Care Home: Appletree House Care Home

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What the care home does well Care plans are in place for each person which are being regularly reviewed and updated.Meals take place in a calm and relaxed atmosphere. Areas which people living in the home have access to are being well maintained and it is comfortable and homely. The garden is attractively laid out and people enjoy going out into the garden when the weather is good. There is a friendly atmosphere in the home, and people find staff approachable and considerate. What has improved since the last inspection? New equipment purchased for the home has included an electric bath on the first floor. Menus have been changed as a result of listening to people`s views. Changes implemented in the home after suggestions made in residents` meetings have included more outings being arranged and more choice in the activities provided in the home. The requirements made at the previous inspection concerning a review of staffing levels was found to have been met. What the care home could do better: Care plans are not always providing detailed guidelines on how the person is to be assisted to meet their needs, and how they would wish their care to be provided. The safety of medication procedures would be increased by providing a photograph to accompany a person`s medication charts, and better flagging of when medicines must be discarded. The provider needs to consider how the temperature in the conservatory can be made more comfortable in summertime for people using it.For the protection of people living in the home the provider must follow current guidelines on safety checks for staff employed. CARE HOMES FOR OLDER PEOPLE Appletree House Care Home 9 Pratton Avenue Lancing West Sussex BN15 9NU Lead Inspector Ed Mcleod Unannounced Inspection 22nd July 2008 08:50 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 Appletree House Care Home DS0000014363.V367041.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. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletree House Care Home Address 9 Pratton Avenue Lancing West Sussex BN15 9NU 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) 01903 762102 Mr Angelo Injenis Dalpadado Mrs Hiranthi Dalpadado Mr Angelo Injenis Dalpadado Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 15 Persons in the registration category I - Old Age over 65 Years Date of last inspection 5th May 2006 Brief Description of the Service: Appletree House is a care home registered to provide care and accommodation for up to fifteen older people over the age of 65 years of age. It is a detached property located in a residential area of Lancing, West Sussex and close to local amenities. Accommodation consists of one double room and thirteen single rooms on the ground and first floors. Three rooms have en-suite facilities. Both floors are served by a passenger lift. On the second floor there is a bed-sitting room for a resident member of staff. There are two lounge/dining rooms on the ground floor and a large rear garden. The range of fees in the home is from £335 per week to £430 per week. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was carried out by one inspector and was arranged to follow up the requirement made at the previous visit, and to assist us in assessing the home’s compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service since our previous visit, including the annual CSCI self-audit completed by the manager and owner of the home. Our planning also took into account the views of six people living in the home and four members of staff who completed and returned CSCI survey forms before the day of our visit. On the day of the visit we were on the premises for five hours and thirty minutes, and spoke with five people living in the home, the manager, four members of staff, and a visiting continence nurse. We sampled the individual plans of care for four people living in the home. Other records sampled included recruitment and training records for three members of staff, and records relating to health and safety issues in the home. We visited the main areas of the care home and ten bedrooms. We observed a number of interactions between people living in the home and staff, and observed the arrangements for lunch. What the service does well: Care plans are in place for each person which are being regularly reviewed and updated. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 6 Meals take place in a calm and relaxed atmosphere. Areas which people living in the home have access to are being well maintained and it is comfortable and homely. The garden is attractively laid out and people enjoy going out into the garden when the weather is good. There is a friendly atmosphere in the home, and people find staff approachable and considerate. What has improved since the last inspection? What they could do better: Care plans are not always providing detailed guidelines on how the person is to be assisted to meet their needs, and how they would wish their care to be provided. The safety of medication procedures would be increased by providing a photograph to accompany a person’s medication charts, and better flagging of when medicines must be discarded. The provider needs to consider how the temperature in the conservatory can be made more comfortable in summertime for people using it. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 7 For the protection of people living in the home the provider must follow current guidelines on safety checks for staff employed. 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. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 8 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 Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident the home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 10 EVIDENCE: We looked at four sets of admission assessments and found that the person’s needs were being assessed before admission was being agreed. We found that admission assessment information was contributing to the care plan subsequently developed with the person receiving the service. Information on the service provided by the home is updated in the service user guide. Most people living in the home who responded to our survey said they had received a contract or terms and conditions of residence. We sampled contracts for two people living in the home, one who is part funded by a local authority and one who is self funded. We found that information on who pays what part of the fee is provided by the local authority where they are assisting in the funding of a placement at the home. Intermediate care (specialist rehabilitation care) is not provided in the home, so this standard has not been assessed. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, people manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 12 EVIDENCE: The six people living in the home who completed our survey told us that they were receiving the care and support they are in need of. We sampled four sets of care plans. We found that appropriate risk assessments were in place, and that care plans are being agreed with the person receiving the care or their relative. We found that care plans were not always providing detailed guidelines on how the person is to be assisted to meet their needs, and how they would wish their care to be provided. For example, none of the care plans seen referred to the support the person would need during the night, or how this was to be provided. The person’s preferences for when they usually liked to get up and go to bed were not recorded on the care plans we looked at. The person’s preferences in how they would like to be assisted with bathing were not recorded in two of the care plans we looked at. We discussed this with Mr Dalpadado and he agreed that it was important for people to have a say in how their care is provided, and for staff to be aware of how the person wishes their care to be provided. A requirement has been made concerning the content of care plans. Survey forms we received from people living in the home indicated that they thought their health care needs were being met. In the four sets of care plans which we looked at, we found that where the person’s weight needed to be monitored this was taking place. People we talked to said they were able to see their GP if they needed to, and the home assisted in arranging a hospital visit if this was needed. A requirement was made at the previous inspection that the record of the person’s medication must be kept up to date. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 13 We sampled medication records and found that these were now up to date. This requirement was assessed as met. We found that when medicines must be discarded, for example 28 days after opening, the date for discarding was not always being recorded. As this was put into place during our visit, no requirement was made. We found that no controlled drugs were being administered at the time of our visit, but that the home has in the recent past administered controlled drugs. We advised Mr Dalpadado that the Royal Pharmaceutical Society had recently changed its’ guidelines for storage of controlled drugs, and that the service should refer to these guidelines. We found that suitable arrangements were in place for the disposal of medicines. Medication administration charts do not at present include a photograph of the person to receive the medicine, and we advised that the safety of medication procedures would be increased by doing this. We asked Mr Dalpadado what system was in place to ensure that people’s medication was being reviewed on a regular basis. Mr Dalpadado said that the GP surgery use their repeat prescription system to identify when the medication needs to be reviewed. We observed interactions between people using the service and staff, and found that care and support was being provided with due regard for people’s needs for privacy and dignity. For example, at lunch people were not rushed and were able to take their own time eating even where other people had finished and left the table. In the care plans we looked at, we found that the person’s wishes concerning terminal care and funeral arrangements, for example, were being recorded and reviewed. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks at a time and place to suit them. EVIDENCE: Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 15 Six people living in the home told us in their surveys that activities were provided, and that they could choose to take part or not take part. On the day of our visit we noted that an outing was planned for later in the week and another was planned for the week after. We noted that a programme of activities provided in the home, usually two activities a day, is shown on the notice board in the hallway. Mr Dalpadado told us that an activities worker is employed and quizzes and reminiscence sessions were popular in the home, and people also liked sitting out in the garden when the weather was nice. Relatives are encouraged to maintain contact, and coffee mornings and Christmas parties to which relatives are invited are taking place. Staff we spoke to told us that one person requests holy communion which is arranged for them, but that other people have not make any requests concerning meeting any spiritual or religious needs they have. The six people living in the home who responded to our survey told us they liked the meals in the home. We observed a lunch on the day of our visit which for most people consisted of sausages, mash, carrots and Brussels sprouts. The dessert was banana and ice cream. People we spoke to said they had enjoyed the lunch. The food seemed cooked well and was presented nicely. We talked with the cook about arrangements for offering a choice of menus in the home. The cook told us that where someone does not like the main meal offered, an alternative is always provided. An example was given of one person who will only eat main meals which include fish, and so each day this is provided for them. Mr Dalpadado told us that menus were discussed during a meeting with residents, as a result of which menus were changed to better suit people living in the home. The lunch was relaxed, sociable and unhurried. People were given as much time to eat as they needed. People who needed support with eating were receiving this. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 16 Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care, they or other people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: Five of the six people living in the home who completed our survey told us that they knew how to make a complaint in the home. The complaints record was not sampled during this visit. Staff training records we sampled indicated that staff are continuing to receive safeguarding training. Mr Dalpadado advised us that no safeguarding referrals had been made since the previous inspection. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 18 We were advised by Mr Dalpadado that the home has a copy of the most recent local safeguarding procedures, and that he and another member of staff have attended a briefing on the recent changes to local safeguarding procedures. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their rooms feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 20 We looked around communal areas of the home, some bedrooms, kitchen and laundry facilities and the garden. We found that the house, garden and driveway are being well maintained. New equipment purchased for the home has included an electric bath on the first floor. Three bedrooms have en suite facilities. The garden is attractively laid out and people living in the home told us they enjoyed going out into the garden when the weather was good. There is a conservatory with wheelchair access to the front of the building, which is also used as one of the dining areas. The day of the visit was a hot day, and although roof blinds were being used some of the people said that there was a lack of ventilation to help control the temperature of the room. The provider needs to consider how the temperature in the conservatory can be made more comfortable in summertime for people using it. Bedrooms we looked at had been personalised by the person, and were homely and comfortable. The six people living in the home who completed our survey told us that the home was clean and fresh, and we found that all parts of the home we visited were clean and there no odours. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have safe and appropriate support as there are enough competent staff on duty at all times. People could have more confidence in the staff at the home if PoVA First checks had been done to make sure that they are suitable to care for them before the commence work in the home. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: A recommendation was made at the previous inspection that staffing levels should be reviewed to ensure the needs of people living in the home continue to be met. During our visit Mr Dalpadado advised us that staffing levels have been reviewed, and as a result of this an extra member of part time staff who attends to administrative tasks has been employed. Mr Dalpadado said this has allowed care staff to concentrate more fully on providing care, and has therefore improved the support provided to people in the home. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 22 Mr Dalpadado told us that temporary agency staff were not being employed in the home, and that where staff cover was needed this was provided by staff already working in the home. The four staff who responded to our survey told us they believed that there were enough staff on duty to meet the needs of the people living in the home. The six people living in the home who responded to our survey told us that their needs were being met. During our visit it was our observation that there were staff in sufficient numbers on duty to ensure that people’s needs were being met. For example, there were enough staff available during lunch to ensure that everyone who needed prompting or assistance with eating were receiving this. We looked at the recruitment records for three people working in the home. We found that records indicated that two of the staff had commenced work in the home before a PoVA First check (which is required before a person starts work) were received. These two staff have started since our previous inspection visit. We discussed this with Mr Dalpadado who agreed that this was what the recruitment records were indicating, and that he would seek to put this right in the future. A requirement has been made concerning staff recruitment checks. This is to better ensure the safety of people living in the home. We looked at the training records for three people working in the home. We looked at training certificates for courses attended by these three staff, and found that staff were receiving training in recommended topics such as the administration of medication, moving and handling, safeguarding adults and palliative care. The manager and owner Mr Dalpadado told us during our visit that distance learning for all staff in dementia is now being provided. During our visit Mr Dalpadado advised us that all care staff except one have achieved the National Vocational Qualification (NVQ) in care at level 2 or 3. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 23 Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. EVIDENCE: Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 25 Mr Dalpadado advised us that he has continued to update his training in areas such as dementia, local safeguarding procedures, and assessor’s training. We observed that there is friendly atmosphere in the home, and people find staff approachable and considerate. We found that the views of people living in the home were being gathered through residents’ meetings which some relatives have also attended. Mr Dalpadado told us that changes implemented in the home through these meetings having included more outings being arranged, more choice in activities provided, and changes to the menus. We looked at supervision records for four members of staff. These records indicated that staff were receiving regular supervision to help them develop their skills and provide good quality care. Staff we talked to confirmed that they were receiving sit-down staff supervision. Staff training certificates we sampled indicated that staff were receiving training in health and safety topics such as first aid, fire training and food hygiene. We sampled records of services and equipment checks relevant to the health and safety of people living in the home and the staff. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1) Requirement Care plans are not always providing detailed guidelines on how the person is to be assisted to meet their needs, and how they would wish their care to be provided. The registered person shall, after consultation with the service user or their representative prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Timescale for action 28/11/08 2. OP29 19(1) For the protection of people 26/09/08 living in the home the provider must follow current guidelines on safety checks for staff to be employed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 28 No. Refer to Standard Good Practice Recommendations Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Appletree House Care Home DS0000014363.V367041.R01.S.doc Version 5.2 Page 30 - 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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