Care Home: Barton Grange

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What the care home does well Residents are provided with a good standard of care and service at the home. They made a range of comments about how happy they are at the home, and how pleased they are with the care they receive. Comments included ` You can talk to any of the staff and they will come at the push of a button `, `Staff come anytime of day or night I only have to ring I would not want to be anywhere else `, and ` the staff are very good I can`t grumble about Anything `. We saw that residents are cared for in a kind and considerate way by the staff when helping them to meet their needs and when talking with them.Residents` can enjoy meals of a good variety and a good quality. Residents` meal choices are nutritionally well balanced and well presented. Residents take part in a range of low-key social and therapeutic activities. This helps residents to enjoy a good quality of life. Staff do a good variety of training to help them understand the needs of the Residents and maintain a good standard of care. The environment is homely and relaxed and residents like the home and the garden. What has improved since the last inspection? There is now an up and running system for monitoring the quality of the care and the overall service. Residents` views are sought about the overall quality of the service, and this information is acted on by the home. What the care home could do better: Make sure that a full assessment is carried out if it a padded alarm mat is used to alert staff when a resident wakes up. These mats are used when people often get up at night, and are confused, and at risk of serious falls and injuries. The assessment must be regularly reviewed and the views of the residents or their representatives must be taken into account. Write a better level of detail on residents` medication administration charts that are hand written. This is to make sure staff can easily know the time of medication to be given and what exact amount. The fire alarms must be tested on a consistently regular basis. CARE HOMES FOR OLDER PEOPLE Barton Grange Barton Road Barton Winscombe North Somerset BS25 1DP Lead Inspector Melanie Edwards Unannounced Inspection 15th September 2008 09:40 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 Barton Grange DS0000049161.V372053.R02.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. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barton Grange Address Barton Road Barton Winscombe North Somerset BS25 1DP 01934 842827 01934 842827 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) Scosa Ltd Ms Sarah Jane Matthews Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th October 2007 Brief Description of the Service: Barton Grange provides personal care for up to 20 elderly residents. The home is situated on the outskirts of the village of Winscombe. Mr and Mrs Scott, trading as Scosa Ltd bought the home in June 2003. Ms Sarah Matthews is the registered home manager. Accommodation is in a Victorian country house with a modern extension. Seven of the bedrooms are on the ground floor. There is level access to these rooms. The remaining bedrooms are on the first floor. A stair lift is provided on both staircases. Additional steps to some of the rooms mean that residents with impaired mobility may not be able to access these areas. The rooms affected are clearly identified in the service user guide. Three of the bedrooms has en suite facilities. There is a large garden with lawns at the front of the building and a patio area to the rear. The home can sometimes accommodate residents’ pets, subject to prior agreement. Barton Grange DS0000049161.V372053.R02.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 stars. This means the people who use this service experience good quality outcomes. The inspection was carried out over one day and the visit was unannounced. We met ten of the sixteen residents living at the home. We met the head of care who is a senior care assistant. We also met two other care assistants and one the head cook. We spoke with them about roles, responsibilities, training needs, and how they help residents. We saw staff helping residents with their needs. We saw the lunchtime meals being served. We saw nearly all of the environment and the only parts that we did not check were a small number of bedrooms. We looked at a number of different records to do with the running and management of the home. These included two residents care plans, two assessment records, training records, staff duty records, staff supervision records, accident records, complaints records, fire records, and menus. We found that the home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of residents, and the numbers of residents who may stay at the home. What the service does well: Residents are provided with a good standard of care and service at the home. They made a range of comments about how happy they are at the home, and how pleased they are with the care they receive. Comments included ‘ You can talk to any of the staff and they will come at the push of a button ’, `Staff come anytime of day or night I only have to ring I would not want to be anywhere else ’, and ‘ the staff are very good I can’t grumble about Anything ’. We saw that residents are cared for in a kind and considerate way by the staff when helping them to meet their needs and when talking with them. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 6 Residents’ can enjoy meals of a good variety and a good quality. Residents’ meal choices are nutritionally well balanced and well presented. Residents take part in a range of low-key social and therapeutic activities. This helps residents to enjoy a good quality of life. Staff do a good variety of training to help them understand the needs of the Residents and maintain a good standard of care. The environment is homely and relaxed and residents like the home and the garden. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 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 Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a good amount of information available for residents and significant others to help them make an informed choice about the home and service provided. Residents’ needs are generally satisfactorily assessed, and they are met. Residents are not provided with intermediate care at the home. EVIDENCE: To help us find out how people can find out what services there are at the home and what daily life is like we looked at a copy of the service users guide and the statement of purpose. A copy of both of these documents is kept in the entrance hall of the home, so that anyone can read them. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 9 We saw that the statement of purpose and the service users guide contain information about the service residents can expect, the qualifications of the staff employed, and the accommodation. The philosophy of care in the home and how the service aim to meet residents needs is also included. The complaints procedure is in each service users guide so residents know how to complain about the service. We read two residents assessment records to see how well needs are being assessed. The assessment records were adequately detailed. They showed the residents range of physical, mental and social needs had been assessed. The actions taken to support the person had also been recorded in the assessment records. The assessment records we read were being regularly reviewed and updated. Assessment records must be regularly reviewed as this information forms the basis for deciding what sort of care and support residents will need. However we met one resident whose care we checked on as part of our inspection. The person has a padded mat in use at night to alert staff if they get up. This is because they are at risk of serious injury from falls and they get confused. While we did see some basic information written in the persons records about the reason for the use of this equipment. There was no assessment carried out, or care plan in place to show why a padded alarm mat should be used to alert staff when the resident wakes up. These mats are used when people often get up at night and are confused and at risk of serious falls and injuries. The assessment needs to be regularly reviewed and the views of the residents or their representatives must be taken into account. We talked to the senior carer about how residents’ needs are assessed. They explained that the home has key worker system and a member of staff will take specific responsibility for writing residents assessments and accompanying care plans. The Home doesn’t provide intermediate care for residents. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents care plans and assessment records demonstrate how needs are met. Residents’ health needs are met. Residents are well treated by the staff who are respectful to them. EVIDENCE: We read two of the residents care plans so that we could see how they are helped with their needs. We found the care plans to be informative and they showed how to meet the needs of the person. The care plans set out what actions staff must follow to assist the resident to meet their needs. Residents care plans had been regularly reviewed to show that their needs could still be met. We saw staff knocking on bedroom doors before entering them and assisting residents in a polite and respectful manner. This shows the staff respect privacy. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 11 The residents that we met told us staff are helpful, kind and caring, when they help them with their needs. The residents also spoke positively about the polite attitude of the staff that helps them. Examples of comments made by residents included, ‘ night and day the care is marvellous ’ ` you feel if you wanted to talk in confidence to the staff they would keep it ’, ‘ the staff are very good ’, and ‘ the staff are polite and respectful ’. Each residents care record includes a written health record. These record when residents see a doctor, optician, dentist and chiropodist and what treatment may be required. There was information in the daily records that demonstrated staff monitor and observe residents and call a doctor if concerned. Residents are registered with local GP surgeries. Community nurses also support them with their health if needed. This helps to shows how residents’ health care needs are met. We were sent four survey forms back from residents and their families Residents told us that they were very satisfied by the overall standard of care they receive. We looked in detail at the practices and procedures for giving residents medication, and for the storage and disposal of it. We looked at six residents’ medication administration charts in detail. We saw a photograph of each resident kept with the chart for identification purposes. The charts we saw were reasonably clearly written. However we saw three entries written by staff at the home for medication to be given. These entries on the charts had not been signed for by staff to confirm they had been written correctly .The date that medication was to start had not been written on the charts. One hand written entry on a medication chart did not say what time the medication was to be given. Medication stock was generally satisfactorily organised. There was a satisfactory system for ordering and receiving medication, and the records were up to date. Medication stock is stored in a cupboard in a movable metal drugs trolley, which is kept in a locked clinic room. We saw the senior carer give residents their medication at lunchtime .The senior carer was calm and patient and took time with each resident to make sure they had their medication. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, 15.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents take part in a variety of social and recreational events and activities Residents are given good opportunities to exercise choice and control in their daily lives. Residents can enjoy a well cooked and nutritionally well balanced diet. Residents are able to keep close contact with family and friends if they so wish. EVIDENCE: Residents’ can do a range of low key activities in the home. There is a copy of the timetable of social activities planned to take place on display in the home. This helps to ensure residents are aware of current activities taking place. Activities that are planned for the near further include, a drives to the country and to the shops, arts and crafts sessions, games, musical afternoons, and gentle exercise classes. The home has its own dog, which is really friendly and likes the company of the residents. Residents told us how much they liked the dog. We saw a number of residents received visits from their family and friends during the inspection. Visitors said that the staff are welcoming and friendly. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 13 Residents and visitors can have lunch together if they so wish. There is a relaxed and flexible visiting policy this benefits residents as this means they can keep in contact with family and friends. Residents told us that yes they are able to choose what time they get up and what time they go to bed. Residents said they are asked about the meal options and their likes and dislikes. There are residents meetings held in the home. These are good way for residents to exercise choices and have some autonomy in their daily lives. We took the opportunity to sample lunch with a small group of residents .The meal was beef casserole with potatoes, and three cooked fresh vegetables followed by choices of deserts. We found the meal tasty, well cooked and well presented. All of the residents that we spoke to commented very positively about the food served at the home. We also checked the residents menu to find out if residents are consistently provided with a well balanced diet .The meal options seen were nutritionally well balanced and varied. There are choices available each day, and staff ask residents what they wish to eat each day. Special diets can be catered for and there are a variety of special meals provided for residents if required. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ complaints are responded to well and are taken very seriously. Residents are satisfactorily protected from the risk of harm or abuse. EVIDENCE: There are copies of the complaints procedure in the reception area. The procedure includes the name of the Commission for Social Care Inspection for anyone who wishes to contact us. How to contact the owners of the home is also explained if people wish to contact him directly to make a complaint. The residents we met told us they would make a complaint to the manager, any of the staff. They told us staff take their concerns seriously and are interested in their concerns and complaints. This shows us the home welcomes and responds positively to complaints. We looked at the complaints record to see how well complaints are dealt with. There had been no complaints received since the last inspection. The majority of the staff team have now done training to ensure they are up to date in their understanding of the principle of ‘safeguarding ’ residents from abuse. We spoke to staff about the subject of ‘ safeguarding ’ residents from abuse .The staff demonstrated a good understanding of what to do to protect the residents from harm. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,23,25,26.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is kept clean and satisfactorily maintained. The home is generally suitable for residents to live in and has the necessary adaptations and equipment in place. EVIDENCE: Barton Grange is an older building, it is a large house set in its own grounds in the village of Winscombe . The home is near to private houses although the nearest shops are in Winscombe village. The building is set in its own grounds. We found the garden looked satisfactorily maintained. There are patio seats and an area where residents can sit and walk safely. We saw residents sat outside during the inspection; they were sitting by the homes aviary that houses a number of birds. The residents looked very comfortable and relaxed in the surroundings. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 16 We have been told that since the last inspection the home have obtained a grant to be able to carry out some maintenance work that is need on the fabric of the building and the parts of the garden area. We found that the fixtures and fittings are domestic and of a reasonable standard. Bedrooms have been made to look more personalised to reflect the tastes of residents. There were photographs, mementos and small items of furniture in residents’ bedrooms. The standard of furniture and fittings is satisfactory. We saw staff working hard cleaning the home. We found the Home to be clean and tidy in all of the areas that we saw. Bedrooms have en suite facilities, so that residents have the additional privacy of using their own toilet and sink. There are hot water temperature regulators fitted to all hot water outlets to which residents have access, and these are routinely tested. Radiators are fitted with low surface temperature covers. Windows are restricted, and this all helps to make the environment safer for the residents. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by enough well trained staff ,who are meeting their needs. Residents are protected by the homes employment practises and procedures. EVIDENCE: We checked the number of care staff to see if there is enough staff on duty to support residents. There is a minimum of two care assistants in the morning, with two to three care assistants on in the afternoon. At night there are two care assistants on duty. There are additional staff members on duty on a regular basis, if needed to give extra support to residents both in and out of the Home. Ms Mathews the registered manager works full time management hours. As we have already commented on all of the staff we saw were really warm and sensitive in manner when supporting the residents. There are full time catering, and domestic staff also employed although the number of these staff was not reviewed. We checked the training records of three care assistants so that we could see if they do a good range of training. We saw evidence that demonstrated the staff had done training sessions, and updating over the last twelve months. There Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 18 is now a good number of care staff in the Home who have now completed National Vocational Qualifications in care. We checked the staff employment files of three care staff. We did not see two written professional references, for the staff. However this could be because the manager was on leave and the head of care may not have known exactly where they were kept .We did see completed Criminal Records Bureau checks for all the staff before starting employment at the home. These checks are a further safeguard for vulnerable residents. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run in their best interests Staff are well supervised in their work to help them to better support residents. Residents’, staff, and visitors, health and safety is generally satisfactorily protected. However there must be a ‘ tightening’ up in current practise for checking that the fire log book record alarms . EVIDENCE: Ms Sarah Mathews is the registered manager. She has been the manager of run the home for a number of years. The company who own the home also own and run three other care homes .Ms Mathews is supported in her work by an ‘area’ manager. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 20 The staff reported that staff meetings are held regularly. A sample of recent minutes were looked at that demonstrated staff are consulted, and their views listened to by the manager. The home has put in place a format for monitoring the quality of the care and the overall service. We looked at the residents survey forms that are one method used to audit the care and service in the home. We could see that the views of residents are obtained, so that the home can ‘ drive up ’ further the standards in the home. The staff told us that the manager is supportive and helpful. We saw good evidence of regular supervision sessions by Ms Mathews, with the staff to assist them in their work and in understanding the needs of residents. When we looked at a sample of supervision records, these showed staff supervision sessions have been taking place regularly over the last three to six months. We check the finance records of two resident’s .The home will hold residents money for safekeeping if needed to . We could see when we checked the records that the cash and record totals are kept separately. Records were up to date and we saw receipts for all items that residents had purchased. There is a regular a health and safety audit of the whole environment regularly. This was information is aimed at addressing health and safety areas through the home. We looked at a selection of recent accident records to find out what action is taken after residents have an accident. The accident records showed the managers in detail the nature of the accidents and what may have caused it. They also monitor all follow up action taken by staff to assist the resident involved in the accident over a period of days after the event. Staff do training in health and safety matters including first aid, food hygiene training and moving and handling practises. This helps to show that residents’ health and safety is protected. The fire logbook record showed fire alarm tests and drills are being done carried out. However there were gaps of times recorded on three occasions when the fire alarms been tested for between two and four weeks This could cause a serious risk if the alarms are faulty and they have not been checked, in the event of a fire. Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 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 3 17 3 18 3 3 X 3 X 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement A full assessment must be carried out if it a padded alarm mat is used to alert when a resident wakes up. The assessment must be regularly reviewed, including the continued suitability of its use, and the views of the residents or their representatives must be taken into account. Handwritten medication charts must set out the amount of medication, and the time it is to be given. The fire alarms must be tested on a consistently regular basis. Timescale for action 29/09/08 2 OP9 13.2 16/09/08 3 OP38 23.4 c(v) 16/09/08 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 Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 23 Barton Grange DS0000049161.V372053.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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