Inspection on 04/08/05 for Nightingales

This inspection was carried out on 4th 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 but made no statutory requirements on the home.

Other inspections for this house

Nightingales 17/09/08

Nightingales 27/09/07

Nightingales 31/07/06

Nightingales 20/02/06

Nightingales 06/01/05

Nightingales 20/05/04

Nightingales 28/01/04

Nightingales 30/09/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Nightingales 34 Florence Road Wylde Green Sutton Coldfield B73 5NG Lead Inspector Zeta Joseph Unannounced 04 August 2005 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. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Nightingales Address 34 Florence Road Wylde Green Sutton Coldfield B73 5NG 0121 350 0243 0121 686 1312 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) Tuskholme Limited Mrs Gayle Goodhead Care Home 13 Category(ies) of Care Home registration, with number of places Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 06 January 2005 Brief Description of the Service: Nightingales is a family run home that operates as part of a limited company Tuskholme Ltd. It cares for thirteen older people both male and female. It is situated in a road off the main Birmingham to Sutton Coldfield road near to Wylde Green shops. Therefore there is access to local amenities and to buses into the main areas of Birmingham and Sutton Coldfield. There is a cross - city rail line in the vicinity. The home itself is housed in an extended large double fronted Victorian House that is not out of place in the surrounding area. It has three floors two of which are used by the service users and one that is used as an office and staff on call accommodation. There is a stair lift that allows service users to reach the first floor although some bedrooms have further steps to negotiate. On the ground floor there is a lounge/dining room, a bathroom, and a conservatory. There is a mixture of both single and shared rooms and some of the rooms are ensuite rooms within the home. The home offers a day care service and also meals delivery service to people in the locality Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced for four hours. The inspection focussed on outstanding requirements from the last inspection. Two residents, the manager and co-director were spoken to and a tour of the home was conducted. There were thirteen residents and two day care service users. All residents, whether privately or publicly funded pay the same top up fees. This home does not cater for residents referred solely for intermediate care. In addition to providing meals for residents; thirty-nine meals are cooked and provided to service users living within the community. There were eleven residents’ sitting in the lounge; residents’ spoken to had eaten breakfast of their choice and were looking forward to the activities of the day. There were two residents in receipt of palliative care and were being nursed in their respective bedrooms. A resident was spoken to who said she ‘liked it at the home very much, that it was wonderful and that the meals are very nice’. A day care service user was spoken to and he enjoyed the meals and the bath he was given. What the service does well: What has improved since the last inspection? What they could do better: Where the Health Authority are involved in patient care, recordings in residents’ care plans and risk/manual handling assessments must be clearly written to reflect the residents’ current circumstances so that management of their health care needs can be safely managed. There was evidence to show that the Community Health Care team were actively involved in patient care. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 6 The Manager confirmed that the use of cot sides was ‘not advised by the Community Health Team and therefore recommended the use of mattresses.’ The Inspector saw the mattresses in place; however there were no communication or risk assessment records to substantiate this. One of the Directors is also an ordained minister for the Church of England as a curate for 10 months until he becomes a Vicar. He works at the home and is also the Registered Manager for the Domiciliary Care Agency based within the home. He offers prayers to residents three times per week, is available to conduct funeral services, and offers Holy Communion. The Provider should make it clear that the Christian Faith is promoted at the home so that all new residents are aware before they are admitted. The last unannounced inspection resulted in a Serious Concerns letter to address the identified matters found within the home that required immediate action. The home has since detailed actions taken to comply with or work towards meeting the minimum standards. 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. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 6 There is an information leaflet and Statement of Purpose available. The Statement of Purpose is satisfactory; however the Service User Guide has not been developed. Each resident has signed and has been provided with a copy of their contract/terms of residency. A care plan is completed for each resident, the resident’s family are encouraged to be involved so that they know the home will meet their needs. Residents are provided with their required communication equipment. This home does not cater for residents referred solely for intermediate care. EVIDENCE: The Manager confirmed that ‘all clients have a copy of the Statement of Purpose and the brochure and have signed to say they have these.’ The Manager said that she was ‘never asked for a Service User Guide at previous inspections’. Inspectors’ have discussed this at length with the Manager at previous inspections so that a Service User Guide is developed as a summary of the Statement of Purpose so that it contains the regulatory Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 9 requirements. Requirements relating to the Service User Guide are recorded in current and previous inspection reports and they remain outstanding. Files relating to residents’ who recently moved in to the home were examined; these contained a copy of a contract/terms of residency. All private residents have a contract; residents funded by Social Care and Health have a 3rd party agreement of authorisation of an external placement. A file was examined for a recently admitted resident; this contained the newly implemented multidisciplinary assessment form and dependency profile completed with the assistance of the resident and family. The care plan record includes personal care, aids that may be used by the resident, communication, medication, social contacts, risk and manual handling assessments. The Manager confirmed that residents’ requiring communication equipment such as hearing aids are provided with these. This home has no facilities to cater for residents’ who need intermediate care. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 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, 9 The staff liaise well with the Community Health Care team so that residents’ needs are met. The service users’ health, personal and social care needs are set out in an individual plan of care. Consultation with service users ensures they are fully informed and contribute to these, however risk assessments are not updated sufficiently nor frequently to ensure health care needs are fully met. The Controlled Drugs Register and Medicine Administration Record (MAR) charts for some residents were examined and found to be satisfactory. There are no residents who self medicate. EVIDENCE: The Manager confirmed that the new multidisciplinary care plans have been implemented for some residents and are completed after discussions with the resident and/or relative. Risk assessments examined were found not to be complete when the dependencies of frailer residents were discussed with the Manager. The new multidisciplinary assessments have been implemented for some residents and will need to be applied to all residents to avoid a two-tier system and parity in managing the assessments. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 11 Care plans implemented by the Manager and examined by the Inspector include recordings of where the residents and relative have discussed preferences of how the plan of care is to be carried out. Where creams were seen in residents’ bedrooms, these belonged to the resident occupying the room; the Manager confirmed that medicinal cream is used by the resident it is prescribed for. Risk assessments for the frailer residents were found not to reflect their current health care needs as agreed with the Community Health team; these must be updated as and when residents care needs and dependency levels change so that staff on duty can continue to meet residents’ changing needs. During the tour of the building a resident’s bedroom cupboard on the ground floor was found to contain equipment belonging to the home. A requirement was left at the last inspection regarding residents’ privacy within their bedrooms. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 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, 15 The management of the kitchen has improved with clearer choices and variety of meals for residents. There is a relaxed atmosphere and staff were seen to interact with residents. Residents are offered prayers and other ministerial services; however, other religious choices were not demonstrated. EVIDENCE: Some residents receive visitors during the day and residents spoken to were very pleased with the type of meals offered to them. Records of residents meetings were available for examination. Resident’s religion is recorded within their care plan; it is unclear whether their religious preferences are being promoted at the home; The Manager confirmed that ‘all residents’ religious needs are met, recorded on their files and taken into account if different from Church of England.’ One of the Directors is also an ordained minister/curate for the Church of England for 10 months until he becomes a Vicar. He works at the home and is also the Registered Manager for the Domiciliary Care Agency based within the home. He offers prayers to residents three times per week, available to conduct funeral services, and offers Holy Communion. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 13 The staff ensure there is a formal choice of meals available at lunchtimes and residents’ are aware of this by menu and reminded verbally when their choice of meal is being served in the dinning room. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 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, 18 The Manager maintains a record of complaint outcomes. Some training in adult abuse has taken place; it is unclear that the level of training provided to staff will fully protect service users from abuse. EVIDENCE: Complaint outcomes were examined; there is no complaint log available so that a clear audit trail can be monitored and tracked. The Manager confirmed that staff have watched an Adult Abuse DVD and discussions took place in regard to this. Staff will need to attend formalised training in Adult Protection to ensure that staff are also made aware of the multi agency guidelines and their responsibility to ensure action is taken on identified issues. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 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, 24, 25, 26 The home is generally well furnished and maintained and the garden appeared well maintained, ensuring the safety of residents’. Residents are provided with sufficient lavoratories and washing facilities. The Manager must ensure that when staff use the laundry care is taken to minimise risk. The infection control policy is still required for the home; strong odours must be managed more robustly. Some communal items found in a bathroom do not contribute to a service user centred approach to care. EVIDENCE: In a number of residents’ bedrooms, the light bulbs were not working above the wash hand basin or shared en suite; sufficient lighting must be provided for residents’ within their private accommodations. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 16 There are lockable storage facilities and the ability for residents to lock their bedroom door. The home has moved the dining furniture into the conservatory; residents choose to eat their meal in here. This has been made the lounge much more spacious, residents have the availability of footstools and small tables for drinks. There is a walk in shower for residents who prefer to use it. Residents who have en suites have aids in these to assist them. There are wheelchairs available to take residents out into the community and there is a range of walking aids that residents have been assessed for. Hot water within the home is restricted to 43 degrees centigrade so that residents do not sustain scalds and burns. There is very little space within the laundry cupboard. When the ironing board is being used it opens partly into the hallway and constitutes a hazard for people walking in the hallway. Laundry services are no longer provided to the community. There are different coloured containers to separate residents’ laundry from kitchen laundry so that laundry is not contaminated. Minor maintenance issues found at the last inspection have been carried out; however a resident’s ground floor bedroom cupboard contained equipment belonging to the home. Food in the fridges has been separated as to food type and raw meats are no longer wrapped with pre-cooked food. Although Environmental Health has inspected the kitchen, there were food items in one of the fridges that needed to be labelled and dated. There was a plastic bag containing raw mincemeat stored above a tray of eggs. When asked about this, the kitchen manager said that Environmental Health confirmed that it ‘does not matter providing the eggs are covered’. These were raised at the last unannounced inspection. There was no food stored on the pantry floor, the Manager confirmed the pantry is kept locked when not in use. There are adequate supplies of plastic disposable aprons for the serving of food and different coloured aprons for when providing care. Staff was seen to be wearing the correct aprons and head covering. There was a strong smell of urine in one of the ground floor bedrooms; a working infection control policy is outstanding. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 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, 29, 30 The rota has not been modified to meet standards. Staff recruitment must be managed more robustly so that residents are protected. EVIDENCE: The rota was examined. It did not reflect the hours or roles undertaken by individual staff, nor who was leading the shifts. The Manager confirmed that ‘all staff rotas has now been rectified.’ Staff files examined revealed that gaps in employment history were not explored; confirmation of status and POVA disclosure had not been applied for despite the member of staff being employed at the home. There was insufficient evidence of induction training for staff; it was not possible to evidence whether all the mandatory or Skills for Care (TOPSS) standard training had been completed. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 18 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, 33, 36, 37, 38 Residents’ and staff benefit from the leadership of the Manager. To be appropriate, staff supervision must take place no less than six times per year. The quality assurance system includes a questionnaire to ensure residents are consulted. The kitchen is better organised from the previous unannounced inspection and advice has been taken from the Environmental Health Department, ensuring that the health, safety and welfare of service users are better promoted and protected. EVIDENCE: The Manager has commenced additional training to gain the Registered Managers Award; she is already qualified with an equivalent to the National Vocational Qualification (NVQ) Level 4. She has invested in an independent company to provide legal advice, policies and procedures and professional Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 19 business support to her so that the home runs more robustly. These changes are to be implemented within the management systems. The staff have conducted a survey; this is to be ongoing to cover all aspects of care delivery. Residents and their family are consulted at monthly residents meetings. An outcome of the survey is based on how staff are viewed from the residents perspective; more work is to done to ensure all aspects of care delivery are surveyed. Staff supervision must take place and records maintained. The Inspector found that residents’ records were not up to date. The multidisciplinary recording system needs to be rolled out to all residents and risk assessments should be up dated more regularly. The Manager must ensure that storage of food in refrigerators meets the requirements from the Environmental Health Department, so that residents’ health is safeguarded. There were Health and Safety requirements within Standard 26 of this report. Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 20 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 1 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 x 2 3 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x x 2 2 2 Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 21 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 OP1 Regulation 4(2),5(2) Requirement The Manager must ensure that all residents have access to the homes Service User Guide in a format suitable to their needs. THIS REQUIREMENT IS OUTSTANDING. The Manager must evidence when residents require cot sides or equivalent their risk and manual handling assessment is updated to reflect changes in their health care needs. The Manager must ensure the homes equipment is not stored in residents bedrooms and ensure residents have privacy within their allocated bedrooms. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager must demonstrate how residents are helped to exercise choice and control over their lives. The Manager must ensure a numerical log of complaints is maintained. The Manager must ensure staff are provided with Adult Protection training to include the revised Multi Agency Guidelines. THIS REQUIREMENT REMAINS Timescale for action 31 Mar 2005 2. OP7 13(4) 4 Aug 2005 3. OP10 12(4(a) 7 Jan 2005 4. OP14 12(4)(b) 30 Dec 2005 30 Oct 2005 31 Mar 2005 5. 6. OP16 OP18 22(8) 13(6) Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 22 OUTSTANDING. 7. OP38 13(3) The Manager shall ensure all food is appropriately labelled and dated. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager shall ensure raw meat is stored at the bottom of refrigerators on a drip tray to prevent drips onto other food stuffs. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager must devise a working Infection Control Policy that reflects practice. A copy of the relevant sections must be available in the kitchen and laundry and the Commission must be provided with a copy. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager shall ensure that communal toiletries are removed from bathrooms and toilets. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager must ensure that staff recruitment is managed more robustly and that staff files contain the required information. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager shall ensure all staff are provided with Skills for Care training within the timed guidelines. THIS REQUIREMENT REMAINS OUTSTANDING. The Manager shall ensure that the quality assurance process measures outcomes for residents so that their views are recorded and acted on appropriately. The Manager shall ensure that persons working at the care home are appropriately 13 Jan 2005 8. OP38 13(3) 13 Jan 2005 9. OP26 13(3) 31 Jan 2005 10. OP26 13(3) 21 Jan 2005 11. OP29 19, Sch 2 31 Jan 2005 12. OP30 18(1) 31 Mar 2005 13. OP33 13(4) 30 Oct 2005 14. OP36 18(2) 30 Nov 2005 Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 23 15. 16. OP37 OP38 17(1) 13(4) 17. 18. 24 38 16(2) 13(3) supervised in line with the minimum standards with records maintained. The Manager shall ensure all residents are safeguarded by the minimum standards required. The Manager shall ensure residents risk and manual; handling assessments are representative of their current circumstances. The Registered Manager shall ensure are provided with bedrooms to assure privacy. The Registered Manager shall ensure robust measures are implemented in the home so that practice in the home prevents the spread of infection and communicable diseases. THIS REQUIREMENT REMAINS OUTSTANDING AND IS LINKED TO STANDARD 26 30 Nov 2005 30 Oct 2005 30 Oct 2005 31 Jan 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. 2. Refer to Standard Good Practice Recommendations Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Birmingham and Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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 Nightingales E54 S17015 Nightingales V242048 040805 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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