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Inspection on 24/01/06 for Tunstall Hall

Also see our care home review for Tunstall Hall for more information

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What has improved since the last inspection?

The objective to improve the standard of the environment for service users is well under way and supervised by the homes maintenance person. Communal areas and corridors looked fresh and clean. However, there are areas of the environment that could be better managed by staff that are detailed in the environment section.

What the care home could do better:

The statement of purpose/service users guide needs to be kept up to date with regards to inspection reports and details of how to contact the CSCI if people wish to make a complaint. Assessments and care plans that have been updated were not consistently evaluated, signed, dated or timed. There is a lot of individual informationrecorded in the assessment phase which is lost in the standard pro-forma used for the care plans. There is a variable quality in the recording between the qualified nurses completing these. One plan for a service user with wound care problems was very difficult to follow and lack of entries re clinical care suggested that treatment stopped when in fact the service user had necrotic pressure ulcers. There was no recorded evidence that care plan training had been provided for staff. Guardian Care stated in their action plan following the last inspection that care plan training had been completed. A member of staff confirmed that training had not been provided. Staff training for some topics has not been delivered as per the homes action plan. Training that had been provided should be recorded more accurately in order to demonstrate the dates it was carried out and for an overview of the individuals future training needs can be easily identified. Regulation 26 reports have been sent to the CSCI on a monthly basis. Complaints should be responded to in line with the timescales within the homes procedure. This should be done even if the complaint is subject to adult protection procedures. Without a registered manager there is not a day to day consistent approach to ensuring that the health, safety and welfare of service users and staff is maintained.

CARE HOMES FOR OLDER PEOPLE Tunstall Hall Market Drayton Shropshire TF9 4AA Lead Inspector Pat Scott Unannounced Inspection 24th January 2006 10:15 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 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tunstall Hall Address Market Drayton Shropshire TF9 4AA 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) 01630 652774 01630 658270 Guardian Care Homes (UK) Ltd Care Home 34 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24) of places Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 34 service users of which a maximum of 22 beds may accommodate service users requiring nursing care. Of the total 34 service users, the home may accommodate 10 clients suffering from dementia. Care staffing levels must be maintained as: Up to and including 22 service users: 7am-2pm - 1 RN, 1 SNR and 2 CAs 2pm-9pm - 1 RN, 1 SNR and 2 CAs 9pm-7am - 1 RN and 1 CA Up to and including 30 service users: 7am-2 pm - 1 RN, 1 SNR and 3 CAs 2pm-9pm - 1 RN, 1 SNR and 3 CAs 9pm-7am - 1 RN and 2 CAs Up to and including 33 service users: 7am-2pm - 1 RN, 1 SNR and 4 Cas 2pm-9pm - 1 RN, 1 SNR and 4 CAs 9pm-7am - 1 RN and 2 Cas The Manager will be supernumerary as follows Up to and including 15 service users - 15 hours Up to and including 25 service users - 20 hours Over 25 service users - totally supernumerary An additional 15 hours per week will be included for an Activities Coordinator. 1st November 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Tunstall Hall is a large 19th Century building set in impressive grounds, which are surrounded by open countryside. The town of Market Drayton in North Shropshire is nearby and there are good road links to the larger towns of Shrewsbury and Telford and to the Potteries.The home is owned by Guardian Care Homes (UK) Ltd, a national organisation, which already operates a care home near Bridgnorth, Shropshire. Tunstall Hall is currently registered to provide accommodation and care, including nursing care, to 34 older people. Accommodation is in single or double bedrooms and there are large communal rooms including an imposing library. The home is without a registered manager at present although steps are being taken by Guardian Care to recruit one. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 24th January 2006 for a duration of 3 hours by the lead inspector and regulation manager. The CSCI conducted this additional inspection to measure the compliance of Guardian Care to address the shortfalls against the National Minimum Standards identified at previous inspections on 13.6.05 and 1.11.05. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records Although improvement in the internal premises is gathering pace slow progress has been made regarding the leadership, training, development and supervision of staff who are directly involved in service user care. What the service does well: What has improved since the last inspection? What they could do better: The statement of purpose/service users guide needs to be kept up to date with regards to inspection reports and details of how to contact the CSCI if people wish to make a complaint. Assessments and care plans that have been updated were not consistently evaluated, signed, dated or timed. There is a lot of individual information Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 6 recorded in the assessment phase which is lost in the standard pro-forma used for the care plans. There is a variable quality in the recording between the qualified nurses completing these. One plan for a service user with wound care problems was very difficult to follow and lack of entries re clinical care suggested that treatment stopped when in fact the service user had necrotic pressure ulcers. There was no recorded evidence that care plan training had been provided for staff. Guardian Care stated in their action plan following the last inspection that care plan training had been completed. A member of staff confirmed that training had not been provided. Staff training for some topics has not been delivered as per the homes action plan. Training that had been provided should be recorded more accurately in order to demonstrate the dates it was carried out and for an overview of the individuals future training needs can be easily identified. Regulation 26 reports have been sent to the CSCI on a monthly basis. Complaints should be responded to in line with the timescales within the homes procedure. This should be done even if the complaint is subject to adult protection procedures. Without a registered manager there is not a day to day consistent approach to ensuring that the health, safety and welfare of service users and staff is maintained. 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. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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 The homes statement of purpose does not contain up to date details of the homes last statutory inspection report which does not enable potential and current service users to be informed about the regulatory conduct of the home. EVIDENCE: The statement of purpose was in the foyer but did not contain the inspection report of 1.11.05. Pre-admission assessments carried out by the placing authority and the home were seen on care files. The home assessments were not consistently dated, timed or signed by the assessor. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 9 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 Errors in the medication administration systems and records create the potential for people to receive the wrong medication The new care plan system in place does not consistently provide staff with the information they need to satisfactorily meet service users needs. Thus the health and personal care needs of service users may be compromised resulting in inadequate care. EVIDENCE: Medication systems were not inspected in full. The medication administration records (MARs) included errors relating to four residents, which were discussed with the nurse in charge. It is acknowledged that accuracy is not helped by some of the printing in the charts which can lead to confusion as to which column relates to which day. Photographs were not available for all service users with the charts. One error related to a man re-admitted the previous night where the chart evidenced that night medication for the day of inspection had already been signed for; in fact these signatures related to the previous evening; one missing signature from the morning medication was a simple omission recognised by the nurse in charge; one record again suggested that night medication had already been administered but this error could have been Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 10 created by an earlier mistake in the dates entered in the MAR chart. The morning medication for one resident had not been signed off – this was because she had refused. The nurse in charge stated that sometimes it is possible to persuade this service user to take her medication later in the day so no entries had been made. This approach is also used for the service user who was re-admitted (above). Entering refused in the box for the relevant time/dosage and using the space in the chart to enter the time of a later administration would promote good practice, and accuracy of the records. Timing between doses may be significant so accuracy is required. The care plan seen for the latter individual re his medication did not match staff practice. The new care plan system has been introduced. Individual risk assessments are conducted and recorded. However, bed rail risk assessments did not record any consultation with other parties, i.e. GP, relative or other supporter. Entries were not consistently dated, signed or timed. One service user having had a body map completed because of pressure area problems did not have a plan of care as to direct staff as to how this area would be managed. Wound care was not comprehensively recorded for one service user or dressings carried out on the dates stated. Although the format is an improvement, the quality of its completion is variable, repetitive and loses track. As such it cannot be relied upon to gauge whether appropriate care is delivered to an individual. A member of staff stated that care plan training on how to use the new documentation had not been provided. There was no written record that this had been provided by Guardian Care despite the action plan having stated so. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 11 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): 15 Improvements to menus have improved choice for service users, but lack of information may mean that service users are unaware of the choices available EVIDENCE: The home is still recruiting kitchen staff and an agency cook is being employed at present, and with established staff the kitchen rota is covered for breakfast and lunch seven day a week. There are only three days a week when there is a member of staff specifically deployed to work in the kitchen to prepare and serve tea. Seven of the home’s staff, including one of the kitchen assistants, have undertaken Basic Food Hygiene training. The District Council Environmental Health Officer visited during the week prior to this inspection and made a number of requirements including some cleaning work and the reprovision of a freezer. The kitchen floor has been replaced and some cleaning has been undertaken but it can be seen that further cleaning, and replacement of damaged tiles, is still required to promote a reasonable standard of hygiene in the kitchen. Cleaning rotas have been started. It was stated that choices are now available at all mealtimes, and a four week menus has been devised, but an alternative to the main lunchtime meal was not shown on the menu in the dining room (the white board menu in the hall area was blank) and an effective system for identifying and recording preferences – for lunch or tea has not yet been established. Menus are not displayed on dining tables as Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 12 noted in the home’s action plan. The dining room was nicely presented with flowers, linen cloths and napkins – but cruets were only in evidence on some tables and for some these amounted to pepper and more pepper, and some were empty. It was not evident from the training records that staff had been provided with guidance on how to assist people to eat, which the home aimed to undertake by end December 2005, and none of the staff were aware of any training relating to the nutritional needs of older people, which again the home’s action plan stated would take place in December 2005. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 13 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 The complaint procedure is incomplete thus providing service users with inadequate information as to whom they can express their concerns other than the home. EVIDENCE: The home has a complaints procedure that informs service users of the option to contact the Commission for Social Care Inspection but omits to provide contact details to enable them to do so. Complaint monitoring forms are sent on a weekly basis to the regional office of guardian care. One previous complaint received at the CSCI was addressed during this inspection of 1.11.05. A copy of the complaint was left with the deputy manager for their response to the Commission. This has not been received. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 14 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, 20,21,22,26 The on-going investment has significantly improved the appearance of this home to create a comfortable environment for those living there and visiting. The maintenance person is very aware of his role and keeps records of all remedial works carried out in the home ensuring the schedule of works is maintained. EVIDENCE: A tour of the premises showed that the environment has been refurbished with new carpets and redecoration. It was clean, odour free and equipment to deal with the needs of dependent service users e.g. hoists, handrails, and assisted bathrooms. However, bathroom 5 on the top floor contained items not relevant to a bathroom and the bath panel was broken and the curtains were dirty. A COSHH item had been left in this bathroom. It is recommended that all rooms currently being refurbished be locked off for safety. Sluice rooms were not locked. Bars of soap were seen in communal bathrooms which is not good infection control practice. Other personal care items were seen in metal Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 15 cupboards in the corridors. These cupboards (also unsightly) should be removed and service user toiletries stored within their rooms for individual use only. It is suggested that baskets, with a washable liner, be provided for personal care toiletries, which are taken to the communal bathrooms at the time of bathing the service user, and returned afterwards. 2 First aid kits were left in the corridors which should be stored within a designated area and the named first aider on duty on display. The hair salon was being used to store items and was in disarray. A cleaning cupboard outside the laundry room containing COSHH items was left unlocked and a cleaning liquid left on the floor which is a hazard to service users. The laundry is to undergo refurbishment and a hand washbasin must be installed. The home does not have thermostatic sluice disinfectors on any floor and has stainless steel slop-hoppers in place. Guardian Care has given an undertaking to install 2 sluice disinfectors. If it is the intention of the Company to use the three sluice rooms then a third must be installed, otherwise the room should be de-commissioned. Soap dispensers and disposable towel holders are to be provided in service users’ bedrooms. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Improvements to training provision, monitoring and supervision of staff are still required in order to ensure that service users are in safe hands EVIDENCE: A training audit has been undertaken and a matrix was shown to inspectors. In discussion with the home’s administrator, it was suggested that rather than completed training being ticked, a date is entered so that everyone who needs to refer to the matrix can see what training is up to date and what needs to be repeated. This can then provide a useful planning tool for management as well as a record of the home’s position regarding training provision. The home does not yet meet the required minimum ratio of 50 staff trained to NVQ2. 14 of the 33 staff have undertaken moving and handling training; 14 have undertaken fire safety training; 7 have done 1st Aid and, as mentioned previously in this report, 7 have undertaken Basic Food Hygiene. All but the new starter on the training matrix had “Induction” ticked off but it is unclear what this refers to; there was no evidence on staff files of completed and signed off induction standards or of mentors being allocated to support staff in completing these documents. Although the home’s training plan stated that Infection Control training was to be provided in January the home’s administrator was not aware of this taking place. Clearly as indicated by the recent audit undertaken by the PCT, there is an urgent need for this to be provided. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 17 An audit of the personnel files has been undertaken and deficits addressed. The only “new” starter file available was for someone who had worked at the home before, and was returning as kitchen assistant, and this contained all the necessary documentation other than a photograph. At the time of inspection the home was providing care and accommodation for 22 service users and staffing levels were appropriate for this number of people. Staff rotas show that on six occasions the home been short of staff under that required by the conditions of registration. These have been notified to the Commission as they occurred under Regulation 37. The home is still unable to admit service users who require nursing care for their dementia. The variable quality in the recording of care plans demonstrates an urgent need for specific training in this area. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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): 31,38 The lack of registered manager does not provide support for senior staff in providing leadership throughout the home and for staff to demonstrate any awareness of their roles and responsibilities. EVIDENCE: Inspectors were informed that the home’s recently recruited manager has now moved on so no progress has been made in terms of ensuring that a qualified, competent and registered manager is in charge. During the visit, Inspectors met with the previous owner of the home who has been brought back in to manage the home alongside the present deputy manager, who is a qualified nurse. CSCI had not been informed formally of this proposal at the time of the visit Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 19 The continued lack of training overall means that that safe working practices are certainly not in place for all areas mentioned in standard 38 e.g. COSHH, infection control. Unsafe practice was observed such as leaving unattended COSHH substances about the home. The stair gates to the main staircases are now in situ and a risk assessment regarding this hazard in place. Exposed hot pipes have been boxed in to address the hazard of service users having a fall against them. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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 1 X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 x 2 2 2 3 X X X 1 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X X X X 1 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4, 5 Requirement The home must revise its Statement of Purpose and service users guide to include the most recent inspection report and information on how to contact the CSCI in the event of a complaint. (Outstanding from October 2004) The assessment records must be dated, signed and timed by the assessor. Medication administration records must be maintained accurately The home must comply with the requirements of the environmental health officer to ensure that the kitchen is an adequate facility for food preparation Choice of meals must be promoted through written or other formats to suit the capacities of all service users Timescale for action 28/02/06 2 OP3 14(1) 28/02/06 3 OP9 17(1)(a) 28/02/06 4 OP15 16(2)(g) 28/02/06 5 OP15 16(2)(i) 28/02/06 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 22 6 OP16 22(3)(8) To respond in writing to the Commission regarding the complaint of 26.10.05 The home must ensure that all outstanding maintenance, refurbishment and redecoration work is completed. The home must install three sluicing disinfectors, one on each floor of the home. (Outstanding from December 2004) Paper towel dispensers must be fitted at all hand washing facilities. (Outstanding from November 2004) Install a hand-wash basin in the laundry A minimum of 50 trained members of care staff must be achieved The home must ensure that staff are trained and competent to do their jobs Staff records must show they have all received appropriate mandatory training to maximise safe systems of work. (Outstanding from 13.6.05) 28/02/06 7. OP19 23 28/02/06 8. OP26 23(2)(k) 30/05/06 9. OP26 13 (3) 28/02/06 10 11 OP26 OP28 13(3) 18(i)(a) 28/03/06 28/06/06 12 OP28 18(1)© 28/02/06 13 OP38 18 (1)(a)(c) 28/02/06 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP38 OP38 OP38 Good Practice Recommendations To keep sluice rooms locked. To lock off all rooms undergoing refurbishment. To lock all COSHH items away. Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Tunstall Hall DS0000059307.V280256.R01.S.doc Version 5.1 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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