Inspection on 24/01/06 for St Michael`s Manor

This inspection was carried out on 24th January 2006.

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

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

Other inspections for this house

St Michael`s Manor 16/01/08

St Michael`s Manor 21/09/07

St Michael`s Manor 23/11/06

St Michael`s Manor 16/06/06

St Michael`s Manor 12/10/05

St Michael`s Manor 08/09/04

St Michael`s Manor 08/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE St Michaels Manor Woolton Road Woolton Liverpool Merseyside L25 7UW Lead Inspector John McCabe Announced Inspection 24th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Michaels Manor Address Woolton Road Woolton Liverpool Merseyside L25 7UW 0151 427 9419 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) M.E.S. Pension Fund Mr Philip Sergeant Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 44 Nursing Care and 44 Personal Care within the overall number of 44 44 Nursing or 44 Personal Care of which 5 may be used for terminally ill (older people) (TI/E) One service user under 65 years of age requiring terminally ill care may be admitted within the overall number of 5 TI(E) 12th October 2005 Date of last inspection Brief Description of the Service: St Michaels Manor is one of two adjacent care homes situated on the same site in a quiet residential area of South Liverpool. A private company owns both homes. St Michaels Manor is registered both for residential and nursing care plus five beds for palliative care. Trees and grassed areas surround the home which gives a sense of privacy, plus the home has its own gardens, there is a car park to the front of the home. The building itself is an older Victorian dwelling, which has been modernised inside whilst keeping many of the attractive original features such as the ornate ceilings and a sweeping central staircase. Passenger lifts and stairs serve the upper floor. Accommodation for residents is provided in single rooms many of which have a toilet and hand washbasin. The home is centrally heated. There is a large central lounge dining room. The home is close to public transport, rail and bus and is near to the M62 and M57 motorways. . St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection began at 0930 hours on the 24/1/06. Due to outstanding issues raised in the last unannounced inspection report, Mr. Paul Gillespie, Regulation Manager from the Liverpool/ Wirral office of the CSCI was present for the morning session of the inspection. The registered manager of the home was present throughout the inspection. Documents for residents and staff were reviewed, and a full inspection of the building took place, which included bedrooms, laundry, kitchen and the garden areas. Residents and staff were spoken to during the inspection period, to get their views on the conduct of the home. What the service does well: What has improved since the last inspection? What they could do better: There appear to be some difficulties with the supply of hot water to resident’s rooms on the ground floor and this extends to the heating also. These must be addressed to ensure all residents have adequate heating and hot water available. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 6 The manager of the home needs to respond to the need to provide training for nurses in Palliative Care so that the assessed and changing needs of the resident needing palliative care can be appropriately met. The registered manager must ensure that all employees who work in the home have the necessary CRB/POVA First checks before they commence employment so that residents are not put at any unnecessary risk from individuals who may be unsuitable to work with vulnerable adults. It is important that all staff participate in regular supervision so they can reflect upon their own practice and have the opportunity to consider how they can improve the care delivered to residents. The home was not a clean as it should be as there was only one member of the domestic staff on duty. It is also important to record how residents have participated in organised activities in the home. This then provides a picture of how each resident is encouraged to maintain their independence and to remain active. 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 Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3,4,5. The Home’s Statements Purpose is up to date and ensures that the home stays within the category of resident agreed with the commission, and prospective residents have some knowledge of the home before they decide to move in on a permanent basis. EVIDENCE: The Home’s Statements Purpose is up to date and ensures that the home stays within the category of resident agreed with the commission, and prospective residents are provided with information about the home before they decide to move in on a permanent basis. This helps them to make a more informed choice about whether they wish to stay at the home. All residents before they move into the home have pre admissionnursing/residential assessment. The importance of the document is to assess the care needs of the resident and to ensure the home has the skill mix of staff to care for the resident. The pre-admission nursing document is the basis of the initial care plan for the resident. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 9 Other health care professionals known to the resident are involved in the pre admission assessment. This helps to ensure that the different aspects of care are considered for each prospective resident. Care staffs in the home do undertake specialist care training. This training includes understanding the impact stroke, challenging behaviours, cognitive impairment and diabetes. This training is ongoing; to ensure that the assessed and changing care needs of the residents can continue to be met. The home is currently registered for five Palliative care beds, however only the homes manager has had training in Palliative Care. The manager is a registered first level nurse who ensures the managerial and administrative functions of the home are carried appropriately. This in effect means that most of the registered managers time is allocated to none direct care. It is understood that the manager does not work at weekends so consequently there are no palliative trained nurse specialists on duty. To ensure that the care needs (especially pain relief) of the residents are met it is essential that other first level nurses be trained in palliative care. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10,11. Residents’ individual health, personal and social care needs are clearly recorded. This provides care staffs with the information they need to meet the residents care needs. Personal support in the home is offered in such a way as to promote and protect the residents’ privacy, dignity and independence. EVIDENCE: All residents in the home have an individual care plan, which is formulated on admission to the home and is reviewed by the senior nurses on a monthly basis. Daily health records are documented for each resident, this includes any critical incidences plus any visits from GPs, specialist nurses etc. Most of the care staff have undertaken training on tissue viability. The Primary Care Trust (PCT) tissue viability nurse will visit the home at any time if needs arise to address any presenting health care need and to offer advice. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 11 Photographic and skin mapping evidence for pressure sores is recorded in the resident’s personal file, so the healing process of the sore can be checked and monitored. All residents in the home can access their NHS entitlements; which includes access to dentists, opticians, and chiropody services. Care staff will accompany residents for hospital or clinic appointments. GPs visit residents when needs arise. None of the current residents in the home self medicate. Nurses or senior carers in the home administer all medications for residents. The protocols for the receipt, storage, disposal, and documentation of medications in the home are in accordance with the National Minimum Standards (NMS). At present the senior nurses in the home are reviewing the systems for the disposable of residents unwanted medications with the Clinical Waste Company who remove residents unwanted drugs from the home. Residents “Unwanted medications” are recorded by two first level nurses and then taken from the care home by the pharmacy. Residents told the inspector that staff in the home were always courteous, respectful, and strove to maintain their privacy and dignity when assisting residents with personal care. Some residents have asked for same gender carers to undertake personal care with them; staff always fulfil this request. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 the following standard(s): 12,13,14,15. Residents are encouraged to exercise choice and to have flexibility how they spend their day in the home. They also pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident Residents receive a varied nutritious diet that is in accordance with their preferences. EVIDENCE: Residents in the home are asked on admission, about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in. On admission to the home the resident with help from a family member completes a social questionnaire, which is a “Work life History” of the resident, and includes schooling, work, hobbies, food likes and dislikes etc. This information is used to facilitate organised activities for the resident. However when residents participate in social activities, it must be recorded in their daily health record sheet. This is to ensure that there is recorded evidence of how the resident coped/responded in the activity, and to reflect St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 13 their mood, emotions, physical dexterity etc. The recordings of the resident activities helps to complete a “full picture” of the resident’s progress, or even identify developing care needs. Visitors are allowed in the home at any reasonable time of the day and residents may entertain their visitors in the communal lounges, or in their own bedroom. Residents told the inspector that they enjoyed the variety of food in the home, but sometimes the food was cold especially for those who choose to eat in the bedrooms. Some of the residents prefer to take their meals in their own room rather than go to the dining room therefore the registered manager must remain mindful that the meals in these circumstances are served hot. The inspector observed the midday meal of pork chops and vegetables being served to the residents; the meal was well prepared and well presented. This helps to ensure that mealtimes are a meaningful social occasion. Therapeutic diets can be catered for in the home for residents with a medical condition. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 the following standard(s): 16,17,18. The home has a satisfactory complaints system, with evidence that residents feel their views are being listened to and acted upon. The homes policy and training programmes for POVA, and Whistle Blowing, ensure that the homes residents are protected from any potential abuse. EVIDENCE: There have been no internal complaints, and no complaints were reported to the commission since the last inspection. Many of the residents are encouraged to use their postal votes in the local or General Elections thus encouraging expression of political opinion. The care home has up to date information on the Protection of Vulnerable Adults (POVA) this information is communicated to new employees on their induction course. On the day of the inspection there was evidence that many of the staff in the home had undertaken training on POVA protocols, and the Whistle Blowing Policy. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 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 the following standard(s): 19,20,21,22,23,24,25,26. More effort is needed to improve the cleanliness of the home, the decor of a number of rooms, and to ensure that residents have hot water and heating in their bedrooms and bathrooms. At present the comfort and well being of the residents is compromised because of lack of basic maintenance in the home. It is unacceptable that previous requirements in respect of providing adequate hot water have yet to be complied with. Further failure to address statutory requirements may lead to enforcement action. EVIDENCE: On the day of the inspection the homes standard of cleanliness was unsatisfactory. The home is large and covers three floors with the accommodation comprising of single bedrooms. The task of maintaining a clean environment is a sizable one for one domestic staff. Therefore the registered person needs to consider having more domestic staff available to maintain a satisfactory level of cleanliness. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 16 Residents’ hand washbasins in bedrooms on the ground floor had no hot water; neither did the communal washbasins in the bathrooms. The resident’s bedrooms were cold, with little heat coming form the radiators. The outside temperature on the day of the inspection was 4 degrees centigrade. At the last inspection there was no hot water in the communal bathrooms, or residents rooms (ground floor). This is a breach of regulations and is unacceptable. Action must be taken to address this shortfall as a matter of urgency to ensure that residents’ comfort and welfare is not further compromised. The registered person should consider installing a modern water system that can heat water for 45 residents and other services in the home. The home’s washing machines in the laundry have had an OTEX system fitted to them; this enables soiled washing to be cleaned at lower temperature, using Ozone, less electricity, soap and water. The washing is ionised and aerated to allow widening of the cloth fibres so soaps can penetrate the fibres and kill more bacteria, including MRSA, Hepatitis B and C. Because of the danger of an Ozone leak from the OTEX system, the laundry must be well ventilated, and alarm monitor installed in the laundry room to detect Ozone leakage from the system. On the day of the unannounced inspection, a window covering had been removed from the laundry room to allow ventilation. The laundry room temperature was less than 20oC at 1130am. The laundry technician told the inspector that room was freezing and very difficult to work in. The registered person must ensure that staff work in the recommended ambient working temperature laid down by the Health and Safety Executive. The homes drying machine is broken, wet laundry has to be carried to the other home on the site to be dried. This is time consuming and adds further stress to staff involved. The machine has to be repaired as soon as possible. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The standard of vetting and recruitment practices is wholly inadequate with significant failings in ensuring all the required checks are undertaken. This places the residents at an unnecessary and unacceptable level of potential risk. EVIDENCE: There is always a first level nurse on duty that is assisted by care staff and ancillary staff. It was apparent that some staffs have been working in the home for some months without an up to date enhanced CRB/POVA First certificate. The manager was fully informed by the inspector at the last inspection regarding the requirement for all new staff to have a CRB/POVA check carried out prior to commencement of employment. The manager told the inspectors that he was aware of his responsibility to comply with safe recruitment practices but the manager acknowledged that he had not done so. This is approach is unacceptable and exposes residents to unnecessary level of risk. References for newly appointed staff were also obscure; it appears that references are usually requested from a ‘friend’ of the prospective employee. No interview notes are recorded for prospective employees that would evidence on what basis an offer of employment was to be offered, and original entry Visa’s for overseas staff could not be evidenced. The first of the two St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 18 required references for any prospective employee should be from their last employer or school. The manager was informed of these facts at the last inspection and has consequently failed to comply with the NMS and Care Homes Regulations 2001. This is a significant failure and is wholly unacceptable. The inspectors evidenced the Personal Identification Numbers (PINS) of all the registered nurses in the home, which was documented on Nursing Midwifery Council (NMC) stationary. Mandatory and specialist training for all staff is ongoing in the home; this is evidenced in the personal files of the staff. The home has two overseas nurses working in the home who are undertaking an Adaptation Course to prepare them for registration on the Nursing Midwifery Council (NMC) as First level Nurses. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Staff morale in the care home is good, resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. However, the registered manager must exercise appropriate control over the checking and vetting of all staff especially in respect of the recruitment, and the requirement for CRB/POVA checks. Continued failure to comply with previous legal requirements reflects on the manager’s ability to fully discharge their responsibilities and may lead to the CSCI considering its use of its powers of enforcement. EVIDENCE: An experienced first level nurse manages the home; currently the manager has not registered on an NVQ Level 4 care programme. Previously the manager was in charge of the two homes on the site before the regulations changed. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 20 The four outstanding legal requirements will be once again repeated. The lack of action in complying with legal requirements is a significant cause of concern and reflects poorly on the management of this service. CRB/POVA checks are still not undertaken on prospective employees, documented supervision of care staff does not take place in the home, and residents still have not hot water or heat in their bedrooms. Both the inspector and the Regulation Manger explained to the registered manager that continued failure as regards to complying with requirements would result in the Commission considering its powers of enforcement to ensure the health and welfare of the residents. It is concerning to note that the requirement to introduce formal regular supervision in line with the NMS remains outstanding from the last two inspections. Documented supervision can ensure that all staff have the opportunity to discuss with the manager, and other senior nurses, any issues, which can effect or improve the care for the residents. Documented supervision of all staff also gives the staff the opportunity to discuss their own /or identified training needs. This will be restated as a requirement. Where possible residents are encouraged to look after their own financial affairs, as the home doesn’t hold any bank accounts for individual residents. The homes certificates of insurance and worthiness for machines, gas, electricity, fire equipments, lift, hoists were in date and valid. All residents in the home have individual fire evacuation details in their personal files, this good practice and helps to ensure the safety of the residents and staff. The Employer’s Liability Insurance certificate is displayed in the main hall of the home and is valid and in date. Both residents and staff files are held secure in accordance with the data Protection Act 1998, thus maintaining confidentiality. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 Standard No Score 16 3 17 3 18 3 2 3 2 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 3 3 1 3 3 St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP12 Regulation 12 Requirement The registered person must ensure that when residents participate in organised social activities that it is recorded on their daily health record sheet. Previous Timescale of 31/10/05 Not Met. 2 OP25 23 The registered person must ensure there is hot water in residents bedrooms and communal bathrooms. Previous Timescale of the 31/10/05 Not Met. 3 OP36 19 The registered person must ensure that all care staff employed in the home receives formal documentation six times per year. Previous Timescale of 31/07/04, September 04 and the 31/10/05 Not Met 28/02/06 28/02/06 Timescale for action 28/02/06 St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 23 4 OP29 19 The registered person must ensure that no one is employed in the care home without all the required checks being undertaken including specifically an enhanced CRB/POVA certificate of a POVA first. Previous Timescale of the 31/10/ 05 Not Met 28/02/06 5 OP4 18 The registered person must ensure that First Level nurses undertake training in Palliative Care to ensure the assessed and changing needs of the residents are met. The registered person must ensure that the home is kept clean and tidy and free from smells The registered person must ensure that the laundry dryer is repaired or replaced. 28/02/06 6 OP19 23 28/02/06 7 OP26 16 28/02/06 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 OP38 Good Practice Recommendations The registered person should ensure that staffs work in the recommended ambient working temperature laid down by the Health and Safety Executive. St Michaels Manor DS0000025418.V279168.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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