CARE HOMES FOR OLDER PEOPLE
The Chestnuts 57 Bargate Grimsby North East Lincs DN34 5AD Lead Inspector
Sarah Urding Unannounced Inspection 22nd August 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Chestnuts DS0000034324.V309571.R01.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. The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 57 Bargate Grimsby North East Lincs DN34 5AD 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) 01472 345513 Cleethorpes Care and Nursing Ltd Marie Rose Land Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the occupant of the room must have no significant mobility problems 21st March 2006 Date of last inspection Brief Description of the Service: The Chestnuts is a well established home situated in a pleasant central location of Grimsby. It has access to local amenities and public transport. The building is Victorian in style with a modern extension providing care for up to 26 residents. The home caters for the needs of residents with the problems of old age and mild to moderate dementia. The home consists of three storeys serviced by stairs and a passenger lift. There are twenty single rooms, of which nine have en-suite facilities and three shared rooms. The home has registered a room on the first floor which has conditions applied due to configuration limitations. There are bathroom and WC facilities located on each floor. There is one lounge, a conservatory and dining room, all of which are located on the ground floor. The home has pleasant front and rear gardens with ample parking to the side of the property. The current scale of fees are £329- £367 per week. Additional charges include chiropody, hairdressing, newspapers and toiletries. The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection and the visit to the home was unannounced, taking place over a period of seven and a half hours. The requirements made at the last visit to the home, which included the need for care plans to identify how pressure care needs were addressed and for a quality assurance plan to be in place have been met by the home. Questionnaires were sent out prior to the site visit to a range of people who have an experience of the service. The inspector received comments back from one GP, nineteen service users and six members of staff. This information as well as information received from the manager provides a focus for inspection and will be reflected in this report. On arrival at the home the building was looked around and a number of records and policies were inspected. The owner and five members of staff were spoken to. Nineteen service users and a visitor to the home were also spoken to. What the service does well:
A number of positive comments were received from service users prior to the visit to the home. They say that staff are kind and look after them well. Service users also said during the visit that staff treat them with respect. The majority of service users said that the food was very good. One service user said that the food was of excellent quality. The meals provided are well balanced and a choice is offered at every mealtime. This was observed during the visit to the home when staff asked service users what they would like for tea. Service users say that they are encouraged to take part in activities that the home offers. They particularly enjoyed the summer fair that was held in the grounds of the home recently. The home is well decorated and homely. The owners make sure that the good standards are maintained. A detailed business plan is in place that outlines the improvements that are to be carried out and maintenance issues are dealt with promptly. Service users commented that the home is clean and smells nice. During the visit service users said that their rooms are cleaned regularly and that the laundry service is good. A number of service users said that they are happy with everything and have no concerns about how the home is run. Service users say that they feel able to approach staff if they have any concerns and that they are helpful. Staff spoken to are knowledgeable about how to protect vulnerable people and service users reiterated this by saying that they feel safe when being offered personal care and helped around the home by staff. The training made available to staff is appropriate for the work that they perform and takes place on a regular basis.
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 6 The home is a safe place for people to live and work with all of the required health and safety checks being undertaken. What has improved since the last inspection? What they could do better:
The home needs to ensure that when monitoring the weight of service users that action is taken when significant weight loss occurs. This had not taken place for one service user. Failure to act promptly could place service users health at risk and the manager was asked to make a referral to the GP immediately. The environment is well maintained. However there were a number of toilets and a shower room without locks on the door. In order to ensure the privacy of the service users this is required. The home was not recruiting staff as safely as it could. One member of staff did not have two written references prior to starting work and a protection of vulnerable adults check had not been carried out for another staff member. This is not robust and does not ensure that the risks of recruiting unsafe staff are minimised. One member of staff did not have a CRB check in place. The owner was asked to confirm the problem in writing to CSCI providing evidence of correspondence with the CRB outlining the issues. This issue must be resolved within the timescales identified within this report. A number of staff expressed concerns about the aggression displayed by one service user. Although a risk assessment was in place outlining the course of action that the home had taken, this was not adequate to protect the service user, other service users and staff. The owner was required to produce a risk assessment within 48 hours of the site visit outlining causes of behaviour and necessary responses of staff so that risks to themselves and others were minimised. The home accounts for service users funds appropriately. However the accounts kept for the residents’ fund are not formatted in a way that evidence enough detail for all transactions and balances. This must be addressed so that the home can demonstrate that the fund is managed appropriately. The Chestnuts DS0000034324.V309571.R01.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. The Chestnuts DS0000034324.V309571.R01.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 The Chestnuts DS0000034324.V309571.R01.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 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is able to meet the needs of service users owing to a thorough assessment on admission. EVIDENCE: The home undertakes a thorough pre-admission assessment of service users needs in all cases. The assessments are well presented and link clearly to the care plans of those service users. The home ensures that it is able to meet the needs of service users prior to looking after them. Standards 3.3 is met for all service users. Service users, their representatives and health professionals have contributed to the formation of the assessment. This evidences that the home works in partnership to glean full information about service users lives. The home does not offer intermediate care. The Chestnuts DS0000034324.V309571.R01.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 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users’ health care needs are met by staff who treat them with respect but an oversight in the effective monitoring of the weight of one service user means that their health care needs have been neglected. EVIDENCE: The home has detailed plans of care in place that describe the needs of service users well and demonstrate to staff how these needs are to be met. The care plans reflect the content of the pre-admission assessment of service users. Staff demonstrated when asked that they had a good working knowledge of people’s needs. Four records of service users were looked at during the visit to the home. The majority indicate that service users health care needs are well met. Service users say that they can see a GP when they wish or the home organises this for them. A chiropodist regularly visits the home and service users say that they are assisted to attend other health care appointments such as the optician and dentist when required.
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 11 The monitoring of service users weight takes place on a regular basis in order for the home to monitor nutritional needs. However there has been an oversight in the monitoring of one service users weight. The service users weight chart indicated a significant loss of weight over a period of two months. There was no record indicating that medical advice had been sought regarding this weight loss. In discussion with the owner it is apparent that this has not been addressed. The owner was asked to make an immediate referral to the GP regarding the nutritional/health care needs of the service user. The owner confirmed the following day that this has been carried out. Service users who are assisted with taking medication say that staff administer the correct medication on time. The home demonstrates that it administers medication appropriately by keeping comprehensive and fully completed records. This includes controlled drugs. Medication is stored appropriately and the temperature of the room and cabinets are monitored. This was a recommendation at the last inspection that is now met by the home. Staff who administer medication have been trained to do so safely. Service users spoken to said that staff treat them with respect and are polite. Positive relationships were observed between staff and service users. A number of service users said that the staff are kind to them. Service users said that staff call them by their preferred name. Staff were observed to talk to service users appropriately on the day of inspection. In discussion with staff about respecting people’s privacy, staff were able to demonstrate that they understand the need for sensitivity when carrying out personal care tasks. Staff were observed to knock on people’s doors prior to entering and service users say that their privacy is respected. The Chestnuts DS0000034324.V309571.R01.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 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Good facilities are provided for service users to experience activities, community and religious involvement of their choosing and maintain contact with their relatives. Meals are nutritious and balanced, offering a healthy and varied diet for service users. EVIDENCE: Service users lifestyle in the home satisfies their social, cultural religious and recreational needs. This was evidenced in care plans and in talking to service users and staff. A range of weekly activities is offered in the home including bingo, reminiscence, board games, baking and arts and craft. Some staff said that they are not always able to spend one to one time with service users or engage in as much activities as they would wish. This matter will be addressed in the staffing section of this report. Religious services are regularly held in the home and service users are able to attend church services in the community if they wish. One service user talked about enjoying attending her church on a regular basis. This was reflected in her care plan.
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 13 Contact with family and friends is promoted by the home. Service users are positive about being able to see their friends and family when they wish. Visitors to the home say that they are made to feel comfortable and that the atmosphere is welcoming. One visitor says that she is always offered a cup of tea when she comes. Another service user says that her daughter has a long way to come to visit her and that she is given sandwiches by staff when she comes. Service users are encouraged to maintain choice and control over their lives on a daily basis. Advocacy services are made available to service users. Staff spoken to described how they ensure that service users are consulted with and empowered to make their own decisions. This ensures that service users maintain their independence for as long as possible and that staff are aware of treating people in a positive and inclusive manner. The home is run in such a way that service users are consulted with and kept informed about changes and events. Residents’ meetings are regular occurrences. A number of people in the home commented about the food and how good it is. One service user said that the food is “excellent”. Another service user said that she did not like the food much but that there is always a choice available. Menus were found to be well balanced and varied. It was observed that staff offered choice at teatime and the menus indicated that a choice is available at every meal. Meals are well presented and organised. The Chestnuts DS0000034324.V309571.R01.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 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for complaints and protection are handled well. EVIDENCE: The home has a clear complaints procedure in place. Service users spoken to said that they have no complaints about the home and feel confident to raise issues of concern if they arise. The relationships between staff and service users were observed to be open and inclusive. This is encouraging and evidences that service users concerns will be dealt with appropriately. Complaints are recorded in a complaints log and addressed by the manager. There have been no complaints since the last visit to the home. The home has an appropriate policy in place for the protection of vulnerable adults. Staff spoken to are clear about reporting procedures should a service user make an allegation and around the indicators of abuse. Service users spoken to say that they feel safe when being looked after by staff. All staff receive training in this area. The Chestnuts DS0000034324.V309571.R01.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 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a clean, hygienic and well-maintained home but the lack of locks on shower room/toilet doors means that privacy is compromised. EVIDENCE: The facilities that the home provides for service users are of a high standard. The home is regularly decorated and a planned programme of maintenance is in place within the business plan. Requirements of the fire and environmental health departments are being met by the home. The toilet and bathing facilities for service users are maintained to a high standard and are sited suitably. However there are a number of locks missing from toilet and shower room doors. These must be replaced so that service users privacy is not compromised. Policies for the control of infection are in place and followed in practice. Staff were observed to practice appropriately to avoid the risk of cross
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 16 contamination. Staff are aware of the need to wear protective clothing when undertaking certain tasks. The home has a laundry, which is suitable to meet the needs of service users. Service users are satisfied with the laundry service that the home provides. The Chestnuts DS0000034324.V309571.R01.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 area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after by well-trained staff but the recruitment process is not robust which places service users at risk. EVIDENCE: The home is staffed appropriately. Four staff are on duty throughout the day, which includes a senior member of staff. The manager is supernumerary to the rota. A further member of staff is being recruited to provide additional cover when needed. Staff questionnaires and interviews indicated that there is not always enough time to undertake activities or spend one to one time with service users. One member of staff said that service users do go out to the park and on trips at times but that it is always the same service users that go out because of mobility reasons. Staff say that they would like to take more service users out but that this presents as a staffing issue. It is recommended that the manager review the deployment of staff so that this can take place. Two members of staff are on duty from 8pm. The owner was asked whether this staffing level is sufficient to meet the needs of service users requiring assistance with their nighttime routines. The owner feels that the staffing levels are adequate as she says that the majority of service users ask to go to bed before this time. It is recommended that service users preferences around morning and evening routines are recorded in their care plans and that this is reviewed on a regular basis and as service users preferences change.
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 18 The standards relating to staff being qualified to NVQ level 2 is not met by the home at this time. Training at this level is on going. The recruitment of staff is not as robust as it could be which means that the risks of recruiting unsafe staff are increased. On the whole POVA first and CRB checks are in place prior to staff staring work. However, in the case of one member of staff a POVA First check was not carried out prior to employment. The manager was under the impression that because a CRB check was in place then POVA First checks are not required. This is not the case and the manager is advised that CRB checks do not preclude the need for a POVA First check to be carried out as well. In all instances POVA First checks must be received prior to staff starting work. It is acceptable that where there are long waits for CRB checks to be returned that staff can start without this, providing that a POVA First check has been carried out. In all cases two written references must be in place prior to staff staring work. In the case of one member of staff one written and one verbal reference was in place. This is not acceptable and the regulation pertaining to the provision of two written references must be adhered to. There is also a long-standing issue regarding the absence of a CRB check for an existing member of staff. The responsible person must address this confusion and inform CSCI in writing of the current situation within two weeks of receiving this report. Discussion regarding the necessary course of action will take place when this information is received. The records detailing when staff induction takes place are not clear. One record indicated that an induction to the home had taken place prior to the receipt of the necessary checks and references. In discussion with the manager it became apparent that this “induction” was in fact an opportunity to inform staff about the nature of the work and part of the interview process rather than an induction to the caring task. It is recommended that this be made clear in the home’s records to avoid misunderstanding. A record of training received by staff in the home was available for inspection and appropriate for the work that staff undertake. Training in working with people with dementia is provided and ongoing for all staff. Staff receive an appropriate induction to the caring task once employed by the home. This is well documented. The Chestnuts DS0000034324.V309571.R01.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 and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are looked after in a safe and adequately managed home but the lack of an appropriate risk assessment for one service user places service users and staff in a vulnerable position. EVIDENCE: The manager has been in post for two years and has achieved the registered manager’s award. She is currently undertaking the NVQ level 4 in care. Staff and service users say that the manager is approachable and supportive. Appropriate levels of consultation and regular audits by the manager ensure that service users are looked after in an environment that is both safe and inclusive. The home operates an effective quality assurance system that seeks the views of service users and staff on a regular basis. This has been further
The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 20 developed to seek the views of health professionals and other stakeholders. There is a monthly audit system in place that looks at key areas aimed at improving standards. The owner intends to produce a report in September that will reflect the review of the quality of care in the home and highlight areas for development. Service users are protected by the financial procedures of the home. The home does not act as appointee for any residents and looks after monies for service users appropriately. Written records of all transactions are accurately maintained. The home also has a residents’ fund that is contributed to by fund raising events and donations. The accounts kept for the residents’ fund are not formatted in a way that evidence enough detail for all transactions and balances. This must be addressed so that the home can demonstrate that the fund is managed appropriately. The appropriate safety checks are carried out within the specified time frame and policies are in place for safe working practice, which means that the environment is a safe place. However, a number of staff expressed concerns about the aggression displayed by one service user. In looking at the records for this person, although a risk assessment is in place outlining the course of action that the home has taken to assess levels of aggression, this is not adequate to protect the service user, other service users and staff. The risk assessment directed staff to “move the service user away from other service users should he become aggressive”. This is not adequate as does not specify how the service user is to be moved and is open to misinterpretation. The owner is required to produce a risk assessment within 48 hours of the site visit outlining causes of behaviour and detailing necessary responses of staff so that the risks to people and the service user are minimised. The Chestnuts DS0000034324.V309571.R01.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 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Chestnuts DS0000034324.V309571.R01.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 OP8 Regulation 13 Requirement Timescale for action 24/08/06 2. 3. OP21 OP29 4. OP38 Weight must be effectively monitored and appropriate medical advice sought regarding the weight loss of one service user. 13, 16 Locks must be fitted on communal toilet and shower room doors. 13, 19 Staff must be recruited safely. 1. Two written references must be in place prior to staff starting work. 2. The lack of CRB check for one member of staff must be resolved by the home. The manager must notify CSCI in writing of the current position regarding this member of staff. 3. Distinction must be made between the recruitment and induction process to avoid confusion over staff start dates. 12, 13, 18 The responsible person must carry out a full and detailed risk assessment for one service user and inform staff how to safely manage behaviour. A copy of
DS0000034324.V309571.R01.S.doc 30/09/06 04/09/06 24/08/06 The Chestnuts Version 5.2 Page 23 this risk assessment must be sent to CSCI within 48 hours of the site visit. 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. 3. 4. Refer to Standard OP14 OP27 OP28 OP35 Good Practice Recommendations Service users should be consulted with about their preferred routines and this should be recorded. The deployment of staff should be reviewed with regards to activities. The registered person should ensure 50 of care staff are qualified to NVQ level 2. The accounting of the residents’ fund should be reviewed. The Chestnuts DS0000034324.V309571.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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