Inspection on 17/05/06 for Orchard (The) - Leonard Cheshire Disability

This inspection was carried out on 17th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard (The) - Leonard Cheshire... 17/04/07

Orchard (The) - Leonard Cheshire... 04/01/06

Orchard (The) - Leonard Cheshire... 27/04/05

Orchard (The) - Leonard Cheshire... 01/09/04

Orchard (The) - Leonard Cheshire... 12/05/04

Orchard (The) - Leonard Cheshire... 03/02/04

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

CARE HOME ADULTS 18-65 Orchard (The) Woolton Road Liverpool Merseyside L25 7UL Lead Inspector Peter Cresswell Key Unannounced Inspection 17th May 2006 09:00 Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard (The) Address Woolton Road Liverpool Merseyside L25 7UL 0151 428 8671 0151 421 1356 www.leonard-cheshire.org.uk. www.leonard-cheshire.org.uk Leonard Cheshire Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Michelle Maxwell Care Home 26 Category(ies) of Physical disability (20), Physical disability over registration, with number 65 years of age (6) of places Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: The Orchard is a care home for 26 disabled adults, owned by ‘Leonard Cheshire’, a charity that provides a variety of services for disabled people in the United Kingdom and Europe. The home is in a suburb of south Liverpool, a short drive from Woolton Village, where there is a range of shops, pubs, a post office, banks and many other amenities. The Orchard is purpose built, standing in its own well-maintained and accessible grounds. All service users accommodation and facilities are on the ground floor. Service users have single bedrooms though one bedroom can be for shared if required. Four bedrooms have en-suite facilities. There are three lounges, one of which has a wide range of games, activities, and a computer with internet access. The breakfast/coffee bar, where service users can make drinks and snacks, is linked to the dining room. The home employs a full time activities co-ordinator who - with the support of service users, volunteers and staff - plans and supports a varied range of activities and entertainment within and outside The Orchard. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to a number of residents and staff, including the manager, the owner’s general manager (very briefly), a support worker and a team leader. He toured the building, including a number of bedrooms and the kitchen. The inspector checked the home’s medication procedures and examined a number of records, including care plans for four residents, safety records, recruitment records for new staff, and the home’s quality assurance processes. The Registered Manager completed a detailed pre-inspection questionnaire before the site visit. Questionnaires were sent to a number of service users and one responded shortly after the site visit. The visit on 17 May lasted over five hours. What the service does well: What has improved since the last inspection? The manager has completed a detailed internal quality assurance document and the owners have carried out a detailed audit of the home. This resulted in a number of recommendations for action and there is a detailed record of the action the manager is taking to carry them out. The residents themselves have devised a new menu, with particular improvements to evening meals, which was due to start shortly after this inspection. Kitchen fridge temperatures are recorded adequately. A programme for reviewing care plans was in place though some reviews were still overdue. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 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. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. Quality in this outcome area is good. Material is available to ensure that prospective service users have information about the home. People are thoroughly assessed before admission, using nationally agreed procedures, thus ensuring that The Orchard can meet their needs. EVIDENCE: One new service user had been admitted since the last inspection. He had been assessed in his previous care home by the manager and the Care Services Manager (deputy). They had completed a detailed assessment document that is used nationally by the Leonard Cheshire organisation. The service user’s family had been closely involved in the assessment and the move and had helped staff to prepare a very detailed and informative pen picture. The service user said that he had not been to the home for a trial stay, as he did not feel that it had been necessary. He told the inspector that he was very pleased with the move. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. Quality in this outcome area is adequate. Care plans provide staff with the information they need to care for the service users. Service users are involved as far as possible in every aspect of the home’s life. However, the programme of reviews needs to be completed to ensure that information is up to date. EVIDENCE: Each service user has a detailed Individual Service Plan (ISP) and a care plan summary is drawn up from this. The Registered Person’s policy is for ISPs/care plans to be reviewed every three months, with a major review once a year. This programme was well behind, and one of the files examined had not been reviewed since April 2005. The issue has been identified in both the quality assurance audit of the home and the internal self-assessment and the Registered Manager said that a schedule for reviews had been drawn up. It is important that this programme is completed as soon as possible. The files also contain detailed pen pictures that give a useful overall impression of the person concerned. These are drawn up with the service users and, where they wish, their families. The daily reports file is kept separately and it may be helpful if the care plan summaries were filed with the daily reports, so that staff have immediate access to the fundamentals of the care plan. The existing system seems to place a high premium on staff’s ability to remember Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 10 detailed information without recourse to written plans. This was also mentioned in the previous report. The Registered Manager is keen to involve the service users more in the use and development of the ISPs and said she is hoping to arrange relevant training for service users through the Disabled People’s Forum. Service users make their own decisions unless there is good reason for any limitations, which are then carefully recorded on the ISP. Service users have regular meetings and also take part in staff interviews. A recent service user meeting decided to revise the whole menu. Service users are also invited to complete questionnaires on how the home is running. The manager compiles the results and takes action on them where that is appropriate. Service users are encouraged to take appropriate and proportionate risks and risk assessments are in place. For instance, when problems emerged with one service user’s independent visits to a particular location, steps were taken to ensure that in future the service user was accompanied by a member of staff or a volunteer. One service user returned a CSCI questionnaire to the inspector, which had been completed with the support of a relative. The service user said that the staff and the care provided were ‘good’ and he was involved in activities arranged by the home. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. The Orchard has good links with the community and staff encourage and support service users to pursue activities and pastimes of their choice. Service users have devised a new menu for the home, ensuring that they will get the meals that they enjoy. EVIDENCE: The Orchard has a full time activities organiser who, with the support of other staff, service users and volunteers, arranges a wide range of activities, both inside the home and externally. Two full time volunteers are staying at the home, on a ‘gap year’ from Australia. Teaching and support staff from Hugh Baird Further Education College provide courses for IT, craftwork, local history and drama on the premises. On the day of the inspection some service users took part in an IT class. Service users who took part in the courses all said how much they enjoyed them. The courses lead to recognised qualifications. Staff accompany individual service users on individual social days, which are activities chosen by the service user. Other recent trips have included theatre visits to see Blood Brothers (a particular favourite) and Hello Dolly at the Empire. Again, those service users who had been on the trips said how much they had enjoyed them. The home has a vehicle that has recently been fitted with a new hoist which can cope with all of the residents’ wheelchairs. The Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 12 Registered Manager has introduced a new system for recording activities. This is not yet fully in place for all service users but the old system did need replacing as it often failed to give a full picture of the activities in which they took part. Activities within the home include craftwork, baking, board games, movies and coffee mornings. The activities room has computers installed and many residents also have their own computers in their rooms as well as televisions and radios. The Orchard has recently received a donation from a major bank, which is being used to provide a fully accessible greenhouse in the grounds. The service users plan to grow their own vegetables in the greenhouse and also in the garden, in what they, perhaps optimistically, call their ‘self sufficiency’ project. Families and friends are closely involved with many of the service users, one of whom told the inspector that members of his family visited every day. Many service users prepare their own breakfast at the breakfast/drinks bar. The service users, with the support of staff, have recently completely revamped the menu. The main meal will continue to be served at lunchtime, which is the service users’ choice. The new menu includes chicken curry, spaghetti Bolognese, beef casserole with dumplings, and toad in the hole. There are no formal choices on the draft lunchtime menu but the cook and the Registered Manager said that individual choices will always be catered for. On the day of the site visit all service users seemed to have the dish of the day and those who needed help were helped discreetly. At least one service user had chosen to eat in her own room and was using specially adapted utensils. Choice at the evening meal has been improved, with cooked options such as ‘bubble and squeak’, hot baguettes and cauliflower cheese on the new menu. The service users were looking forward to the new menu. The service user questionnaire that was returned said that the service user liked the food ‘usually’ but this was before the menu had been revised. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Basic medication systems are sound but have not been properly implemented in some cases. EVIDENCE: Care plans set out service users’ views on how they wish to be supported, including whether they have a preference for male or female staff to provide personal care. Visits by health care professionals are recorded on the files. Concerns about skin integrity are reported promptly to the district nurse. The recent quality audit identified that if any service users wanted to look after their own medication there are few facilities in which they can be locked. The Registered Manager said that this was in hand. Those service users who currently look after their own medication do have secure, accessible facilities. Most medication is securely stored in service users’ own rooms in facilities that are not accessible to the service user. The Monitored Dosage System is now provided by a new pharmacist who also provides training for staff. On the whole, medication was in order and its administration was properly recorded on the Medication Administration Record sheets. However, there were some shortcomings in the way that the administration of medication had been recorded in two cases. Some days had been left completely blank even though the tablets were no longer in the container; staff initials in other places had been scratched out with no further explanation. Where a service user had Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 14 been on holiday a ‘D’ (‘social leave’ in the key) had been entered without further explanation, though the medication was not in the system and had presumably been administered whilst on holiday. It was not clear how it had been recorded (possibly by using a photocopy) but whatever is done must be fully recorded and kept on file. The Registered Manager may wish to reconsider the home’s policy for medication whilst on holiday, possibly by requesting separate prescriptions for each holiday. In some cases where a service user had been to an evening theatre visit their evening medication had not been administered and a ‘D’ entered. Staff said that in these cases service users had probably returned by about 11.30 pm and there is therefore no evident reason why the medication should not have been given. The manager should review the home’s practices in these circumstances. Medication requiring refrigeration is kept in a lockable, dedicated fridge in the staff office. The fridge temperature is checked each day and recorded. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. The home has satisfactory complaints and adult abuse procedures to protect the interests of the service users. EVIDENCE: The organisation has clear procedures for dealing with complaints and allegations of abuse. Two complaints have been received in the last year and have been dealt with appropriately. One was investigated by the Commission for Social Care Inspection and a report has been completed. Staff receive training in adult abuse procedures. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. The home is clean, well maintained, and on the whole well decorated, providing a comfortable environment for the service users. EVIDENCE: The home is purpose built and has a range of comfortable communal spaces. These include a spacious dining room/coffee bar and a large internal courtyard. Corridors are wide, allowing independent wheelchair users to move around the home freely. Service users have spacious single bedrooms, four of them with en suite facilities. All have built in electric ceiling hoists. Bedrooms are on the whole adequately decorated and furnished. Door surrounds receive very heavy wear from the wheelchairs and improved protective measures have not yet been fitted, making the doors and corridors unsightly. The Orchard has sufficient baths, assisted bathing facilities and toilets. Some of the toilets have been modernised but others still look rather old fashioned and would benefit from modernisation. The locks on toilet H and the bathroom opposite room 18 cannot be opened from the outside. This was identified at the last inspection and the work must now be carried out without delay. The home was clean and odour free. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is good. Staff recruitment and training procedures help to ensure that well trained care, support and ancillary staff are available to meet the needs of the service users. Staff are supported by volunteers who are fully checked before recruitment, providing additional support for service users, especially with activities. EVIDENCE: The home is adequately staffed. In addition to the Registered Manager the home is staffed at all times by a Team Leader and between four and six care staff. In addition there is a Care Supervisor (deputy manager), Activities Organiser, domestic staff, kitchen staff and administrative staff, ensuring that the care workers are able to concentrate on care and support. At the moment, volunteers work with the service users for around 198 hours a week. Some funding authorities (Social Services Departments and Primary Care Trusts) pay for additional hours for particular residents. This pays for staff from specialist agencies to help to provide one-to-one support for activities. 15 care staff (56 ) have at least NVQ2 and a further seven are working towards it. The remaining staff will begin a course some time during 2006. Leonard Cheshire has an extensive training programme but at the time of the site visit The Orchard did not yet have its 2006-07 training programme in place. The Registered Manager said that it would be available shortly and would be similar to the previous year’s. That included training on the Protection Of Vulnerable Adults (POVA), Risk Assessment, Manual Handling, Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 18 Health and Safety First Aid and Recruitment. Staff receive regular supervision and records are kept though they were not scrutinised on this site visit. The General Manager for the area is also based in the home and provides supervision for the Registered Manager. Three new staff had been employed since the last inspection. All of the necessary checks had been carried out before they were able to start work. One additional recruit is waiting for POVA clearance before she is able to start. Records of the interviews are kept on file and one of the new members of staff confirmed that service users had been present at the interview. Induction training was in progress. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42. Quality in this outcome area is good. The Registered Person has quality assurance procedures in place to ensure that the service users’ views are taken into account in reviewing and improving the service provided. The home takes steps to ensure that service users’ safety is protected. EVIDENCE: The Registered Manager is qualified and experienced. Leonard Cheshire carried out a Quality Assurance audit on The Orchard in November 2005. The audit took place over five days and was conducted by four senior national and regional officers of the organisation. A detailed report was published in January and an implementation meeting held to assess the response of the manager. In addition the manager completed a Self Assessment report on the service in February 2006. The 119 page long assessment covers all aspects of the home’s operation. The national organisation carries out an annual survey of residents/service users in all of its services and the findings are broken down for individual homes. The most recent report was produced in March 2006. This represents a powerful combination of quality assurance tools in addition to the normal line management procedures. The QA audit identified Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 20 electrical work required following an electrical inspection last year and this is in hand. Fire safety procedures were up to date and the manager said that the owners are proposing to fit door closers with an automatic release on service users’ doors. The home currently has adequate fire safety precautions as it is split into four self-contained fire zones, each protected by automatically closing fire doors. Closers to individual rooms would offer additional protection. Accidents are properly recorded and the temperatures of all fridges and freezers, including the medication fridge, are regularly taken and recorded. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 4 X 3 3 X Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 YA6 Regulation 15 Requirement The Registered Person must ensure that all service users’ care plans are regularly reviewed. Timescale for action 01/07/06 2. YA20 13(2) 3. YA24 16 The Registered Person must 01/06/06 make arrangements for the recording and safe administration of medicine and must therefore ensure that: *all medication administered is recorded and accounted for; *medication is administered as prescribed. The Registered Person must 01/08/06 arrange for suitable furniture and decoration in service users bedrooms by repairing and repainting those door surrounds badly marked from wheelchair use. (Originally required by 01/07/05) The Registered Person must ensure the safety of service users by replacing the locks on bathroom H and the bathroom opposite room 18 with locks which are durable and openable DS0000025360.V289062.R01.S.doc 4. YA24 16 01/06/06 Orchard (The) Version 5.1 Page 23 in an emergency from the outside. 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 YA26 Good Practice Recommendations Some toilets are rather old fashioned and institutional in appearance and it is suggested that the Registered Person continues its programme of replacement. Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Orchard (The) DS0000025360.V289062.R01.S.doc Version 5.1 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. 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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