Care Home: Alnwick Road (4)

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What the care home does well As stated above, the service offered a good programme of activities such as all- day rambling excursions during the summer; we were informed that this activity occurred twice a week. There was a recognisable emphasis upon supporting the residents to be part of their local community. Staff presented a good knowledge of the individual needs of the residents, such as their routines and favourite foods. What has improved since the last inspection? Four requirements and no recommendations were issued in the previous inspection report. We noted at this inspection that three of the requirements had been met and a fourth requirement was partly met. The hot water cylinder Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 storage cupboard was kept locked and the care plans (containing confidential information) were now stored in a secure office area. The service ensured that all newly arrived medication was checked and recorded on the medication administration chart, which was part of a requirement concerning medication within the previous report. Items within the refrigerator were being marked with dates of opening. What the care home could do better: The service would benefit from having a permanent manager; the issues to be addressed within this report appear to arise from the service receiving insufficient experienced and knowledgeable guidance and direction. It was noted that the service provider has been addressing shortfalls within the care home, such as bringing in an acting manager with suitable prior experience of improving services. A care plan for a new resident (inclusive of risk assessments and a health action plan) should be in place within the first week of admission, even if this is an elementary document that will be further developed and improved as staff gain more information about the person. There needs to be written guidance for staff regarding how to apply prescribed topical treatments; this is a repeated requirement. Medications need to be kept securely and first aid equipment should be checked to ensure it has not expired. Staff need to be supported with their work with clients through receiving regular supervision, which would also identify individual training needs. The expiry dates for dried foods also needs monitoring. Staff need to bring in documentation to the care home to demonstrate that they have attended training sessions. Key inspection report CARE HOME ADULTS 18-65 Alnwick Road (4) 4 Alnwick Road Canning Town London E16 3EX Lead Inspector Sarah Greaves Key Unannounced Inspection 3rd July 2009 09:00 Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alnwick Road (4) Address 4 Alnwick Road Canning Town London E16 3EX 020 7511 4854 020 7511 4845 bertram.okeke@heritagecare.co.uk www.heritagecare.co.uk Heritage Care 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) Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 25th July 2008 Date of last inspection Brief Description of the Service: Alnwick Road is a care home for six adults with severe learning difficulties that first registered in 1994. The home is divided into three self-contained flats, the largest of which also accommodates staff and administration offices. The exterior of the building is in keeping with the surrounding properties. The home is situated in Custom House, close to public transport and other amenities. Presently there are five residents at the home; all of the residents are male. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has been rated as 1 star (adequate). This key inspection was conducted by one inspector over one day. It was necessary to provide twenty-four hours notice of the inspection to the care home, since there is an active programme of residents and staff going out for day trips; we wished to meet as many of the residents as possible on this visit. Evidence was gathered through speaking to and observing the residents, reading care plans, touring the premises, looking at health and safety documents, and checking the administration and storage of medication. We also spoke to staff and the acting manager; there were no personal or professional visitors at the time of this inspection. The service was sent an Annual Quality Assurance Assessment (AQAA) prior to this inspection, which is a self-audit tool. This was completed as required and demonstrated a realistic view of the service’s strengths and weaknesses. The service has informed the Care Quality Commission of its proposal to deregister and become a supported living unit. What the service does well: What has improved since the last inspection? Four requirements and no recommendations were issued in the previous inspection report. We noted at this inspection that three of the requirements had been met and a fourth requirement was partly met. The hot water cylinder Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 6 storage cupboard was kept locked and the care plans (containing confidential information) were now stored in a secure office area. The service ensured that all newly arrived medication was checked and recorded on the medication administration chart, which was part of a requirement concerning medication within the previous report. Items within the refrigerator were being marked with dates of opening. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are appropriately supported to move into the care home. EVIDENCE: We found that one new resident had moved into the care home since the last inspection. The service had received a full assessment regarding this person’s needs prior to him moving in. The care home offered visits to prospective residents, such as initial short visits followed by overnight and weekend stays. We noted that the care home had gathered information regarding the needs of the most recently placed resident through liaison with relevant professionals and family members. All of the residents were provided with a pictorially presented contract, which clearly identified entitlements and responsibilities that accompanied their tenancy. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the care planning was of a satisfactory quality, the absence of a care plan/risk assessments for one resident was not acceptable. Staff need to ensure that residents benefit from a consistent approach to promoting choices. EVIDENCE: We read three care plans during this inspection; two were randomly selected and one care plan was specifically chosen because we wished to assess the care planning for a recently admitted resident. We found that two of the care plans needed some minor adjustments but were of a satisfactory standard. However, the service had not developed a care plan for a resident that had moved to the service in April 2009; a care plan was being used that had been written prior to admission, by a key worker from another organisation not connected to the care home. Staff stated that they were still assessing the resident’s needs before developing a care plan and that Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 10 they were undertaking on-going monitoring, but no monitoring records were produced. We found some positive examples of how staff supported residents to make meaningful choices. We met one of the residents upon his return from a café lunch with his support worker. The choice of lunch and the groceries within the resident’s flat clearly met his personal and cultural preferences. It was also noted that a couple of the residents could not access their wardrobes or toiletries cupboards as these facilities were being kept locked. We asked staff why this occurred and were informed that it was because these residents had a tendency to take these items out and put them on the floor. The acting manager stated that she would look into this in more detail, since people should have the right to freely access their personal belongings in accordance to their own wishes. We did not find appropriate risk assessments to explain how these actions had been considered and agreed upon. The risk assessments for two of the care plans that we viewed were satisfactory; as previously stated in this report, one of the residents did not have a care plan (inclusive of individualised risk assessments) developed by the service. A requirement within the previous inspection for the service to ensure that care plans are stored in a safe place was satisfactorily met. There were no concerns regarding how the service promoted the rights of the residents to confidentiality. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were suitably supported with their social and personal development needs, including their wishes to enjoy a balanced diet at home and in the community. EVIDENCE: We noted that each resident had their own plan for social activities, within the care home and in the community. Residents were supported to use local amenities such as shops, cafes and restaurants, parks, tea dances, pubs, the nearby city farm and entertainment venues. One of the residents went to a weekly music and singing session at another Heritage Care service, and residents were supported to attend their different places of worship, in accordance to individual wishes. An aroma therapist visited the care home every week. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 12 There were no concerns in regard to how the service supported residents to maintain relationships with their families and friends. We learnt how one of the residents was making new friends through regularly visiting a local café with his support worker. Due to their disabilities, none of the residents were able to engage in responsibilities within the community. However, staff spoke positively regarding the enjoyment that the residents experienced when spending time with family members or visiting favourite local places. We noted that the menu plans in the flat for three residents seemed quite varied but did not accurately reflect the food provided. Discussions with staff evidenced that the individual food and beverages likes and dislikes of the residents were clearly known and used for menu planning. We were pleased to find that staff were supporting one of the residents with his specific cultural preferences, which was evidenced by ingredients kept in the kitchen. There was a range of fresh fruits, cereals and snack foods, although the biscuit barrel contained broken biscuits. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A more rigorous approach is needed to ensure that the health care needs and medication needs of the residents are addressed. EVIDENCE: The care plans and health action plans demonstrated that the personal and health care needs of the residents had been identified. One of the health action plans that we looked at was out of date in regard to the medications that the resident was presently receiving. A care plan stated that a ‘punny stone’ needed to be used for foot care; although this was a minor error, we felt that it should have been picked up through care plan auditing to ensure that staff were clear about the required use of a pumice stone. As previously stated in this report, one of the residents did not have a care plan; hence he also did not have a health action plan. A requirement in the previous inspection report regarding the counting and recording of newly received medication has been deleted. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 14 Upon arrival at the care home we briefly looked at the rear garden. It was noted that a shed was not locked and within the shed we found a throat spray (benzyamine hydrochloride); staff did not know who it belonged to. We also found that a correcting fluid had been used on a medication administration record and that prescribed build-up drinks were being kept in an open cupboard. A prescribed cream did not have any instructions for application on the pharmacy label, or the medication administration record, or the resident’s care plan. A requirement was issued in the previous report for the service to ensure that staff are provided with safe instructions for the application of prescribed topical treatments. We found that a medication cupboard in one of the flats was not being kept locked as it was not a lockable facility. Actions were taken on the day of the inspection to transfer the medications into a lockable area; however, we were informed that the resident was not happy with this change. The acting manager was aware of the need to work with the resident to help him to understand why medication needed to be kept locked. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to listen to and protect the residents, although focused managerial presence is needed to ensure that these systems are effective. EVIDENCE: The service produced an appropriately written complaints procedure and a pictorial version. Due to the residents’ disabilities, we noted that it would be difficult for people to express any complaints. Some of the residents were supported by family members who acted as their advocates; we were informed that there has been the involvement of advocates to support the residents to make choices about the planned move to supported living. Staff training records demonstrated that Safeguarding Adults training was delivered once every two years, although the training records (regarding Safeguarding Adults) for one person could not be found. A few weeks prior to this inspection, a safeguarding concern relating to the conduct of two staff members was raised through the service’s whistle-blowing procedure. Two members of staff were suspended at the time of this inspection. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises were well designed but needed to be made more homely. EVIDENCE: We toured the premises with the acting manager. Although the care home was in a reasonable decorative condition, it was felt that actions could be taken in order to create a more comfortable and pleasing environment. The rear garden is large and needs further landscaping and development to create a truly relaxing and inviting communal space. The division of the care home into three separate flats offered residents greater privacy, and a sense of independence. There were no unpleasant odours and the care home was clean. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 17 Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs to demonstrate a better organised approach to demonstrating that staff has received necessary training, which needs to be supported with a good quality programme of individual supervision. EVIDENCE: At the last inspection we noted that it was difficult to make a proper check of which staff had undertaken both mandatory and additional training, as the service did not maintain comprehensive lists. This situation had not particularly improved; for example, we were unable to track if one member of staff had received up-to-date training for moving and handling, and Safeguarding Adults. We have identified some concerns regarding staff knowledge within this report; for example, their medication training should have alerted staff to the potential problems caused by applying creams to residents’ without having any written guidelines as to where the doctor wants the cream applied. A senior member of staff stated that they did not know that there needed to be an accurate Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 19 record of the daily nutrition provided to residents. We spoke to the acting manager in regard to the need for a senior support worker to be trained and assessed to administer medications, so that they can effectively support medication assessed staff that they are supervising. We checked two staff files in order to assess the quality of the recruitment; there were no issues of concern. At the time of this inspection all of the care staff had acquired either a National Vocational Qualification (NVQ) in Care at level 2 or 3; hence all of the staff had a minimum qualification for their roles. We found that the frequency of supervision (a minimum of six per year is stated by the National Minimum Standards) was not being met. This shortfall was acknowledged by the acting manager, who stated that she would now be responsible for implementing a regular supervision programme for staff. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service was addressing managerial issues in order to improve the quality of the service for the residents. EVIDENCE: As stated within the summary, this service plans to apply for de-registration in order to operate as a supported living scheme. The manager at the care home during the last inspection had left and had been replaced by another manager, who had left a few days before this inspection. At the time of this inspection, the service was being managed by the registered manager of two other Heritage Care services. We were pleased to find that the service was receiving managerial input; however, we felt that there needs to be a permanent Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 21 manager for this care home. The acting manager stated that this would be addressed by the service provider. We have cited some good examples of how staff sought the views of the residents, and the staff that we met during the inspection demonstrated a commitment to understanding the needs of the residents so that a good standard of individualised care could be offered. However, an absence of appropriate management of the service had impacted upon the quality of internal auditing and continuous service development that should have been an inbuilt element of the care home’s day-to-day management. We were concerned when staff stated that they had been advised by a previous manager that they should begin to regard 4 Alnwick Road as being a supported living unit, as the care home is still a registered service and subject to The Care Home Regulations; possibly this philosophy was misunderstood by staff. The acting manager was able to identify the areas in which the care home was not performing to the National Minimum Standards, and expressed suitable strategies to achieve improvements. The health and safety records viewed during this inspection were up-to-date. A requirement was issued in the previous inspection report for the service to ensure that labelling of opened refrigerated food items; this has been deleted. We discovered an out of date dry food item and another product that had no expiry label; both items were discarded. The acting manager explained to staff the importance of checking all groceries, even if recently bought. It was noted that the majority of the first aid equipment had expired; these items were removed during the course of this inspection. Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Version 5.2 Page 23 Alnwick Road (4) DS0000066795.V376780.R01.S.doc YES 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 YA20 Regulation 13(2) The registered person must ensure that there are written instructions for the application of prescribed topical medications. This is a repeated requirement. 2. 3. YA20 YA6 13(2) 15 The registered person must ensure that medications no longer required are disposed of. The registered person must ensure that all residents have a valid care plan, inclusive of risk assessments and specific health care planning. The registered person must ensure that staff receive regular supervision. 30/09/09 30/09/09 Requirement Timescale for action 30/09/09 4. YA36 18 31/12/09 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 Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 24 Alnwick Road (4) DS0000066795.V376780.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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