CARE HOMES FOR OLDER PEOPLE
The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ Lead Inspector
Judith Roper Unannounced Inspection 4th October 2005 10:00 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 Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Firs Nursing Home Address 251 Staplegrove Road Taunton Somerset TA2 6AQ 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) 01823 275927 01823 336463 Care West Country Limited Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to six places for personal care. A person will be recruited into the position of manager and he / she will complete the registration process within 6 months of the issuing the Certificate of Registration. 13th April 2005 Date of last inspection Brief Description of the Service: The Firs Nursing Home is located in a residential area on the outskirts of Taunton, close to a local pub and Staplegrove Village Hall. In front of the home, next to the car park, is a lawned area with seating. The home is registered to take up to a maximum of 37 elderly persons (aged over 60years) who require general nursing care; six places are registered for personal care only. Over the years there have been alterations to the premises and eight bedrooms have en suite facilities of WC and wash hand basin. There at least two bedrooms that have a toilet partitioned with a curtain only. Not all of the single bedrooms measure 10 square metres or the double bedrooms 16 square metres. Bedrooms on the first floor are accessed by a 4-person/300Kg lift. Part of the first floor area, known as the flat is accessed via a ramp. The communal toilets are all small and not large enough to allow a person in a wheelchair to access the toilet with one or two helpers and a hoist. In view of this the bathroom toilets are used for disabled access. One first floor bathroom has been converted to create a spacious shower facility. There are two assisted bathrooms, one on each floor. There is planning permission to extend the home and improve facilities and individual accommodation to meet the National Minimum Standards. This work is due to commence this year though no date has been set yet. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector and took place over one day between the hours of 10.00 am – 3.30 pm. 20 residents were at the home on the day of the inspection. Several of the residents have lived at the property for a number of years. There are vacancies at the home. The inspector was able to see most residents and speak with seven. There were several visitors to the home during the inspection. Visitors were welcomed by staff on duty and offered assistance with information requested by the visitors. Staff on duty were able to give time to speak with the inspector. The newly appointed manager Mrs. Vound (promoted from the post of deputy manager) and the operations manager Mrs. Middleton were available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff went about their duties in an unhurried manner, giving time to attend to resident’s needs. This CSCI inspection focused on outcome statements for National Minimum Standards that were not met or not inspected at the previous inspection in April 2005. Management staff and duty staff at the home cooperated fully with the inspector during this visit. Records examined during the inspection were 9 resident care and support plans (4 in detail), resident risk assessments, medication records, quality assurance systems, accident analysis records, complaints procedure, staff supervision systems, staff training records and a sample resident contract. What the service does well: What has improved since the last inspection?
At the last inspection 6 requirements and 1 recommendation were made. The home has met 4 of the requirements made with respect to care planning records, staff recruitment checks, storage of confidential resident information and bed rail safety monitoring. The requirement for a formal system of staff supervision has been partially met with a system being introduced but having tailed off recently due to unavoidable managerial extended leave. The requirement with regard to medication that there must be two signatures
The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 6 recorded for any hand transcribed medications has not been met. The recommendation that there is photographic ID on staff files is met. There has been an improvement in care planning records since the last inspection. Care plans generally demonstrate evidence of regular review and are detailed and holistic. There is now in post a manager who is being considered as the registered manager for the home through the CSCI ‘fit person process’. There is also a responsible individual for the Company in post, who is also completing her registration process via the CSCI. This will give the home more direction and stability of management. What they could do better:
The Firs has stagnated over recent year suffering from premises that have not been fit for purpose in some areas, limiting the available number of beds at the home. This accounts for the homes’ under occupancy. Before this necessary building work to improve the facilities commences, the home has been working to recruit into a vacant home manager role. With the recent successful appointments into the posts of home manager and responsible individual for the home, the CSCI would welcome a commencement date for extensive building work at the home to improve facilities to meet National Minimum Standards. The home is not Quality Rated due in part to the facilities and insufficient numbers of care staff holding or studying toward a minimum level 2 of the NVQ qualification in care. It is required that the proprietor forwards an action plan detailing how a commitment to care staff training in NVQ awards will be met. The system of managing medication in the home is generally organised, systematic and safe. It has been made an immediate requirement that there must be two staff signatures for any hand transcribed medications on medication administration records (MARs) in order to demonstrate that nurses administering medications are following the procedures of the home in order to protect residents from medication errors. This was a requirement at the previous inspection and it has not been met. Staff supervision has been formalised and will be monitored at the next inspection as the frequency of formal supervision has tailed off recently. There is an out of order washing machine beyond economical repair at the home. This needs replacing. Record keeping of fluids taken and excreted for residents nursed in bed needs to improve in order for the home to demonstrate that it is meeting the care needs of these poorly residents.
The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 7 Any resident utilising a bed rail for their own safety must have a written risk assessment and written evidence of consent by the resident or of consultation with family members or next-of-kin if the resident is unable to consent. Two recommendations are made with regard to registering each resident with a dentist and information held on a resident’s contract. 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 Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Prospective residents have access to clear service information. Visits to the home to look around are welcomed to enable residents to sample the service before admission. The matron or a senior nurse carries out assessment of prospective residents. The home takes sensible precautions at assessment to ensure that residents admitted are suitable and that the home can meet their needs. A recommendation is made that information included in resident’s contracts includes the room to be occupied, as this provides a clear statement to both parties about terms of admission into a room at the home. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide, updated in 2003. When the newly appointed responsible individual is approved by the CSCI, this person’s details should be included in a revised Statement of Purpose. The home’s management welcomes pre-admission visits and the first four weeks after admission is considered a trial settling in period at the home. The home’s contract with residents gives clear information about the financial agreement with the Company. It is recommended that the resident’s room to be occupied and general reasons why a room change may be required be
The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 10 included in the resident’s contract. This would meet recommendations included in the 2005 Office of Fair Trading (OFT) report into care home contracts with residents. Two pre-admission assessments were inspected and were detailed and carried out by a registered nurse in order to access suitability of placement at the home. The home also obtains a community health assessment from the placement authority to support their own assessment of prospective client need. The home is meeting the current health care needs of residents, but the home must address staff training issues for the future and improve record keeping of care tasks performed in order to demonstrate that care tasks are being carried out. (See standards 8 and 28). The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Resident care plans had improved since the last inspection. The 4 care plans inspected in detail were holistic in design, contained good recording of current needs and were generally regularly updated. On clinical observation and in talking with residents, it was evident that health care needs are met, but record keeping must improve for clients nursed in bed in order to support this conclusion. Medication is also generally managed well, but hand transcribed records must be countersigned in order to demonstrate a safe and robust system of medication management. Staff are kindly and respectful to residents and palliative care was managed sensitively. EVIDENCE: 9 resident care plans were inspected, 4 in detail. The plans gave a good plan of resident overall current needs. 3 care plans had not been updated for 3 months due to the named nurse leaving. This was brought to the attention of the matron for her to address by re-allocating residents to a new named nurse. In order to improve care records the following observations were made and relayed to the matron. Although no resident nursed in bed appeared clinically dehydrated, shift leader must ensure that records of fluids taken and excreted by residents nursed in bed must be complete and accurate. This was not evident at the inspection and belies the actuality that care needs are being met. The home needs a clearer system for monitoring and triggering nurse
The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 12 intervention for resident bowel management following constipation. Residents ought to be registered with a dentist in order for emergency or routine dentistry appointments to be accessed or planned for. Residents utilising bed rails must be risk assessed and consent or consultation carried out before bedrails are used. (See Standard 38). Medication record keeping was inspected. Overall the home has a systematic and organised medication room with organised methods of managing medication into the home. At the last inspection it was required that there must be 2 signatures to witness any hand transcribed entries onto medication administration records (MARs). This echoes best practice of the Nursing and Midwifery Council (NMC) and the Royal Pharmaceutical Society. At this followup inspection this requirement had not been met as there were 23 instances of hand transcribed entries on MAR charts having 1 nurse signature only. It was made an immediate requirement that the home’s management address this. Residents spoken with said that staff were kindly and spoke respectfully to them. Staff were observed carrying out their duties in a sensitive manner. Records of 2 recently deceased residents were inspected. They showed evidence of good palliative care planning, G.P regular review, monitoring of pain control and family consultation. The matron said that she varies staffing levels to provide additional staffing support to a resident in the terminal stages of their life whilst living at The Firs. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 13 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. Activities for residents are taking place at the home and trips out are provided. However, there is a vacant post for an activities organiser in the home and the appointment to this post should improve the planning and amount of regular activities in the home, as presently activities are quite ad hoc. EVIDENCE: There is currently a vacancy for the post of activity organiser at the home. This post has been advertised and the matron hopes to be in the position to offer the position in the coming week. In the meantime, staff on duty are taking some additional part-time activity shifts. This has included outside trips and activity sessions in the home but the post of activity organiser will add some clarity of job role, planning for activities and monitoring of resident need and wants closer for activity sessions. This will be further monitored at the next inspection. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17. There have been no formal complaints made to the home since the last inspection. The home makes its complaints procedure accessible to visitors. Residents were supported to vote in the local and general election via postal voting, in order to maintain their place in the civic process. EVIDENCE: The home has received a verbal concern to the home’s management between inspection visits and it was reported that this was resolved to the satisfaction of the person who raised the concern. The CSCI has not received any complaints directly about the home since the last inspection. The home displays its complaints procedure accessibly in the main entrance hall. The matron said that current residents are entered onto the electoral roll and support was given for residents to vote in the May 2005 elections via postal voting and family assistance to vote via this method. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,26. Several of the physical environmental standards are not met and the proprietor has planning permission on architectural plans to improve the environment and facilities at the home. This would be welcomed by the CSCI and would significantly enhance the home and increase the number of available beds in the home. EVIDENCE: There have been no changes to the physical environment since the last inspection. The CSCI is now waiting a start date for the proposed approved plans for extensive building work to improve the environment at the home where it falls below National Minimum Standards. The overall environment is somewhat dated but is maintained well and is clean. There is one pocket of malodour by the ground floor lounge and corridor running off this lounge. This will be further monitored at subsequent visits to determine whether the odour is of a transitory of permanent nature. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 16 Bathrooms and toilets for residents are in need of upgrading to better meet the needs of disabled residents and this is addressed in the plans for the home’s upgrade. Bedrooms in use are personalised and cosy. There are two spacious lounges and a dining room at the home. The home has its own laundry. One washing machine requires replacement. The home has suitable facilities and procedures in place to manage cross infection in the home. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 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. Staffing levels in the home are sufficient to meet the needs of current residents. Staff are receiving statutory training but the absence of an annual training plan for the home is affecting staff gaining access and support to NVQ training. This must be addressed in order to ensure that the care staff are adequately trained. Recruitment practices are robust in order to ensure the protection of vulnerable adults. EVIDENCE: Staffing rosters for three weeks prior to the inspection were examined. Staffing levels are adequate to meet the current needs of residents. Agency staff are used periodically to cover shifts available due to staff sickness or holidays. There is a registered nurse on duty at all times in the home. Many of the recruited overseas staff employed as care staff have professional health qualifications in their mother country. Satisfactory POVA checks have now been returned for all staff and CRB checks are now completed. At the last inspection the home was meeting the target of at least 50 of the care staff having an NVQ at a minimum of level 2 in care or equivalent. There have been some staff changes since the last inspection and the home is no longer meeting this target. There is no training plan at the home budgeted to train staff without the NVQ qualification. This is made a requirement in order to demonstrate a commitment to staff training in NVQ awards in order to further professionalize the care workforce. The manager is ensuring that staff receive statutory training in moving and handling, fire safety, first aid and health and safety. An annual training plan is
The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 18 required for all aspects of staff training as this will assist individual staff training planning, will open access to training grants available to the business and will also allow the home to proceed with applying for the Quality Rating status from Somerset County Council. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 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): 33,36,37,38. The Company has promoted the deputy manager to the post of matron. It had been a condition of the home’s registration that a manager of the home was appointed. The home is using good internal quality assurance questionnaires to identify what areas of the service residents and relatives think highly of or wish could improve. Results of the survey will be published in the home. Staff are supervised but the frequency of this needs to improve. Records of care given by the bedside were poor and belied actual care given. The manager needs to address this. Health and safety issues are addressed but the use of bedrails must be risk assessed, justified and consented to. EVIDENCE: The deputy matron has been promoted to the post of matron since the last inspection and she is currently awaiting her ‘fit persons’ interview with the CSCI. If successful she will then be the registered manager for the home. (Until then Standards 31 and 32 will not be assessed). The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 20 The home has formal processes for internal quality assurance. This includes an annual questionnaire to residents and relatives about the service. The questionnaires are currently with residents and relatives and the home will then publish its findings by displaying general comments and an action plan by the home in the main foyer at the home. This is good practice. The home does not hold the Quality Rating status from Somerset County Council. The management of the home recognises that applying for and obtaining this award is likely to increase the number of bed referrals currently made from Somerset Social Services. The home is monitored by the parent company on a monthly basis. Regulation 26 reports of these visits were not available in the home and the manager was reminded to request from the Company that Regulation 26 reports are available in the home for her own reference and for examination by the CSCI on request. There is an improvement in the supervision of staff at the home to a more formal system where supervision records are maintained and signed by both supervisor and supervisee. The frequency of staff supervision has fallen over recent months due to unavoidable managerial leave. This will be monitored at subsequent inspections and the home needs to consider training other staff to be supervisors in order that staff supervision is manageable and maintained. Records examined during the inspection were stored appropriately in order to maintain resident confidentiality. The manager must ensure that care records maintained at residents’ bedsides are accurate in order to demonstrate that care prescribed has actually taken place. Health and safety was discussed. The manager has arranged for a refresher training session in first aid for some staff and this will then ensure that there is a staff member holding a current appointed persons first aid qualification on each shift. At the home several residents utilise bed rails for their own safety. Although this is referred to in individual care plans, risk assessments and consent/consultation records on the use of bed rails was lacking. This documentation is required. Since the last inspection the bed rails in use are now numbered and checked weekly to ensure safe fitting. This is good practice. Accident records are audited on a monthly basis and this is also good practice. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 2 2 2 2 3 X 2 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A N/A 3 X X 2 2 2 The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2). Requirement Hand transcribed medications entries must be countersigned in order to provide a safe system of managing resident medications. The washing machine that is out of order and beyond economical repair must be replaced in order to meet laundry needs in the home. The proprietor must forward to the CSCI an action plan demonstrating how the home will fund and support a minimum of 50 of the care staff to train to a minimum of NVQ level 2. Records of fluids input/output charts for residents must be accurately recorded in order to demonstrate that care needs are being met. Any resident requiring bedrails for their personal safety must be risk assessed and consent to bedrails being provided by the resident must be recorded. If the resident is unable to consent then consultation with the nextof-kin must be recorded. Timescale for action 04/10/05 2 OP26 13(3) and 16(2) (e) 04/01/06 3 OP28 18(1) (c) (i) 04/12/05 4 OP37 17(1)(a) & 17(3) (a) 13(4)(3) 13(7)& (8) 04/11/05 5 OP38 04/12/05 The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 23 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 OP2 OP8 Good Practice Recommendations It is recommended that the resident’s room to be occupied and general reasons why a room change may be indicated be entered on a resident’s contract with the home. It is recommended that the home arranges for all residents to be registered with a dentist. The Firs Nursing Home DS0000003297.V252796.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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