Inspection on 15/08/06 for The Orchards

This inspection was carried out on 15th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Orchards 02/08/07

The Orchards 05/01/06

The Orchards 21/09/05

The Orchards 13/10/04

The Orchards 15/06/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Orchards 1 Wilmer Drive Heaton Bradford West Yorkshire BD9 4AR Lead Inspector Susan Knox Key Unannounced Inspection 15th August 2006 08:45 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 Orchards DS0000001167.V301504.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 Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchards Address 1 Wilmer Drive Heaton Bradford West Yorkshire BD9 4AR 01274 547086 01274 548776 orchardcare@btconnect.com 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) Baybury Limited Mrs Susan Davies Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (2) The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: The Orchards is a detached property set in its own grounds and located adjacent to Lister Park and close to local shops, churches and the city bus route. Accommodation is provided on the ground, first and second floors. The majority of rooms are singles. A passenger lift provides easy access to the first and second floors. Residents regularly use the well-kept garden but access is restricted, as steps have to be negotiated at both entrances to the home. The providers have plans to ramp the side entrance. The home is registered predominately for older people. A small number may have mental health needs and/or physical disabilities. A pre inspection questionnaire is sent by the CSCI to providers in time for an inspection. This requests details about the fees paid by or on behalf of residents. The manager on duty said that she was not aware that this document had been received and could not give accurate details of current charges. The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Armstrong and Mrs Davies are the registered managers of the home. Mrs Armstrong is also the registered provider. A pre inspection questionnaire was sent to the providers to be completed with up to date information about the home in time for the inspection. This had not been returned in time for the inspection. One inspector carried out this unannounced key inspection between 08.45am and 4.45pm. This inspection was to ensure the home was operating and being managed to a satisfactory standard. The inspector spoke to six residents, one relative, four staff and the registered manager. Some parts of the building were checked. Records were inspected including care plans, assessments, staff recruitment and training records, accident reports, financial records and health and safety records. One survey was completed with a resident on the day, the remainder were left to be given to residents and sent to relatives. Discussions were held with two visitors on the day. The majority of the resident’s surveys were returned in time for this report. Positive responses were made to the questions asked and are incorporated into this report. During the visit observations of morning routines showed that care staff were observant of resident’s needs and safety, they provided them with choice and respected their privacy. However, a number of requirements are outstanding from the last inspection. What the service does well: A homely atmosphere is evident when visiting and the residents spoke well about the care given by staff. The home is clean with good malodour control. Residents said the care given by staff was good and they thoroughly enjoyed the good standard of meals that are provided in the home. Staff recruitment procedures were good. The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 6 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 Orchards DS0000001167.V301504.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 Orchards DS0000001167.V301504.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made following a site visit and looking at documentation. The Statement of Purpose/Service User Guide provides sufficient information about the home but staff must be more proactive in giving the document to residents and/or relatives. The residents are assessed prior to admission but the individual details of the assessment must fully meet this requirement. EVIDENCE: The manager confirmed that the Statement of Purpose/Service User guide is given to prospective residents and/or relatives. A resident confirmed that this information had been provided. A relative was unable to confirm that this had been provided and none were displayed in the home for visitors to see. It is recommended that these documents be displayed in the home so that they can be shown to prospective residents and families. In the care documentation for the service user’s case tracked there was evidence that all had been assessed before admission. The managers or deputy undertake these visits. Three residents were case tracked during this inspection. One had been a resident for some years and the assessment met The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 9 guidelines at that time. The other two more recent admissions had been assessed using an ‘enquiry resident form’ that does not meet this standard. The manager explained that an assessment is also carried out on admission. This is good practice but the manager was advised to delete the word nursing on the form, as the Orchards do not provide nursing care. The Orchards DS0000001167.V301504.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 judgment has been made using the available evidence during a visit to the home. Care plans are required for all residents. Further work is necessary in order to fully safeguard the residents and address all their needs. Health needs are met. The procedures for administering medication have improved but further work is necessary for the safety of the residents. Steps have been taken to address the issues from the last inspection and these must be continued. EVIDENCE: Three resident’s care was case tracked including talking to care staff about individual needs. Some of the care documentation for individual residents is now part of the Single Assessment Care File issued by the local authority. This is a document that is intended to accompany a service user who is receiving care whether in own home, hospital or care home. The manager was reminded that under the Care Homes Regulations care records have to be retained for three years. Staff have worked hard to address the requirements from the last inspection when it was said that the care plans should be more person centred. Care plans and risk assessments were in place for two of the three residents but one The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 11 admitted two months previously had no care plan. This puts the resident at risk as staff could overlook essential needs. Care plans must be set up using the initial assessment and then up dated as needs change. In one care plan staff referred to dementia but as discussed this was incorrect because there had been no diagnosis. The documentation had improved but further work is necessary. In addition, care plans must address all needs including social life, interests and daily activities. There was some documented evidence that the residents were involved in care planning. Two relatives confirmed that they were consulted about care. Care plans are reveiwed monthly as required. Care staff were able to verbally confirm their understanding of resident’s care needs. Health needs were being met. It had been recognised that one resident had lost significant weight and was being referred to a dietician. In the meantime staff were encouraging a full fat diet. The care records showed evidence of the frequent involvement of the GP and/or the community nurse. The manager had contacted the pharmacist following the last inspection in order to address some concerns. The pharmacist had visited to give advice and new procedures were set up. At this inspection the medication records and storage were checked. A monitored dosage system (MDS) is in place. At the last inspection there were some concerns about the storage and records of administration of medication. Storage has improved. Five resident’s medication including controlled drugs was checked. Four were satisfactory. One could not be stock controlled because on five days staff had not recorded whether the drug had been administered or omitted. When administering medication the drug should be taken to the individual with the record so staff can sign this immediately. It is recommended that the manager check daily the records of administration of medication. During this inspection it was agreed that the stock control records could be kept on the monthly MAR forms. However, staff must remember to record any carried forward medication from one month to the next. Certificates were available showing medication training that had been undertaken in the home. A new list of specimen signatures/initials is required. The senior care confirmed that a record is kept of medication returned to the pharmacist although the record was with the pharmacist. Residents who were able said that staff maintain privacy, they knock on doors before entering. This was observed on the day. Residents spoke well about staff care and interaction between both was very positive. These comments were also reflected in the returned quality surveys to the CSCI. The Orchards DS0000001167.V301504.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 judgment has been made using the available evidence during a visit to the home. The residents are happy in the home and visitors are welcomed. The residents enjoy home cooking. EVIDENCE: It was evident from observations that the morning routine was flexible. Some residents had just finished breakfast. Visitors who called during the inspection, spent the time in the privacy of the resident’s own room. Staff were observed welcoming visitors into the home. One resident confirmed that he goes out independently into town and to the local pub. Although residents and relatives were happy with the daily routines, staff said that activities were difficult to promote in the home. Some card games or bingo are organised. One resident confirmed that there is little interest expressed in outings ‘it is the same two or three who always go’. Residents said they enjoyed sitting out in the garden and staff encourage residents to enjoy the fresh air. In the recent hot weather staff had been aware of the need to ensure the residents had drunk enough fluids. There is little written evidence that staff promote activities other than staff confirming this is done. Although many of the residents are elderly and frail some would benefit from a more structured arrangement of activities. The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 13 A cook is available seven days a week. One of the managers undertakes cooking duties for two days. Both had an awareness of nutritional diets and gave examples of using full cream milk and food supplements when required. No special diets were required at the time of inspection. A three-week cycle of menus is in place and these showed good alternatives for the evening meal but no choice for the main meal of the day. An alternative must be made available so that residents can make an informed choice. At the time of the inspection the cook had done a batch of cakes and buns. The residents confirmed that they enjoyed the meals that are provided. The manager advised that the cooks are introducing new procedures in the kitchen by working to the Safe Food documents provided by the local authority. The Orchards DS0000001167.V301504.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 judgment has been made using the available evidence during a visit to the home. An appropriate complaint’s procedure is in place. The home receives very few complaints. Service users would be better safeguarded once staff have attended adult protection training. EVIDENCE: The home’s complaint procedure was displayed in the hallway readily available for visitors to see. The procedure is also in the Service User guide. The providers are aware that complaints have to be recorded with a report of the action taken to address the complaint. The CSCI have received no complaints about the home since the last inspection. One relative said a concern was dealt with speedily. The manager advised that she was still waiting confirmation from the local authority about staff attending the adult protection training. On discussing issues relating to abuse staff said any concerns would be reported to senior staff. A number of residents confirmed in the returned surveys the name of staff who they would speak to about any concerns. The Orchards DS0000001167.V301504.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 and 26 The quality of the outcome in this area is adequate. This judgement was made using available evidence including a site visit when observations were made and discussions held with the staff on duty. The home is clean and odour control is good. Staff are failing to use infection control training in order to safeguard service users. EVIDENCE: A full inspection of the building was not undertaken other than the rooms where discussions were held with residents. The home provides three communal rooms two lounges and a separate dining room. Decoration and furnishings were to a good standard. Cleanliness and odour control was also to a good standard. Many service users had their own possessions around them in their rooms and enjoyed pointing out their favourite photographs. They said they were very comfortable living in the home. Staff are not conforming to infection control procedures. Soft towels and bars of soap were seen in bathrooms and WC’s. Although paper towel dispensers are fitted these had not been refilled. This has been referred to at the last The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 16 inspection. If residents prefer to use own towels and soap these should be taken back to their bedrooms after use. The laundry is located in the cellar area therefore soiled linen does not have to be taken through the dining or kitchen areas. Laundry equipment meets with the specifications of this standard. The laundry walls and floor are impermeable and easily cleaned. However, on the day of the inspection the pots from commodes were blocking staff access to the wash hand basin and the basin had been used to store clothing. Therefore it was evident that staff were not immediately washing their hands after dealing with laundry. In addition, no paper towels or liquid soap were available. This has been referred to at the last two inspections. Staff have attended infection control training but are not putting the training into effect. The Orchards DS0000001167.V301504.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 and 30 The quality of the outcome in this area is poor. This judgement was made using available evidence including a site visit when documentation was inspected and discussions held with the staff on duty. Staffing levels are low. Recruitment processes are good. Staff training has not been kept up to date. EVIDENCE: The person in charge on the day of inspection was one of the registered managers. A copy of the rota for the week of the inspection and the week prior was made available. Staffing levels were low for the needs and numbers of residents. National Vocational Qualification (NVQ) training is on going. The requirement is to have 50 of care staff with NVQ level 2 qualifications or above. Currently the home is failing to meet this requirement. Recruitment files for four members of staff were checked. Application forms had been completed and two references sent for and received for the four staff. Criminal Record Bureau (CRB) clearance and a copy of the Protection of Vulnerable Adults (POVA) first check were available. A basic training and development portfolio provided details of individual staff training but for one employed since April 2005 no training had been carried out since July 2005. There was evidence that staff had received an induction into working in the home but for a care assistant with no previous experience there was no statutory training such as Health and Safety, Moving and Handling, The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 18 Infection Control or Food hygiene although employed since April 2006. New staff must receive an induction within six weeks of employment and then within six months foundation training, which equips them to meet the assessed needs of residents. The manager advised that five staff had attended an Infection Control course in April 2006 and another two had started. The manager has still not been able to locate her moving and handling training certificate this was evident at the last inspection. A qualified assessor must train care staff in moving and handling. External assessors must be employed until an up to date qualification has been attained. There was evidence that a talk had been given in February 2006 on dealing with challenging behaviour but this was by the deputy who is not a qualified trainer. A training programme is required that must meet Skills for Work criteria. The Orchards DS0000001167.V301504.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, 36 and 38 The quality of the outcome in this area is good. This judgement was made using available evidence including a site visit when documentation was inspected and discussions held with the staff on duty. The managers are trained for their roles. More formal QA systems are required. The majority of Health and Safety requirements are met. EVIDENCE: The two managers have attained the Registered Managers Award (RMA) Staff and residents spoke well about management qualities. Observations showed that residents were very much at ease with the manager. Records of staff meetings were available for inspection although there are no formal meetings with residents. It was clear that informal ways are undertaken in order to ascertain resident’s views this was confirmed in discussions with residents, relatives and staff. The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 20 There is no formal quality assurance (QA) within the home. A book is available in the hallway for concerns or comments. This had last been completed in 2002. Although resident and relative surveys have been done in the past QA systems must be improved. Systems must be introduced that will measure outcomes for residents in all levels of care within the home. The manager said that they hold no valuables or monies for safekeeping on behalf of residents. The manager has undertaken the supervision of care staff. These records were available for inspection. The records for fire safety checks were checked. The fire alarm and emergency light testing is carried out weekly. Staff fire drills are held. These were recorded with the names of those staff that attended. Staff confirmed this during discussions. Health and safety within the home was well maintained although a number of fire doors did not close effectively. These were identified to the manager as needing attention. One bedroom window was seen to be wedged open, as the sash had broken. This could cause an accident so the sash must be repaired. Maintenance records were seen and were up to date including the fire alarm system and extinguishers and passenger lift and hoists. The Orchards DS0000001167.V301504.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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 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 OP3 Regulation 14 Requirement The registered persons must ensure that a full needs assessment is carried out and meets the criteria. The registered persons must ensure that care-planning addresses all individual needs including social life, interests and activities. Only refer to a diagnosis in care plans that have been made by a professional. The registered persons must ensure that the record and procedure for the administration of medication is improved. Investigate the reason for not giving prescribed medication and report to the CSCI the results. The registered persons must provide a definite choice/alternative for the main meal of the day. The registered persons must arrange for senior staff to attend the local authority adult protection training. The registered persons must ensure that staff can access WHB in the laundry. (Referred to DS0000001167.V301504.R01.S.doc Timescale for action 30/09/06 2. OP7 15 30/09/06 3. OP9 13 (2) 30/09/06 4 OP15 16 30/09/06 5 OP18 18 30/09/06 6 OP26 13 (3) 30/09/06 The Orchards Version 5.2 Page 23 7 OP27 18 8 OP28 18 9 OP30 18 10 OP33 24 11 OP38 13 at the last 2 inspection) Provide paper towels and dispensers. Clean and tidy the laundry and store items away that are not needed. Observe the procedures for appropriate protective clothing for carers when carrying out different tasks. The registered persons must provide sufficient levels of care staff so that service users needs can be met. (This was referred to at the last inspection) The registered persons must make sure that 50 of care staff have attained NVQ level 2 or above. The registered persons must ensure that an appropriately trained person carries out staff training. (This was referred to at the last inspection) Care staff must receive an induction within 6 weeks of employment followed by foundation training within 6 months. The registered persons must introduce quality assurance systems. (Referred to at the last 2 inspections) The registered persons must ensure that all fire doors close effectively. Sash windows must not be wedged open broken sashes must be repaired. 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 The Orchards DS0000001167.V301504.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. 1. 1. 2. Refer to Standard OP1 OP3 OP12 Good Practice Recommendations Ensure the statement of purpose is more readily available to residents and relatives. Delete the word nursing from the needs assessments form. Provide a more structured arrangement of activities for residents to participate in. The Orchards DS0000001167.V301504.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Orchards DS0000001167.V301504.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. 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