Inspection on 11/07/07 for Pinewood

This inspection was carried out on 11th July 2007.

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

Pinewood 08/11/08

Pinewood 09/11/07

Pinewood 05/06/06

Pinewood 31/01/06

Pinewood 21/06/05

Pinewood 07/10/04

Pinewood 09/06/04

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

CARE HOMES FOR OLDER PEOPLE Pinewood Pinewood Tringham Close Ottershaw Surrey KT16 0HL Lead Inspector Kenneth Dunn Unannounced Inspection 11th July 2007 09:30 X10015.doc Version 1.40 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 Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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 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. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pinewood Address Pinewood Tringham Close Ottershaw Surrey KT16 0HL 01932 872489 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) penny.lamb@surreypct.nhs.uk Welmede Housing Association Ltd Penelope Lamb Care Home 5 Category(ies) of Learning disability over 65 years of age (0) registration, with number of places Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability, over the age of 65 years - (LD(E)) The maximum number of service users to be accommodated is 5. Date of last inspection 5th June 2006 Brief Description of the Service: Pinewood is small home accommodating up to five people who have learning disabilities and are over 65 years of age. The home is a purpose built, single storey property, with five individual bedrooms and a spacious lounge / dining room. A garden is available to the rear of the property and there is a large driveway, with parking space for a number of vehicles. The service is managed by Welmede, a local organisation, which runs a network of homes in the area. Staff at the home are employed by the North Surrey Primary Care Trust (NSPCT). Pinewood is situated in a residential cul-de-sac in Ottershaw, which has a range of local facilities, including shops, post office, pubs and public transport. The larger town of Woking, with its greater range of shops and leisure facilities, is a short drive away. Pinewood is adjacent another home in the Welmede group. Fees range £1153.00 per week. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over 4.5 hours commencing at 09:30 am and ending at 14.00 pm and was undertaken by Mr K Dunn, regulation inspector. The manager was not on duty, but the senior care worker was available and assisted with the inspection process. Three residents allowed their bedrooms to be viewed as part of the inspection process. All the residents were spoken with throughout the visit. The residents and staff were friendly, welcoming and helpful. The residents had previously been assisted by staff to complete comment cards for preinspection data. An annual quality assurance assessment (AQAA) was supplied to the home by CSCI, and this was completed and returned. Information from the AQAA will be referred to in this report. The AQAA states that the home has policies and procedures to promote equality and diversity and all staff have received training, to increase their knowledge and awareness of these issues. Three residents’ files were inspected including their person-centred plans, reviews, risk assessments, medical information and weekly schedules. The recruitment process of five staff members was reviewed and the staff training and development logs viewed. Menus, staff rotas, health and safety certificates and the complaints and compliments log were sampled. The preinspection material supplied by the home and information received since the previous key site visit, as recorded on the inspection record, was also used in compiling this report. What the service does well: The service is good at treating the residents as individuals, ensuring their person-centred plans cover all their assessed needs and that the residents are fully involved in the process of developing and reviewing them. The personcentred plans are well illustrated and describe in clear language a holistic plan of care for the individual, whose likes and dislikes, opinions and aspirations are fully explored. Those things, which mean the most to the individual, are described in their own words and the support required bringing those wishes to fruition. The care plans are reviewed regularly confirming that the resident’s changing needs are being addressed. Minutes of the review meetings are recorded from the resident’s point of view and in a format accessible to them. Health protocols ensure that the individual’s personal and healthcare needs are assessed and that support was provided in the way that they preferred and required. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 6 The home has strong links with the local community, makes good use of the facilities and resources available and the residents have a full programme of activities based on their individual needs and choices. Throughout the day, the staff were observed interacting with the residents and the relationships were warm, supportive, friendly, encouraging and respectful. What has improved since the last inspection? What they could do better: The ratio of staff having achieved or in the process of achieving a National Vocational Award Qualification should be improved to ensure that qualified and competent staff support residents and to professionalize the workforce. The management of the home needs to review the staffing levels to ensure residents are safe at all times. In the event of an emergency it is unsafe for one member of staff to be in the home with five residents. The home needs an office, currently there is a small table in the hall opposite the front door, and any management duties are undertaken there. This is not appropriate when making calls or discussing residents with staff, under the data protection act there is a lack of confidentiality. The computer is positioned on a table in the residents lounge. None of the residents are able to use the computer at the moment, they require training in this area. However there is still outstanding requirement from previous site visits (21/06/05, 28/04/06 & 25/08/06) requiring the front and back garden to be made secure and private for the residents. The kitchen floor must be made level or replaced. (Timescale 21/06/05, 28/04/06, 25/08/06 not met). An annual development plan must be drawn in respect of the care home. (Timescale 21/06/05, 28/04/06 25/08/06 not met). Please contact the provider for advice of actions taken in response to this Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All potential residents are assessed prior to admission to the home to ensure that their needs can be met. EVIDENCE: Clear and concise assessments are in place for all residents in the home, including the social and healthcare needs of the individual. Information contained within the assessment identifies the cultural and diverse needs of potential residents. The inspector was informed that the home does not offer any form of intermediated care. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are provided with an individual care plan, detailing their individual needs and goals. The health needs of the residents are fully developed. The medications policies and procedures ensure that the residents are protected. The residents are supported to make decisions about their lives and are treated with respect and the utmost dignity. EVIDENCE: The inspector sampled care plans for three residents. Each resident has a completed care plan which was person centred in approach and based on full needs assessment including personal care, health and emotional needs, communication, safety and social skills. The individual plans were of a good standard they were very detailed and structured they set clear priorities, objectives and established goals for the residents. Then inspector reviewed clear support plans for routines and outlining the strengths and need of the residents. The care plans clearly defined individual preferences for example favourite community and leisure activities, favourite diet and tasks. It was Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 11 evident that plans were regularly reviewed with the involvement of the residents. There is a key worker system in place and the two members of staff on duty were aware of the care plans and their involvement in the review processes. Plans were agreed and signed by the residents and where this was not possible this was recorded in their plan. The residents are invited to their reviews and comment cards received from the residents and their family members indicate that staff listen to their views and act upon them. The service has a set of policies and procedure in place for the administration, storage and recording of medication. The inspector cunducted a random sample of medications one arithmetic error was found resulting in a incorrect total being recorded on a residents MAR sheet. This was discussed with the staff member on duty who accepted the error and indicated that thie would be immediately rectified. The inspector was informed that the home had a policy on privacy and dignity and staff have training in privacy and dignity, this is reflected in the staff induction programme. Observations confirmed staff addressed the residents by their preferred names and knocked on doors before entering bedrooms and bathrooms. The cultural and diverse needs of people living in the home has been assessed and action taken to meet these needs where possible. Family and professional visitors who have visited the service have praised the work that is undertaken by staff and have stated that they are always made welcome and that their relatives enjoy living in the home. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities at the home are good satisfying the social, recreational, religious and leisure needs of the residents. The arrangements for community contact are good promoting links with families and friends. Policies and procedures are in place to enable the individuals to exercise choice over their lives. Meals at the home offer variety, choice and healthy eating options. EVIDENCE: The home provides a range of recreational and leisure activities for the residents to attend. It was clear that activities were tailored to suit individual needs and preferences. An activity plan was available for each individual and three plans were sampled which included for example attending cooking, bowling, pottery and gardening. Three residents attend the local Church of England service every Sunday and in addition they attend the Church Rainbow social club once a month. One resident attends a regular monthly care mass with a friend from the local community. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 13 The inspector was informed that one of the residents is in the process of preparing to go on an annual holidays to Devon. The inspector was provided with copies of the homes menus, which were varied and well balanced with the residents being given the opportunity to make choices about their meals, and this is discussed as an agenda item during their weekly meetings. The residents spoke positively about the meals provided. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed during this inspection. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints process ensures the residents and their family members feel confident that any complaints will be listened to and acted upon. The arrangements for safeguarding adults are robust and designed to safeguard the welfare of residents. EVIDENCE: There is a complaints procedure in place, which complies with the National Minimum Standards. A review of the complaints log indicated that there have been no complaints made since the last inspection. The CSCI has not received any complaint regarding the service since the last report. The homes has policies and procedures in place for the protection of vulnerable adults and a whistle blowing policy. The inspector was informed that all staff have received the protection of vulnerable adults training. Staff on duty confirmed they had undertaken this training and were aware of the procedures. The home has a copy of Surrey Multi Agency procedures. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed during this inspection. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Internally the residents live in comfortable and homely environment, although hazards to residents’ health and safety have not been addressed. However there is still a two outstanding requirement from three previous site visits (21/06/05, 28/04/06 & 25/08/06) requiring the front and back garden to be made secure and private for the residents. The home is clean and hygienic ensuring that the residents have a pleasant home to live in. EVIDENCE: The home was found to be clean and tidy. Some of the residents like to be involved with the cleaning in their bedrooms and other jobs around the house. During the course of this visit two residents were seen cleaning and tiding not only their bedrooms but parts of the communal areas as well. The bedrooms were individual and the residents were proud to show the inspector their bedrooms and their choices in colours and furnishing for their private areas. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 16 Internally the home is decorated and furnished to a good standard, but improvements urgently need to be made in some areas to safeguard resident’s health and safety. The floor in the laundry is uneven and must be considered a serious trip hazard, to residents and staff. There is also an outstanding requirement on making the kitchen floor level, again because of potential trips (Timescales of 21/06/05, 28/04/06 and 25/08/06 have not been met). This is also referred to at Standard 38, which relates to health and safety. In addition there is an urgent need for external maintaince to be carried out to ensure that the gutters are free from debris and possible water penetration. The garden was also subject to requirements from the previous reports and again this was not actioned. The garden still requires to be fenced front and back to ensure residents have privacy and are safe when opening the patio door. (Not met 28/07/06) The home is still using the hallway opposite the front door as an office. This practices was discussed during the previous site visit when it was demeaned unacceptable for staff to be discussing residents, making telephone calls about residents in the hallway. It also still the practice for staff to use the computer, which is situated on a table in the lounge/dining, area of the home. The residents are currently not able to use the computer until they have received appropriate training. This was previously discussed (25/08/06) as a direct infringement on the resident’s home and an alternative space for this must be found. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed during this inspection. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing must be reviewed to ensure that sufficient numbers of staff are on duty to meet the needs of residents. Training is continual. Recruitment and vetting practices are good safeguarding the welfare of service users. The arrangements for the induction training of staff is well developed. EVIDENCE: Staffing levels at Pinewood must be reviewed the inspector was informed that the home is normally staffed two cares on both early and late shifts and one carer over night. The manager operates out of Pinewood and the care home next door. This level could cause potential problems during peak times if an incident occurs and one member of staff is has to react to rectify the predicament. Two members of staff have completed National Vocational Qualifications (level 3) and one member pf staff has recently started to work towards the qualification. Each member of staff has their own training record in place and it was evident that staff have received mandatory training in safeguarding adults, fire, food handling, food hygiene manual handling, health and safety, first aid and managing medication. The inspector was informed that staff have all received training in recognising the residents rights and ensuring they are treated with dignity at all times. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 18 The home had a policy on staff recruitment and it was confirmed that prospective employees are vetted before being employed by the home. The inspector sampled staff recruitment files which contained completed application forms, written references, statement of terms and conditions, training records, CRB (Criminal Record Bureau) disclosure information, a recent photograph of the employee and staff have copies of the GSCC (General Social Care Council) code of practice to safeguard the welfare of the residents. The inspector noted staff recruitment files were securely stored in the office of the neighbouring home to promote confidentiality. The files must be kept on site and is further evidence to support the needs to supply Pinewood with a secure office of its own. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed during this inspection. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although many aspects of the home’s operation are effectively managed, there has been a consistent failure by the home to comply with requirements set over the last 3 CSCI site visits and as a result the overall safety of the residents could be compromised. EVIDENCE: The manager who was registered by the CSCI in January 2007 is meeting the general day-to-day management of the home. The manager oversees two care home next door to one and other this practices should be reviewed to enable the service to be more effectively managed by one person on site in a full time capacity. However weaknesses have been noted in the management and organisational structures of the home, requirements that have been made over the course of Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 20 three previous site visits (21/06/05, 28/04/06 and 25/08/06) concerning the health and safety of the residents have not been met and rectification of these must now be an urgent priority. Please refer to pages 23 and 24 of this report. The inspector received pre- inspection information (AQAA), which indicates that the organisation provides a range of policies, and procedures, which have been updated with the manger bringing this information to staff attention during staff meetings. The inspector reviewed policies, which clearly demonstrated consistent reviews in line with information received from the AQAA. There is clear indication that for the most parts the home is in deed run with the best of the residents and the CSCI have received comment cards from the residents and there families that would indicate that staff listen to them and act on what they say. In addition records at the home indicate that the residents are supported to have a voice and to come forward with thoughts and requests if they have any. The inspector was informed that the staff are responsible for supporting the residents manages their own finances. The inspector was also told that all of the residents have their own bank accounts and money is paid from their bank account for their fees, accommodation and care. One member of staff stated that the resident’s manage their own day-to-day personal finances and allowance with staff support. It is the responsibility of the staff to record all transactions in individual ledgers to ensure open and accountable financial dealings. The inspector was informed that the ledgers are regularly audited by the organisation and have been randomly scrutinised by an outside auditors. An amenity fund covers resident’s holidays and outings. The home had a policy on health and safety and staff have training in health and safety, fire safety, food hygiene, infection control and other relevant and appropriate training. Further evidence confirmed the home had a policy on COSHH (Control of Substances Hazardous to Health) with products stored in a locked cupboard to promote safety. A random review of records indicated the home had a gas safety certificate dated 21/05/07, fire alarm certificate dated 14/06/07, Assisted bath check certificate dated 11,05,07 and service inspection records pertaining to fire safety, emergency lighting and other equipment were up to date and valid. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 3 Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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 OP19 Regulation 13 Requirement The responsible person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks. The kitchen floor must be made level or replaced. (Timescale 21/06/05, 28/04/06 & 25/08/06 not met). The registered person must ensure that the home is conducted so as to promote and make provision for the health and welfare of service users. The management of the home must be reviewed. (Timescale 28/04/06 & 25/07/06 not met). An annual development plan must be drawn in respect of the care home. (Timescale 21/06/05, 28/04/06 & 25/07/06 not met). The garden needs to be fenced DS0000013749.V340317.R01.S.doc Timescale for action 25/08/07 2. OP31 12 28/08/07 3. OP33 25 28/08/07 4. Pinewood OP19 23 28/08/07 Page 23 Version 5.2 front and back to ensure residents have privacy and are safe when opening the patio door. (Not met 28/07/06) 5. 6. OP19 OP27 13 18.1 (a) The laundry floor must be made level or replaced. Staffing levels at Pinewood must be reviewed to ensure that there are sufficient staff on duties at all times for the safety of the residents 06/08/07 06/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP36 Good Practice Recommendations The home needs office space to ensure the privacy and dignity of all residents. The staff files should be kept on site in Pinewood. Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Pinewood DS0000013749.V340317.R01.S.doc Version 5.2 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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