Inspection on 20/06/05 for Northwick Grange

This inspection was carried out on 20th June 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

Northwick Grange 21/05/07

Northwick Grange 31/05/06

Northwick Grange 02/03/06

Northwick Grange 30/11/04

Northwick Grange 08/06/04

Northwick Grange 09/02/04

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 NORTHWICK GRANGE 19 Old Northwick Lane Worcester WR3 7NB Lead Inspector Andrew Spearing-Brown Unannounced 20 June 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. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Northwick Grange Address 19 Old Northwick Lane Worcester WR3 7NB 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) 01905 453916 Northwick Grange Limited Ms Georgina Betty Moss CRH 32 Dementia - over 65 Old age Physical Disability - over 65 32 32 32 Category(ies) of DE(E) registration, with number OP of places PD(E) NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are no other conditions of registration other than those refered to on the previous page of this report. Date of last inspection 30/11/04 Brief Description of the Service: Northwick Grange is a Georgian house, situated in a residential area on the outskirts of Worcester. It was first registered in 1993, and is part of the Redwood Care Home group. The home is on three floors and provides a stair lift to all bedrooms. Northwick Grange provides personal care for a maximum of thirty- two older people who may have a physical disability and or a mental health need associated with the ageing process. A comfortable lounge and dining room are provided on the ground floor. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken by two inspectors from the Worcester office of the Commission for Social Care Inspection (CSCI). This visit consisted of just less than six hours of inspection time. The last inspection took place at the end of November 2004. The main focus of this inspection was therefore to assess the progress made in relation to the requirements from the previous inspection. On the day of this inspection the registered manager and her deputy were on duty. Other staff consulted included a senior carer and the cook. Many areas of the home were seen including some bedrooms and all communal rooms. The care records of a small sample of residents were seen. Other documents seen included medication records, fire records and some training records and some policies and procedures. What the service does well: What has improved since the last inspection? There had been improvement in the care plan documentation since the last inspection however initial assessments remain in need of improvement. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 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 NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 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) 3 and 4. Standard 9 is not applicable to Northwick Grange Residents are assessed prior to admission to the home: the information contained in the document was not sufficient to allow a care plan to be developed, placing residents at risk. EVIDENCE: The care plan and documentation of a recently admitted resident was viewed. The initial assessment was of a poor quality and did not contain sufficient information regarding individual care needs to ensure that the initial care plan could be implemented. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 9 Northwick Grange is registered to care for people with a dementia type illness. Despite this approximately 33 of staff have not received any training in dementia care. The training matrix seen indicated that some staff who have received training undertook it in 2002 and have not received any up date since that date. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.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 9 Progress has been made in improving care plans; development needs to continue to ensure residents receive consistent care by means of having full and effective plans available for staff to refer to. The home needs to improve arrangements for administration and recording of medication as current standards and practices could potentially place residents at risk. EVIDENCE: Representative samples of care plans were viewed as part of the inspection. The information contained upon them was appropriate, easy to read and would enable staff to carry out those identified care needs. However the care plan of a resident who had recently died contained some conflicting information for example ‘encourage mobilization’ while also stating ‘ not mobile’. A loss of weight was recorded without a record of any required intervention. Another event noted within daily records was not reflected in the monthly review of the care plan. No photographs of residents were held on file for the purpose of identification. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 11 Care plans did not include any details of residents’ choice surrounding the time they are got up or return to bed. Risk assessments regarding the prevention of falls were in need of developing. A number of requirements were set following the last inspection regarding medication procedures. Some improvement was noted on this occasion. However other areas continue to need improvement, for example, it was noted that secondary dispensing was taking place whereby medication was taken from the monitored dosage system and placed into a plastic ‘pot’ prior to administering to residents. Furthermore hand written amendments to the Medication Administration Record (MAR) sheets were not double signed, one MAR sheet had no instructions regarding the dosage of a painkiller and the section on each MAR sheet regarding any known allergies were blank, these records must state ‘none known’ if that is the case. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.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 and 15 Opportunities for residents to engage and participate in activities or interests need to be improved. Meals were provided in comfortable surroundings but the choice of menu and availability of fresh products needs improvement. EVIDENCE: Meaningful and purposeful activities are not regularly carried out, carers have limited availability for such activities and no records exist of those that have happened. A programme, which was seen, contained activities such as bingo, cards, reminiscence, knitting and dancing – these may not be accessible or appropriate to a number of residents residing at Northwick Grange. Residents had a choice of mid day meal however as one was gammon and the other sausage it is assumed that both consisted of pork. No fresh vegetables were available as the delivery had not come therefore all were frozen. The dining room was suitably laid up for lunch; residents were seen to have a drink available to them. Residents who needed assistance with feeding were offered it appropriately. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 13 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 The information displayed regarding the complaints procedure needs to be improved to ensure that residents views are safeguarded. The policies and procedures detailing the action to be taken in the event of an allegation of abuse need to be improved. EVIDENCE: The complaints procedure on display in the entrance hall made reference to the former National Care Standards Commission. Furthermore the address of the Birmingham office of the Commission was given as opposed to the Worcester office. A number of staff were consulted, while they were aware of the home’s complaints procedure the CSCI did not form any part of their response. The protection of vulnerable adult policies and procedures are not sufficiently robust and do not contain the necessary information such as telephone number for the adult protection coordinator employed by the County Council. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 14 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 and 26 Shortfalls in environmental standards do not provide a safe and comfortable environment for residents to live in. EVIDENCE: During a tour of the home a number of matters needing attention were noted. Some shortfalls reflected upon a lack of regard for residents’ privacy and dignity such no locks on bedroom doors, the upstairs bathroom and the toilet off the lounge. In addition no lockable furniture is provided. Other shortfalls showed deficits in health and safety such as a light not functioning and worn carpets. Some areas of infection control need improvement, in particular the lack of towels that were in place within the toilets; this was especially noted in the toilet near to the lounge. Other infection control shortfalls included having no liquid soap in toilets and carers continuing to wear disposable gloves having toileted a resident and attending to another resident’s needs. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 15 Northwick Grange is registered to care for older people with a dementia type illness the however suitable signage on toilets and bathrooms as a means to promote a degree of independence is lacking. It was noted that a list on bedroom doors stated ‘N/F’ in relation to hot water temperature checks. The registered manager believed this meant that fail-safe thermostatic control valves are ‘not fitted’ although confirmation was not obtained. It was noted that caution very hot water stickers were in place. Window restrictors were in place; assurance was given that bedrooms identified as a significant risk at the time of the last inspection now have suitable restrictors in place. Heating and lighting levels were not assessed on this occasion, as the weather was warm and sunny. The laundry contained two washing machines neither, of which have a sluice facility. The home was free of odour when the inspectors arrived at lunchtime. A malodour was noted in the entrance hall first thing in the morning. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 16 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 Residents could be placed at risk due to insufficient numbers of staff and inflexible routines at certain hours of the day. An insufficient number of carers have received training in dementia care to ensure that care needs can be met. EVIDENCE: Although the inspectors only stayed for ½ an hour on arriving at 7.45 am prior to leaving and returning later in the day it was noted that at least 17 residents were up and were sitting in the lounge. Some residents were sleeping. It was evidenced that night staff start getting residents up from 6.00 am in order that all those identified via a list are got up. This is unacceptably early unless residents make a positive and informed choice to be up. No indication of residents making such a choice was recorded upon the care plan. The above practice is as a result of staffing levels between 8.00 pm and 8.00 am the following morning, when only two carers are currently on shift. Similarly it is necessary for staff to undress and sit residents in night clothing before 8.00 pm due to staffing levels after that time. As some residents will require two carers to put them to bed this results in the entire staff on duty attending to one persons care needs. Care staff are supplied with a list of residents who they have to get up in the morning; additionally a bath rota exists which demonstrates a task orientated regime, based on staffing levels rather than one which offers genuine choice around daily routines. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 17 Taking the above into consideration, as well as the size and layout of the home, staffing levels must be reviewed during the early morning and late evening. The 8.00 am handover between the night staff and the senior on duty was particularly poor in that only two residents were discussed NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 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) 37 and 38 Shortfalls in health and safety practices and training at Northwick Grange could potentially place residents and staff at risk. EVIDENCE: Care records were left unsecured within a trolley in a corridor thus not preventing unauthorised access to information. Information contained within one care plan, which was also recorded on an accident form was noted. The event recorded was not reported to the CSCI as required under Regulation 37 of the Care Home Regulations 2001. It was evident that a member of staff who may have a need to report incidents was not aware of this requirement. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 19 The fire log was examined. This log contained a report sheet following a recent service of the fire / smoke detectors, the emergency lighting and the fire panel. This report indicated that some ‘old’ items of equipment need to be renewed. The report was discussed with the registered provider who stated that he had discussed the matter with a fire officer from Hereford and Worcester Combined Fire Authority who did not believe the items needed to be replaced. The report from the fire officer’s visit has not, as yet, arrived at the home. A copy of the fire officer’s report should be forwarded to the CSCI. The fire log was poorly compiled, although it indicated that the vast majority of the required weekly / monthly checks take place; the information recorded was scant and unsatisfactory. Not all the fire signage was in line with the required standard in that some was not pictorial. The fire exit sign over a door leading out of a door stairs corridor was partly obscured by a curtain track. The training matrix indicated that some staff have not received either mandatory training or up dates to mandatory training. The last fire training recorded was in November 2004 – no refresher training was recorded. Other training shortfalls were noted in relation to: moving and handling, basic food hygiene and infection control. The registered individual had previously informed the CSCI that a risk assessment in line with current health and safety guidelines is being developed with regard to legionella. Carers were seen pushing a wheelchair occupied by a resident without footrests in place. The using of wheelchairs without footrests can be potential hazardous. It was of concern to note that the cellar door was open on arriving at the home. The inspector was able to enter this area and descend the brick stairs out of the sight from any member of staff. Residents could therefore potentially have accessed this area, which could have posed a serious health and safety risk. The registered manager was required to take immediate action to ensure that the door remains locked at all times. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 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 x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 1 x 1 x x 1 x 1 STAFFING Standard No Score 27 1 28 x 29 x 30 x 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 x x x x 2 1 NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 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 2 Regulation 5 Requirement The statement of terms and conditions must be amended so that it includes all the information detailed in Standard 2.2 and accurately reflects the services offered at the home. (This standard was not assessed as part of the inspection carried out on 20th June 2005. The timeframe previously set remains - this requirement will therefore be re- assessed as part of a future inspection). A written assessment must be completed in detail, before the admission of any service user and in accordance with the requirements of Regulation 14 and Standard 3. (Previous timescale of 31/03/05 not met). All staff must receive training in Dementia care to meet the specialist needs of the service user and to reflect the service that the home provides. (Previous timescale of 31/03/05 not met). NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 22 Timescale for action 31/03/05 2. 3 14 immediate and on going 3. 4 18 (1) (a) 30/09/05 4. 7 15 (1) Service user plans must be recorded in a style accessible to the service user, agreed and signed by the service user whenever capable and/or their representative (if any). (Previous timescale of 31/01/05 not met). 31/08/05 5. 7 15 (2) Care plans must be reviewed on a monthly basis or more frequently to reflect changing care needs. Care plans must include all aspect of residents daily routines including those around getting up in the morning. Secondary dispensing of medication must not take place. Manual amendments to MAR (Medication Administration Record) charts must be signed by two members of staff and dated. (Previous timescale of immediate and on going not met). immediate and on going immediate and on going immediate and on going immediate and on going 6. 7 15 7. 9 13 (2) 8. 9 13 (2) 9. 9 13 (2) The prescribed dosage of all mediaction must be recorded upon the MAR charts. immediate and on going 10. 9 13 (2) Details of any known allergies must be recorded onto service users’ MAR charts. When none is known, “none known” must be recorded. (Previous timescale of immediate immediate and on going NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 23 and on going not met). 11. 16 22 The complaints procedure must be in line with the regulation 22 and standard 16 The procedure for dealing with suspicions or alligations of abuse must be reviewed. All areas of the home must be kept in good repair and good order.. The use of suitable signage to promote a degree of independence of residents with a dementia type illness must be reviewed. The bathroom facility located on the second floor of the home must be reviewed and upgraded if the second floor area is to continue to provide accommodation to service users. (Previous timescale of 31/03/05 not met). 16. 24 23 (2) (b) Service users must be provided with single action locks on their bedroom doors to provide privacy and means of escape in the event of a fire. (Previous timescale of 31/03/05 not met). 17. 24 23 (2)(m) Residents must be provided with a lockable piece of furniture for the safe storage of valuables. All fatigued items of bedroom furnishing must be replaced. 31/08/05 31/08/05 31/07/05 12. 18 12 13 13. 19 13 (4) 23 (2) (b) 31/08/05 14. 19 23 (2) (a) (b) 31/08/05 15. 21 23 (2) (j) 31/08/05 18. 24 16(2)(c) 31/08/05 Page 24 NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 (Previous timescale of 31/03/05 not met). 19. 24 16(2)(c) Fatigued floor coverings must be replaced. (Previous timescale of 31/03/05 not met). 20. 24 13 (4) The loose carpet leading into the indentified bedroom must be secured. All staff must receive training in infection control. (Previous timescale of 28/02/05 not met). 22. 26 13 (3) Effective infection control measures must be in place. Staffing levels at the home must be reviewed, to ensure service users’ needs are effectively met during the daytime and nighttime periods. (Previous timescale of 31/01/05 not met). 24. 33 24 A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (This standard was not assessed as part of the inspection carried out on 20th June 2005. The timeframe previously set remains - this requirement will therefore be re- assessed as part of a future inspection). 25. 37 17 Residents care plans and other records must be held securly at E52 S18666 Northwick Grange V224319 200605.doc 31/07/05 immediate and on going 31/08/05 21. 26 13(3) 18(1)(a) immediate and on going immediate and on going 23. 27 18 (1) 28/02/05 immediate and on Page 25 NORTHWICK GRANGE Version 1.30 all times. 26. 38 37 The CSCI must be notified of certain events as required under regulation 37 The fire log must be appropriately completed A copy of the most recent fire officers report must be forwarded to the CSCI once it arrives at the home. going immediate and on going immediate and on going within 7 days of receiving the report from the fire officer action plan to be received within 7 days of this report. 31/07/05 27. 28. 38 38 23 (4) 23 (4) 29. 38 18 All staff must receive core / mandatory training. 30. 38 13(4)(a) (c) The most recent Legionella risk assessment must be forwarded to the CSCI, along with details of any work undertaken arising from the risk assessment. (This standard was not assessed as part of the inspection carried out on 20th June 2005. The timeframe previously set remains - this requirement will therefore be re- assessed as part of a future inspection). 31. 38 13 Foot rest on wheelchairs must be used at all times. The door to be cellar must be locked at all times to prevent unauthorised access. immediate and on going immeidate and on going 32. 38 13 33. 34. NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 26 35. 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 Good Practice Recommendations NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 27 Commission for Social Care Inspection The Coach House John Comyn Drive Droitwich Road Worcester WR3 7NW 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 NORTHWICK GRANGE E52 S18666 Northwick Grange V224319 200605.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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