CARE HOMES FOR OLDER PEOPLE
Nora Chase House 50 Valentines Road Ilford Essex IG1 4SA Lead Inspector
Stanley Phipps Unannounced Inspection 30 August 2005 16:20 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. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Nora Chase House Address 50 Valentines Road, Ilford, Essex IG1 4SA 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) 0208 518 0336 0208 554 9129 microsdale@hotmail.com Mrs Mary Louise Crosdale Mrs Mary Louise Crosdale CRH Care Home 10 Category(ies) of OP Old Age (10) registration, with number of places Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17 March 2005 Brief Description of the Service: Norah Chase House is registered as a care home for ten (10) older people. It is owned and run by the Proprietor/Manager – Mrs Crossdale since it opened in 1985. Although Mrs Crossdale is a registered nurse, nursing is not provided on the premises, except that which is provided by the district nurses. The aims of the home are to offer high standards of care in a homely atmosphere. There are six single rooms and two double rooms on the ground and first floor, currently accommodating six service users. Therefore, all service users currently have their own room and do not share. Sharing rooms in future will only be because of positive choice. There is no lift and most of the service users are mobile and self-caring.There is a main lounge which is separate from the dining area, but no separate quiet room for service users to see visitors. There is a back garden which service users use in the better weather.The home is near Valentines Park with reasonably close access to public transport and the centre of Ilford. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place in just over three hours and was carried out to coincide with the fact that the registered manager had, just prior to the visit, expressed an interest in applying to the Commission for a variation in its registration category to provide dementia care to a small percentage of her clientele. As such, the visit was a good opportunity to at least preliminarily explore her consideration/s. The visit was also timed to monitor the outstanding requirements and recommendations from the last visit (17/3/05) and to meet with service users, as they were most likely to be in during the evening. At the time of the visit there was construction work taking place in the home as a conservatory was being built at the rear of the building, adjoining the ground floor bedroom closest to the rear of the building. The manager’s office was being turned into a bigger utility area and her office was extended outwards as part of the overall process. The works caused little disruption to practical and daily routines, but some documents e.g. policies and procedures, training records, staffing files as well the manager’s computer were secured in the garden shed and was not easily accessed during the visit. As such some previously made requirements could not be tested and hence are repeated in this report. An empty bedroom on the first floor was also in the process of being refurbished. Generally there were areas of improvements in the quality of service delivery in the home and service users interviewed echoed this. A general tour of the building and external grounds took place to include the building works to the rear of the home, an assessment of a sample of service user plans, menus, food storage and medication charts took place. A discussion was held with both the manager and deputy manager and all six service users were spoken to. What the service does well:
All service users were unanimous in saying that they feel safe in the home and pleased with the way in which staff worked with them. They were clear that the staff are really there to support them in achieving a good standard of life at Norah Chase. One service user compared living in a home run by a large national organisation to Norah Chase and stated, ‘I feel more valued here and the service is more personal. Whenever I have a need, the response times are much quicker than where I was previously. I wouldn’t change living here, for the world’. In essence the staff input at the home left a positive image on both the minds and lives of the service users and that is commendable. Service users were also pleased with the level of external stimulation they receive at Norah Chase and think the world of the meals provided by the manager and staff at the home.
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The manager could do more to ensure that requirements made by the Commission are complied with, so that the overall quality of the care provided in the home is enhanced. This is particularly important where those repeated requirements are referred to in this report. The manager could also work closer with the Commission when considering structural developments to the service, so that advice particularly with regard to these developments and the Care Homes Regulations (2001) could be given, to the benefit of service users and the manager. Risk assessments for services must be kept updated as these are working documents that are required that work undertaken with and for service users are kept minimal at all times. These assessments would detail the action/s
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 7 required to keep them (the risks) to a minimum and of significant benefit to the individual. Although it was understandable that the works taking place in the home would have caused some displacement to some records, more could have been done to ensure that key records such as staff recruitment, complaints’ and the records listed in Schedules 3&4 of The Care Homes Regulations 2001 are made available for inspection. 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. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 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 Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 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) (1,3,5) The home has a good record of admitting service users whose needs are thoroughly assessed and would admit only if those needs could be met. Prospective service users now have access to an updated service user guide, which sets out rights and obligations of both the provider and the service users. As part of the admission process, service users visit the home prior to accepting a place there to give them an insight into what happens in the home. EVIDENCE: A reviewed service user guide was now in place and available to both current and prospective service users. The advantage of this reviewed document is that service users are able to make decisions about living in the home based on updated information. Although there have been no recent admissions to the home, it is part of the practice at Norah Chase for prospective service users to visit the home prior to accepting a place there. This enables them to assess what and how things are conducted in the home, before making a decision about the suitability of the facilities. In the past there was evidence of relative and/or friend’s involvement in order to view the home prior to the admission of the service user. From records held by the home, the needs of service users are assessed in detail prior to admission. This assessment identifies what support is required and whether they are in line with the home’s statement of purpose, before a decision to admit is made. This is good
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 10 practice and once it continues for future admissions, then service users would be appropriately placed at Norah Chase House. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) (7,8,9) The health care needs of service users are satisfactorily provided for at Norah Chase, details of which are in their individual plan of care. Personal and social care needs are also well provided for and although service users generally benefit from the safe handling of medication, further safety measures need to be in place to handle spillages in the home. EVIDENCE: From a sample of service user plans examined, it was clear that they covered the personal, social and health care needs of the service users for whom they were designed. More importantly there was evidence of either the service users’ involvement or that of their relatives, in this process. All service users were registered with a GP and for many records of professional healthcare visits e.g. dentist, district nurse, were in their individual files. In speaking with one service user she informed that she had to pay for her dental care, something she was not happy with. This should to be looked into by the management and staff of the home in the interest of the service user concerned. Some aspects of personal care practices were indirectly observed e.g. giving support with regard to toileting, and they were handled with dignity and integrity by the staff involved in the care. The service user was delighted with the way she was treated on that and every other previous occasion, she
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 12 declared that ‘staff do treat you with respect here and the care feels more personalised than when I was in one of the big [name of national organisation] homes’. Although the support and administration of medication was satisfactory and in the interest of service users, the policy needed reviewing. This is so that it takes into account how staff would handle spillages particularly for the benefit of staff having to deal with it. This is an outstanding requirement and would be repeated in this report. It was also observed that at least one of the service user’s risk assessment was outdated and in need of review. This tool works in tandem with the individual service user plan and as such need to be updated to reflect the current level of risk for each service user in the home. This needs to be improved. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 13 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) Service users at Norah Chase are encouraged to participate in a flexible lifestyle suited to their individual needs and preferences. This enables them to have a wider choice as to when they do what they do. The approach also lends itself to service users maximising their autonomy and choice. Meals provided by the home were generally satisfactory and service users were happy with them. EVIDENCE: From talking to service users it was clear that they had individual preferences for social and religious practices, and this was enabled by the staff and management of the home. A good example of this is where one service user goes to church with dial-a-ride every Sunday because this was her choice. The service also spoke of visiting Kew Gardens in July and also visited Cambridgeshire for a day. She also delightedly spoke of going away for a week to Jubilee Lodge and this is a holiday arranged for individuals in wheel chairs. It is positive that the manager and staff were working individually with service users to enable them to live their life to the fullest, given their individual circumstances. Credit must be given to the manager as one service user complimented her efforts in assisting her in doing crossword puzzles. Another service user prefers visiting the pub, attending the Sinclair Day Centre, visiting a synagogue and going to theatre plays and this was also encouraged. He too
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 14 feels that he is leading a full life at Norah Chase House. In essence the home was working well in promoting the wishes and lifestyle preferences of service users on an individual basis. Arrangements for accessing information held on them is still to developed, although there are informal arrangements in place. This is also a repeated requirement as it was made previously at the last inspection. It was unanimous that the meals provided by the home were satisfactory and all service users were satisfied with the current arrangements that are in place at the home. From interviews it was clear that they had a choice of what they wanted to eat, a record of which was held in the home. Food storage was satisfactory and there was evidence of fresh fruit, vegetables and hot and cold drinks. This is a strong area of the homes operations. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 15 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) A satisfactory complaints procedure is in place at Norah Chase House. This, along with satisfactory adult protection guidelines and protocols provides a sound protective framework for service users living at the home. EVIDENCE: Service users spoken to knew of their right to complain and how they would go about this if they were unhappy with any aspect of the service. The complaint’s record could not be located at the time of the visit and as such it not possible to determine the volume and/or how they were handled. It should be noted that previously complaints were handled satisfactorily. A positive step has been taken to protect service users from abuse, training in Adult Protection has been provided to all staff in the home. This is an improvement when compared with the findings of the last inspection visit. Service users can be assured that signs and/or suspicions of abuse would be handled appropriately and in their best interest. There were no adult protection matters in the home. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 16 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) (19,20, 21,24,25,26) Norah Chase House provides a homely, safe and cosy environment for elderly service users. Service users are made to feel secure and as such, feel assured that they have a home for life. New structural developments however would be better discussed with the Commission prior to undertaking works to ensure compliance with regulatory guidance. EVIDENCE: All service users spoken to were happy with their communal and private accommodation, which was generally in a good state of repair. There were repair/refurbishment works in an unoccupied bedroom as well as extension of the utility room and manager’s office. A conservatory was also under construction at the time of the visit. Service users spoken to confirmed that they were consulted on the development of the conservatory. One service user is directly affected as the conservatory merges with her outer wall, which provides natural light to her bedroom via a window. She was primarily happy with the construction of the conservatory and didn’t see a problem with it. She thought it would be beneficial to other service users who are able to sit out in it. However, access to this area is either through the kitchen, which is
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 17 relatively small with steps down or more comfortably through a side door, which is currently a fire exit. The registered manager is required to consult with the local fire authority to determine the safety and/or practicality of using the fire exit as an option to accessing the conservatory. The kitchen would be an undesirable option and the manager would be best advised to conduct a risk assessment on the safety aspect of using this option. On the day of the visit the home was clean and hygienic, considering the works taking place in the property. Maintenance is carried out by a part time handy man and this generally works well in terms of getting minor jobs done quickly. Service users were observed comfortably accessing the lounge, their bedrooms toilets and the dining room, during the course of the inspection. The manager had responded positively to a previously made requirement by securing the flooring boards in a service user’s bedroom, making it safer for her. Improvement was also made in relation to carrying out temperature and water heating checks for monitoring the control of Legionella in the home. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 18 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) (27,28,29,30) Services users benefit from having staff that are motivated, skilled and trained in meeting their needs. The Commission could not be certain that the service users are protected by the quality of information held on staff in the home. EVIDENCE: There was strong evidence to support the fact that the manager did embark upon the provision of training for all staff in the home. This would be of tremendous benefit to service users in that it would equip the staff with the knowledge and expertise in dealing with the specific needs of the service user group. Examples of training booked and already provided included, the deputy manager starting NVQ 4 in September 2005, one member of staff completing NVQ level 3, while another in the final stages of NVQ level 2. A new staff member has started her induction training, while all other staff have had a three-day training in ‘Person Centred Approach in Dementia’. Other training provided included listening skills (two staff attended), Falls and Fracture Risk Prevention and training in adult protection. The manager had in essence developed her staff training and development plan as evidenced by the training provided thus far. It should be noted that the training in Dementia is in anticipation of the registered manager’s application to the Commission for a variation in its registration to provide care for service users with this diagnosis (Dementia). However the training is invaluable even for future application. All service users expressed their happiness with the work of staff in supporting and enabling them to live as full a life as they possibly could. Service users
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 19 were also in a position to name individual staff members whom they thought were exemplary and this is a credit to the staff team as a whole. The staff team in its make up is quite diverse and mirrors the wider picture of the borough. Although the current service user mix is predominantly from the mainstream grouping (i.e. white British), it is positive in that future placements to the home may well be diverse. As stated earlier in this report, the recruitment records of staff were not accessed as a result of the storage of these records. As such, the requirement would be repeated until the registered manager could demonstrate that she is meeting the standard relating to the records required by regulation with regard to staffing. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 20 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) (32,33,34,35,36,37) Service users and staff benefit from the support of the manager and the home is generally run in the interests of the service user group. More could be done however to enhance the overall quality of the service, through the application of quality assurance systems. EVIDENCE: Staff and service users were happy with the management arrangements in the home. Staff informed that they felt supported and that the manager was always available. Service users thought she was doing a great job and that she treated and spoke to them in a more dignified manner than previously. This as an outcome for service users was positive, as they looked more relaxed at this visit. Given the current developments in the home it was impractical to assess fully the quality assurance actions implemented by the manager. As such the requirement would be repeated until evidence of compliance is demonstrated.
Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 21 This statement is specific to Standard 33 of the National Minimum Standards for Older People (Quality Assurance). The manager has an accountant who audits her business and this is crucial to the service user group with respect to the viability of the service. There was evidence of staff supporting a service user to handle his finances and this was commendable. For others, relatives assist them with the cooperation of the manager to manage theirs. However a business and financial plan was still unavailable for inspection and needs to be available at the next inspection. This requirement would be repeated in this report. There was an improvement in the supervision of staff, in that formal supervision according to staff has commenced and further evidence of this would be sought at the next inspection of the service. Staff were pleased with the support that the manager gave them overall and this would have a positive impact on their ability to carry out their work with service users. Due to the works in progress at the time of the inspection, it was not possible to assess whether the registered manager had in place, the records required by Regulation 17 (Schedules 3 & 4) of the Care Homes Regulations 2001. As such this requirement would be repeated in this report. Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3
COMPLAINTS AND PROTECTION 3 2 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 2 2 3 3 2 x Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 7 Regulation 14(2)(a) Requirement The registered person is required to ensure that risk assesssments for al service uses are kept updated. The registered person must review the medication policy to include the handling of spillages. (This was a previously made requirement). The registered person must develop an access to information policy. (This is a previously made requirement). The registered person is required to a) conduct a risk assessment on the accessing the newly built conservatory and b) consult with the local fire department with regard to the use of the fire exit as access to the conservatory. The registered manager/proprietor must be able to demonstrate that she operates a thorough recruitment procedure based on equal opportunities to ensure the protection of service users. All necessary information must be obtained in order to assess the fitness of staff and appropriate records kept. (This is a Timescale for action From 30th August 2005 & Ongoing 31st October 2005 31st October 2005 15th November 2005 2. OP 9 12,13 3. OP 14 12 4. OP 20 23 5. OP29 19 From 30th August 2005 & Ongoing Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 24 previously made requirement). 6. OP 33 24 The proprietor/manager must establish an annual development plan for the home and effective quality monitoring systems to ensure that the home meets all aspects of Standard 33 and the Regulations (Care Homes2001). Any system must regularly review and improve the quality of care and include consultattion with service users, representatives and staff. The result of any review must be made available to service users and the Commission. (This is a previously made requirement) The registered manager is required to have a business and financial plan relating to the home. Alternatively confirmation in writing from an appropriate source (e.g. a qualified accountant), that the business is financially viable.(This is a previously made requirement) All statutory records listed in Schedules 3&4 of the care Homes Regulations 2001 must be kept in the home, including a record of all staff employed in the home with all the information required by the schedules. (This is a previously made requirement) 31st October 2001 7. OP 34 25 31st 2 October 2005 8. OP 37 17 Schedules 3&4 31st October 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 OP 21 Good Practice Recommendations The registered manager should contact the Commission for regulatory guidance with regard to new structural developments she may wish to undertake.
G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 25 Nora Chase House Nora Chase House G55_S0000025919_Nora Chase_V247000_300805_Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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