CARE HOMES FOR OLDER PEOPLE
Rosewell Country Home Church Hill High Littleton Bath & N E Somerset BS39 6HF Lead Inspector
Kathy Marshalsea Unannounced 13 July 2005 10:30
th 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. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Rosewell Country Home Address Church Hill High Littleton Bath & N E Somerset BS39 6HF 01761 472062 01761 479124 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) European Care (UK) Limited Ms Gillian Galloway Care home with nursing 94 Category(ies) of OP Old age (94) registration, with number PD Physical disability (6) of places Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 6 Beds may be for young physically disabled persons age 18-50 years. Staffing Notice dated 18/04/2001 applies. Manager must be a RN on parts 1 of 12 of the NMC register. May accommodate up to 60 persons aged 50 years and over requiring nursing care, in the Main House. May allocate up to 34 persons aged 65 years and over requiring Personal Care only, in the Farm House. May accommodate up to 40 persons aged 65 years and over requiring personal care only, in the Main House. May accommodate one named individual requiring nursing care in the `Farmhouse` until such time as her nursing needs increase to the point that the `Farmhouse` is unsuitable to meet those needs, or she chooses to move. Date of last inspection 10 March 2005 Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 5 Brief Description of the Service: Rosewell Country Home is an extended farmhouse situated in the village of High Littleton. The accommodation consists of an open style conservatory entrance area, which links the Farmhouse and Main house. The conservatory area provides a focal point for the home, housing the main reception, hairdressing salon, small shop, service user seating, a piano and a small bistro. The accommodation in the farmhouse consists of single and double en-suite rooms (WC & hand basin) with 3 stair lifts and is registered for social care (residential) service users. Not all rooms in the Farmhouse have level access from the stair lifts The main house provides accommodation over three floors. There is lift access to all floors and each floor has a separate communal lounge and dining facility. Bedrooms vary in size, most are en-suite (WC & hand basin) and there are assisted bathrooms and shower rooms on each floor. The home is registered for a maximum occupancy of 94 but the usual operational maximum is lower than this because few of the 12 double-sized rooms are in shared use at any one time. The home offers respite care subject to bed availability. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. The focus of this inspection was to assess nursing care. The inspectors toured the main building, spoke with staff, residents and relatives, read documents and observed care practices. There were many issues of concern which will be detailed in the report. A meeting has been arranged with representatives from European Care to discuss these concerns. Immediate requirements were issued at the end of the inspection. These were actioned by the manager and complied with the timescales set. There will be a requirement that the organisation seeks specialist advice about whether the environment (particularly on the top floor- Bluebell) is suitable for those residents with cognitive impairments. What the service does well: What has improved since the last inspection? What they could do better:
During the tour of the building the inspectors were concerned to note that on the two nursing care floors no residents who were in the lounges had a drink in front of them, despite the weather being humid and very warm. When staff on both floors were questioned about this they indicated that this was usual practice, and that drinks are given out at set times. The inspectors required that cool drinks were available for all residents at all times, particularly when it is very warm. This was done. The care files, which include all assessments and care plans, were locked in the treatment room, which is on the ground floor. Although staff said that they are able to go downstairs, in reality this is not practical. They must have access to this vital information to be fully informed of their residents care needs.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 7 When questioned about the care of several residents on both floors staff were not following the planned care which the inspectors had read in the care plans. This is of major concern as needs prescribed were not being met. This needed urgent action to remedy. The manager agreed to move the care plans so that they were more accessible. The rooms on Bluebell have restricted light due to the fact that they are dormer windows. The residents cannot see out of the windows in the lounge, additional lighting is required. The table arrangement at lunch did not encourage social interaction amongst staff and residents. Three residents were left sitting in their easy chairs to be assisted with their food. They were also using infantile beakers, which were heavily stained from tea/coffee. Condiments were not being used and plastic aprons as clothes protectors, which are both undignified and unsuitable for the hot weather. The layout of the lounge does not allow for varied activities and the armchairs are tightly set against the outside wall. The TV was on but no one was watching it. This may have been because of the position of their chairs, which made it difficult for them to view the screen. During the case tracking process it was noted that one resident who had been at the home for two months had recorded: Previous interests NONE Present interests NONE Previous/past hobbies NONE Activities NONE Social care plan “Invite to socialization” The inspector spoke with this resident’s relative, who gave the inspector lots of interesting information about the life and interests of this person. This relative visited often and had been asked by staff about physical needs. As this resident cannot communicate it is vitally important that the staff ask and record every aspect of this person’s needs including their social, psychological, emotional and spiritual needs. Another staff member was questioned about another resident who has been at the home for some time. The inspector was told that they liked watching TV in the evening but had no idea what their preferences were. Nor was this recorded anywhere. This resident is also unable to communicate. Care plans seen for the nursing residents were generalised and did not contain specific information about each resident. Risk assessments were present but the actions required in them was often not being carried out. This was so for recording fluid and food intake, weight loss and for checks for safety issues.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 8 The environment on both Sunflower and Bluebell is not conducive to residents being as independent as possible. For those residents with dementia and impaired vision there needs to be good levels of contrast, particularly relating to signage. Residents should be able to find their way around the building with ease. There were no signs on the bathroom or toilet doors. People with dementia often have impaired vision so higher than normal levels of lighting are required. The inspectors noted that in Sunflower lounge alone there had been numerous falls recently. Some of these related to one resident who is experiencing a particular difficulty. As there are four staff allocated to this floor, due to the dependency of the residents, thought should be given to allocating one carer to be responsible for monitoring the lounge and being based in there. Opportunities should be created for normal activities such as dusting or gardening. This improves self-esteem and has been shown to be useful for those residents who have previously had busy, productive lives before moving into a care home. For this to happen the culture of the home has to embrace this concept so that everyone is involved, then activities becomes a part of the life of the home, which has benefits for staff as well as residents. 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. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 9 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 Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 10 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 Holistic needs are not assessed sufficiently. EVIDENCE: Pre-admission assessments seen and admission forms did not reflect the whole person and in some cases gave completely misleading information, eg.has no interests. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 There is no evidence that health, personal and social care needs of nursing residents are being fully met. EVIDENCE: Care plans seen did not evidence short-term health problems or detailed specific needs following assessment. There were no agreed goals for personal achievement. They did not contain details on medication, privacy, money management, independence and emotional and spiritual needs. Risk assessments relating to health issues had either unrealistic actions or those actions which were not being acted upon. Waterlow risk assessments for the prevention of pressure sores were completed monthly mostly, but there was no action plan for steps needed to minimise the risk. Staff, when questioned about pressure relief, were not able to demonstrate their competency or individualised knowledge. Risks identified were also not identified in the care plans. There were occasions where a resident’s health had deteriorated, and external specialist advice sought, however details of this was not fully recorded in their care plan.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.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) 12,15 The surroundings on Bluebell are not appropriate to meet residents’ holistic needs. EVIDENCE: The lifestyle for those residents who are very dependent is not of an acceptable standard. Staffing levels must allow for social needs and choices to be made about every aspect of the resident’s life. This includes rising and retiring times. As mentioned before, scant regard was being paid to social needs for those residents who have dementia such as reminiscence therapy, reality orientation or any other cognitive intervention. There is an activities organiser in the home but due to the size of the home is unable to fulfil all needs. Therefore the culture of the home needs to change so that it is not just the activities organiser who encourages activities. There are no aids to orientation such as clocks, calendars or staff on duty information. There is no regard to adapting the environment to suiting the needs of the residents who have dementia. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 13 The dining area in Bluebell is cramped and gloomy. There is not room for all residents to sit at the table. No condiments were being used and little effort made to make it a sociable and pleasant experience. Menus were not examined at this visit. During the previous inspection the staff were advised by the inspector to consider placing jugs of water and glasses on each table, in order for residents who are able to help themselves to a drink. There was no evidence that this was happening throughout the whole home. There was no evidence of fresh fruit being placed around the home. There was no evidence of large print menus around the home outlining food choices. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaint given to the inspectors was not acted upon. EVIDENCE: The inspectors were told that there had not been any complaints since the last inspection. One inspector spoke with a resident who told her that they had previously made a complaint. This had been about waiting unreasonable lengths of time for care, meals being late or cold or both. They also said that frequently their urinal and meal trays were left for hours before being collected by staff. This was evident on the day of the inspection when at approximately 11.30am a full urinal and breakfast tray remained in the room. Also they were supposed to be receiving leg exercises from the staff which was not happening. As no action had been taken this resident purchased a microwave. The resident gave their permission for the inspector to bring this up with the manager. Her response was that she did not think it had been a complaint and had thought the leg exercises were happening. The inspectors will monitor the response to this complaint. It will be a requirement that the home responds to complaints promptly recording the outcome. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 26 The environment on the top floor is not suitable for those residents who have a cognitive impairment. EVIDENCE: On the top two floors both kitchen areas were dirty and the equipment such as the urn for the porridge and the dumb waiter were stained with old food. An immediate requirement was made for these areas to be deep cleaned no later than the following day. There was also a concern about the hot water urns on both floors. Both were unguarded and the staff told us that four-six residents on Sunflower wandered and were sometimes confused. This risk needed to be re-assessed and the manager did this after the inspection finished. A faxed copy of the risk assessment was sent to the inspector the following day and the urns were decommissioned until the risk could be minimised. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 16 The lounge on Bluebell (top floor) is cramped and gloomy. The dormer windows mean that there is no view for residents. The armchairs are tightly packed together which does not allow privacy or for staff to be able to get in between chairs. There are no adaptations for promoting well being and independence. This will be a requirement. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers and skill mix of the staff were not meeting residents’ needs. EVIDENCE: Staff spoken with during the inspection were not able to demonstrate their competence. There was little recognition of individualised needs. The task delivered was being done as part of their daily rituals and not as personcentred care. There was no recognition that elderly people needed extra fluids when the weather was hot. One staff member said that they didn’t get hot because they weren’t moving around. This attitude was very concerning and must be addressed urgently with training/direct supervision of care staff. The trained staff on duty consisted of two adaptation nurses, one who was still doing her course and another who has successfully completed her course this year. The nurse who had completed their training told the inspectors of their lack of confidence at being in charge of the nursing residents. They had therefore requested to work as a senior carer while they improved their skills. This is to be commended and was discussed at the feedback session. The inspectorate will be discussing the homes adaptation programme with the home’s line manager. An immediate requirement was made for the trained staff to be increased the following day. This should allow for supervision of staff so that care can be directed.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 18 The inspectors were also concerned about the whole aspect of Bluebell floor. It accommodated thirteen residents on the day of the inspection. Three were in bed and six need assistance with their meals. Only two care staff were allocated to that floor. There were thirty seven nursing residents accommodated at the home on the day of the inspection. There was only one registered nurse on duty. Rotas showed that this was not an isolated occasion. The home therefore was not meeting its staffing notice. A requirement was made that this be increased to two trained nurses on the 8am-2pm shifts from the following day. The staffing notice is a guide to the minimum number required and needs to be increased according to the dependency and needs of the residents. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36, 38 All residents are not benefiting from the leadership of the home. Some residents are not able to have the same quality of life as others who are more able. Staff are not being adequately supervised. There were some issues of Health & Safety which were not being addressed by the home. EVIDENCE: As mentioned previously in this report it was evident that those residents who are dependent are not receiving the same opportunities and choices as more able residents. Staff were also working ritualistically and not according to individual needs. Health & safety issues were dealt with during the inspection by immediate requirements. This included the risk from hot water urns on Sunflower and Bluebell floors. The hazards from dirty kitchen areas was also concerning.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 20 The sluice on Sunflower also poses a risk to residents due to the fact that it is not locked. Staff told the inspectors that several residents on that floor often walked around that area. At the time of the inspection the home’s deputy manager had been working at another home within the organisation. The inspectorate will be discussing the management of the home to ensure that both nursing and residential staff are adequately supervised and supported. The home runs an adaptation programme for nurses who are registered abroad who, on successful completion of the programme, can then be registered with the Nursing Midwifery Council. Both inspectors felt that the home needs to consider the suitability of continuing with this programme. There was evidence in the fire log that staff had received fire drills, but with such a large number of staff employed it was difficult to determine the frequency of drills for each person. A high proportion of recorded drills stem from staff responding to the fire alarm, activated by burnt toast etc. An easier tracking method for identifying staff that need to attend fire drills should be considered. Weekly tests on the fire alarm system had been carried out, but there are some occasions when such tests fall outside of the required time period. There were two dates in the fire log for the servicing of the fire fighting equipment, which were the 28/2/02 and the 21/2/05.The manager was surprised at this, stating that she thought that annual checks had been carried out. The inspector asked that if further information on dates could be supplied, then this would be detailed in the inspection report. Emergency lights have been tested on a regular basis, in line with the required practice. The last fire safety inspection was carried out on the 16/12/02. On walking around the home there was evidence that storage space was at a premium, and wheel chairs, hoist and Zimmer frames were parked inappropriately in corridors, which would present a hazard to service users. The toilet in the Bluebell wing is used as a storeroom, which contained continence pads, commodes and a hoist, thus taking one toilet out of action to service users. Those staff consulted agreed there was a severe lack of storage space around the home. Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 1 1 x 1 x 2 2 2 STAFFING Standard No Score 27 2 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 x x 2 x x x 2 2 2 Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. 5. 6. Standard 15 38 26 27 38 7 Regulation 12(1)(a)( b) 13(4) 23(d) 18(1)(a) 13(4) 15 Timescale for action To ensure that all residents have From access to drinks at all times. 13/7/05 To complete risk assessments for By 13/7/05 the hot water urns in use and take any action needed. To deep clean the kitchen areas By 14/7/05 in Sunflower and Bluebell. To increase the registered nurse From numbers by one on the 8am14/7/05 2pm shift. To make safe the sluice door on By 14/7/05 Sunflower. The care plans need to set out in By 15/9/05 detail the action needed to meet all aspects of the health, personal and social care needs of all residents. Care plans must be given to the residents and/or representative. Risk assessments must be By 15/9/05 completed and include risk of falls. Complaints must be fully From investigated within 28 days after 15/7/05 the date the complaint was made. Staff must be continually From supervised as part of the normal 15/7/05 management process. Care offered to those residents From
Version 1.30 D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Page 23 Requirement 7. 8. 8 16 13(4) 22 9. 10. 36 4 18(2) 14 Rosewell Country Home 11. 19 23 12. 13. 14. 15 21 37 16(2)(g) 23 17 15. 16. 15 12 16(i) 16(m)(n) 17. 18. 19. 20. 4 25 19 14 23 23 who have dementia must be based upon current good practice and reflect specialist and clinical guidelines. The premises needs to be suitable for the purpose set out in the Statement of Purpose and so appropriate to the needs of the residents on Bluebell. Suitable and sufficient crockery must be supplied on the nursing wings. Toilets and bathrooms must be clearly marked and be appropriate for elderly persons. The names of residents who have had a fall and/or accident must be included in the accident records. Meals must be hot when delivered to each resident. Activities need to be provided for all residents and provision made for those residents who are cognitively impaired. Aids must be used to encourage independence and orientation. Lighting must be suitable for residents who have dementia and/or are partially sighted. The carpet in a bedroom identified at the inspection must be replaced. 31/7/05 By 31/11/05 By 31/7/05 By 31/7/05 From 15/7/05 From 15/7/05 From 31/7/05 From 31/7/05 No later than 31/8/05 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.
Rosewell Country Home D56_D05_S44632_Rosewell_V236707_130705_Stage 4.doc Version 1.30 Page 24 Refer to Standard Good Practice Recommendations Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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