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Inspection on 07/09/05 for Tyndale Nursing Home

Also see our care home review for Tyndale Nursing Home for more information

This inspection was carried out on 7th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 the care home does well

Nursing care and community health care support for residents was documented well and monitored in individual care plans. Resident`s spoken with expressed satisfaction with the care they receive and the kindness of staff in the home. The standard of meal provision remains good. More than 50% of care staff employed in the home hold a minimum level 2 in the NVQ care award. Care staff are also supported to levels 3 and 4 in NVQ health and social care. This is commendable.

What has improved since the last inspection?

One requirement was made at the last inspection. This was to improve upon staff recruitment practices by ensuring that all appointed staff have two satisfactory references and a UK CRB. This requirement has now been met. Three recommendations were made at the last inspection. The social activity plans for each resident is in the process of being reviewed with the newly appointed post of an activity organiser at the home. There is now more evidence of family consultation with resident care plans, although most residents are unable to be directly involved in the drawing up of their personal care plans. There is a new bath in the ground floor bathroom installed since the last inspection. This improves the facilities in the bathroom. There remains an outstanding requirement from previous inspections to provide a permanent staff room with changing, seating and washing facilities. This is planned and quotes have been sourced to build the facility. The progress of this will be monitored via subsequent inspections this year and by keeping in telephone contact with the home.

What the care home could do better:

The inspection findings were positive. Care at the home seems professional and sensitive. The staff are settled and work well as a team. A designated permanent staff room will improve facilities for the staff team for them to use during scheduled work rest periods. The ground floor bathroom would benefit from being redecorated in order to improve the experience of using the bathroom. The proprietor acknowledges this and plans to arrange for this work to be carried out in the coming weeks. The redecoration will include improving the usable floor space in the bathroom and alterations to the shower cubicle to upgrade the facility. Progress on this will be monitored at the next inspection visit.

CARE HOMES FOR OLDER PEOPLE Tyndale Nursing Home 36 Preston Road Yeovil Somerset BA21 3AQ Lead Inspector Judith Roper Unannounced 07 September 2005 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 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. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tyndale Nursing Home Address 36 Preston Road Yeovil Somerset BA21 3AQ 01935 474520 01935 706624 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Christopher Michael Bruce Wharton Mrs Pauline Purnell Care Home with Nursing 27 Category(ies) of Old Age (27) registration, with number of places Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 27 elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Up to two persons of either sex, between the ages of 18-60 years, who require general nursing care. 3. To provide day care for up to two persons per day between the hours of 0700 and 1700. 4. Up to three places for personal care. Date of last inspection 10th February 2005 Brief Description of the Service: Tyndale is a 27-bedded care home providing nursing and personal care for older people. The home is in Yeovil, which has all the facilities of a medium sized town including hospital, shops, theatre, churches and other leisure facilities. There are smaller shops and a park within walking distance. The home is situated on a site, which also includes a sheltered housing complex and residential care home. This affords service users from all three facilities the opportunity to socialise and maintain friendships should they move into different areas for care. Tyndale is an old converted house with a purpose built extension, built in 1987, attached by a short walkway/entrance hall. Accommodation is provided in 17 single and 5 double bedrooms on two floors, the first floor being reached by either stairs or a stair lift. There is an attractive, large front garden that looks onto the main road and a quieter courtyard garden accessed from the lounge. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector and took place over one day between the hours of 10.15 am – 2.30 pm. 25 residents were at the home on the day of the inspection. There is currently 1 vacancy at the home but an admission is expected next week. The inspector was able to interact with 7 residents and see most others. Many residents were attending the Holy Communion service in the home on the day of the inspection. A summer fete is to be held this Saturday for the complex, in the grounds, as a fund raising event to buy a mini-bus for the complex. Staff on duty were able to give time to speak with the inspector. The registered manager Ms. Purnell and the owner Mr. Wharton were available for comment during the inspection. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff carried out their duties in an attentive and professional manner. This is the first inspection using the new CSCI reporting format, which focuses on outcome statements for National Minimum Standards. The inspector’s aim on this inspection visit was to seek views on the quality of the service from as many service users as possible and to speak to staff and any visiting relatives. Records examined during the inspection were resident care and support plans, resident risk assessments, medication records, activity records, 3 staff recruitment files, a sample private contract and some internal quality assurance documents; other records will be examined at subsequent inspection visits. What the service does well: What has improved since the last inspection? One requirement was made at the last inspection. This was to improve upon staff recruitment practices by ensuring that all appointed staff have two satisfactory references and a UK CRB. This requirement has now been met. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 6 Three recommendations were made at the last inspection. The social activity plans for each resident is in the process of being reviewed with the newly appointed post of an activity organiser at the home. There is now more evidence of family consultation with resident care plans, although most residents are unable to be directly involved in the drawing up of their personal care plans. There is a new bath in the ground floor bathroom installed since the last inspection. This improves the facilities in the bathroom. There remains an outstanding requirement from previous inspections to provide a permanent staff room with changing, seating and washing facilities. This is planned and quotes have been sourced to build the facility. The progress of this will be monitored via subsequent inspections this year and by keeping in telephone contact with the home. 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. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,5. The home provides a welcome pack to new residents, which provides good information about the home, its services and facilities. The management of the home ensures that a robust pre-admission procedure is followed to determine whether the placement at Tyndale is appropriate and that a new resident’s needs can be met at the home. The staffing structure at the home is defined well and staff are supported to obtain professional qualifications in their job roles, thus providing residents with a service that is delivered by skilled staff. EVIDENCE: The home has a detailed Statement of Purpose and Service User’s Guide that was reviewed and revised in 2005. Charges for extras at the home are detailed in these documents. An example of a private contract was inspected. The contract made clear any charges that the residents would be liable to pay during their admission at the home. Written pre-admission assessments are carried out by the home; meeting the prospective resident at their home or place they are staying at. The home also obtains a community care assessment from the placing care manager. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 9 The home is staffed twenty four hours a day by an appropriately qualified nurse and a team of care staff, many of whom have a number of years experience in caring for elderly people. The home uses a named nurse and key worker system for continuity of care. The care staff are supported and encouraged to achieve NVQ awards in care. The home’s contracts and documentation states that there is a trial period of one month at the home before the placement is made permanent. This gives the new resident, existing residents and the home’s management time to determine if the placement is appropriate. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10. Health care needs are risk assessed and documented well in care plans. This enables staff to plan for changing needs. Social care needs are not yet documented fully but a newly appointed activity organiser has this to address as part of her job role. Care plans were regularly reviewed and had a detailed daily report completed in order to demonstrate that care was updated each day. Medication systems were inspected and were found to be managed safely. Residents spoken with said that their privacy and dignity was respected in the home by staff and that the home was a good place to live. EVIDENCE: Three care plans were examined in detail. There is still not a great deal of social activity planning in care plans but an activity organiser had been appointed at the complex for 25 hours per week the week of the inspection and part of her role will be the monitoring and recording of planned activities in the home. The activity organiser who has been appointed has past experience in similar roles at care homes. The monitoring and recording of nursing care and community health care support for residents was good. Wound care plans were documented and appropriate clinical risk assessments tools were used to plan for care. The home uses a key worker system and the input of key workers spending time with residents could be better demonstrated if this was more frequently recorded in care plans. Where one resident had limited Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 11 speech a fuller written explanation was needed in the care plan of how staff would communicate with this person. Health screening and routine care appointments such as chiropody, audiology, dentistry and opticians was sourced appropriately and documented in care plans. The home also uses specialist community nursing services such as tissue viability, diabetes and community psychiatric nurses. Medication management and medication records recording were inspected at the home. The overall management of medication in the home was good. The inspector made one comment to the manager that where it is recorded on medication charts (MARs) that a medication had been omitted that a clear explanation needed to be recorded. In a minority of cases this explanation was not sufficiently clear at first glance. The home has a privacy policy and all new staff sign a confidentiality declaration at induction. There is also a ‘Resident’s Charter’ acknowledging rights to privacy and dignity. Residents spoken with during the inspection said that staff treat them with respect and that privacy is maintained. During the inspection the inspector observed staff conducting their duties in manners that maintained the dignity of residents. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 standard(s) 12,13,15. One of the aims of the newly appointed activity organiser will be to provide more 1:1 activity attention for residents. This would be welcomed, as it will focus individual attention to the more disabled residents in the home. Tyndale makes visitors feel welcome and documents when families have been contacted should their relative become unwell. There are relatives meetings allowing relatives to be directly involved with feeding back opinions about the service to the management. The kitchen is managed well by a catering manager and menus are nutritionally balanced and appetising. Residents can serve their own vegetables, condiments and drinks from their table at meal times making meal times interactive and like a restaurant service. EVIDENCE: Residents who spoke to the inspector said that the routines for rising and retiring each day are flexible. An activities organiser has been appointed for 25 hours per week to oversee planned activities for the complex. Part of her role will be to provide more 1:1 individual activities for residents. Activities at the home for groups are already established and work well. There is an active resident’s activity committee on the complex. Residents in their rooms or lounges were observed to have call bells within reach. Staff also stopped when passing residents to enquire if they needed any assistance. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 13 Residents said that their families are made welcome when visiting the home. The home runs relatives meetings and relatives are invited to social events held at the grounds. The standard of meals is good. There has been a recent EHO inspection at the home and the EHO inspector made some recommendations. The home has responded with an action plan addressing recommendations made. The menus in the home offer choice and nutritionally balanced meals. Lunch was observed during the inspection. The catering manager spent time talking with residents and offering alternative dish options to residents preferred other than the menu choices. Some residents needed assistance with eating their lunch. The inspector observed staff carrying out this task in a sensitive and discreet manner, providing individual attention at the pace of the residents. The home uses two dining spaces at meal times and residents may eat in their rooms if they want to. The kitchen is both domestic and industrial in character. On the day of the inspection two residents from the on-site supported living complex were taking their lunch with residents at Tyndale. One of these people spoke with the inspector and described the meals and staff at Tyndale as ‘marvellous’. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 standard(s) 16,17,18. The home has a clear complaints procedure and the management makes routes available for residents and families to contact them in order to express concerns. Residents spoken with said that the management and her deputy were approachable. Staff receive training in abuse awareness and the home has policies and procedures to protect vulnerable adults. EVIDENCE: The home reported that it has not received any complaints since the last inspection. The complaints procedure is displayed in the home and is in the Statement of Purpose, Service User’s Guide and Welcome Pack for new residents. The manager confirmed that residents are entered onto the electoral roll and that many chose to exercise their vote in the 2005 general election. Abuse awareness for staff is included at both induction and NVQ training. The home has adult protection and whistle blowing policies. Incidents required to be notified to the CSCI have been reported by the home appropriately. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,26. The environment at Tyndale is suitable to meet the nursing needs of residents. The proprietor continues to invest in improving the facilities in the home for residents and staff. The home is clean and inviting, making a pleasant home for residents to live in. The gardens are attractive and used for social events involving the other homes on site giving a community feeling at the complex. EVIDENCE: Tyndale is a large house converted to meet the needs of nursing residents. There is a shaft lift to the first floor and a stair lift on the stairs. The gardens are pleasing and accessible for wheelchair users. Furnishings in bedrooms and communal spaces are homely and inviting. The home has four bathrooms but one is not used. The staff reported that the number of bathrooms used is sufficient to meet the bathing needs of residents. Care plans inspected indicated that residents receive a bath approximately weekly. There has been a new assisted bath in a ground floor bathroom since the last inspection. The proprietor is also planning in the coming months to improve the layout of this bathroom in order to provide better space for staff assisting residents to bathe. The improvement in the bathroom will also Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 16 upgrade the shower facility and décor in the bathroom. This is welcomed and progress will be monitored at the next inspection. There are some shared rooms at the home and appropriate screening is provided in these rooms. The home has a sufficiently equipped laundry, which is shared by the sister home of Latimer Lodge. There are sluices for managing the use of commodes. The home is clean and staff were observed following infection control measures to manage the risk of cross infection. The proprietor is planning to provide a permanent staff room at the home, which was made a requirement at a previous inspection. He reported that quotes have been sought for providing this facility for staff. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29. The staff team is a cohesive unit and appear to work well and harmoniously to meet resident needs. Residents spoke highly of staff attitudes. There is a strong commitment to the development of the staff team at the home through staff training. Recruitment practices for newly appointed staff were maintained in appropriate order, thus providing protection for vulnerable adults at the home. EVIDENCE: The home uses some agency staff at times but the vast majority of the staffing numbers are made up of permanent staff employed by the home. The manager has slightly adjusted the care staffing daily compliment in the last year by rostering additional care workers in the early morning and twilight hours in order to meet a changed dependency level at the home. There are two part-time care vacancies at the home. Residents asked said that they thought there were sufficient numbers of staff on duty to care for their needs. There is a high percentage of staff holding NVQ awards at and beyond level 2 at the home. Managers and deputy managers have or are working towards level 4 in NVQ managerial awards. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 18 A sample of 3 staff recruitment files were inspected and found to be maintained in a satisfactory manner in order to protect residents. CRB checks for overseas staff employed at the home have been sourced from the UK as well as the mother country since the last inspection, as was required by the CSCI. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36,37. Tyndale is managed well with managerial staff having defined roles and responsibilities. The proprietor continues to invest into services and facilities at the home in order to provide a good service for residents. Staff are supervised and their performance is monitored in order to protect residents and provide good level of care. Records are generally well maintained and are stored in a manner that protects confidentiality. EVIDENCE: The registered manager Mrs. Purnell is also the general manager for the site complex. This is a new arrangement agreed by the CSCI early in 2005 and will be reviewed in October 2005. This inspection indicates that the arrangement has been working well to date and that standards of care at Tyndale have not dropped as a result of this arrangement. Residents spoken with during the inspection said that they found the general manager and her deputy approachable, kindly and dependable. The home holds the Investors In People award and is Quality Rated by Somerset County Council. There are formal Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 20 systems of quality assurance used at the home with minuted resident and relative and staff meetings and an annual quality questionnaire sent to relatives and their family members. Occupancy rates and referral remain high and constant. The proprietor also continues to invest into the structures and environment of the home. There is a system of regular formal staff supervision at the home. This is documented as a job review and takes place on a 1:1 basis with a supervisor. Records in the home were stored appropriately in order to maintain resident and staff confidentiality. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 3 3 3 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 2 x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 x 3 3 x Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 22 No 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 Regulation Requirement No requirements were made as a result of this inspection. Timescale for action 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. Refer to Standard Good Practice Recommendations No additional recommendations were made. Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 Tyndale Nursing Home D53 - D02 S43153 Tyndale V246707 070905 Stage 4.doc Version 1.40 Page 24 - 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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