Inspection on 31/08/06 for Stapleton House

This inspection was carried out on 31st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stapleton House 07/10/08

Stapleton House 19/05/08

Stapleton House 25/05/07

Stapleton House 07/02/06

Stapleton House 28/07/05

Stapleton House 11/01/05

Stapleton House 05/07/04

Stapleton House 06/11/03

Stapleton House 11/07/03

Stapleton House 23/10/02

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

CARE HOMES FOR OLDER PEOPLE Stapleton House Back Borough Road Jarrow Tyne And Wear NE32 5XW Lead Inspector Irene Bowater Unannounced Inspection 31st August 2006 09:00a 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 Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stapleton House Address Back Borough Road Jarrow Tyne And Wear NE32 5XW 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) 0191 430 0179 0191 483 3294 the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Care Home 45 Category(ies) of Dementia (12), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (31), Physical disability (4), Physical disability over 65 years of age (6) Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Stapleton House is a purpose built home providing both personal, nursing and dementia care for older people. It is a two storey building serviced by two passenger lifts. All bedrooms except one are en-suite, and there are lounges, one with an adjoining conservatory, and separate dining rooms. The corridors and doors are wide and allow access for people using wheelchairs. There is a 12-bedded dementia care unit situated on the first floor. This is a self-contained unit with individual bedrooms, dining room and lounge. There are adapted bathrooms, showers and toilets close to all resident areas. The home is located in a quiet, discreet area with well-laid gardens to the rear overlooking a green belt area, which offers a picturesque view from some bedrooms and the communal areas. The home is close to the town centre of Jarrow, to all amenities, and public transport, including the Metro railway system. Car parking facilities are available. The current fee rates range from £359 to £482 and includes the nursing care contribution, which is set nationally. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over seven hours. The inspector spent time with the Manager, staff, residents and visitors. The inspector looked around and talked to residents and staff, and saw the contact between them. Time was also spent checking the cleanliness, maintenance and decoration of the home. A number of documents were looked at including, training, maintenance, catering, medication, financial, recruitment, health and safety, and complaint records. What the service does well: The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs. Staff often talk with other professionals to ensure residents health care needs are met. The staff team have good relationships with the residents and know how to care for them. Residents said that “I am happy here” and “the girls are kind”. Relatives comment include “They offer care, compassion and dignity and we are happy with the care”, “Everyone is helpful and they keep us well informed on things we should know”, “I am satisfied with the overall care”, The meals are nutritious, nicely presented and choices are available. Residents agreed with this by saying, “the meals are fine”, “there’s plenty to eat” and “I can have what I want”. Visitors are made welcome and there are good links with the local community. Residents said they would be able to use the complaints procedure if they had a concern. The activities organiser and care staff work hard to provide activities inside and outside of the home. The staff receives the training they need to care for the residents needs. The recruitment policies are followed. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 6 Staff and residents are kept informed about any changes in the home. The home is clean, homely and a comfortable place for people to live. What has improved since the last inspection? What they could do better: Further work is needed on the care plans so that they are clear and detailed about the care provided. Improvements are needed to the medicine charts. The manager needs to look at how meal times can be managed better for those residents who need a lot of help. Different use of colour and signs is needed on the dementia care unit so that residents can easily find their way around the unit. Repair work is needed to the radiators in communal areas. The light cords need to be changed to make sure they can be cleaned on a daily basis and the water needs to be run in unused bathrooms and shower rooms. Another hot trolley is needed to make sure residents do not have to wait for their meals. In house maintenance records need to be completed weekly. The manager needs to complete application forms to become registered with the Commission. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 7 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. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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 Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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): 3. Standard 6 is not applicable. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The pre-admission assessments ensure the residents care needs will be met. EVIDENCE: A random sample of care plans were inspected and showed that the manager carries out comprehensive assessments before any resident is admitted to the home. The care managers and the nurse’s assessments were also available. These records form the basis of the care planning process for the resident. Where possible the relatives or resident’s representative is involved in the assessment process. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The care planning system needs further improvement to provide staff, residents and their representatives with the information they need to meet resident’s needs. The health needs of all residents are being met. There is interagency working. The systems for the administration of medicines are safe and consistent. Personal support is currently promoting residents right to privacy and dignity. EVIDENCE: Each resident has a care plan which is based on the preadmission assessments which are carried out by care managers, home manager and when necessary the nurse assessor. The assessment tools include pressure sore risk assessments, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 11 The staff are in the process of changing the care plan documentation as the home has recently been taken over by another company. This has meant that it is difficult to review the care plans as information is written in two different places sometimes under different headings. It also means that the staff are recording daily events but are not then updating the new care plan when the residents health or personal care needs change. Care plans which identify that residents are presenting with some challenging behaviours in the daily records do not then have a care plan for the rest of the staff to follow to make sure the resident receives consistent meaningful care. There is limited information about residents’ previous lifestyles and social care needs especially on the Dementia Care Unit. The manager confirmed that staff have had care planning training, however further input by senior staff is needed to make sure residents needs are being met. One care plan was completed with the new documentation to a good standard It was clear up to date and had information regarding discussions with relatives and other health professionals. The residents have access to all NHS facilities. There are regular visits from GP’s and other health professionals including dentists, opticians and chiropody services. There are appropriate pressure relieving devices, hoists and other equipment available to support the staff and residents in daily activities. Advice is sought from tissue viability specialists, speech therapists and continence advisors. The home has comprehensive medication policies and procedures for staff to use. Records are in place for all medicines received, administered and disposed of. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. Handwritten directions on the M.A.R. sheets did not have two witness signatures. There is a register of staff who are authorised to administer medication. Residents spoken to felt that they are treated with respect and their right to privacy is upheld. Residents spoke about their personal wishes and preferences, which are respected by staff and documented. Examples include locking their bedroom doors, receiving their mail unopened, being addressed by their preferred name and being able to go wherever they wish in the home. There was a good rapport between staff and residents, which was friendly and professional. Care was delivered in private and staff were seen to knock on doors and wait for permission before entering. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. Social activities provide stimulation and interest for residents living in the home. Support from relatives and representatives provide residents with opportunities to maintain their previous lifestyles. Residents are supported to make choices and take control over their lives. Dietary needs of residents are catered for with a balance of food available that meets residents’ needs. EVIDENCE: The home benefits from a designated activities organiser who arranges various events both inside and outside the home. Evidence of events are displayed and an activity diary is available which records activities undertaken or refused. On the day of the inspection residents were enjoying painting and crafts and their completed paintings were displayed in the home. Other events include coffee mornings, pie and pea suppers, a visit to the Customs House, local shopping trips, pub lunches and in house entertainment. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 13 Links with the local community are maintained with evidence of residents going out to shops, trips out for lunch and visits to the theatre. Church services are held on a regular basis. Relatives and friends are made to feel welcome and know that they can visit at any time. There were visitors on the day of inspection and the staff took time to welcome them and discuss events with them. Residents are encouraged to take responsibility for their own financial affairs for as long as possible. The staff supports anyone who needs assistance and involve families, advocates and care managers if there are any problems. Residents have been encouraged to bring small items of furniture and other belongings with them, making their rooms highly individualised and reflective of their lifestyles. The home has two dining rooms on the ground floor and one dining room on the upstairs unit. The tables were appropriately set with tablecloths, napkins, crockery and condiments. The inspector observed the lunchtime meal being served on the downstairs unit. The meal was served from a hot trolley, which has to serve both dining rooms. This meant that staff had to push the trolley up and down the corridor and residents in one dining room had to wait whilst the residents in the other dining room were served their meal. It was noted that all of the residents who needed assisted sat in one dining room and all of the residents in the other dining room needed minimal assistance, however the majority stayed in their wheelchairs for their meal. This practice was discussed with the manager as it brought attention to those residents who needed a lot of help. Several residents had their lunch served in their own rooms. The residents were offered a choice of cottage pie or vegetable pasty with gravy. The fresh vegetables were savoy cabbage, carrots and sauté potatoes. Other alternatives available were, a selection of salads, sandwiches or omelette. Dessert was semolina with jam with ice cream or yoghurt as alternatives. Hot and cold drinks were available throughout the meal. Residents said the “food is nice” and “there is always plenty to eat”. The staff were kind and attentive to all of the residents and the lunchtime meal was a pleasant period. Fresh fruit hot and cold drinks and biscuits were available and offered to residents throughout the day. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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): 16,18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to the service. The complaints procedures are clear. Residents and relatives are confident that their views are listened to and acted upon. Arrangements for the Protection of Vulnerable Adults are satisfactory and protect residents from harm. EVIDENCE: There are detailed complaints policies and procedures available in the home. The procedures are displayed in reception and are in the Statement of Purpose and the Service User Guide. There have been no complaints since the last inspection. There are policies and procedures in place for the Protection Of Vulnerable Adults and staff were able to discuss what to do should there be any allegation of abuse. All of the staff apart from the new starters have completed the training. The manager sources external training and she also carries out training in the home. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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): 19,21,20,26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The home is comfortable and clean and meets the needs of the people who live there. Some areas require improvement. EVIDENCE: Since the last inspection the home has had a variation to registration. This means that a separate Dementia Care Unit has been provided upstairs. This unit has twelve bedrooms, adapted bathrooms and toilet facilities and a dining room and lounge. It has been decorated and furnished to a good standard and further work is going to be carried out regarding the decoration to make sure residents can easily find their way around the unit. There are dining rooms and lounges downstairs and one lounge leads to a pleasant conservatory. Residents can access the garden, which is at the back of the home. Several of the radiators throughout the home are in need of repair as the ends are loose and ill fitting. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 16 All of the bedrooms apart from one have an en-suite facility. There are adapted bathrooms, shower rooms and toilets close to all resident areas. Shower room 47 was being used for storage of two hoists, a bedside table and a television. This room had a stale odour, as the water was not being flushed on a regular basis. A tour of the home found it to be clean and fresh. The laundry was clean and organised and is situated away from resident areas. The sluices were generally clean and odour free and there is a sluice disinfector, which enables the staff to deal with contaminated fluids effectively. A tour of the home found that the light cords have become knotted and grimy. In order to minimise the risk of cross infection these need to be replaced to enable to staff to clean them on a daily basis. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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 Quality in this outcome is good. This judgement has been made from evidence gathered both during and before the visit to the service. The current staffing levels and staff deployment ensures the residents assessed needs are met. The arrangements for training and recruitment ensure that residents are protected and staff are competent. EVIDENCE: The home and the staff have undergone several changes since the last inspection. There has been a change in Company, a new manager and a variation to registration. The staff said they now are settling and are pleased to have the new manager in post. Many of the staff have worked at the home for many years and have formed a stable staff team. The home has two units. A qualified nurse and care staff manage the nursing unit and a senior carer and care staff staffs the Dementia Care Unit. The staffing rotas show that agency staff have been used recently however new staff have now been recruited and agency use has reduced. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 18 On the day of inspection the home was staffed as follows: Dementia Care Unit: 1 senior carer and 1 carer until 5pm. 1 senior carer from 5pm and overnight. The manager confirmed that the staffing levels would increase as more residents were admitted to the home. Nursing Unit 1 Qualified nurse over 24 hours 5 care staff until 2pm 4 care staff until 8pm 2care staff overnight. The manager confirmed that the staffing levels would increase as more residents were admitted to the home. There were sufficient ancillary staff on duty including laundry, catering, administration and activities organiser. The home has recently recruited a maintenance person. The home continues with NVQ level two training although 50 do not have this qualification. Five staff files with their training and development files were inspected. The records for recruitment were satisfactory. There was evidence of Criminal Record Bureau checks, Protection of Vulnerable Adult checks, two written references, proof of identity, professional identity numbers for registered nurses and completed signed induction programmes. Evidence from the files and from discussion with staff confirmed that staff have received training in safe working practices, protection of vulnerable adults, prevention of pressure damage and dementia care training. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The manager is appropriately qualified to manage the home. The systems for consultation and quality monitoring are satisfactory with evidence that views of residents and their representatives are sought and acted upon. Residents personal accounts are managed to ensure their best interests are protected. Some in house maintenance records are not in place, which may affect residents. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 20 EVIDENCE: The manager is a first level registered mental health trained nurse who has many years experience. She has completed the Registered Managers Award and also has a BsC Diploma in Health and Social Welfare. She has recently been recruited and now needs to progress with her application to become registered with the Commission for Social Care Inspection. There are quality assurance and quality monitoring systems in place. Monthly visits by the regional manager take place and a report of the areas audited are available .The home manager has completed a medication and kitchen audit and a care plan audit is being completed. Regular staff, resident and relatives meetings take place with minutes kept. Resident’s personal financial records were inspected. A record is maintained for each person’s transactions. Entries were clear with signatures available. A random check of balances and cash were found to be correct. The hairdresser submits communal receipts; these should be individual for each resident to assist with audits. Staff have had training in safe working practices with records kept. Fire training is completed every three months for night staff and six months for day staff. Accidents are clearly recorded and the manager completes monthly accident analysis to examine and track any trends. A fire risk assessment is available and is up to date. Weekly in house health and safety checks were not up to date. Contract maintenance records are available and generally up to date. The Gas Safety test was last completed in May 2005 and it was confirmed that this was scheduled for retesting. The company have a Health and Safety Officer who is available for advice and regularly visits the home. The last visit being August 2006. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 22 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 OP7 Regulation 13,15 Requirement The registered persons must ensure that all care plans set out in detail the action to be taken by staff to ensure all aspects of the health, personal and social care needs of residents are met. The care plans must include detail how staff deal with difficult or challenging behaviours. The registered persons must ensure that the plans are reviewed at least monthly and are updated to reflect any changing need. The registered persons must ensure that all handwritten directions on the Medicine Administration Records have two signatures. The registered persons must review the practices at mealtimes to ensure residents’ dignity is not compromised. The registered persons must ensure that all radiators are repaired and securely fitted. The registered persons must ensure that the light cords are DS0000000276.V308521.R02.S.doc Timescale for action 01/11/06 2 OP9 13,17 01/11/06 3 OP15 12,16 01/11/06 4 5 OP19 13,23 13,23 01/11/06 01/11/06 OP26 Stapleton House Version 5.2 Page 23 6 OP28 18 7 OP31 9 8 OP38 13, free from knots and easily cleanable. The registered persons must ensure that 50 of care staff achieves NVQ level 2 or equivalent. The registered persons must ensure that the new manager progresses with the application to become registered with the Commission. The registered persons must ensure that the water is flushed at regular intervals in unused bathrooms and shower rooms. The registered persons must ensure that in house maintenance checks are carried out weekly with records kept. The registered persons must ensure that there are sufficient hot trolleys available for serving food. 31/03/07 01/11/06 01/11/06 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 OP35 Good Practice Recommendations The registered persons should ensure that individual receipts are provided to enable detailed audit. Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stapleton House DS0000000276.V308521.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!