Inspection on 10/05/05 for Shakespeare House

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Shakespeare House 30/06/10

Shakespeare House 17/05/10

Shakespeare House 27/05/09

Shakespeare House 27/05/08

Shakespeare House 10/05/07

Shakespeare House 13/06/06

Shakespeare House 22/11/05

Shakespeare House 22/12/04

Shakespeare House 18/05/04

Shakespeare House 15/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Shakespeare House 19 Shakespeare Road Bedford MK40 2DZ Lead Inspector Leonorah Milton Unannounced 10th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Shakespeare House Address 19 Shakespeare Road Bedford MK40 2DZ 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) 01234 359224 01234 359224 Mr S Mrs V Camiah Ms Louisa Bedeau Care Home 18 Category(ies) of PD(E) Physical Disability over 65 - 18 registration, with number DE(E) Dementiia over 65 - 18 of places OP Old Age - 18 Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22.12.04 Brief Description of the Service: Shakespeare House was registered to provide for eighteen older persons who may also have physical disabilities and/or dementia. The arrangements to care for older people with physical disabilities associated with old age can be accomodated under the registered condition of OP. It was therefore agreed with the proprietor at this inspection that the category PD for physical disabilities would be removed from the conditions of registration. Mr and Mrs Camiah had owned the home for a number of years and participated in the operation of the home as financial manager and care practice advisor. Mrs Louisa Bedeau had managed the home for several years. The home was located in a pleasant suburb of Bedford within walking distance of the town’s amenities including bus and train links.The physical environment had been suitably adapted internally to meet the needs of frail older people.. Access to the building from the garden to the rear was restricted for those with mobility problems. Accommodation was arranged over three floors with seventeen bedrooms, one of which could be used for double occupancy. Access was provided to the upper floors via a shaft lift. The communal accomodation of a dining room and a lounge was located on the ground floor. A range of adapted bathrooms and toilets were located for convenient access throughout the building. Arrangements to meet service users needs at this inspection were satisfactory but aspects of the building were deteriorating. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over 6.45 hours. The manager was present for some of the inspection. Mr Camiah co-proprietor attended briefly at the end of the inspection and received a verbal and written feedback. The methods of inspection included conversations with three service users, a visitor, three members of staff, a student worker and the manager. Case tracking was carried out in relation to the care of three service users. Sundry other documents were assessed. A partial tour of the building was carried out. Conversations with service users were a little limited because fourteen of the sixteen people in residence had some cognitive impairment. Conclusions drawn about the service delivery therefore also took account of the testimonies of others, the observation of practice and assessment of records. What the service does well: What has improved since the last inspection? What they could do better: The training provision was organised on a piecemeal basis rather than as a result of a training needs analysis. Training had been organised by the manager but the budget was held by the proprietor. A systematic approach to Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 6 training must be introduced in consultation with the manager to ensure that the team is properly inducted and has opportunities to develop. Although some staff had undertaken training in adult protection procedures the written guidance in the home was not sufficiently detailed. The guidance did not identify the various forms of abuse that can occur in residential care homes and the measures that must be taken to prevent the development of abusive practice. Recruitment practices had not taken account of the requirement to check that staff from overseas had permits to work or were working within the conditions of their entry visas. Procedures and assessments for the management of safety had not been developed in full to ensure that the details specified by the National Minimum Standards had been taken into account. Service user access to gas boilers was hazardous and gaps under bedroom doors, which should act as fire breaks, compromised safety standards. The manager had reintroduced a maintenance request record but there had been little action on issues identified. Maintenance issues overall had not been dealt with. As a result the environment was deteriorating. The unhygienic condition of the flooring in the kitchen and a bathroom being but two examples. The number of outstanding requirements was concerning. Given that the proprietors’ monthly reports had not indicated timescales for action, they will be asked to attend a meeting with the CSCI, at which it will be expected that a plan for action will be available for discussion and agreement. 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. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4. The written guidance to enable people to make an informed choice before moving into the home was a little inaccurate. EVIDENCE: The written guidance to the home had been updated since the previous inspection. However the documents were inaccurate in that the home did not provide physiotherapy or chiropody treatment. These services would be arranged through local practitioners and in the case of private rather than National Healthcare Services, there would be an appropriate charge. The home did not provide a satellite television as detailed in the guide or employ a laundry assistant as shown in the organisation’s personnel plan. It was not possible to verify that contracts for service users’ accommodation in the home met requirements as these were held off site. The staff on duty had the skills to meet service users’ needs. However some management responsibilities had not been met in full because the manager spent some of her time carrying out care assistant duties. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 9 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) 7,8,11 Staff were aware of service users’ needs and demonstrated appropriate practice to meet them. EVIDENCE: Staff were observed to treat service users with respect and compassion. A similar approach had been taken in the compilation of care plans that had been recorded in a sensitive manner. Care plans assessed at this inspection had continued to develop and covered most of the required aspects including wishes for last rites and funeral arrangements. Omitted from these records were limitations to ability, such as the management of personal monies and the ability to hold keys to bedrooms. Records must also show why service users do not take their meals at a dining table. The service user or where appropriate their representative must sign to agree their plan of care. Conversations with staff showed that they were conversant with service users’ needs and able to recognise any significant changes to health and demeanour. Records showed that changes in need had been noted quickly and interventions made where appropriate. Records indicated that appropriate referral had been made to specialists in order to meet service users’ healthcare needs. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15. The daily lifestyle in the home was sensitive to the needs of frail people with dementia. EVIDENCE: The provision for activities was limited for the majority because of their loss of ability to concentrate. However there had been efforts to engage service users in stimulating activities and a monthly arrangement for the visit of a professional entertainer. Service users had been taken on shopping trips and for pub lunches on a one to one basis or in small groups. It was evident that the home had adopted a flexible approach to daily routines in relation to bedtimes and similar. Service users’ visitors were welcome to visit at anytime. Three service users were without visitors. The manager was advised to seek advocacy or befriending services where appropriate. The observed mealtime was a social and pleasant affair during which service users were provided with sensitive assistance. The space in the dining area was a little cramped as it was used to store a freezer and a fridge. A place at a dining table must be available to all service users. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 11 It was noted that guidance on care plans in relation to individual nutritional needs was followed. Those with poor appetite were encouraged appropriately to eat their meals and in one instance an alternative snack was provided. Fluid intake was similarly encouraged. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 12 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) 16,17,19. There was no systematic approach to complaints investigation and response or in the development of the home’s protection of vulnerable adults procedures. EVIDENCE: The previous inspection had noted that procedures to enable complaints to be raised were available but would benefit from display in the home in a more prominent position. There had been no action on this. The procedure was advertised on a notice board that was obscured by the entrance door as it was opened. The advertised procedure had not been updated to show the change of the regulatory body to the CSCI. A case file contained an acknowledgement of a complaint but no evidence of a subsequent investigation and response. The home’s central index contained some further information but no copies of the response or resulting action to prevent a reoccurrence. A service user who expressed an interest in recent elections stated that he had not received a postal vote. Some staff had attended training to recognise and prevent the development of abusive practice and commented favourably on the benefits of the course. However the actual written protection procedures to underpin the home’s philosophies, which had been identified as inadequate at the previous inspection, had not been reviewed with reference to the Department of Health’s “No Secrets” guidance. This must be actioned as a priority. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,25,26. The environment was mostly suitable for the care of frail older people. EVIDENCE: The layout of the home met service users’ needs with the exception of limited access for disabled persons/wheel chair users to the garden and insufficient dining space and dining tables and chairs. A service user with a walking frame was observed to make his way into the building through a side door. Staff assisted the service user to negotiate a step up. The proprietor must take action on the outstanding requirement to provide a ramp for access to the rear of the building. Suitable adaptations and equipment had been provided to assist service users to access bathing and toilet facilities and to promote safe moving and handling practice. Radiators were covered and the delivery of hot water supplies controlled to prevent the risk of accidental burn or scald. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 14 The décor in bedrooms seen at this inspection was satisfactory. Bedrooms had been supplied with basic furnishings but lacked sufficient illumination in some instances. None of the bedrooms had been supplied with a lockable facility. The door locks to bedrooms were unsuitable because staff would be unable to enter if the key were to be left in the lock on the inside of the room. Areas of the home seen at this inspection were clean and orderly with the exception of the flooring to the kitchen and the ground floor bathroom. The doors and shelving to kitchen cupboards had deteriorated. The interior of the woodchip shelving was exposed and prevented thorough cleaning procedures in food storage areas. As had been noted at the previous inspection the décor throughout was mostly in good order with the exception of doorways and doors on upper floors that were showing signs of wear and tear. These areas had continued to deteriorate to an unacceptably poor standard. The previous inspection had also noted, “The proprietor had not introduced a planned maintenance programme. As a result some requirements from the previous inspection were unmet.” This requirement remained unmet with the inevitable consequences. The proprietor stated at this inspection that recruitment was underway to employ a maintenance person. It was noted that the sole occupant of the room for double occupancy had a disturbed sleep pattern and also wished to watch his television late into the night. The home must ensure that the future sharing of this double room is a positive choice for both service users and that the needs of the current occupant and any future joint occupant are both met within the arrangements to share the bedroom. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 15 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) 27,29,30. The staff on duty had a good understanding of the service users’ support needs. The numbers of care staff on duty however, was insufficient at times. EVIDENCE: The staff on duty presented as knowledgeable and skilled. Friendly banter was overheard between service users and the staff, which gave an impression of an informal and relaxed environment. The staff on duty were evidently aware of the care needs of those with cognitive impairment. Service users who wandered were provided with sympathetic support and not made to sit down. Two service users who contributed to the inspection passed positive comments about the staff. Staffing arrangements whilst meeting the levels agreed with the previous regulator had not been reviewed in relation to service users’ current needs. There was an expectation that the manager would assist with care tasks. It was stated that without her assistance morning routines were rushed. There must be a review of staffing arrangements to ensure that sufficient staff are scheduled to meet service users’ needs and to enable the manager to carry out her responsibilities effectively. The dependency levels of service users must be taken into account in any calculation not merely the numbers of people to be care for. Recruitment practice had not taken account of permits to work or the number of hours that staff on student visas are permitted to work. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 16 The majority of personnel had worked at the home for a significant time and had received training in statutory health and safety topics. However the training provision did was organised on an organised basis and had not developed to include induction to required standards. It was noted that two care staff who had worked in the home for four months had only recently received training in safe moving and handling practice. This was concerning especially in relation to one of these who carried out night duties with one other person only on duty. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 17 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) 31,33,35,36,38. The manager was suitablely experienced and qualified to manage the home but had not fulfilled her role sufficiently because of constraints on her time. EVIDENCE: The manager was evidently skilled in the management of personnel and the care of frail older people. Staff commented on her positive leadership style. There had been an improvement in procedures for the use and recording of monies held on behalf of service users but a quality audit to review performance and obtain the opinions of service users and their representatives about the service had yet to be completed. This was unsatisfactory given that three years had elapsed since the introduction of the regulation governing this standard. Similarly supervision was not proceeding with the frequency detailed by the National Minimum Standards. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 18 At the previous inspection Mrs Bedeau had acknowledged that she required an update in her training to assess and manage risk for the operation of the home. At that inspection it continued to be unclear where the responsibility for the management of safety lay as the proprietor had taken over the responsibility for a review of the health and safety policies and risk assessment strategies, that had continued to be overdue from previous inspections. The situation remained the same at this inspection although Mrs Bedeau stated that she was scheduled to undertake risk assessment training in the near future. The proprietor must ensure that there is a systematic approach to the review of risk assessment and relevant maintenance issues to maintain the safety of the environment. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 19 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 2 1 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x 2 2 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 1 1 2 x 1 x 3 2 x 2 Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23(2)(n) (o) Requirement Timescale for action 30.06.05 2. 33 24(1)(2) (3) 3. 19 23(2(b) 4. 38 13(3)(4) The garden must be made accessible to wheelchair users. The registered provider must construct a ramp with handrail to enable service users with mobility difficulties safe access to the garden (Previous timescales of 31.10.04 and 31.04.05 had not ben met.) A quality assurance programme 30.06.05. for the home must be developed. The formal process of monitoring quality must involve service users and staff and be recorded. An audit of outcomes must be completed and a record made of any action taken to improve quality(Previous timescale of 31.07.04 and 31.04.05 had not been met). There must be a planned 30.06.05 maintenance programme for the home.(Previous timescale of 30.09.04 and 31.04.05 had not been met) The home must have a robust 31.07.05. health and safety policy and that all the required procedures are in place to protect service users and staff from unnecessary risks or measures are in place to Version 1.30 Page 21 Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc 5. 5 14(2) 6. 18 13(6) 7. 31 18(1) 8. 38 13(4)(a) 9. 2 5(1)(b), 17(2) Schedule 4(8) 15(1)(2) 10. 7 11. 16 22(3)(6) (7) minimise risks. (Previous timescales of 31.07.04 and 31.04.05 had not been met in full) Formal review procedures must be introduced after trial admissions for all service users and records mintained of the review meetings. (Not assessed at this inspection). The home’s protection procedures must be reviewed against the Department of Health’s “No Secrets” guidance.(Previous timscale of 31.04.05 had not been met). The registered proprietor must arrange for the manager to undertake accredited training in the assessment and management of risk.(Previous timescale of 31.04.05 had not been met.) Secure the laundry when not in use. Prevent access for service users to the heating boiler situated in a lobby leading off from the second floor bathroom (Previous timescale of 31.01.05 had not been met. See new requirements). Each service user must receive a copy of a contract/terms and conditions of residency. A copy of each contract and records of payments of fees must be maintained in the home. Care plans must show limitations to abilities such as the ability to hold keys , indicate why service users do not take their meals at a dining table and be signed as agreed by the service user or their representative. Complaints must be fully investigated and show what action has been taken. 31.04.05 31.06.05. 31.8.05. 30.05.05. 31.07.05. 31.08.05. 30.05.05 Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 22 12. 23 23(2)(e) 13. 26 16(2)(j) 23(2)(b) 16(2)(j) 23(2)(j) 14. 26 15. 13,19 23(4)(i) 16. 17. 13,25 27,31 13(4)(a) 18(a) 18. 19. 29 30 19(4)(a) (b) 18(a)(c) (i) 20. 21. 30 38 18(c )(i) 13 Service users who share a bedroom must have both made a positive choice to do so. The arrangement to share a room must meet the needs of both occupants. The flooring in the kitchen must be thoroughly cleaned where dirt had accumulated at the joins of the covering. The flooring in the ground floor bathroom/toilet must be replaced with an appropriate non slip covering. The edges of any new flooring must be sealed to prevent seepage of any fluids. Gaps underneath the doors of bedrooms 11,12,13 on the second floor must be removed to limit the spread of fire and smoke. Service users must not have access to any of the homes heating boilers Sufficient care staff must be rostered each day to meet service users needs so that the manager is not required to assist the care team on a routine basis. Recruitment procedures must take account of permits to work for staff from overseas. There must be sufficent staff on every shift who are trained in safe moving and handling techniques to ensure safe handling of service users. All care staff must receive induction training to NTO specifications The carpet immediately beyond the lift doors on the first floor must be replaced so that the trip hazard is removed. 30.05.05 30.05.05 31.07.05. 30.06.05 30.07.05. 30.06.05. 30.05.05 30.06.05. 30.06.05. 31.06.05. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 23 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. 3. 4. Refer to Standard 26 14 17 36 Good Practice Recommendations A means of ventilation should be installed in the laundry. Advocacy services should be arranged for service users. Service users should be supported to vote in local and general elections via postal voting procedures. Staff should receive supervision at least six times each year. Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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 Shakespeare House I51 S14965 Shakespeare House V222396 100505 Stage 4.doc Version 1.30 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!