon help in lounges should they have needed. Service users benefit from a varied menu and nicely presented food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Routines in the home are still fairly rigid and not person centred. Service users commented, “They come and wake me up at eight o’clock”. Another service user commented “they don’t get me up till gone 10’oclock, this is to late. Carers spoken to said they start in an area and go from room to room. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 15 This is evidence of a task-oriented regime that is not flexible. There is an activities programme at the home. At the time of this inspection the activities co-ordinator was off sick. Activities took place during the afternoon organised by the carers. The inspectors had discussions with service users about the daily life style in the home. Service users were sat in their wheelchairs in the lounge from 09:45am. The call bell was in reach and carers were observed to walk through the lounge at various times. Service users spoken to said they are got up at eight o’clock. The majority of carers are nice. Breakfast is taken in bed if you wish, cereal and toast; a cooked breakfast is available if you want it. My daughter usually cleans my hearing aid and changes the batteries. We usually sit here until lunchtime then go back to the room and watch television. We generally have activities but the lady is off sick. The food is quite good, there is a choice of two things, they ask you the day before what you want, but we usually forget. The evidence collected showed that service users are generally given the opportunity to take part in a variety of activities. Visitors confirmed that the home has open visiting arrangements and service users can see them in private or in communal areas. The food is good and well presented. Discussion with a service user who needed a special diet said the food is good. Discussion with another service user about the life in the home commented. The care staff is very good, some take longer to respond than others. “I only ring when I need to” “Food is good”. Diabetic on insulin, twice a day. I get a good diabetic diet and I choose to eat in my room. I have no complaints. Service users benefit from a varied menu and nicely presented food. The process of delivering meals to service users rooms was observed and has improved since the last inspection. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. The home has a satisfactory complaints system in place with evidence that concerns were acted upon. Systems were in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received no complaints since the last inspection in June 2006. None of the service users spoken to said they had any complaints at the time. One comment card received commented that the person did not know about the home’s complaints procedure. The home has the multi-agency policy on Safeguarding Vulnerable Adults. The home had a Whistleblowing Policy (Confidential Reporting), which is comprehensive and details outside bodies that staff can approach. Care staff spoken to on the day of inspection were aware of the Whistleblowing Policy and lines of communication to be taken if necessary. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 17 Recruitment files sampled evidenced Protection of Vulnerable Adults First checks and enhanced Criminal Record Bureau disclosures being received prior to employment. . Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good. Service users live in a safe, clean and comfortable environment, which is able to meet the assessed needs of service users living there. Service users have access to specialist equipment where there is an assessed need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a tour of the premises it appeared safe and well maintained. Maintenance records had been recorded. The building complied with the local fire service requirements. The environmental health department had visited and inspected the kitchen. The home was warm on the day of inspection. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 19 Windows were restricted and radiators were guarded in line with HSE guidelines. Lighting is domestic in character. Bath temperature records were seen in bathrooms. Hot water outlet temperature records indicated that they were checked monthly. All service users spoken to were happy with their rooms and felt that they were adequate to meet their needs. Rooms seen were furnished to a high standard and were personalised and homely. Profiling beds and adjustable height nursing type beds were available for all those with assessed nursing needs. Infection control systems were in place at the home. The cleanliness of the home was very good at this inspection. One malodour was identified and brought to the attention of the managers. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate Service users benefit from staffing levels being maintained at the agreed level, however continue to feel that the home is short of staff especially at weekends. The home’s staff recruitment procedures were robust and protected service users from the risk of abuse. Overall, service users benefit from staff that have received appropriate training, to enable them to deliver the care to meet their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users commented they were generally happy with the service they received although there were times when no one was available to attend to them. Comments “There’s enough staff normally and they can be quite helpful but sometimes there’s not enough staff”. Weekly duty rotas are recorded reflecting staff on duty 24 hours per day. At the time of this inspection there were 50 service users residing at the home including 1 in hospital. Staffing levels were adequate. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 21 The manager confirmed that she had recruited more full time staff and a relief team. This has reduced the need for agency staff however weekends are still a problem. The manager said the organisation is reviewing the sickness and absence policies and managing absence appropriately with return to work interviews. Staff spoken to told inspectors that they enjoyed working at the home and that staff morale was good. Although busy staff observed appeared happy in their work. Discussions with the registered nurse’s on duty confirmed they are provided with regular training opportunities. The staff-training matrix was reviewed. This showed all statutory training attended by each individual staff member. Although the records show training is delivered to all grades of staff, the evidence relating to poor care plans indicates that some of the training is not put into practice. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. Service users will benefit from a changed ethos introduced into the home. Staff operate on rigid practices therefore the home is not for the benefit of the service users. The home has systems in place to ensure the health and safety of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 23 Comments received from staff include “the homes manager is very good, always available and friendly”. “She is always available, treats all staff the same. Service users will benefit from the changed ethos in the home. The manager is experienced and runs the home for the benefit of the service users. Staff spoken to felt that at times routines were dependant on who was on duty however staff morale and the teamwork was generally good. Comments received from service users included “they come and wake me up at eight o’clock” are evidence to show the home is not entirely run for the benefit of the service user. Staff had been supervised on a one to one basis; records were kept, and were seen in the staff files examined at inspection. Minutes of staff meetings taken were seen. The manager said most of the staff appraisals had taken place with training needs being identified. Appraisal records were seen filed in the individuals file. Quality monitoring systems are in place. Care plan and medicine audits are carried out regularly as part of the quality assurance system. The organisation also carries out service user satisfaction surveys however there was no supporting evidence to show that actions had been put into place as a result of the surveys. Staff spoken to were aware of the homes health and safety policies. Food was stored correctly in the kitchen. Fridge and freezer temperature records were available and current. All service histories were found to be up to date. Hot water outlet temperatures had been tested and were up to date at this inspection. Risk assessments for falls were recorded in the individuals care plan however those service users who have lap straps to secure them into their wheelchairs did not have risk assessments identifying the possible injuries associated with the lap strap. Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 25 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(2) Requirement The registered person shall— (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review. This refers to the need to ensure the service users care plan is comprehensive and identifies fully all care needs. 2. OP8 12(1)(a)( b) The registered person shall ensure that the care home is conducted so as— to promote and make proper provision for the health and welfare of service users. This refers to the need for all service users with specialist needs e.g. wounds have clear detailed care plans written with advise from a wound specialist. 3. OP12 16(2)(m) The registered person shall DS0000003271.V320231.R01.S.doc Timescale for action 28/02/07 28/02/07 (a) 28/02/07 Version 5.2 Page 26 Milton House (n) having regard to the size of the care home and the number and needs of service users— (m) meet the social and psychological needs of all service users. This refers to opportunities for all service users to engage in stimulating activities suited to their needs, preferences and abilities. The registered person shall establish and maintain a system for— (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. This refers to reviewing practices in the home to ensure flexibility with service user needs. The registered person must ensure that all accidents and/or injuries to service users are also recorded in the individuals daily records and an associated risk assessment compiled where necessary. 28/02/07 4. OP33 24(1)a b 5. OP38 17(1)(a) S3 (1) 28/02/07 Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that where a service user is identified as needing supplement drinks, the type is reflected in the nutritional risk care plan. The registered person should, in consultation with service users, review the length of time they are sitting either in the sitting areas or at the dining room tables at mealtimes without supervision or any social interaction. The registered person should ensure that a risk assessment is developed and recorded on persons using a lap strap when sitting in a wheelchair. 3. OP15 4 OP38 Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Milton House DS0000003271.V320231.R01.S.doc Version 5.2 Page 29 - 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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