Inspection on 14/02/07 for Wavertree Nursing and Residential Home

This inspection was carried out on 14th February 2007.

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

Other inspections for this house

Wavertree Nursing and... 09/09/08

Wavertree Nursing and... 09/10/07

Wavertree Nursing and... 17/10/06

Wavertree Nursing and... 15/03/06

Wavertree Nursing and... 31/08/05

Wavertree Nursing and... 09/12/04

Wavertree Nursing and... 28/05/04

Wavertree Nursing and... 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Wavertree Nursing and Residential Home Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Les Smith Unannounced Inspection 14th February 2007 10:00 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 Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wavertree Nursing and Residential Home Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 228 4886 0151 228 4867 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) Mr Ilam Din Chaudhry Mrs Evelyn Young Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate up to a maximum of 36 nursing and 24 personal care within the overall total of 48. To accommodate four named service users under the age of 65, but no younger than 55 years. To accommodate one named service user under the age of 55. Date of last inspection 17th October 2006 Brief Description of the Service: Amber Court is a purpose built care home providing both nursing and personal care to 48 residents. All of the accommodation is provided on the first floor and are easily accessible by a passenger lift. On the ground floor there is a large dining room and on the first floor there is large lounge and conservatory, which could be used for a variety of activities. The home is staffed twenty-four hours a day with qualified nursing staff. All of the accommodation is provided in single bedrooms and many of them are very large. The home has many aids to promote the residents safety such as assisted baths, grab rails and a call system. The home is centrally heated throughout. Fees at Amber Court range from £317:50 to £395:00 depending upon the level of service required. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 14th February and was carried out by two regulatory inspectors. The visit lasted a total of 5 hours equating to 10 hours inspector time in total. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Discussions took place with residents, relatives, members of staff, and the registered manager. The home is purpose built and is benefiting from a redecoration and refurbishment programme. During the visit there was little seen of any activities or social interactions and a lack of engagement and stimulation fails to promote residents wellbeing. Record keeping in most areas has improved but still falls short of the standard required. Policies and Procedures require revision in order to promote up to date practice, which will support the residents’ health, safety and welfare. A comprehensive training programme is now in place, which will benefit the residents’ health, safety and welfare. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 6 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 Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information to make an informed decision on were they wish to live but cannot be confident that their needs will be fully assessed or that those assessed needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide require updating to fully reflect the facilities and services provided to meet requirements. This is an outstanding requirement from the previous inspection and must be addressed. Following revision it is recommended that the Service User Guide be distributed to all residents or their representatives. A random selection of residents’ files was examined and all contained an appropriate contract or Statement of Terms and Conditions in place. All prospective admissions to the home have a pre-admission assessment carried out by the registered manager or senior nurse. Files seen have preadmission assessments in place which have improved since the previous visit Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 8 but still lack some of the detail required. The home is reminded of the importance of including family or appointed representatives and other health care professionals if relevant in order to achieve a comprehensive assessment. The home is equipped with the necessary aids such as handrails, hoists and assisted bathrooms to aid residents and promote independence. Whilst training for staff is addressed fully in another section of this report it is relevant to the homes capacity to meet assessed needs. The homes records show that twenty residents have dementia and a further four have mental health needs, which accounts for 50 of the homes places. There has been no training in either dementia or challenging behaviour and this must be addressed to ensure that staff members have the knowledge and skills required to meet residents’ needs. The manager encourages and promotes visits or trial periods of stay in the home before the resident moves in on a permanent basis. Discussions with the manager at these visits and the written information provided allow prospective residents’ and their representative to make an informed decision. Wavertree Nursing and Residential Home does not provide intermediate care. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning process is not as comprehensive or consistent as required and medication management needs to be strengthened to fully support residents’ health and personal care. EVIDENCE: A range of care plans and associated documentation were examined on the day of inspection. These included residents with differing needs such as specialist nursing needs, cultural needs and varying levels of cognitive ability. The standard of care plans has overall improved with daily reports now being written. The care plans remain inadequate, as they do not always detail the interventions required and need to be more specific. One care plan examined stated that the peg feeding tube was to be flushed but failed to say with what, how much and how often. Care plans seen did not give any detail of the date or who had prepared it and other documents such as a body map for a resident with multiple wounds was blank. The lack of detail in care plans fails to ensure that staff members have all the information required in order to meet the needs. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 10 Two files for recent admissions to the home lacked any care plans at all despite having been in the home for over two weeks. The risk of required care not being given due to lack of appropriate care plans is not acceptable. The promotion of independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments. One care file was seen that lacked any risk assessments including an assessment for the use of bed rails. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate and any reviews did not always reflect changes, which were evidenced in other parts of the care file. The standard of regular care plan review in care plans seen is variable depending upon who has completed the evaluation. Evaluations ranged from inadequate such as ‘needs met by care plan’ to a detailed statement justifying the continuation or otherwise of the plan interventions Daily reports have improved significantly and now give an indication as to the actual care delivered, the outcome of that care or how the resident has spent their day. Entries on daily reports require the time and signature of the person writing them. Residents identified as having sensory impairment had no plans in place to address their special needs and plans in relation to their activities of daily living failed to reflect the additional input and care required due to their sensory impairment. Care plans for residents with specific cultural needs must demonstrate that any such needs e.g. dietary or communication have been identified and addressed. Medication management has improved but still needs strengthening in order to meet good practice guidelines. Not all residents had photographic identification and handwritten transcriptions were not double signed or dated. One entry in the controlled drug register had only one signature. Eye drops requiring storage at room temperature were found in the fridge. Whilst the Nursing and Midwifery guidelines were seen in the clinical room it is recommended that a copy of the homes up to date policy and procedure for medication management be kept for staff members to refer to. Residents were dressed and spoken to appropriately and all personal care was given in private. The home has policies and procedures in place in relation to end of life wishes and several files were seen were appropriate details had been obtained and documented. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home but limited activities and social recreation does not promote residents’ wellbeing. EVIDENCE: There is no established activities co-ordinator at Wavertree at this moment in time. The home currently has a volunteer working three days per week on activities at the moment and is hoping that the person will accept a full time position in the very near future and they are attending a activities study day shortly. Whilst there has been an increase in activities provision it still falls far short of that required. As stated earlier in this report 50 of the residents have dementia and it is essential that that appropriate engagements and activities that focus on individual strengths and abilities are provided. The provision of one to one activities should be provided for those residents who cannot for whatever reason participate in-group activities. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wish. Visitors were observed to be arriving at the home throughout the day and residents Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 12 were able to see their guests in one of the communal areas or in their own rooms as they wished. Meals are taken in one of the two dining rooms or in the residents’ own room if that is their choice. The dining room tables on the both floors were nicely presented with tablecloths and appropriate condiments. Staff members were seen assisting residents in a sensitive and dignified manner as required. Several residents require liquidised meals and these were presented after being pureed all together. The stimulation of colour, flavour and texture is lost when all elements are pureed together and is not acceptable. Menus are currently being revised and assurances were given that alternative meals will be included. There is a need to address the dietary needs and preferences of those residents with different cultural backgrounds. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that any complaints will be taken seriously and procedures to protect residents from abuse are robust. EVIDENCE: The home now has appropriate mechanisms in place for the recording of all complaints made. Records showed that there was one complaint dated December 2006, which had been dealt with in a timely and effective manner. The home is reminded that it is good practice to document all complaints whether verbal or in writing together with details of the complaint and the actions taken in order to demonstrate an open and transparent process. Residents at Wavertree are registered on the electoral roll and assisted to exercise their legal rights as needed. The home has commenced a training programme and records show that 15 members of staff had attended training in protection of the vulnerable adult. This training must be continued and extended to include all staff members. Staff members spoken to had a good understanding of adult abuse, its recognition and the procedures to follow if abuse is alleged or suspected. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at Wavertree is improving with a redecoration and refurbishment programme promoting a homely, safe and comfortable place to live for the residents. EVIDENCE: A tour of the home was made accompanied by the registered person. A redecoration and refurbishment programme has commenced which has seen a significant improvement throughout the home. Residents’ rooms were found to be generally clean and tidy. A number of unlabelled creams were seen in rooms including a tube of Daktarin in a resident’s tooth mug. Other inappropriate items such as toiletries were seen on trolleys left in corridors. The carpet in room 14 is badly stained and needs a minimum of deep cleaning or replacement and a number of other rooms require deep cleaning. Many of the sink vanity units were seen to be damaged and require attention. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 15 Bed rails seen were not fitted in accordance with current health and safety guidelines and records in relation to the checking of bed rails are not kept. Lighting in the home is domestic in character and has been replaced to improve the lighting to the benefit of residents. There are sufficient and suitable lavatories for the residents use and appropriate aids such as handrails, grab handles, assisted bathing facilities and hoists are in place to maximise residents’ capabilities. There is a good level of personalisation of individual rooms with residents’ personal memorabilia and furniture. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of care staff employed to meet the assessed needs of the residents and recruitment policies and procedures are not robust and fail to support and protect the residents. EVIDENCE: Examination of the off duty records shows that the staffing levels have increased following the previous inspection. Given the size of the care home, high dependency of residents and 50 of residents having dementia the home is reminded that the level of care required and dependency of residents with dementia increases over the course of the day and there is a need to keep staffing levels under review to ensure residents needs can always be met. Records show that 24 of staff have NVQ level 2 or higher. A selection of staff files were examined and showed a much-improved compliance with requirements for the recruitment of staff. Two files examined related to foreign nationals and there was no evidence of valid work permits. None of the files had appropriate job descriptions or contracts of employment in situ. Evidence of induction within the staff files was not present in two files. Induction records when present were inadequate and do not meet the ‘Skills Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 17 for Care’ guidelines. The home must provide a structured induction to care programme for newly appointed staff. A training programme is in place and training in mandatory and specialist areas is ongoing. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management at Wavertree promotes the health, safety and welfare of residents. EVIDENCE: The registered manager is a first level nurse and holds the registered managers award. The deputy manager also holds NVQ level 4. There is no evidence of a system of quality assurance, which takes account of residents’ views or continuous self-monitoring. Staff meetings have been held and are minuted. Residents’ monies are held in a separate ‘Wavertree Residents Pocket Money’ account with the registered manager and administrator being joint signatories. This account however, is a non-interest bearing account and the home should investigate the feasibility of changing to an interest bearing account with Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 19 appropriate interest being apportioned to the relevant residents. No resident’s monies are held at the home and all expenditure is made via a float system. Receipts for any expenditure on behalf of residents are kept. Formal staff supervision is in place and evidence was seen that this is up to date. Policies and Procedures are in place but there is a need to review and update policies inline with current legislation were appropriate e.g. fire policy last reviewed in 2002. A policy review should also put in place missing policies e.g. peg feeding. The home must also ensure that any guidelines used as a basis for care are up to date e.g. Pressure sore grading guidelines were dated 1985 and have been superseded. Records are held securely and in accordance with the date Protection Act and accessible to residents if requested. The use of books such as communications book, weight and observations book is not in accordance with the Data Protection Act and is not acceptable. Fire alarm and emergency lighting tests are carried out at regular intervals and all portable appliance tests were up to date. Valid service and inspection certificates were seen for all required items. It is recommended that relevant tests for Legionella be carried out. Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 3 3 Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 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 OP1 Regulation 6 Requirement The registered person shallkeep under review and, where appropriate, revise the Statement of Purpose and the Service User’s Guide; and notify the Commission and service users of any such revision within 28 days (Previous timescale of 31/01/07 not met) 2 OP7 15(1) The registered person shall, after 31/03/07 consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (Previous timescale of 31/01/07 not met) 3 OP9 13(2) The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council DS0000025083.V330828.R01.S.doc Timescale for action 30/04/07 31/03/07 Wavertree Nursing and Residential Home Version 5.2 Page 22 guidelines to cover all aspects of medicines management. (Previous timescale of 30/11/06 not met) 4 OP12 16(2)(n) The registered shall having 31/03/07 regard to the size of the care home and the number and needs of service users Consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training (Previous timescale of 31/12/06 met in part) 5 OP18 13(6) The registered person shall make 31/03/07 arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse (Previous timescale of 31/12/06 met in part) 6 OP19 23(2)(d) The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. (Previous timescale of 31/12/06 met in part) 7 OP27 13(5) The Registered Person shall 31/03/07 make suitable arrangements to provide a safe system for moving and handling service users (Previous timescale of 31/12/06 met in part) 31/03/07 Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 23 8 OP30 18(1)(c) The registered person shall having regard to the size of the care home and the number and needs of service users ensure that a staff training programme is put in place and implemented which meets the Skills for Care criteria and includes structured induction training to ensure that staff are able to meet the assessed and changing needs of service users The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home including the quality of nursing where nursing is provided at the care home. (Previous timescale of 31/12/06 not met) 30/04/07 9 OP33 24(1) 30/04/07 10 OP38 (c) 13(4)(a)(b) The registered person shall 31/03/07 ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wavertree Nursing and Residential Home DS0000025083.V330828.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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