Inspection on 03/07/07 for The Limes

This inspection was carried out on 3rd July 2007.

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

The inspector 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

The Limes 29/10/08

The Limes 09/06/08

The Limes 27/04/06

The Limes 03/02/06

The Limes 03/10/05

The Limes 07/02/05

The Limes 01/09/04

Similar services:

Claremont House

Chesham House

Oak Ridge

Argyll House

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

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

CARE HOMES FOR OLDER PEOPLE The Limes High Street Henlow Bedfordshire SG16 6AB Lead Inspector Mrs Louise Trainor Unannounced Inspection 3rd July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Limes DS0000014929.V340344.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 Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address High Street Henlow Bedfordshire SG16 6AB 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) 01462 811028 01462 811028 kevin@mexicanmule.com Mr Michael Wilkinson Mrs Joan Wilkinson Mrs Joan Wilkinson Care Home 23 Category(ies) of Dementia (23), Dementia - over 65 years of age registration, with number (2), Mental disorder, excluding learning of places disability or dementia (3), Old age, not falling within any other category (23) The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users must not exceed 23. The home shall accommodate persons of either sex. No one falling into the category of MD (age range over 65 years) may be admitted into the home where there are already 3 persons of category MD (Age range - over the age of 65 years) accommodated within the home. No person aged under 45 years of age who falls within the category of DE may be admitted to the home. 27th April 2006 4. Date of last inspection Brief Description of the Service: The Limes is a privately owned residential care home, providing care for 23 residents who have physical and mental health needs. The property is situated within the village of Henlow on the High street. It was built in 1840 and has been sympathetically converted by the proprietors to retain much of its original character and charm. In 2001 a further large extension was added to increase the registered accommodation to its present occupancy. Bedrooms located on the upper floor of the original house are accessed via staircases and a chair lift; bedrooms in the extension are accessible via a shaft lift. There is a large well-maintained enclosed rear garden and car parking is available at the front of the home. The fees for this home vary from £550.00 per week, to £850.00 per week, depending on the funding source. The Limes DS0000014929.V340344.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 was carried out on the 3rd of July 2007 between 09:30 hours and 16:30 hours by Regulatory Inspector Mrs Louise Trainor. Both the manager and the deputy were available throughout the day to give support and assistance. As this was the first visit to this home for this inspector, a full tour of the premises internal and external was carried out. During the inspection, the personal files and documentation of three of the people who use this service were examined, and six people were interviewed informally. This included five people who live in the home and a visiting friend of one of them. Three staff files were picked at random by the inspector to examine and three members of staff were spent time with the inspector discussing their roles and their experiences in the home. Documentation relating to: staff training and supervision, quality assurance, complaints and medication administration were also examined, and periods of observation of care practices were carried out during this seven and a half hour inspection. The inspector would like to thank the manager and all those involved for their assistance and support throughout this visit. What the service does well: The pre admission information, and the systems in place for assessing prospective admissions, is sufficient to ensure that people who live in this home, their relatives and the staff, can be sure that their individual needs will be fully met. All prospective residents for this home are encouraged to visit the premises prior to confirmation of a permanent placement. Robust systems are in place to ensure complaints and safeguarding issues are appropriately managed so that people who use this service are protected. There are a wide variety of activities available in this home, and individual people who use this service are encouraged to pursue personal interests. Menus are varied and appealing offering a nutritionally balanced diet to the people who live in this home. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 6 Observation of care practices revealed staff being respectful and treating the people who live in this home with dignity All areas of the home were clean and the home was well maintained. There is an ongoing decorating programme in place, whereby as a room is vacated it is decorated. The gardens were tidy and well cared for including a greenhouse and a vegetable patch that is tended by one of the people who live here. There were paths running right around the garden so that wheelchair users could easily access all areas. The induction that the care staff receives meets the Sector Skills Council targets and timescales, documentary evidence of this is kept by the home. The staff spoke of their roles in the home and were very clear about their responsibilities. The health, safety and welfare of the people who use this service and the staff are promoted and protected What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre admission information, and the systems in place for assessing prospective admissions, is sufficient to ensure that people who live in this home, their relatives and the staff, can be sure that their individual needs will be fully met. EVIDENCE: There was a detailed Statement of Purpose and Service User Guide in place for this home. The Statement Of Purpose was displayed in the entrance hall, and the people who live in this home were familiar with the content of this document and the Service User Guide. These documents are issued to service users and their families prior to moving into the home so that they can make an informed choice as to whether or not the home will sufficiently meet their needs. All prospective residents for this home are encouraged to visit the premises prior to confirmation of a permanent placement. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 9 Pre admission assessments are carried out by a senior member of staff, on every individual prior to admission. This is sometimes done in the individuals home or in hospital depending on the individuals’ circumstances prior to admission. Terms and conditions seen within the individual records of residents showed that this document met this standard. The term of residency was set out in a simple easy to understand format and had been signed by the resident or their representative. Intermediate care is not provided at this home. The Limes DS0000014929.V340344.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of service users are set out in individual care plans. However the practice of administration of medication by some staff is insufficient to ensure that all the people who use this service are protected. EVIDENCE: Information related to sensory needs was also clearly identified. ‘Wears glasses’ and ‘slightly deaf’ were included. These plans also included personal preferences such as ‘prefers to were trousers not skirts’ and ‘likes to stay in bed until 11am’, as well as food likes and dislikes. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 11 All files contained a full pre admission assessment, a photograph and written description of the individual including any distinguishing body marks, a clear diagnosis and an overview of any medical conditions. One person’s file identified that they were diabetic and suffered with bouts of depression. The file contained a personal history that included life events that may have been a contributory factor to the depression. This information enables all the staff to have a greater understanding of this person and the care she requires. Care plans included, personal hygiene, sleep, continence, mobilisation and skin integrity. Generally care plans were well written, and had been dated and signed by the individual service user indicating their involvement and agreement with the plan. There were risk assessments in place supporting all the care plans, although they were not all being reviewed on a regular basis. The Medication Administration Record (MAR) sheets and medication stock for individuals were examined during this inspection. The medication file included a description of abbreviations, storage instructions, fridge temperatures and a list of staff that are permitted to administer medication. There was a photograph of each person who receives medication attached to their MAR sheet, and details of the individual’s allergies, date of birth, GP and Key-worker were also included. Medication is delivered to this home on a two weekly basis and the MAR sheets form a six-week record. Unfortunately there were several missing signatures on the charts, and when stocks were checked the medication was not in the blister packs for the corresponding dates indicating that some of the staff are not always following the administration procedures. Observation of care practices revealed staff being respectful and treating the people who live in this home with dignity. Some individuals’ that were interviewed talked positively about the way they are treated. One said. “They’re always very thoughtful and always try to help”. However one person discussed her shame at having continence problems and the lack of empathy and understanding shown by some staff. The Limes DS0000014929.V340344.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a wide variety of activities available in this home, and individual people who use this service are encouraged to pursue personal interests. Menus are varied and appealing offering a nutritionally balanced diet to the people who live in this home. EVIDENCE: The atmosphere in the home was very relaxed and visitors are permitted any time. When the inspector arrived a group of residents were gathering in the dining area. This group was gathering to discuss a trip to Woburn that was planned for nine people for the following day. This also integrated an art session where individuals were encouraged to draw pictures of what they expected to see on their planned day out. Everyone involved appeared quite excited about this forthcoming event. There was an activities programme displayed on the notice board in the entrance hall, and this included both weekly and monthly events such as music groups, film afternoons and audio bible tapes. The home has a Catholic priest The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 13 that visits once a fortnight and one person goes out to a church service every week in Shefford. One person who lives in this home told the inspector how much he enjoyed living in the home and tending the gardens. He showed the inspector his vegetable patch and talked about how he was planning to enter some of the produce in a local show. He also works restoring old furniture in the home and clearly appeared to enjoy that too. People that were interviewed confirmed that they were always given the opportunity of participating in activities, but some preferred to watch television or just sit and chat. There were mixed comments from the residents about overall choices in the home. One lady said. “We’re not imposed upon to do anything, we sometimes fill in pieces of paper that give us choices, I go to bed when I like and get up when I’m ready.” Where as, another said. “They get me up at 06:30 in the morning, I don’t get a choice it gets on my nerves, but the foods very good and I always get a choice”. The menus offered a wide variety of choice for the people who live in this home. The menu for this particular week consisted of: Sausage squares, shepherds pie, fish and chips, braised lamb, Toad in the hole and Sunday roast. All meals offered fresh vegetables and a choice of desserts. Salads and other light alternatives were available every day on request. Everyone that was interviewed spoke very highly of the standard of the meals. During the lunchtime period the inspector noted that one person was not eating much and gestured that she was not very hungry, staff notice this efficiently and offered an alternative a lighter option such as soup or sandwiches. The Limes DS0000014929.V340344.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust systems are in place to ensure complaints and safeguarding issues are appropriately managed so that people who use this service are protected. EVIDENCE: There is a clear complaints policy that is displayed in the home so it is easily accessible to all visitors and people who live in this home. This is also summarised in the service users guide. There had only been one complaint since the previous inspection and this was regarding the dogs that were living on the premises. This complaint was dealt with through the Commission for Social Care Inspection (CSCI). It was responded to appropriately and the animals that were causing concerns are no longer at the home. The inspector spoke to several people who live at the home during this inspection, and also one visitor who attends the home on a regular basis. No one had any concerns or complaints, and all knew whom they should speak to if the need arose. To date, not all staff have attended formal training on safeguarding issues, however it is addressed through the induction process. All staff that were The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 15 interviewed were able to discuss the types of abuse they could be faced with in a care home, and all were very clear about actions they would take, and who they would contact if it was necessary. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a clean, comfortable and homely environment for the people who live here. EVIDENCE: This was the first visit for this inspector to this home; therefore a full tour of the home and gardens took place. The home has recently had approval for a minor variation to increase their registered beds by one. All areas of the home were clean and the home was well maintained. There is an ongoing decorating programme in place, whereby as a room is vacated it is decorated. There is presently still some decorating in progress following the relocation of the laundry room and the provision of one extra bedroom, but this has not affected the facilities and running of the home which presently has two vacant beds. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 17 The new laundry room is in the basement of the home. It has been fitted with new ‘Ortex’ washing machines in order to enhance the control of infection within the home. All staff have attended a training session on the use of these machines. The inspector questioned the safety of a flight of stairs leading down to the laundry and the fact that, despite being behind a door, could pose a risk if accessed by the people who live here when unsupervised. Although this had already been risk assessed the manager agreed to look at an appropriate lock for this door in line with the homes fire and health and safety policies. All communal areas of the home appeared spacious and comfortable and personal rooms were decorated and furnished to meet individual’s tastes, and reflect personal life histories. Some also included small sofas and armchairs as well as basic bedroom furniture. The gardens were tidy and well cared for including a greenhouse and a vegetable patch that is tended by one of the people who live here. There were paths running right around the garden so that wheelchair users could easily access all areas. Following the recent introduction of the smoking ban, the home has become a smoke free zone, however a large patio area at the rear of the building has been designated to those who wish to continue smoking, and an awning is due to be constructed as a cover for this area. This home has recently been awarded a three star certificate for hygiene and presentation by Mid Beds County Council. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally the systems in place for the training, supervision and recruitment of staff ensure that the people who use this service are protected, however one of the files seen was lacking some documentation. EVIDENCE: Staffing levels in this home are presently four staff between the hours of 07:00 and 21:30 hours, and two staff plus one sleeping in staff during the night. Additional ancillary staff are employed for, domestic, food preparation and maintenance. Recruitment of staff generally follows the homes policies and procedures. Records and staff files demonstrated that a structured interview had taken place. Three staff files were inspected, all contained competed application forms, various forms of personal identification, a job offer and job description, an induction booklet, a confidentiality declaration signed and dated. Two of the files contained Enhanced Criminal Record Bureau (CRB) clearance, POVA first checks and appropriate references, however one was still awaiting CRB clearance, and only contained one reference. This matter was discussed with the manager and the member of staff concerned brought in a copy of the The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 19 second reference before the inspection was completed. Regarding the CRB for this employee, the manager had been informed by the company that processes the homes’ CRB s, that it was acceptable for staff to commence employment on a POVA first check only. The inspector advised the manager that this was not routinely the case, and only in exceptional circumstances would this be permitted following discussion with CSCI. The outstanding CRB was received within a week of the inspection and the member of staff worked in a supervised capacity in the interim. The induction that the care staff receives meets the Sector Skills Council targets and timescales, documentary evidence of this is kept by the home. The staff spoke of their roles in the home and were very clear about their responsibilities. Staff were very positive about the home and were very committed to their job. One said. “I love it here, I’m so well supported and everyone is really approachable if I have a problem, staff moral is really good, and I never feel like I ‘ve done a long shift”. The inspector was very impressed with the competence and mature outlook of this young carer. All staff were doing mandatory training, such as fire, Moving and Handling, Food Hygiene and Abuse, and their personal development discussed and monitored through appraisals and supervision. Individual members of staff are also undertaking a variety of other courses to include; Bed bathing / shaving, Challenging behaviour, Dementia, Grievances and Complaints, Finances, Advanced Care Practices and NVQ at varying levels. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the people who use this service and the staff are promoted and protected. EVIDENCE: The manager of this home Mrs Joan Wilkinson is also the owner. She is visible and accessible to the people who live here and their relatives. She is supported by a competent deputy manager, who although relatively new in this role, has been at the home for several years. Residents meeting are held every six months to ascertain individual’s opinions on the service, and questionnaires are given to service users and their representatives. However there was no current report in place to review the quality of care in the home. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 21 The health and safety of the people who use this service is promoted by this home, and risk assessments are in place for everyone who uses this service. Records were seen that evidenced that required safety checks had been carried out relating to fire, gas and electrical equipment. Approved contractors undertake the servicing of equipment, and the homes personnel undertake regular maintenance checks. Fire Awareness training and drill tests were being attended by staff, and the fire policy is being reviewed annually in line with the new fire regulations. Equipment such as wheelchairs, were clean and well maintained with footrests and safety straps fitted as required. The records of finances of six people who live in this home were inspected. All transactions had been clearly documented, dated and signed, either by two senior staff or the individual and one member of staff. Funds kept in the homes’ safe were checked and all corresponded correctly with the records. For those residents who have an appointee on their behalf managing their finances, records were thorough, with all transactions listed with receipts and invoices. Staff are all receiving regular supervision from the manager or a senior member of staff that has completed training in support and supervision practices. All files contained documentary evidence to support this, including a new member of staff that was being supervised through her induction booklet during the first twelve weeks of employment. The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) Requirement People who use this service must have an individual care plan that is reviewed regularly to reflect changing needs. When medication is administered to people who use this service it must be clearly recorded, to ensure people have received the correct levels of medication. The manager for this home must be in receipt of all the appropriate documents specified in paragraphs 1 to 7 of schedule 2, for each employee prior to them commencing work. A report reviewing the quality of care in this home must be submitted to CSCI to ensure that the people who use this service are being listened too, and their opinions considered. Timescale for action 31/08/07 2. OP9 13(2) 31/07/07 3. OP29 19(1)(b) 31/07/07 4. OP33 24(2) 31/08/07 The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 The Limes DS0000014929.V340344.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!