Inspection on 06/09/05 for Stepping Stones

This inspection was carried out on 6th September 2005.

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

The inspector 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

Stepping Stones 14/07/08

Stepping Stones 04/08/07

Stepping Stones 17/10/06

Stepping Stones 19/02/06

Stepping Stones 11/01/05

Stepping Stones 20/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Stepping Stones Broadoak Newnham on Severn Gloucestershire GL14 1JF Lead Inspector Lynne Bennett Announced 6 September 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 3 SERVICE INFORMATION Name of service Stepping Stones Address Broadoak Newnham on Severn Gloucestershire GL14 1JF 01452 760304 01452 706786 Nigel@steppingstonesru.co.uk Stepping Stones Resettlement Unit Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nigel Greenhalgh Care Home 33 Category(ies) of LD - Learning Disability Both (33) registration, with number of places Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11.1.2005 Brief Description of the Service: Stepping Stones is a registered care home for 33 adults with a learning disability who may also exhibit challenging behaviour. Accomodation is provided in 7 small units. Each unit accomodates between 3 and 7 service users. There are further developments planned in the long term to provide self contained accomodation for up to 6 people. The home is set in extensive grounds which includes a horticultural area, an aviary and a swimming pool. There is also a day centre on site which is staffed separately. It is attended by service users from Stepping Stones and also from other homes in the Stepping Stones group. Stepping Stones Resettlement Unit Ltd has recently retained its ISO 9002 award. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a day in September 2005 between 9.30 and 18.00. A tour of the grounds was conducted and five of the houses were inspected including Poplars Cottage, Pine Brook, Willow Green, Rose Lawn and Cedar Falls. One person in each of these houses was case tracked, which involved looking at their personal records, meeting them and looking at their room. Their care was also discussed with staff working in the houses. Other information examined included staff files, medication and health and safety records. The registered manager was present during the inspection with support from the deputy manager, personnel manager and clinical nurse. Time was spent with nine care staff discussing the care they provide. What the service does well: What has improved since the last inspection? There has been a significant improvement in opportunities at weekends for people living on the unit to go out and about in their local community, nearby towns and for day trips. Any restrictions or limitations of freedom of movement or choice are recorded and in the best interests of the person living at the unit. The Commission for Social Care Inspection has been kept fully informed of any incidents that have occurred at the home. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 4. The home’s Statement of Purpose and Service User Guide give prospective people moving into the home details of the services the home provides and a series of visits enables them to make an informed choice about whether they wish to live there. The categories of registration must reflect the needs of the people living at the home. EVIDENCE: The Statement of Purpose and Service User Guide were reviewed in June this year. Further amendments will need to be made to these documents to reflect changes to the staff group. The Statement of Purpose needs to include the upper age limit of people living at the home. The Service User Guide indicates this as 65. A variation to registration will need to be applied for a person who has lost their sight. This was discussed with the registered manager after the inspection. The home has admitted three new service users since the last inspection. The care for a person who moved in the week before the inspection was case tracked. Staff confirmed that visits with members of their family were made to the unit before moving in. Staff from the home also visited the service user at their former placement to make an assessment of the needs. Information was Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 9 obtained from the placing authority and from the former placement. Some staff felt that they had not been given sufficient information about the daily routines of the new service user. Management acknowledged that they had identified this shortfall and were completing a Pathways assessment to obtain this information as quickly as possible. They also said that they are in close contact with the family. Discussions with the management and staff confirmed that where the home feels it is unable to continue to meet the needs of people living at the home then the appropriate steps are taken to inform the service user, family and placing authority. Records verify that support is given to help the person to move on to an appropriate placement. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 and 10. Care planning in the home is generally good promoting the development of skills and independence. Most of the risk assessments encourage and support people living at the home to challenge and deal with problem areas in their lives. Personal records are not always stored appropriately ensuring the confidentiality of information. EVIDENCE: The new care planning system is now fully operational. It provides the opportunity for staff to monitor individual care plans on a daily basis. At the end of the month the key worker prepares a report that is then used as a basis for the annual review. Annual reviews include reports from key workers, the behavioural therapist, nurse, day care and the G.P. Members of the service user’s family and a representative from the placing authority are invited. Staff spoken to have a good understanding of the needs of the people they support. A person who lives at the home indicated that they have a positive relationship with their key worker. There is some inconsistency in the quality of writing in some of the care plans and the recording of information. Management explained that this has been Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 11 identified and they are dealing with this through supervision and by providing training for staff. Staff should make sure that records are signed and dated and where appropriate the service user involved in this process. Limitations on personal freedoms are recorded including access to door keys, an alarm on a bedroom door and use of listening monitors. This now meets with requirements from previous inspections. Risk assessments clearly identify the hazards and how these should be minimised. Discussions with staff indicated that they are aware of these documents and how they would reduce risks when working with people living at the home. Most risk assessments are being reviewed and the author is indicated. Additional risk assessments for people living at Poplars Cottage are not individualised and talk in general terms about ‘the client’. The same risk assessments were in place on two files examined. Whilst people living at Poplars Cottage may face the same risks, these risk assessments should be individualised to specify who they are referring to and indicate their specific responses to these risks and how they can be managed. In several of the houses personal information regarding the care needs of people living in the houses was displayed in a public area such as the kitchen. The management must discuss with staff a more appropriate way of storing information that needs to be readily accessible to staff. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 and 17. A varied programme of social and recreational activities is scheduled providing people living at the home with the opportunity to lead a fulfilling lifestyle. There has been a significant improvement in the range of leisure and social activities being offered at weekends to people living at the home. Contact with family and friends is encouraged and supported EVIDENCE: People living at the unit have access to a range of day care provision, both on site and in their local community and nearby towns. Each person has an activity programme indicating what is available for him or her each day and evening. Staff indicated that this was flexible and if a person chose not to participate in an activity then this was respected. The day centre provides activities ranging from pottery and crafts to computer work and literacy. There is a café on site for people attending from other homes in the organisation and people are encouraged to work there. People also have access to a riding stables and farm where work experience is also available. One person said Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 13 they are looking forward to attending a local college in September and others said they liked pottery and doing crafts. Good use is made of the garden at Poplars Cottage to provide a sensory environment for one person living there. There is also a swimming pool for the use of people living at the unit. A sensory environment is also being developed for a person with a visual impairment. Staff were observed supporting this person in activities identified in their care plan. Since the last inspection shift patterns have been changed at weekends to increase the opportunities for staff to support people living at the unit in activities away from the home. One person said they enjoy shopping and another likes going to the pub. Staff said trips are arranged to the beach and to Chepstow market. Staff said that there is sufficient transport on site to enable them to take people out and about. People are supported to maintain contact with families and friends. Diaries keep a record of these contacts and visits home. Each house has a different system in place for menu planning. Some have a roll over 6-week menu and any changes to this are recorded in the daily diary. Other houses plan menus on a weekly basis with the people living there and keep a record of the meal provided in the diary. Daily notes for people living at Poplars Cottage indicated occasionally that an alternative meal was being provided but not what the meal was. This must be recorded. Staff at the house also indicated that one person often chooses to have sandwiches instead of the meal being offered again this must be recorded. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20. The way in which the people living at the home would like to be supported is clearly recorded and managed ensuring that their personal and healthcare needs are being met. There is good evidence of multi disciplinary support on a regular basis. Medication systems need to be improved to ensure that the risk of medication errors are minimised. EVIDENCE: The way in which people wish to be supported is indicated in their care plans. People were observed being supported with respect and dignity. One person was distressed and staff were observed supporting them in line with their management plans. Another person has complex physical needs and staff confirmed the way in which their needs are met as indicated in their care plan. Health Action Plans are being introduced for all people living at Stepping Stones. Two plans were examined providing comprehensive information about each person’s health care needs and appointments with healthcare professionals. Records of appointments with healthcare professionals are being kept for people without a Health Action Plan. The unit’s clinical nurse meets with the G.P. each week to discuss the healthcare needs of people living at the unit. A consultant psychiatrist visits Stepping Stones every 6 weeks and there is regular contact with the community nurse of the local Community Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 15 Learning Disability Team. Behaviour management plans are in place and are being regularly reviewed by the unit’s clinical care manager, manager and key workers. Medication systems for Poplars Cottage are mostly satisfactory. Some drugs are taken out of the container in which they are supplied by the pharmacy and placed in plastic folders with drugs supplied in the monitored dosage system. Staff hand write the labels on these plastic folders. Medication must not be taken out of its original containers. At the main medical office, medication is kept in plastic folders but with the original container and with the pharmacy label. This significantly reduces the risk of errors. At present medication is transported around the site to the other houses in its original containers and the individual monitored dosage system. The management must find a more secure way of taking medication to the units using a lockable container. The administration of medication to these houses is otherwise satisfactory. Staff will receive accredited training in medication through the new Learning Disability Award Framework course and the NVQ awards. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home is protecting people living there from abuse by providing appropriate training for staff and having robust systems in place to challenge poor practice. EVIDENCE: Staff spoken to have a good understanding of the home’s policy and procedures in relation to the protection of vulnerable adults and whistle blowing. They confirmed that training is provided in the protection of vulnerable adults. All staff attend training in the management of challenging behaviour with a trainer accredited with BILD. Two new members of staff confirmed they had completed this course. The management team challenge poor practice dealing with this through the organisation’s disciplinary procedure. The local adult protection team are involved with the home when needed. Acute incident records are completed after incidents of aggression and challenging behaviour. Copies are forwarded to the clinical team who monitor the frequency of incidents and review behaviour management guidelines in response to any significant changes. The Commission is kept informed of any incidents under Regulation 37. This complies with a requirement issued at the previous inspection. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30. The houses are pleasantly decorated and comfortably furnished. There is an ongoing maintenance and refurbishment programme in place making sure that the houses continue to meet the needs of the people living in them. EVIDENCE: Poplars Cottage, Pine Brook, Rose Lawn, Cedar Falls and Willow Green were inspected on this occasion. The standard of decoration and furnishings are generally good. People are supported to decorate their rooms to reflect their interests, lifestyle and needs. In some cases this may mean a minimal approach to fixtures and fittings. Copies of Regulation 26 reports confirm that day-to-day maintenance issues are monitored and actioned for attention. Since the last inspection the kitchen in Pine Brook has been totally refurbished. The bathroom in Poplars Cottage is to be refurbished. There are plans to refurbish the kitchens in Rose Lawn and Willow Green in 2006. This work has been identified for some time and will now become a requirement. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 18 Other issues identified during the inspection include: • • • • • Curtains in many houses were hanging off the curtain rails, this needs to be addressed Pine Brook – Bathroom floor on the first floor has an unpleasant odour – this must be investigated and action taken to remove the odour Light pull in bathroom at Poplars Cottage to be replaced Rose Lawn – the smell of urine in the lounge to be investigated and addressed Rose Lawn – cushions on the sofas in the lounge should be replaced. At the time of the inspection those parts of the unit inspected were clean and tidy, apart from those identified in the text. Staff confirmed they are supplied with personal protective equipment. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35. Robust recruitment and selection procedures are in place protecting the safety of people living in the home. Staff have access to a range of training providing them with the knowledge and skills to meet the needs of people at the home. EVIDENCE: Personnel files were examined for seven new members of staff including information for a member of staff from overseas. Comprehensive recruitment and selection procedures are in place with a team dedicated to process applications and employ new staff. Staff from overseas are processed by an external agency. Stepping Stones obtain Povafirst and CRB checks for all new staff including staff from overseas. There was evidence of the dates these checks were obtained. Criminal Record Bureau checks for all staff were destroyed during the inspection in line with Data Protection Recommendations. Staff files contained information as required under Schedule 4. The Personnel officer confirmed that occupational health questionnaires are being introduced for all new staff. It was evident that gaps are being checked in employment history and a full employment history is being requested. One person was appointed without reference to a former care position or indication of the reason for leaving. This was acquired during the inspection. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 20 Stepping Stones has a comprehensive training programme in place for all staff starting with induction, training in the management of challenging behaviour, Learning Disability Award Framework and then a NVQ in care. A rolling programme is available for core training, refresher courses and training specific to the needs of people living at the unit such as Autism. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39 and 42. The home’s quality assurance programme involves people living at the home in the review of services being provided. Systems are in place enabling the home to provide an environment that promotes the welfare and safety of people living there. EVIDENCE: The Commission for Social Care Inspection has recently confirmed the registered manager in post. He has considerable experience in the field of learning disability and is maintaining his own professional development. He has a management qualification that is equivalent to the Registered Managers Award at Level 4. Stepping Stones Resettlement Unit has retained its ISO 9002 and Investors in People Award. The Commission receives regular monthly reports of Regulation 26 visits. There was evidence on files examined that people living in the houses complete a quality assurance survey each year. Monthly health and safety checks are also in place monitoring the quality of the environment. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 22 The pre-inspection questionnaire confirmed that regular health and safety checks are in place to monitor: • Fire systems and fire equipment • emergency lighting is being tested but not at the correct frequency. This must be done each month • portable appliance testing is due – staff have just been trained to complete these tests and they will be put in place as soon as possible • fridge and freezer temperatures are being recorded in the houses • the temperatures of cooked food are being recorded in some of the houses – Cedar Falls and Rose Lawn are not recording these temperatures • food boxes in the freezer in Poplars Cottage were not sealed or labelled with the date of opening. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stepping Stones Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6 Timescale for action Review the Statement of Purpose 9 to include the upper age limit of December service users and changes to the 2005 staff team. A variation to registration must 9 October be applied for a person with a 2005 sensory disability. Risk assessments must indicate 9 who they refer to and how these December risks are managed. 2005 All personal care records must 9 October be kept securely. 2005 A record of all food provided to 9 October service users must be recorded. 2005 Medication must not be taken 9 October out of its original containers. 2005 Medication must be transported around the site in a lockable container. The kitchens in Rose Lawn and 30 June Willow Green must be 2006 refurbished. Environmental issues as 9 identified in the standard to be December actioned. 2005 Emergency lighting must be 9 October tested each month. 2005 Requirement 2. 3. 4. 5. 6. 1 9 10 17 20 CSA 15(1)(a) 13(4) 17(1)(b) 17(2) Sch 4.13 13(2) 7. 8. 9. 24 24 42 23(2)(b) 23(2)(b) (c)(d) 23(4)(c) (iv) Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 6,9 42 Good Practice Recommendations Records should be signed and dated and where appropriate the service user asked to sign these documents. Food in fridges and freezers should be sealed and labelled with the date of opening. Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 26 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB 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 Stepping Stones D51_D03_S16589_SteppingStones_V201294_Stage2_060905A Version 1.40 Page 27 - 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. 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