Inspection on 27/10/05 for Tranquility House

This inspection was carried out on 27th October 2005.

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

Other inspections for this house

Tranquility House 20/11/08

Tranquility House 28/12/07

Tranquility House 15/12/06

Tranquility House 20/02/06

Tranquility House 26/01/05

Tranquility House 17/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Tranquility House 39 Cheriton Gardens Folkestone Kent CT20 2AS Lead Inspector Lois Tozer Announced Inspection 27th October 2005 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 Tranquility House DS0000036015.V257006.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. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tranquility House Address 39 Cheriton Gardens Folkestone Kent CT20 2AS 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) 01303 244049 TINAWRATTEN@AOL.COM Mrs T.Wratten Mrs Veronica Anne Miles Care Home 20 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (17) Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users with DE(E) to be restricted to 2 (two) whose DOB are 11/01/1921 and 23/01/1916. Service users with Mental Health needs to be restricted to 1 (one) whose DOB is 07/08/1927. 26th January 2005 Date of last inspection Brief Description of the Service: Tranquillity House is a large detached premises offering accommodation over four floors for up to 20 Service Users over the age of 65, requiring residential care. The Home is located within the town of Folkestone and all local amenities are within easy reach (main train and bus stations being 5 minutes walk away). There are 12 single and 4 shared bedrooms available. Although no bedrooms are provided with en-suite facilities, all have a wash hand basin, call systems, and are well furnished. Residents are encouraged to bring personal possessions to furnish their bedroom, the Home having adequate storage space to enable Residents who wish to fully furnish their room themselves to do so. A shaft lift provides access to all upper floors. Communal areas comprise a main lounge, a reading / quite area, a large dining room and spacious conservatory. The property has a secluded, small back garden, where work to enable wheelchair accessibility has been completed, and small private parking area. Mrs Tina Wratten is the sole proprietor of the Home. Although Mrs Wratten employs a registered manager, Mrs Veronica Miles, Mrs Wratten works in the Home on a regular basis. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 27th October 2005 between 09.30 am and 4.40 pm. Mrs Veronica Miles, registered manager and her deputy manager were present throughout. Feedback was given to the management team and to Mrs Tina Wratten, registered provider. There were 17 residents living at the home at the time of inspection, 8 residents gave verbal feedback, and comments, where possible, are included in the summary below. Feedback cards were received from 12 residents and 7 of their relatives or friends. Staff were observed working with residents and conducting the medication round. Paperwork seen included pre-admissions assessment, individual support plans, risk assessments, medication and administration documents, duty rota, menu and record of food eaten and the training matrix. A tour of communal areas and some random bedrooms took place. Food is said to be good and the vast majority said they do like it very much. One commented ‘They are so particular with my meal, it is presented just as I like it, and they know my preferences. There is no [hurry] at mealtimes’. Another said ‘I feel safe here, I didn’t want to come into residential care, but it is very nice here, and I do get on very well with the staff’. One resident felt that staff were very good, but must always remember to ask before taking things for washing or disposing of items like flannels, as it caused anxiety. Relatives and friends found the staff at the home welcoming and all said they could visit in private. All felt they were kept informed of important matters, and all felt there were sufficient staff on duty. Most were aware of the complaints procedure, and half were aware of forthcoming inspections. All were satisfied with the overall care provided. Full feedback (anonymous, where required) was given to the manager and registered provider What the service does well: Initial needs assessments are clear and easy to follow. Staff try to get to know residents in a non-intrusive manner and are perceived by residents as friendly and helpful. Changing health needs are swiftly followed up and where necessary, assistance to find another, more suitable home, takes place. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 6 Semi-regular trips out of the house are offered to all residents, and staff are made available to assist people to get into town to do personal shopping. Activities within the home are offered several times a week, and a residents group meeting takes place approximately 3 monthly. Several residents said that the organised activities were good, and they got to go out of the home quite regularly. Ongoing investment has ensured that the home remains comfortable and homely. Residents like the décor and appreciate the wide range of communal space. Residents like the food very much and appreciate the attention to detail about likes and dislikes. Residents made it clear that they know who to make complaints to and feel that they would be listened to. What has improved since the last inspection? What they could do better: Staff are held in high regard, but some, whom English is not their first language, were reported by some residents as hard to understand – this must be assessed and addressed. Residents fed back and told the inspector that what they really would like is more chance to chat to staff, in an every-day way, passing the time about current affairs and generally what is going on in the world. One resident pointed out that although they got on well with the other residents, they themselves were hard of hearing, and it was difficult to hear other voices sometimes. The most pressing outcome in need of improvement is the management of medication and the adherence to policies and procedures by the manager and Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 7 staff. Several serious errors were found in the medication records, and the system was not being managed in a safe way. Examples of the shortfalls include; prescription medication had been missed for 2 days, and no action to remedy this was evident. Medication given out by staff did not follow safe procedures, and avoidable errors occurred during the inspection. Action to remedy the situation and ensure the health and safety of the service user did not take place until the inspector highlighted it and prompted the manager. Pain relief, stated by the GP to be given ‘as required’ was being given habitually. Medication administration records stated times that medication was to be given out, but this was not a true reflection of the practice itself. Serious training and competency issues are highlighted and full feedback has been given verbally and in writing to the registered provider. The management of this element has an effect on the health and safety, and therefore on the protection of the people living in the home. The manager must reflect on her own practice and ensure that she and the staff are suitably trained, understand and follow the policies and procedures to protect the residents. Some aspects of environmental health and safety need improvement, these being the regular, documented checks of bathwater delivery temperature at source – to ensure that unsupervised bathers are not at risk from scalding. This is the third time this requirement has been made. There seems to be an overriding element of complacency and historic practice that must be stamped out to ensure swift improvement. The registered provider is required to ensure that the manager receives regular supervision and all elements are systematically audited – those of high risk, on a monthly basis, with reports being submitted to the commission. 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. Tranquility House DS0000036015.V257006.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 Tranquility House DS0000036015.V257006.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): 3, 4, 5, 6 All prospective service users have their needs assessed in advance of being offered a placement. A trial period is given to all individuals to ensure they will have their needs met. Family and friends are encouraged to visit and welcomed by staff. Intermediate care is not offered. EVIDENCE: The home conducts individual assessments to highlight individual needs. Individuals who have care management input benefit from this additional needs assessment, both go on to inform the care and support plan. Prospective residents and their families / supporters are encouraged to visit the home in advance. The first 28 days of residency is deemed to be a trial period for both parties. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 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, 10, 11 Physical health and personal care needs are well described in the individual plan and are reviewed regularly, but access to greater social contact with staff on a day-to-day basis require improvement. Medication management has serious shortfalls and needs rapid improvement. Residents feel that staff uphold their right to privacy and dignity. Staff offer considerate support to people at the end of life and offer support to relatives and friends. EVIDENCE: Individual care plans have improved and are much easier to read. The content is relevant to individual care support needs and describes how to meet health care needs, however the social care aspect could be improved. There are regular opportunities for people to get out and about and to do activities within the home, but what residents said they lacked was a chat. Quality, everyday chats with staff would be very welcome. Some residents said that they did not understand staff that English was not their first language very well, so increasing contact (as well as supporting staff to speak with clarity) would be doubly beneficial. Medication management needs significant improvement. Although there has been improvement in storage, other areas of major concern were seen during the visit, including observed mediation errors taking place, without the staff Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 11 member taking appropriate action to seek advice and act in the residents best interest. Records were not accurate, MAR stated dose times that were different from that actually taking place. Records showed that medication had run out for an individual, but no action was documented as taken to resolve this or notify the individuals care manager. The manager reported this was an ordering issue with the individuals GP that could not be resolved, but there was neither evidence to support action being taken nor the use of the local Primary Care Trust complaints procedure, or reporting to the individuals care manager. Antibiotics had been missed. There is an element of compliancy as neither the manager or staff are following the policies and procedures for administration and management of medication, and this requires swift attention. Full feedback was given to the Registered Provider. The majority of residents felt that their privacy was respected and all felt they were treated in a courteous manner, feeling that they could access staff for help whenever needed. Feedback was given to the manager relating to a specific individuals concern. The home supports individuals, wherever possible, to remain in their familiar surroundings, at the end of their lives. Families are kept informed and are supported through difficult times. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 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, 15 Most residents are satisfied with the activities provided by the home, but some would like more 1:1 contact with staff for chats. Family and friends feel welcomed and know the home will keep them informed of important matters. Residents have meetings, and their suggestions are acted upon. Residents like the food and the attention to detail for particular requirements. EVIDENCE: In the main, people living at the home are very happy. They say that the staff are friendly, it is not a formal place, and outings and activities are a regular occurrence. Visitors are welcome at any reasonable time and all seven friend or relatives responding to the CSCI questionnaire felt the staff were welcoming and privacy, when visiting, was supported. All were satisfied with the standard of care. As noted above, some residents said they would benefit from greater social contact with staff, for a regular chat or discussion, and as three residents felt activities were not suitable, this may be a way of finding out what would be more appropriate. Individuals are actively encouraged to participate in resident meetings and speak up, and this has resulted recently in a requested change to suppertime. A minority of residents wished to have their mealtime unchanged, and this has been accommodated. Food is freshly prepared with quality ingredients. All residents agreed that the food was good, and was well presented. A resident said that they were very particular about their food, and the staff made sure that special requirements were catered to. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 13 Records of food consumed are in place, but would benefit from being more accurate, and reflecting the range of vegetables served with the main part of the meal. Tranquility House DS0000036015.V257006.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, 18 Residents know who to approach if they have concerns and feel confident they will be listened to. Policies and procedures are in place to protect service users from abuse, however shortfalls in standard OP9, medication, highlight a vulnerable area where neglect to ensure medication was available and correctly administered has occurred. EVIDENCE: There have been no complaints over the last 12 months, and residents know whom they should approach with concerns. The Registered Provider regularly speaks to each resident individually, and the manager is on a direct care shift at least once a week. Most relatives / friends returning comment cards knew the home had a complaints procedure. This is displayed in the hallway when entering the home. Staff are expected to read the abuse policy, but no adult protection training has taken place in the past 12 months. The errors highlighted in the medication standard are unacceptable and could constitute a form of abuse, and therefore, the manager must increase the level of awareness in this area. Tranquility House DS0000036015.V257006.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, 25, 26 The home has an ongoing maintenance development plan in place. The areas that are most used by residents are maintained to a high standard and are attractive. Rooms are comfortable and to individual liking. There are sufficient bathing and lavatory facilities. Hoists to aid safe moving and handling are situated throughout the home. EVIDENCE: The home is an older style four-story building that has a lot of corridor space. There is a long-term development plan to redecorate and improve these areas. Individual rooms and communal areas have been the focus of investment and refurbishment, as this is most meaningful to the residents. A walk in shower room and assisted bathroom, with new hoist, is available. A bathroom / WC is available on each floor. A new hoist has been purchased to enable bathing and safer moving and handling. Each individual has a room that suits their needs. Those who share a room do so because they like it, and enjoy the company. The home is clean and homely throughout. Redecoration of personal rooms is done so in negotiation with the resident(s). Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 16 Improvements to ensure the ongoing health and safety provision within the home remains adequate are detailed in standard 38. Tranquility House DS0000036015.V257006.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, 30 Residents and their relatives feel sufficient staff are available to meet individual needs. Over 50 of staff hold an NVQ 2, or above, care qualification. Staff have benefited from a range of service relevant training, which has had a positive impact on many aspects of individual lives. Shortfalls exist in respect of medication training. EVIDENCE: Residents generally feel their needs are well met by staff. Where individual residents needs have changed, staffing has been revised accordingly. Catering and domestic staff are employed for these specific tasks and a senior staff member, or manager, is available on the majority of shifts. Over 50 of the staff employed now hold a NVQ2 or above qualification. Staff have attended a wide range of service user specific training, with especial focus on moving and handling, which was a major shortfall at the last inspection. Major shortfalls exist around the safety of medication management; this highlights a shortfall in training and direct supervision. Some residents expressed difficulty in understanding the spoken English of some staff. The manager must ensure that action is taken to resolve this problem wherever possible. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 18 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, 36, 37, 38 The manager is not discharging her responsibilities fully, and as a consequence, in relation to medication management, the health and safety of residents is compromised. The registered provider must monitor the manager practice to ensure the safety of the service users. Quality assurance procedures would benefit from being strengthened. Staff practice requires greater supervision and support to ensure that policies and procedures are adhered to. Environmentally, health and safety appears reasonably safe, but documented checks are required to take place, that ensure action is taken when shortfalls are identified. EVIDENCE: Shortfalls found relating to medication management and the supervision of staff in this area has led to the health and safety of residents being compromised. The manager has significant experience and a recent NVQ4 award, however is not taking sufficient measures to ensure delegated duties are carried out to an acceptable standard. Policies and procedures are in Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 19 place, but these are not being followed; the practice of the manager and staff indicate a level of complacency that does not promote critical reflection to improve the quality of care provided. The registered provider works in the home on a regular basis, but is not in day to day charge, as a manager is employed. The findings of this inspection indicate that a greater level of management supervision and accountability is required, and a requirement that monthly reports, under Regulation 26, be submitted has been made. Quality assurance processes are taking place by way of residents meetings, and this is highlighting some areas of improvement from a service user perspective, however does not offer opportunities for those unwilling or find it difficult to speak up in a group to have a say. Measures to improve consultation and contact with residents have been highlighted earlier in this report, and have been raised at the service users meetings. The recommendation to improve this outcome remains unmet. A previous requirement to document the delivery temperature of bath water on a regular basis remains outstanding; this is to ensure that any unsupervised bathers are not at risk from scalding. Environmental risk assessments are in place, but are not receiving robust, documented, monitoring, which is required. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 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 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 1 2 Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 21 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 OP7OP12 Regulation 15 Requirement Greater assessment of individual’s need for social contact with staff & increases such contact. All OP9 - With reference to the Royal Pharmaceutical Society of Great Britain guidance; Medication management to be improved with rapid effect; seek professional assistance where required Manager and staff to seek and obtain training that meets the service needs. Medication administration records must be accurate – ‘as required’ medication must be administered as such and records to show the time medication was administered accurately. (Previous recommendation) 01/01/06 After suitable training, documented internal competency assessment must be implemented and conducted on a regular basis. DS0000036015.V257006.R01.S.doc Version 5.0 Page 22 Timescale for action 01/01/06 2 OP9 13 18 01/12/05 3 OP9 13 18 Tranquility House 4 OP9 13 18 Procedure for ordering and keeping sufficient medication in the home must be revised and made safe Handwritten entries must be accurate & countersigned as a safeguard. Medication errors & unauthorised omissions must be reported to GP, care management (where applicable) and to CSCI without delay. (Previous requirement, timescale previously 1/11/04 & extended to 1/4/05) Revise policy and procedure with staff to understand what to do in the event of an error and the importance of following the procedure itself. Staff training and input must include adult protection training. Manager to be aware of neglect aspect re medication omission and incorporate all such considerations into the policy and training provision and monitor practice through supervision. Registered Provider to ensure that the registered manager is competent to run the home and meet its stated purpose, aims, and objectives. Submit monthly reports to CSCI under Regulation 26. Previous requirement timescales 1/10/04 & extended to 15/2/05; Regular, documented bath water delivery temperature checks to prevent scalding. Regular, documented environmental health and safety checks, against the environmental risk assessment DS0000036015.V257006.R01.S.doc 14/11/05 5 OP9 13 18 27/10/05 6 OP9OP30 37 13 18 37 14/11/05 7 OP18OP30 OP36 12 13 18 01/01/06 8 OP31 OP36 9 26 01/12/05 9 OP37OP38 13 01/11/05 10 OP37OP38 13 01/12/05 Tranquility House Version 5.0 Page 23 be conducted – taking action as necessary. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP15 OP30 OP33 Good Practice Recommendations General records of meals consumed include vegetables. Assess spoken English skills of staff against service user needs and take measures to aid improvement where needed. Previous recommendation; Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Tranquility House DS0000036015.V257006.R01.S.doc Version 5.0 Page 25 - 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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