CARE HOMES FOR OLDER PEOPLE
St Michael`s House Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX Lead Inspector
Lorraine Mavengere Announced Inspection 20th September 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Michael`s House Address Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX 01782 233435 01782 233436 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Stoke on Trent City Council Mrs Lesley Kokai Care Home 44 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (44), Physical disability (5), Physical disability over 65 years of age (44) St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 5 Physical Disability (PD) - Minimum age 55 years on admission Date of last inspection 21 December 2004 Brief Description of the Service: St Michael’s House, Chell is a purpose-built Local Authority managed home that is registered to accommodate 44 older people. The home was located within the residential area of Chell and was close to local community amenities and public transport. The home is owned by Stoke-on-Trent City Council and operated by Stoke-on-Trent Social Services Department. The home had the benefit of its own garden and patio area with distant views over the city. Pathways were appropriately ramped to provide ease of access and there was a car parking area to the front of the building. Accommodation was provided on two floors accessed by a shaft lift or staircases. There are 44 single bedrooms none of which had en-suite facilities. Eight of the beds were allocated for short-stay and rehabilitation/reablement where service users were admitted to promote independence in order that they may return to their own homes in the community and so avoid moving into residential care prematurely. Located on the ground floor of the home are a large lounge and a large dining room with a separate adjacent smoking room. There is a small lounge/kitchenette area for the specific use of the eight service users admitted for rehabilitation needs. On the first floor there is also a small lounge/dining/kitchenette room and a hairdressing and beauty salon. Service users bedrooms are located on both floors and there are four assisted bathrooms with toilets, a shower room and seven separate toilets conveniently sited around the home. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on a Tuesday during the day and into the evening. During the inspection many service users and a few relatives were spoken to, their comments and contributions are included in the body of the report. Although the inspection was announced, not many pre inspection questionnaires were returned to the Commission for Social Care Inspection. The feedback from those that have been received back will also be included in the report. Although the home is registered for 44 service users, on the day of inspection there were 36 admissions in the home. The home is divided into sixteen permanent beds, eight assessment beds, eight rehabilitation beds and the rest are short stay beds. At present the home is phasing out all short stay beds as a result of some alterations taking place within the home. At the time of the inspection, the short stay beds had been reduced to five with the view to eliminate them completely. At the time of inspection, the home had one service user with pressure sores and had received five complaints since the last inspection. All complaints have now been resolved. One visiting professional was spoken to at great length during the inspection and his comments will be incorporated into the report. What the service does well:
On the day of inspection, the home was clean, comfortable and free of offensive odours. Most of the service users spoken to expressed satisfaction at the level of care provided by the home. More than half of the standards assessed on this occasion were fully met. The food standard in particular scored exceptionally high. The cook is very knowledgeable about individual service users’ dietary preferences. The choice of food offered by the home is varied and nutritionally balanced. The home also caters for special dietary needs such as diabetic meals and liquidised meals as required. The home has had no staff leave since the last inspection and although there were some staffing vacancies, the home adequately cover all shifts with the appropriate number of staff either through existing staff taking on extra work or through the use of agency staff. The registered manager is currently campaigning for more staffing hours to further meet the more individualised needs as well as providing higher levels of activities as needed. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 6 A social worker who works closely with the home was spoken to at great length and was able to give the home respect and recognition for the work that it does. He praised them highly for performing well under circumstances that are not always easy. Relatives spoken to were also able to verify that on the whole the service is satisfactory. What has improved since the last inspection? What they could do better:
There were a number of requirements made during the inspection. Although the service user guide and statement of purpose have been amended as per requirement from the previous inspection, the documents need to be further amended to include staff qualifications that support the home’s stated purpose.
St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 7 The service needs to have some relevant documentation such as service users’ wishes concerning death and dying recorded. Further more, it was noted that the level of activities offered by the home could be improved. In terms of health and safety, there was a condemned fire extinguisher (extinguisher six) that was still in place. A requirement was made for that extinguisher to be removed or replaced accordingly. 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. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 The home provides information to prospective service users to enable them to make informed decisions about whether they choose to live in the home. The information provided however has minor shortfalls. The home does not provide a statement of terms and conditions for service users. All service users have their needs assessed prior to being admitted into the home. Staff have the skills and experience to meet the stated purpose of the home enabling residents to know that the home will meet their needs. The home offers trial visits for all residents but prospective service users are not clearly informed of this. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 10 EVIDENCE: Both the Statement of Purpose and the Service User Guide were seen during the inspection. These documents have been amended since the last inspection and are much improved. All service users spoken to stated that they were aware of the Service User Guide and relatives spoken to confirmed that they had received relevant information to do with the home prior to the service user moving in. There are no contracts/ statement of terms and conditions as of yet. The registered manager confirmed that contracts are being finalised on a corporate level and will be filtered to all the Stoke on Trent homes once the process is completed. This is a requirement not met by any of the Stoke On Trent homes presently. Discussions with the registered manager confirmed that all service users have their needs assessed prior to moving into the home. Discussions were also held with the social worker who was able to state that he works closely with the home to ensure that service users are placed appropriately. One assessment was seen for a short term resident. It is required that the registered manager has in place an assessment carried out by the home for all service users admitted into the home. The staff training schedules seen during the inspection show that the home provides sufficient training to meet service users’ needs and that is in line with the home’s stated purpose. The home does provide services for some residents with dementia. Training schedules show that staff are trained in dementia and Disability Awareness training and other relevant areas. The Statement Of Purpose does not, however, highlight this. It is recommended that the Statement of Purpose be amended to show the home’s ability to meet the needs of service users with dementia and other areas of specialism as detailed in the Statement of Purpose. Discussions with the registered manager confirmed that service users are offered trial visits to the home prior to admission. Some service users spoken to could confirm this while others could not. It is therefore recommended that the service user guide includes service users’ right to trial visits. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 10, 11 Service users’ health personal and social care needs are not fully set out in their care plans. This therefore means that some of the care needs are not met. All service users have access to primary health care services and specialist input as required. Service users are treated with respect at all times and their privacy and dignity is upheld. There was not enough supporting evidence to show that service users’ wishes concerning death and dying are taken in account and recorded. EVIDENCE: As part of the inspection process, a random sample of four care plans was examined. The plans seen did not cover all areas as listed within standard 3 of the National Minimum Standards. The registered manager must ensure that all care plans include the items listed in standard three of the National Minimum
St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 12 Standards. Records indicated that care plans are reviewed at least once per month to reflect the changing needs of service users. The care plan reviews highlight that changes have taken place but do not specify what the changes are, how they are to be dealt with and by whom. The registered manager must ensure that all reviews specify what changes have taken place, how these are to be dealt with and by whom. The sampled files showed that care plans are carried out differently depending whether the service user is short stay, permanent, rehabilitation or assessment. Two of the files sampled showed that some areas of risk were not assessed. The home’s latest admission did not have the home’s own care plan and neither were any risk assessments in place. She did, however, have a specialist social worker assessment in place. The registered manager must ensure that all service users have a care plan in place. The registered manager must ensure that all areas of risk are assessed. The registered manager confirmed that there was one service user with pressure sores at the time of inspection. It was also confirmed by the registered manager the district nurse was involved with this service user. Records showed that service users have access to all primary health care services and specialist care as required. There was evidence of provision from the chiropodist, dentist, optician, continence nurse, dementia care, district nurse and G.P. Discussions with staff and the registered manager indicated that the home provides pressure relieving equipment where needed. In the rehabilitation unit, service users are provided with daily input from the physiotherapists and the occupational therapists. Feedback from service users about this input was extremely positive. Service users were very vocal in stating that the service provided in terms of rehabilitating them was second to none. One service user stated that she had been given hope because she never thought that she would ever be able to cope after her fall but now she feels confident that she can. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 13 In discussion the Manager stated that all staff were trained in how to maintain service users privacy and dignity during their induction. Staff records seen, as well staff spoken to, confirmed this occurred. Service users interviewed were of the opinion that staff make every effort to ensure that their privacy and dignity is respected and maintained at all times. Staff confirmed that service users wear their own clothes at all times and medical examination is always carried out in private. No service users share bedrooms at the home. Observed practice showed that staff do respect the privacy and dignity of the service users on every occasion. They were observed knocking on bedroom doors and bathrooms before entering. The relatives who spoke to the inspector confirmed that all of the staff showed the utmost respect for their loved ones. It was clear when speaking to staff that they had the needs and wishes of the service users at the forefront of their actions. Service users all spoke highly of all of the staff and their approach towards them. The home has a comprehensive policy document on dealing with death and dying. The registered manager stated that there is also support in place for both staff and other service users should they be affected by the death and of another and wish to talk about it. Records seen do not contain service users’ wishes concerning death and dying. The registered manager must ensure that service users’ wishes concerning death and dying are discussed and taken into account. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 12, 13, 14, 15 The quality of activities offered by the home was difficult to conclude upon as different people gave different input about activities. Service user contact with friends, relatives and significant others is actively promoted within the home. The home acts to maximise service users’ capacity to exercise personal autonomy and choice. The food provided by the home is varied, nutritional and wholesome. Service users preferences are taken into account when putting together the menus. EVIDENCE: St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 15 During the time of inspection, a church service was taking place. Many of the residents of St Michaels attended the service. Many of the service users spoken to said that they really looked forward to the monthly service and felt extremely inspired by it. Generally speaking, there was mixed feelings amongst those spoken to (both residents and relatives) about the level and quality of the activities provided by the home. Some felt that the home needed to improve on these while others were satisfied. The activity schedule showed that the home does have outside entertainers, and planned activities such as bingo with in the home. The care records seen did not always specify what people’s preferred activities are. The registered manager is required to indicate in residents’ records what their preferred activities are and ensure that those activities are catered for in as much as possible. The home has an open visiting policy where visitors are welcome to the home at any reasonable time. Service users informed the inspector that they can entertain visitors within the home and that they are able to attend other activities away from the home. Care records seen confirmed service users’ statements. Discussion with the manager indicated that service users are encouraged to personalise their own rooms. A tour of the premises found evidence of personal possessions including small items of furniture in service users rooms. The manager also indicated that she does not manage or hold for safe keeping service users money, and that service users are encouraged to manage their own finances and that there were some service users’ whose relatives/representatives managed service users money on their behalf, and in line with service users’ wishes. Discussion with service users’ confirmed this occurred. During the inspection, the inspector was invited to sit in on a Rehabilitation meeting. The meeting was for service users to discuss their care, what it means to be in rehabilitation and generally state how they feel about the support that they are receiving. These meetings are held weekly. The service users involved stated that they benefit immensely from these meetings and look forward to having them. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 16 The inspector was able to join service users in the dining room for a main meal. The meal was well presented and tasty. Service users consulted confirmed that the meals are generally of a good standard and that in the event of a service user not liking a particular meal then alternatives are found. The meal was served in an unhurried manner and those residents that needed assistance with feeding were given this assistance in a respectful and dignified manner. Care records seen indicated that the home provided specialist meals for example diabetic, vegetarian and soft diets for service users with eating or swallowing difficulties. Service users made positive comments about the quality and quantity of food available to them. Staff advised the inspector that a cooked breakfast is available upon request. Service users interviewed confirmed this occurred. A detailed inspection of the kitchen was carried out. The kitchen is maintained to a very high standard and in line with all Environmental Health Requirements. The cook who was interviewed at great length was able to demonstrate knowledge in providing for various dietary needs and formulating of menus to ensure that the meals were both healthy and nutritious. The home is to be commended for the variety and good standard of food available. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 17 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 the following standard(s): 16 Service users and all concerned parties are confident that their complaints will be listened to and taken seriously and the home will resolve them in a timely and appropriate fashion. EVIDENCE: The policy/procedure for responding to complaints was seen; this document meets the required minimum standard. The Manager informed the inspector that the home had received five complaints since the last inspection. The complaints logs were examined. These showed that the complaints had been dealt with in an appropriate and timely fashion. The record of complaints is kept in a hard- bound book and used to compliment the complaints log forms. Service users interviewed were aware of their right to complain, and stated they would complain if they were dissatisfied with any aspect of the service. All service users interviewed made positive comments about the care and consideration afforded them by the staff. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 18 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 the following standard(s): These Standards Were Not Assessed on this Occasion. EVIDENCE: Standards Not Assessed. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 The numbers, qualifications and skill mix of staff are adequate to meet service users’ needs. All staff are offered a TOPSS certified induction programme that enables them to be competent in their jobs. On going training and development is satisfactory and addresses any potential staff limitations and training needs. EVIDENCE: St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 20 The inspector examined the staffing rota and found that the skill mix of staff was adequate in meeting service users’ assessed care needs. The home presently has three vacancies as follows: One temporary care assistant. One night care assistant at 10 hours per fortnight and one domestic vacancy at 37.5 hours spread over two weeks. The home covers these vacancies through existing staff taking on extra hours and agency staff. The manager confirmed that the home is actively recruiting for these vacancies. Evidence was seen of appropriate deployment of care staff at peak times of activity such as assisting service users with personal care during the morning and evening. In discussion the manager informed the inspector that all staff were over eighteen years of age and those left in charge were at least twenty-one. The home employs two waking night care staff and sufficient numbers of ancillary staff required to ensure that standards relating to food, meals, nutrition and cleanliness are fully met. Discussions with the registered manager and training schedules seen evidenced that all staff undertake an induction programme at the on set of their employment. The induction programme provided by the home meets the National Training Organisation workforce training targets. The registered manager confirmed that all staff receive foundation training to NTO specifications within the first six months of appointment. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36, 38 Staff are properly supervised to ensure that they work in line with the home’s stated purpose. The health, safety and welfare of service users and staff are promoted although there are minor shortfalls to be addressed. EVIDENCE: Records seen indicated that staff supervision takes place at least six times a year. Staff spoken to during the inspection were able to verify this. The inspector noted that all relevant policies and regulations were on display throughout the home for all staff to read. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 22 The inspector noted that the manager routinely reported all reportable incidents in accordance with regulation 37 of the Care Homes Regulations2001. A tour of the premises found the kitchen and storage areas clean and well managed. Records of fridge, freezer and high-risk cooked foods were held and well maintained. Disposable gloves and aprons were available and in use in the laundry area. Records for the Control of Substances Hazardous to Health (COSHH) were readily available to staff. Records are held of annual portable electrical appliance checks. The homes policy/procedure for the disposal of body waste and soiled material was seen. This was a detailed and informative document. Staff interviewed confirmed that the procedure was being adhered too. The manager informed the inspector that a premises fire risk assessment had been undertaken along side all the generic risk assessments. The fire safety logbook was seen. Fire alarms are tested and the outcome recorded weekly. A tour of the building showed that one of the fire extinguishers (extinguisher 6) was condemned. The registered manager must ensure that the condemned fire extinguisher is removed or replaced. St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 1 3 3 2 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 2 St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 5(1) Requirement The registered manager must ensure that all service users are provided with a statement of terms and conditions/ contracts. The registered manager must ensure that all reviews specify what changes have taken place, how these are to be dealt with and by whom. The registered manager must ensure that all service users have a care plan in place. The registered manager must ensure that all areas of risk are assessed. The registered manager must ensure that service users’ wishes concerning death and dying are discussed and taken into account. The registered manager is required to indicate in residents’ records what their preferred activities are and ensure that those activities are catered for in as much as possible
DS0000032516.V251615.R01.S.doc Timescale for action 31/12/05 2 OP7 15(2) 31/12/05 3. OP7 13 31/12/05 4. OP11 12(2) 20/09/05 5. OP12 16(2)(m) 20/09/05 St Michael`s House Version 5.0 Page 25 6. OP38 13(4) The registered manager must ensure that the condemned fire extinguisher is removed or replaced. 20/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Michael`s House DS0000032516.V251615.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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