Inspection on 23/05/05 for Southfields House EPH

This inspection was carried out on 23rd May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Southfields House EPH 07/08/07

Southfields House EPH 30/10/06

Southfields House EPH 22/11/05

Southfields House EPH 19/07/04

Southfields House EPH 27/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE SOUTHFIELDS HOUSE EPH Farmhill Road Southfields Northampton NN3 5DS Lead Inspector Pat Harte Unannounced 23rd 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. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Southfields House EPH Address Farmhill Road Southfields Northampton NN3 5DS 01604 499381 01604 790719 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) Mr Philip Jones, Northants County Council, Oxford House, West Villa Road, Wellingborough, Northants, NN8 4JR Mr Phil Terry CRH 46 Category(ies) of DE(E) Dementia over 65yrs - 30 places registration, with number PD(E) Physical Disability over 65yrs - 5 places of places OP Old Age - 46 places DE Dementia - 2 places SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No person falling within the OP category can be admitted where there are already 46 people of OP category already in the home No person falling within the DE(E) category can be admitted where there are already 30 people of DE(E) category already in the home No person falling within the DE category can be admitted where there are already 2 people of DE category already in the home No person admitted within the DE category will be below the age of 60 The total number of service users within the DE(E) and the DE category must not exceed 30 No person falling within the PD(E) category can be admitted where there are already 5 people of PE(E) category already in the home To be able to accommodate one named service user who has needs within the MD(E) category To be able to accommodate one named service user who has needs within the LD(E) category Total number of service users in the home must not exceed 46 Date of last inspection 19th July 2005 Brief Description of the Service: Southfields House is owned by Northants County Council. The Manager is Mr. P. Terry. The Home provides permanent places and personal care, without nursing, for older people over the age of 65 years, including up to 5 people who have a Physical Disability and up to 30 People who may have a diagnosed Dementia. The Home has specified conditions that it may continue to provide care for 2 existing, named Residents one with a Mental Disorder and one with a Learning Disability. The Home is situated in a suburb on the outskirts of Northampton close to local shops. The premises offer all ground floor accomodation and all Residents are provided with single bedrooms. There are six self contained units with their own lounge/dining/kitchenette and bathroom and toilet facilities. In addition there are seating areas by the main entrance and in the conservatory area providing Residents with additional communal space. Residents have access to graden areas. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 3 Residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. 5 staff, 10 Residents and two visiting Relatives were spoken with. Positive written comments were also received from 39 Residents and 14 Relatives. Comments on the care provided were mostly positive although there were some negative comments on the level of activities provided. A partial tour of the premises took place and a selection of records was inspected. The Inspection took place during the late morning and afternoon over a period of 5 hours and was carried out on an unannounced basis What the service does well: What has improved since the last inspection? Some refurbishment of furniture has been provided. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 6 Security fencing and electronic gates have been installed to improve overall security. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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 SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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 & 5 Prospective Residents are provided with information to enable them to make informed choice regarding their placement. The pre-admission assessment is thorough and effective but there are premises issues that affect the Home’s ability to meet Residents needs in full. EVIDENCE: The admission process ensures that all prospective Residents are visited and assessed by staff from the Home to ensure their needs can be met. Residents and their relatives have opportunities to visit the Home and are given information on the services and facilities. Residents spoken with felt that staff were well briefed on their needs and the care to be provided. Staff spoken with felt that they were provided with good information on their Residents needs, routines and wishes. Individual records are kept for each of the Residents and inspection of the records showed that the assessment process was thorough, specific SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 9 assessment tools were used to identify needs and risk and assessments were carefully documented. However there are issues with the premises that can affect the Home’s abilities to meet Residents needs particularly for those residents dependent on the use of hoist. No Toilets can accommodate a hoist and therefore the Physically Disabled Residents care needs cannot be met in full and their dignity and rights of choice are compromised. Contracts are provided to all Residents. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 Little progress has been made in the development of Care plans to adequately provide staff with detailed instruction on how the needs are to be met. There was a failure to update care plans resulting in the potential for needs not being met. EVIDENCE: Individual plans of care are available for all Residents. The plans inspected showed that account is taken of Residents wishes and preferred routines. References to personal care needs remained limited and instructions for staff were not fully documented. In one instance recent changes in care needs due to failing health had not been updated and in another instance the location of the Resident’s unit was wrongly recorded. References to reviews were shown but plans had not been updated to accurately reflect needs. Information gathering on Life histories, to aid understanding of the conditions and behaviours of Residents with Dementia, was limited and not crossreferenced to the care plans. Strategies for the management of behaviours and anxieties were not detailed. Care plans did not take account of Residents SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 11 emotional and social needs or anxieties and did not provide staff with guidance on how to deal with these areas. The approach to Dementia care is still fragmented although specific dementia care units for Residents with high dependency needs are being created. One Unit has been developed to date and 2 dedicated staff are deployed on all daytime shifts to provide constant monitoring, care and supervision. The documentation of Health care needs was also limited in detail and changes had not been fully updated, though staff showed that they responded quickly to any changes to their Residents’ health and made prompt referrals to medical professionals. The Manager recognised that Care planning is an ongoing area for development and demonstrated that he was in the process of introducing new formats that would provide more detailed instruction and guidance for staff. The Home’s medication systems were inspected and found to be in good order. Records were carefully maintained, storage of medication was secure and appropriate and medication administration practice was safe. Service Users felt that they were treated as individuals and were respected by staff. Relationships with staff were confirmed as good. Staff ensured that their privacy and dignity was protected when personal care was carried out. Care can be provided for Residents who may be dying so long as their needs can be fully met with the assistance of the community Medical Services. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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, 13, 14, 15 The meals in the Home are good, offering choice and variety and catering for special dietary needs and individual likes and dislikes. Whilst activities are provided attention should be paid to ensure activities are not subject to constant disruption and meaningful individual activities are further developed for Residents with Dementia. EVIDENCE: A number of Residents were spoken to and everyone who commented on the food said it was good, they had choice and their special dietary needs and likes and dislikes were catered for and respected. Residents are asked to comment and offer suggestions on the menu and changes are made accordingly. The midday meal was efficiently served, nicely presented, of good quality and Residents were provided with choice and a wide range of alternatives. Staff helped Residents with their meals where necessary. The Kitchen was in good order and records of the food provided were maintained. The Environmental Health Officer has noted deterioration in the work surfaces. Although these are deemed safe at the moment replacement will be required if further deterioration occurs. Residents felt routines were relaxed and flexible and that their lifestyle preferences were respected. They felt that they were free to decide on how SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 13 and where they wished to spend their time and that they were enabled to be as independent as possible. Staff are deployed to individual units and have responsibility for the activity provision for their Residents, which includes group and individual activities. Residents felt that staff did make time to assist them in the pursuit of individual interests and to talk with them although they stated the activity programmes were constantly interrupted when staff were called away to meet care needs. Currently meaningful activities are being further developed for Residents who have Dementia. The Home has an open visiting policy. Residents confirmed that they were enabled to receive their visitors in private if they wished. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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, 17 & 18 Systems are in place to protect Residents from abuse and to ensure that complaints are listened to and acted upon. Resident’s rights are protected. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. Residents spoken with felt confident and able to raise any issues or concerns with staff. A complaints record is maintained. No complaints have been received by the CSCI in the last year. The Home has a procedure for the Protection of Vulnerable Adults. Notifications have been made to the relevant Authorities and action taken to investigate and resolve issues. In one instance there was a delay in the reporting procedure and as a result refresher training is planned shortly for all staff. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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 -26 The Home is in urgent need of redecoration and carpet refurbishment. The Local Authority has failed to ensure that redecoration, repairs and general maintenance are appropriately and promptly addressed. EVIDENCE: The recommendations of Occupational Therapist have not received attention and despite an addition recommendation made by the Commission in July 2004. There are no handrails on the exits from the Home, there is no pathway around the Home, and grab rails are not provided in the Toilets. These areas compromise Residents’ safety. None of the toilets can accommodate a hoist and Residents requiring this method of transfer have no choice but to use commodes in their rooms. Windows are not double-glazed and have been recognised as in need of replacement to eliminate draughts. Whilst this has been listed in the Home’s three-year development plan the actual timescale for the work to be carried through is unknown. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 16 Currently the Home’s central heating system is not controllable in individual rooms or areas. This area has been recognised as in need of improvement in the three-year development plan but again the timescale for work to be carried out is unknown. Lighting is poor throughout the Home. This has been recognised as in need of improvement and included in the three-year development plan but the timescale for the work remains unknown. The Home has been the subject of attempted break-ins, security fencing has been erected around the Home and electronic gates have been installed to improve the overall security. However there is one area at the front of the Home, bordering neighbouring gardens, that does not have security fencing. Garden areas were found to be overgrown, the garden area outside Unit 6 was not safe for Residents to use and Residents could access the rubbish bins in the garden of Unit 3. In Unit 4 there was a hole in and staining of the ceiling over the dining tables. Whilst the roof leak had been repaired no action had been taken to repair the hole and redecorate the ceiling. In Unit 1 there was water staining on the wallpaper by the windows. The flooring in one of the toilets of Unit 5 was coming away from the wall, the toilet was badly stained and the pipe work was in need of painting. The enamel at the edge of a bath in Unit 6 was chipped and the toilet floor was badly stained. The safety glass in the conservatory roof was cracked in several places and in need of replacement. The roof area is not easily accessible and was in need of cleaning. The Corridor and Lounge areas were shabby, dark and in need of redecoration and re-carpeting and, in some case, the curtaining needed replacement. The woodwork of doors and surrounds throughout the home are in need of redecoration. Carpeting in some of the Residents bedrooms is in need of replacement. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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, 28, 29, 30 Procedures for the recruitment of staff were robust and provided safeguards to offer protection to people living in the Home. Staffing levels need to be increased in the afternoon/evening shifts to provide sufficient staff to meet Residents needs. EVIDENCE: Residents spoken with said that the staff were very kind, committed and caring. Relationships between staff and Residents were good. On daytime shifts 8 care staff are deployed on the morning shifts and 7 from 1.30 to 10pm. 2 of the available staff are deployed at all times to the high dependency Dementia Care unit with 1 carer deployed to other units. On the morning shift one carer is available to “float” between the units and assist other staff where two carers are required for movement and handling. In the afternoons Residents with Dementia may be left unsupervised, as there is no provision for a “floating” member of staff. The Home had the potential to accommodate to 30 Residents with Dementia and safety could be compromised by a lack of supervision and monitoring. Currently 4 care staff provide night care although this is to be increased in the near future to 5 to provide appropriate cover. The sample of three staff members records inspected showed that the necessary checks and references had been obtained. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 18 A sample of staff training records confirmed that staff receive induction and ongoing training and regular updates. Training on specialist areas is provided and staff are encouraged to undertake National Vocational Qualifications. Staff spoken with showed a commitment to the well being of their Residents and knowledge of the Home’s aims and objectives and policies and procedures. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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) The Management of the Home is effective and accessible and responsive to the needs of both the Residents and staff. The systems for moneys and valuables held for safekeeping need further development to ensure Residents have access to their monies at all times and valuables are appropriately documented and receipted. EVIDENCE: Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues and guide them in practice. Supervisions systems were in place to ensure that staff receive guidance and support. Residents felt the Manager was readily available to them. They commented that regular Residents meetings were held and that the Manager also sought their individual views. Residents felt that their opinions were listened to, SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 20 valued and acted upon and that they had trust and confidence in the staff group as a whole. The system for safekeeping of Residents moneys must be reviewed. Staff do not have access to the system in the Manager and Administrator’s absence. At these times only small amounts of money can be withdrawn from the petty cash system. Receipts were not maintained for all purchases made by staff on Residents behalf. Personal Allowances paid to Residents are still held in the Home’s bank account and Residents do not receive interest. The required visits to the Home by the Responsible Individual, on behalf of the Local Authority, are not being made monthly. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 1 1 3 3 3 1 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 1 3 x 3 SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 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. Standard 19 &`21 Regulation 23(2)(a) &(j) 23 (2)(n) 23 (2)(b) & (p) 23 (2) (p) Requirement An action plan must be submitted detailing proposals to alter the Toilet facilities to enable the use of a hoist. Grab rails must be provided to all toilets. An action plan showing the timescales for replacing the windows to the home must be submitted to the Commission. An action plan showing the timescales and detailing the work to be carried on the central heating system An action plan showing the timescales for work to be carried out to improve the lighting throughout the Home must be submitted to the Commission. The security fencing is to be completed in full to eliminate the gap by the neighbouring houses. The hole in the ceiling of the dining room Unit 4 is to be repaired and redecorated. All corridor and lounge areas are to be redecorated including the woodwork. Corridor and lounge carpets are to be replaced. The flooring of all toilet and Timescale for action 10.7. 2005 2. 3. 19 & 22 19 10.7.2005 10.7.2005 4. 19 10.7.2005 5. 19 23 (2) (p) 10.7.2005 6. 7. 8. 9. 10. 19 19 19 19 19 23. (1) (a) 23 (2) (b) 23 (2) (d) 23 (2) (d) 23(2) (d) 10.7.2005 10.7.2005 1.11.2005 1.11.2005 10.7.2005 Page 23 SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 11. 12. 19 19 23 (2) (j) 23 (2) (b) 13. 14. 15. 19 27 & 28 35 23 (2) (d) 18 (1) (a) 20 (1)(a) 16. 33 26 (2) bathrooms areas must be reviewed and action taken to replace staioned or damaged flooring where necessary. The enamel of the bath in Unit 6 must be repaired. The cracked safety glass in the conservatory area must be replaced and the roof area cleaned thoroughly. Carpeting in Residents bedrooms as identified with the Manager must be replaced. Staffing levels on the afternoon evening shifts must be increased. The Registered Person must ensure that money belonging to Service Users is paid into individual bank accounts and written confirmation that this work has been carried through is to be forawarded to the Commission. This was the subject of a previous requirement Timescale 1.7.2004 The registered person must ensure that Regulation 26 visits are made to the home and that copies of the reports following these visits are available in the home and are sent to the Commission for Social Care Inspection. This was the subject of a previous requirement Timescale 1.9.04 10.7.2005 10.7.2005 1.8.2005 10.7.2005 10.7.2005 30.6.2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 & 22 Good Practice Recommendations It is strongly recommended that Hand rails are provided at all exit doors. DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 24 SOUTHFIELDS HOUSE EPH 2. 19 It is strongly recommended that a regular garden maintenance programme is maintained. SOUTHFIELDS HOUSE EPH DC51 S34882 Southfields House EPH V223460 230505 stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Newland House, First Floor Campbell Square Northampton NN1 3EB 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. 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