CARE HOMES FOR OLDER PEOPLE
Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED Lead Inspector
Christine Grafton Unannounced 11 May 2005 at 09:30 am
th 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 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. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Montague House Address 10 Brockenhurst Road, Ramsgate, Kent, CT11 8ED 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) 01843 591907 Mr Roy Edward Howse Mrs Susan Rule Care Home 19 Category(ies) of Older People (19) registration, with number of places Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19/01/2005 Brief Description of the Service: Montague House provides care for a maximum of 19 older people and admits people with low to meduim dependencies. It does not accept people who have high dependency needs, such as: those who cannot stand, who need lifting equipment to move from bed to chair (or wheelchair) or are wheelchair dependent for mobilisation. The home does accept people who use walking sticks and walking frames to move about and provides assistance with washing, dressing and bathing. Montague House is a detached two-storey building with 15 single bedrooms and 2 doubles. 13 bedrooms have ensuite facilities of a toilet and washbasin; all rooms have a call bell and television point. There is a stair lift to the first floor. There is a large well-maintained garden to the front and rear of the building, providing a number of areas for residents to sit. There is an off-street parking area at the front. The home is located in a quiet residential area of the town, close to the cliff top promenade. The nearest shops and amenities in the town centre are within easy reach. The staff complement consists of the manager, a team of carers, two part-time cleaners and two part-time cooks. Care staff work a rota that includes one person on waking duty and one person on duty sleeping in at night. The registered provider spends four days a week at the home. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a scheduled unannounced inspection, the purpose of which was to follow up some of the requirements made at the last inspection and to focus on residents’ health and personal care and their daily life and activities. The manager was on a day off, but was telephoned to inform her of the inspection and came into the home later in the morning. The inspection lasted five and a half hours and covered the morning, lunch time and early afternoon period. Additional time was spent in preparation and report writing. Two staff members were spoken to and four residents were seen in private in their bedrooms, plus a further four were spoken to individually in the lounge. A tour of the building was not undertaken on this occasion, but communal areas, a bathroom and the laundry on the ground floor were seen, plus the first floor shower room. The care of four of the residents was case tracked by reading their care plans, discussion with the residents and talking to staff. This was followed up in discussion with the manager, whose attendance was appreciated. What the service does well:
There has been a stable nucleous of staff since last year’s announced inspection in August 2004. One staff member retired earlier this year and a resident said she regularly comes back to visit her. The resident was looking forward to her visit on the afternoon of inspection. Apart from that, the cook has recently left, but the residents spoke positively about her replacement. Residents spoken to all said that the staff are “very good”. Other words used to describe the staff included: “trustworthy”, “the staff are very fair to us and kind” and “they treat me with respect”. Residents spoke positively about the food provided, with comments varying from “the food is good”, “the food is excellent”, “the new cook makes nice home made puddings” and “I had a nice pastie yesterday which was full of meat”. This is particularly pleasing to hear as following the requirement made at the 11th August 2004 inspection, the manager has worked hard to vary the menu, to provide two cooked choices at mealtimes and to ensure the diet is nutritious. Residents were also appreciative of the manager’s ready availability to them, stating that she listens to them and they feel confident that they could speak to her if they had a concern and that she would deal with it. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The manager must introduce a dependency assessment into the care plans. These must then be used to calculate staffing numbers according to how many high, medium and low dependency residents there are at any one time. Further work is needed to develop the care plans so that they clearly show what action is needed to meet the residents’ health, personal and social care needs. Care staff need to be trained in care planning to develop their confidence so that they may become more involved in the care planning process. Care plans must be reviewed and updated when health care needs change. One care plan for a resident with high dependency needs must be updated straight away and the manager agreed to do this by 31st May 2005. A set of ‘sit on’ scales needs to be provided to monitor the weight of residents who cannot stand unaided. A review of medication storage is needed to ensure safety and this has been carried forward from the two previous inspections. The introduction of more organised group activities would be of benefit, especially to the less able
Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 7 residents. A suitable call bell must be provided for the resident who cannot use his/her hands to press the call bell. Action is needed ensure that the ongoing maintenance, redecoration and furnishing replacement previously identified is completed. The guarding of radiators to ensure safety is still outstanding, although some action was taken but proved unsuitable. Weekend staffing numbers on duty in the afternoons are not sufficient to ensure residents’ safety. Action must be taken to ensure there are enough staff on duty to care for residents and to provide an additional person to prepare the evening meal. The manager needs to make sure she allows herself enough time when drawing up the staff rota to attend to her management tasks. The registered provider needs to review the management structure of the home and take the necessary steps to make sure the important management tasks identified in this report are completed. 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. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none inspected on this occasion EVIDENCE: Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10. The individual care plans are not sufficiently detailed and do not provide all the information that staff need to ensure residents’ health care needs are fully met. This poses a potential risk to residents. The complex personal and health care needs of a resident were not all being met. Residents are treated with respect by staff. EVIDENCE: Little progress has been made on the previous requirement for staff to use the care plans as ‘working documents’ and to ensure that all identified needs are covered. The manager writes the care plans and although the care staff have access to them, they are not actively involved in updating them, or in carrying out the monthly care plan reviews. The daily comments written by the care staff are kept in separate files and do not present a picture of the care provided, lacking crucial details that would link to the identified care needs. Significant changes had occurred in two residents’ health care needs that had not been added to the care plans, which did not show the actions staff should take to reduce risks. One resident spoke of recent breathing difficulties and although a doctor had been consulted and medication prescribed, there was no record of the
Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 11 breathing problem in the care plan. Another resident spoke of having a small appetite and of not being asked about the size of food portions. This was an important factor as the person had a medical condition that requires monitoring of food intake and nutrition. The person’s weight had not been recorded in the care plan on admission or subsequently and there was nothing recorded about appetite and diet. A third resident described a recent deterioration in health and general ability. Significant health care needs were evident but the care plan was too generalised and risk assessments lacked detail, without specifying what staff should do. High dependency needs not covered, included risks such as skin integrity, nutrition, continence management and risk of falls. Staff were undertaking a hand dressing, which was not being recorded. There was no record of whether the doctor had been consulted. The resident’s weight had not been recorded recently (although there had obviously been some weight loss) as the home does not have a set of ‘sit on’ scales. The daily records gave no indication of the personal care provided. Discussion with care staff indicated that they were aware of some of these changes and were addressing some of these needs. These three residents each complimented the staff on the way they provide assistance with their care and said they felt that their care needs were being met. Two residents spoke of the sensitive way that a staff member assists them with bathing. Five residents each said that the staff treat them with respect for their dignity. One resident said “we are very lucky with the people looking after us here”. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 The home routines are flexible and residents are able to exercise choice in their individual daily activities. There is a lack of regular organised group activities to provide stimulation, particularly for the less able residents. Meals are varied and residents are offered a choice of food. EVIDENCE: Three residents said that their preference to stay in their bedrooms is respected. One resident chooses to go to the dining room for breakfast and dinner, but prefers to have tea in her bedroom. Another chooses to go to the dining room for all three meals, but stays in her bedroom all day. Five residents spoke about pursuing their own interests, such as: reading newspapers, doing crossword puzzles or word searches, watching favourite television programmes and sitting in the garden in fine weather. A resident said they have occasional film shows. Three residents said there are no organised activities any more. A number of residents were observed just sitting in their armchairs in the lounge and dining room with nothing to occupy them. Two residents spoke of their enjoyment from watching the recent VE Day celebrations on television and three residents spoke about the General Election. They were not sure about the procedure for arranging a postal vote if they wished, but each added that they did not wish to vote.
Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 13 Seven residents confirmed that they like the food provided and that they are asked to choose from two options for dinner. Two residents commented that the cook comes round each morning and tells them what is on the menu and asks their preference. Several residents commented favourably about the quality of the food that the new cook provides. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents know that complaints will be listened to and acted upon. EVIDENCE: The home’s complaints procedure is prominently displayed together with some individual complaints forms that can be taken away to fill in. Details of how to contact the Commission For Social Care Inspection have been included in the procedure. Residents spoken to said they had no complaints and would speak to the manager if they had any concerns, saying that the manager listens to them. No complaints have been received by the Commission since the last inspection in January 2005. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 24, 25 and 26 The standard of environment within the home is generally satisfactory but a planned maintenance and fabric renewal programme is needed. The quality of lounge seating has deteriorated with wear over the last year and this does not provide a comfortable and pleasant environment. A highly dependent resident did not have a suitable call bell facility to meet his/her needs posing a potential risk of harm. EVIDENCE: The four bedrooms seen were comfortable, highly personalised and homely. The lounge and dining room walls had been redecorated, but the paint on both radiators was flaking. A number of lounge chairs were still worn on the arms and generally shabby and no new lounge chairs were seen, although this had been pointed out in August 2004 and at the last inspection in January. The manager said that two very worn armchairs had been removed since then. The wallpaper was coming away from the wall in the ground floor corridor and there was a plastic beaker under the radiator valve. The glass was cracked in
Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 16 the window of the Quiet Room. A double bedroom had no lampshades on the two bedroom lights and the light in the ensuite toilet, where the lino was lifting near the toilet pan. The door lock on the first floor shower room was still broken and the washbasin was badly stained. The laundry room sinks, although cleaner than at the last inspection, still had grime around the plugholes. A highly dependent resident was unable to access the call bell in his/her bedroom, where the resident spends each day. The manager said that the resident is unable to use his/her hands to press the bell, so the care staff go to the bedroom regularly to see if the resident needs anything. However, this was not recorded in the daily notes and the resident cannot call for assistance if required. The manager stated that following the last inspection, some cloth radiator covers had been purchased, but these proved ineffective, as they did not let the heat through. Therefore the registered provider is considering other ways to address the risk of burns. The previous requirement is therefore ongoing. A lock has been fitted to the cupboard in the laundry where hazardous liquids are stored. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 There has been some improvement in staffing numbers on weekdays, but there is still a shortfall at weekends, placing residents at risk. There is no system for determining residents’ dependencies and for calculating the staffing numbers required. This has an impact on the quality and consistency of care provided. Staff morale is good and recent training has given them more confidence in their roles. EVIDENCE: There were two carers, two cleaners and one cook on duty in the morning of inspection for the care of eighteen residents. The cook and cleaners went off duty at 14.00 hours, when a changeover took place and there were three carers on duty until 20.00 hours to care for residents and prepare the evening meal. The manager said that following the last inspection she had rearranged the duty rota and she now does split shifts on four days during the week, where she works from 09.00 hours to 13.00 hours and 15.00 hours to either 18.00 hours or 19.00 hours, so that she is the third person on duty over the tea time meal period. Rotas indicate that at weekends there are only two people on duty for care in the afternoons and one carer has to prepare the tea time meal. The manager has not yet formulated a method to determine staff numbers according to residents’ needs. She stated that she has obtained a copy of the Department of Health Guidance, but has not been able to put this into practice yet. Residents’ care plans do not include a dependency assessment tool. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 18 Residents spoken to said that their care needs were being met, but some said that they would like more activities if staff have time. A carer said she has recently completed her National Vocational Qualification in Care level 2 (NVQ) and another is three quarters of the way through the level 2 required elements. A staff member spoke positively about recent training provided. Two staff said that staff morale is good and they like working at the home. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37 and 38 The manager sets an example by working flexibly and creating an open management approach. The manager has an understanding of what needs to improve in the home, but this management style does not leave enough time for her to fulfil all the record keeping and management responsibilities. EVIDENCE: The manager is undertaking her NVQ level 4 in management and care and hopes to complete this by June 2005. She works split shifts Monday, Tuesday, Thursday and Friday each week and does the cooking on Sunday mornings. Residents said they appreciate her openness, saying that she is easy to talk to and listens to them. Staff spoken to said that the manager is supportive and is available to them when off duty for advice. This was evident at this inspection, when the manager came into the home on her day off. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 20 A new lockable metal cupboard has been obtained since the last inspection for the safe storage of care plans, where they are accessible for staff. Residents’ records did not contain sufficient detail to protect their best interests (see comments under Health & Personal Care). An oxygen cylinder was being stored in the first floor shower room and there was no warning sign on the door. The manager stated that seven staff are undertaking a moving and handling course and eight staff have completed a medication training course. A staff member said that this had given her more confidence when handling drugs. Access to the fire log book and maintenance records were not available as the office was locked. Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x 2 1 x 2 2 2 STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 3 x x x x 2 2 Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 22 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 7 Regulation 15 Requirement Timescale for action 30/6/2005 2. 8 3. 9 4. 19 Service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. The plans must be updated following reviews when health and/or personal care needs change. (Previous timescale of 30th April 2005 not met) 12, 13, 14 The registered manager must & 15 ensure that residents health care needs are fully met. (1) Care plan for resident with high needs to be sufficiently detailed. Care plan to show actions to be taken to reduce risks. (2) Staff to be trained in how to complete care plans. 13(2) Medication storage must be safe and comply with the Royal Pharmaceutical Society guidelines. Medication storage must be reviewed and action taken to address the previoulsy identified risks. Action plan to be submitted. (Previous requirement made 12/8/2004 plus extended timescale of 1/3/2005 not met). 23 Worn lounge armchairs to be
H56-H05 S23499 Montague House V225012 110505 Stage 4.doc (1) 31/5/2005 (2) 30/9/2005 31/7/2005 30/6/2005
Page 23 Montague House Version 1.30 5. 22 13(4) 16(2) 23(2)(n) 6. 25 13(4) 7. 26 13(3)(4) 16(k) 8. 27 18 replaced, shower door lock to be repaired,portable electrical appliance checks to be completed (carried forward from 26/8/2004) and a programme for the routine mainteanance and renewal of the fabric of the premises to be introduced. Action plan to be submitted. (Previous requirement 26/8/2004 plus extended timescale of 1/3/2005 not met) The registered manager must ensure that the resident with high dependency needs has a suitable call bell in the bedroom that s/he is able to access and use to call for assistance when necessary. Action plan to be submitted. Action plan to guard radiators and pipework (prioritised according to risk) to be submitted. Action plan to be submitted showing action to address infection control risks previously identified in the laundry on 26/8/2004 including replacement of the sinks with a suitable sink and wash hand basin. Suitable hand washing facilities of liquid soap and paper towels must be provided in bathrooms, toilets and bedrooms where personal care is given. (Previous requirement 26/8/2004 plus extened timescale of 1/3/2005 carried forward) The registered manager must ensure that there are sufficient numbers of suitably qualified, competent and experienced staff on duty at all times to meet the needs of residents and the size of the home. Staffing calculations must be based upon residents dependency 30/6/2005 30/6/2005 30/6/2005 30/6/2005 Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 24 9. 10. 31 37 9 & 10 17 11. 38 13(4) assessments, which must be kept up to date at all times and specify whether the resident is high, medium, or low dependency. Evidence of residents dependency calculations and 4 weeks staff rotas to be submitted. (Previous requirement timescale of 1/3/2005 partly met and carried forward) The registered manager must achieve NVQ level 4 in management and care. The registered manager must ensure that the specified records contain all the required information. The registered manager must ensure that oxygen is stored safely. A warning notice to be placed on the door. Action plan to be submitted showing plans for the disposal of the oxygen cylinder no longer required. 2005 30/9/2005 30/6/2005 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 12 Good Practice Recommendations That activities for residents to participate in group and individual activities, both within and outside the home, are developed. (Previous recommendation made 11th August 2004). That some sit on scales are provided to monitor the weight of resdients who are unable to stand unaided. 2. 8 Montague House H56-H05 S23499 Montague House V225012 110505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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