Inspection on 26/09/05 for WCC - Lower Meadow

This inspection was carried out on 26th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

WCC - Lower Meadow 27/01/09

WCC - Lower Meadow 08/03/07

WCC - Lower Meadow 05/03/06

WCC - Lower Meadow 25/02/05

WCC - Lower Meadow 14/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Lower Meadow Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF Lead Inspector Yvette Delaney Unannounced Inspection 26th September 2005 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 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lower Meadow Address Drayton Avenue Stratford upon Avon Warwickshire CV37 9LF 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) 01789 268522 01789 266757 paulgaskell@warwickshire.gov.uk Warwickshire County Council, Social Services Department Paul Gaskell Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Manager`s Qualifications That Paul Gaskell achieves the required NVQ level 4 by the year 2005. 25th February 2005 Date of last inspection Brief Description of the Service: Warwickshire County Council manages Lower Meadow. The home is a local authority care home registered to provide personal care for up to 35 Older People. Lower Meadow is situated about one mile from Stratford Upon Avon town centre, where all community and health facilities offered in the town can be found. There is a bus service to the town every 15 minutes. The home was refurbished in approximately 1993. There have been some minor changes to the environment (communal space) during early 2004. The ground floor provides long term care for fifteen older people, respite care is also accommodated for on the ground floor. Within this area there is one lounge/kitchenette, and there is now a separate dining area. Day care is provided within a dining/sitting area with attached conservatory area. The first floor accommodates twenty service users. Communal areas on the first floor consist of a lounge/kitchenette, and a small sitting / dining room. Lower Meadow under went a refurbishment in the early 1990’s, with a small scale refurbishment of the kitchenettes and other work during 2002. The home remains to have a pleasant appearance and has a homely feel about it. The communal areas are well decorated and furnished attractively. All bedrooms contain en-suite facilities comprising of a toilet and wash hand basin. Two bedrooms also contain a shower. The home has a shaft lift. Car parking is provided to the front of the building. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, carried out on a Monday during hours of 10.00 am and 7.00 pm. A tour of the premises was undertaken. Records were examined, which include care plans, risk assessments and accident records. Conversations were held with six members of staff, ten residents and two day care persons. The inspection focused on the progress made on the requirements and recommendations made at the last inspection. The home provides facilities and services for up to thirty-five residents requiring long term care. The home manager was present at the inspection. Staff were receptive and positive throughout the inspection with a good level of knowledge about residents in their care. Residents were happy with the home, relaxed and able to speak openly about their day-to-day life in the home. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide need to be completed as required by Regulation. The manager needs to produce two separate documents, which are informative to current and prospective residents. Information provided should support both groups to make choices about moving into and living in the home. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 6 The other area, which needs improvement, is the completion of the new care plan documentation. Although care staff have made a good attempt at completing the new care plan documentation it is evident that there is a lack of training and clear guidance to inform and support staff in completing the care plans effectively. Examination of care plans made it clear that staff were unsure as to what should be included under each heading, causing confusion and could lead to omission of care. Other areas, which need to be addressed are the omissions by care staff when writing daily statements in not ensuring that written entries are dated, timed and consistently signed and not as in some instances using initials. Staff should not be scribbling out statements and use abbreviations. Daily statements should give an immediate picture of a resident’s 24-hour day, be meaningful and reflective. All records must also maintain confidentiality and thereby comply with the Data Protection Act 1998. 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. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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 and 3 The home’s Statement of Purpose and Service Users’ Guide are not complete therefore potential are unable to make an informed decision about admission to the home. The assessments completed by senior care staff at the home, prior to residents moving in, ensures that residents’ personal, health and social care needs can be met by the staff working at the home. EVIDENCE: A document representing the Statement of Purpose and Service User Guide as a combined document were examined. The document was not complete or available as two separate documents. The manager advised the inspector that both documents would be reviewed these will be examined at the next inspection. A comprehensive pre-admission assessment based on the activities of daily living has recently been introduced. Examination of the information that could be gained would be sufficient to make an informed decision as to whether the home has the resources to meet the needs of potential residents. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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 Residents’ health, personal and social care needs were not consistently described in care plans, which could result in the oversight of care and possible harm to residents. Written entries in care plans were not always dated, timed, signed and free from errors, which would ensure that an effective audit trail was available to ensure that appropriate care had been delivered. EVIDENCE: New care plan documentation has recently been introduced into the home. Care profiles are based on the activities of daily living, which requires the person carrying out the assessment to identify a residents strengths, needs/problems and causes of problems. Care plans examined do not make it clear whether one or all of the above must be identified, hence a mix of issues were identified, making it difficult to complete the remainder of the care plan with clarity. Examination of care plans made it clear that staff were unsure as to what should be included under each heading, causing confusion and could lead to omission of care. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 10 Care plans did not detail that the opportunity had been taken to discuss the plan of care with residents and appropriate family. Daily statements were not dated, signed and timed, staff were scribbling out statements instead of putting one line through and initialling and a lot of abbreviations were used for example ‘p/care’. Initials were used to sign statements made and not signatures as indicated. Daily statements do not give an immediate picture of residents’ 24-hour day as separate night records are maintained. Daily statements made were not meaningful and examples of entries made include ‘fairly cheerful’, ‘appears fine’, ‘seems fine’, ‘no problems’ and ‘no concerns’. Completion of care plans in this way does not allow for effective auditing of the care delivered by staff. Daily statements did not observe confidentiality and data protection as records contained the names and room numbers of other residents. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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): 12, 13, 14 and 15 A good lifestyle is offered to residents related to social, cultural, religious and recreational interests resulting in a high level of well being and quality of life. Residents are encouraged and enabled by staff with the support of their family to exercise control over their lives, resulting in increased self-esteem and quality of life. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet in pleasant surroundings, which promote social interaction and wellbeing. EVIDENCE: Activities are encouraged both in and outside the home, visits have been made to the Royal Spa Centre and residents enjoy going to plays and the theatre. The manager uses the opportunity at lunchtime to update and remind residents on the events of the day and coming week with the opportunity for residents to ask any questions. This was done on the day of inspection and expression and comments from residents confirmed that it was something they were used to. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 12 Links are well established with the League of friends, who are volunteers for the home. Fetes and barbeques have been organised. An art project is in progress at the moment with a local community group to produce an art mural for the reception area. Residents are involved in planning activities they wish to be involved in. A local church representative visited the home on the day of inspection to donate produce from their recent harvest festival. The inspector ate lunch with the residents this consisted of home made Cornish pasties, potatoes and a choice of vegetables and an alternative choice of cauliflower cheese was also available. The meal was enjoyable appetising and nutritious and residents said that they enjoyed their meal and ate well. Residents are very sociable and conversations were taking place in small groups. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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): This section was not assessed at this inspection. EVIDENCE: Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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, 23, 24, 25 and 26 The environment is varied throughout the home in relation to safety, maintenance, comfort and cleanliness, which overall promotes a positive experience of quality of life for residents. EVIDENCE: A tour of the home was carried out with the home manager, the home is pleasant, well presented and full use is made of the facilities available. Bedrooms are available over two floors and opportunities are taken to make individual bedrooms homely and personal to each resident by the use of their own furniture and furnishings. The maintenance man is also available to assist residents with any minor changes needed. The garden is well laid out, tidy and accessible to residents. En suite facilities are provided in each bedroom and suitable accessible communal bathrooms and toilets close to lounge and dining areas. Equipment, furniture and adaptations in the home are suitable to the needs of residents, which include hoists, assisted baths, toilets and doorways accessible. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 15 Domestic lighting is provided in the home and natural lighting and ventilation provided by windows, which are fitted with suitable opening restrictors, adding to a safe environment for residents. The laundry is a spacious area, clean and procedures carried out are good. Staff in the laundry are knowledgeable about health and safety and safe storage of cleaning products used in this area. There is an awareness of infection control procedures although concern was discussed about the placing of dirty laundry on the floor. A staff room is available on the ground floor of the home. An electrical cupboard is also in this area, which was not locked and could be dangerous if there was, a resident who wandered. The kitchen area is well laid out, spacious and clean providing good storage facilities with separate areas for dry stores, fridges and freezers. Procedures to ensure the smooth running of the kitchen are followed. Cleaning records and fridge/freezer temperatures were available but not consistently recorded. The frequency of cleaning was not clear but daily general cleaning records are maintained. Records were signed with initials and not signatures as required. The large dining room offers a pleasant spacious area for residents to dine in, which also suitable for activities to take place. A separate hairdressing room is available. The room is well laid out providing good facilities. Hair products used were not locked away to ensure the safe storage of chemicals. A visit to the home was undertaken by the Environmental Health Department on22 February 2005. The overall findings state that at the date and time of inspection the areas, practices, processes and food safety controls appeared generally satisfactory. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 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 and 29 The numbers and skill mix of staff on the day of inspection were sufficient to meet the needs of residents accommodated in the home, which should lead to appropriate care provision and support an increase in the quality of life of individual residents. There was no evidence to demonstrate that the deployment and number of staff provided during the night shift are sufficient to meet the care needs of residents on both floors. The home’s recruitment policies and procedures support and protect the residents from harm. EVIDENCE: Examination of staff rota and observation of staff on duty identify that there are sufficient staff on duty during the day. There are six staff on an early and late shift but concern is raised about only two care staff on night duty for 35 residents. Separate staff cover the day care service and ancillary staff is employed to cover catering and housekeeping duties. Casual staff covers staff vacancies and absences. Four staff files were examined, one of which was for a recent employee. Records were complete and appropriate information available, foe example copies of Criminal Records Bureau checks to confirm that security checks had been carried out. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 17 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, 32, 33, 36, 37 and 38 Generally the home has got an effective management structure in place, which has resulted in effective leadership and a clear ethos, which safeguards the rights and welfare of residents and staff. Quality systems need to be further formalised to ensure a systematic approach that provides a robust plan of action. The outcome of, which is shared with all interested parties and promotes the best interests of residents. Supervision procedures implemented, monitors care practices delivered by staff ensuring that residents’ health, safety and welfare is maintained at all times. Service records are not easily accessible, the residents’ rights and best interests may not be safeguarded at all times making them at risk from harm. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 18 EVIDENCE: Observations made indicate that the manager is approachable, has good interaction with residents and staff. The home manager completes a weekly planner detailing his commitments for the week. The plan is posted on a notice board and available to residents, staff and visitors to view. Residents are aware of who the manager is and relatives expressed positive comments. There were no relatives seen at this inspection. Records examined include accident details, which were well maintained. Action taken as a result of the accident or incident was identified and appropriate. Other records examined were staff files and supervision documentation. Supervision for all staff is carried out two monthly interjected by a full staff appraisal. Care staff said that they are receiving supervision and one member of staff was receiving supervision on the day of inspection. Service contracts and information related to equipment and ongoing maintenance in the home was not organised and will be assessed at the next inspection. Water temperatures are monitored and water chlorination procedures had been carried out in August 2005. Records, which evidence regular servicing and maintenance of equipment, facilities and services in the home, were not readily available for examination. Care plan profiles were examined these show that daily statements made did not continuously observe confidentiality and thereby comply with the Data Protection Act 1998 as records contained the names and room numbers of other residents. Minutes of a formal resident meeting held on 15 September 2005 were seen and examined. The meeting was well attended by residents and chaired by the home manager in the presence of an independent acting chair. Areas covered at this meeting include resident and staff changes, welfare fund, activities, events and outings. An open questionnaire is issued to residents surveying the views of permanent residents. The questionnaire gives the opportunity for open comments, views and suggestions on topics, which include meals, activities, bedroom and service given by staff. Respondents are also asked to score each category out of ten. The results are collated and ranked dependent on their score, the highest being the best. The quality of the environment is ranked the highest and communication is at the lower end of the scale. Any comments made by residents were not available. Confirmation that the provider has a system in place to carry out unannounced visits to the home to conduct their own review on the quality of service provided and share the outcome with the Commission was not available. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 19 There are issues related to the health, safety and welfare of residents, which have been discussed in this report the placing of dirty laundry on the floor. An electrical cupboard, presenting a potential danger was not locked and hair products used were not locked away to ensure the safe storage of chemicals. Cleaning records and fridge/freezer temperatures were not consistently recorded. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 2 2 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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, Sch 1 Requirement The registered manager must ensure that there is a suitable Statement of Purpose available in the home. A copy of the completed document must be forwarded to the Commission. Previous timescale of 07/03/05 not met. The registered manager must ensure that a suitable Service User Guide is available in the home. All residents must be issued with a copy of the Service User Guide. A copy of the document must be forwarded to the Commission. Previous timescale of 07/03/05 not met. Timescale for action 31/12/05 2 OP1 5 31/12/05 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 22 3 OP1 4, Sch. 1 The statement of purpose must be reviewed to reflect the range of needs the home caters for. Any changes in the homes registered categories must first be agreed with the Commission through an application for variation. • 31/12/05 4 OP7 15 The actual sizes of rooms in the home (we suggest enclosing a floor plan with room sizes included) (Old timescale 31/01/05) Previous timescale of 07/03/05 not met. Care plans must set out in 31/12/05 detail, the action needed to be carried out by care staff to ensure all aspects of the health; personal and social care needs of the service user are met. Written information must allow for methodical monitoring and provide evidence that all care needs are identified. To support this staff must receive training and clear guidance on how the new care profile information is to be completed. Evidence is required to demonstrate that care plans are drawn up with the involvement of the service user and/or their representative. Entries made in care plan profiles must observe confidentiality and thereby comply with the Data Protection Act 1998. 31/12/05 5 OP7 15(1), Sch3(k)(m) 6 OP7 15 31/12/05 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 23 7 OP26OP38 13(3)(4), 16 The registered manager must 31/12/05 ensure that effective measures are in place to control the risk of infection and maintain the health and safety of residents at all times. The following must be addressed: • The placing of dirty laundry on the floor. • The electrical cupboard identified must be kept locked. • Hair products in the hair dressing room must be securely locked away. The registered manager must 31/12/05 ensure that all staff practice strict food hygiene procedures. Issues to be addressed: • Cleaning records and fridge/freezer temperatures must be consistently recorded. The frequency of cleaning in the kitchen needs to be clearly identified. Records to confirm cleaning has been completed must be signed. 31/12/05 8 OP26OP38 13 • 9 OP27 18(1)(a) The registered manager must confirm that there is sufficient care staff on duty at night to meet the needs of individual residents. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 24 10 OP33 26 The Registered Provider shall visit the home in accordance with Regulation 26 and prepare a written report on the conduct of the care home, supply a copy of the report to the Commission for Social Care Inspection and the Registered Manager. Records, which evidence regular servicing and maintenance of equipment, facilities and services in the home, were not readily available for examination. 31/12/05 11 OP37OP38 12, 13 31/12/05 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 25 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 OP8 Good Practice Recommendations Pressure area care/tissue viability should be developed, including recording of practice delivered by staff for example what pressure relieving equipment is used, position changing etc. This recommendation was not assessed at this inspection. Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Lower Meadow DS0000035959.V254575.R01.S.doc Version 5.0 Page 27 - 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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