Care Home: The Rubens

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What the care home does well What has improved since the last inspection? The care plans have been reviewed and revised, a person centred approach is now used for delivering the care to individuals. The home has benefited from some improvements to the general environment with new floor coverings to the main corridor, new armchairs in the quiet lounge and locks fitted to all private bedrooms. The bath/shower room has had a total refit, with the work almost completed. Recruitment has been and is ongoing for care and ancillary staff. What the care home could do better: No requirements have been made following this inspection. All evidence points to a service that has developed systems to provide good quality outcomes for people living at the home. The continuity and effectiveness of the improvements seen and evidenced during this inspection will be determined in the fullness of time. CARE HOMES FOR OLDER PEOPLE The Rubens Pave Lane Newport Shropshire TF10 9LQ Lead Inspector Joy Hoelzel Key Unannounced Inspection 29th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Rubens DS0000064155.V369128.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. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rubens Address Pave Lane Newport Shropshire TF10 9LQ 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) 01952 810400 01952 820698 markandrewfuller@msn.com United Care Ltd Vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd October 2007 Brief Description of the Service: The Rubens is a privately owned Residential Home, which opened as a care home in 1987, and is registered to provide personal care and accommodation for up to 26 older people. Situated in a semi-rural location, on the edge of the Shropshire Town of Newport, local amenities are available within a short drive. The Home is a conversion of a 19th Century building, with a purpose built extension added in 1999, and accommodation comprises mostly single bedrooms, 20 of which having en-suite lavatory and wash-hand basin facilities. There are a number of lounge/seating areas and one dining room. With pleasant gardens to the rear of the building many of the rooms benefit from extensive rural views. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. The service users guide details the current level of fees ranging from £355.00 -£420.00 per week. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk The Rubens DS0000064155.V369128.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 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over five hours on Tuesday 29th July 2008. Twenty two of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Twenty two people are currently living at the home and during the inspection were observed to be in all areas of the home. The acting manager was in charge of the home, supported by three care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us the areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. We asked the acting manager to distribute ‘Have your say’ surveys to people living at the home and their relatives/representatives. Seven were completed by service users, one with help, and five were completed by relatives. Surveys were sent to health care professionals who have an interest in the service, one was completed and returned. The comments from the surveys are included in this report. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The care plans have been reviewed and revised, a person centred approach is now used for delivering the care to individuals. The home has benefited from some improvements to the general environment with new floor coverings to the main corridor, new armchairs in the quiet lounge and locks fitted to all private bedrooms. The bath/shower room has had a total refit, with the work almost completed. Recruitment has been and is ongoing for care and ancillary staff. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 7 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. The Rubens DS0000064155.V369128.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 The Rubens DS0000064155.V369128.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): OP 1,3,6 Quality in this outcome area is good. Admissions are not made to the home until a full needs assessment has been undertaken. This tells the home all about them, what they hope for and want to achieve, and the support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the service provision is detailed in the statement of purpose and service user guide and is available upon request at the home. Both documents have recently been updated and revised to ensure that they contain current information. The documents are informative and user friendly. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 10 The case file of the most recent person to move into the home was looked at and confirmed that a rigorous admission procedure is in use. The file contained a pre admission assessment completed by the acting manager prior to the service offering a placement. Additionally there was information from social worker and community based assessments. This ensures that the service can be confident of meeting a persons care needs. A family member discussed the admission process and stated that they found it very difficult to make such life changing decisions on behalf of their relative. They visited the home and met with staff and other people living at the home and ‘liked what I saw’ and believes that it is the right decision. Other case files looked at included social worker reviews; assessments from Primary Care Trusts and community care services. The home does not provide an intermediate care service. The Rubens DS0000064155.V369128.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): OP 7,8,9,10 Quality in this outcome area is good. Care plans are person centred, written in plain language, are easy to understand and look at all areas of the individual’s life ensuring that health, personal and social care needs can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is based on the information gained prior to admission. The plan is reviewed at the point of admission to the home and then on a regular basis. Three case files were selected for inspection and recorded the information required to successfully meet assessed care needs. All three files indicated that either the service user and/or their representatives had involvement and had agreed with the plan. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 12 The care plans are based on the activity, goal, plan, and action. They include a person centred approach based on assessments of daily living activities, religious observance, social and leisure activities, and mental and psychological needs. Risk assessments are completed and when a risk has been identified there is a corresponding care plan with the actions needed to reduce the risk or hazard. For example one person was assessed as being at risk from falling. The care plan recorded the actions and interventions needed to reduce the risk of an accident happening. Another plan indicated that a person occasionally experiences periods of unhappiness and insecurities. Comprehensive detail is recorded of the possible triggers to these experiences and the actions to be taken by staff to assist with this. One person wished to continue to self-administer a particular medication. A risk assessment has been completed, discussed with the person and their relative and records the action needed to assist with obtaining the medication regularly. Staff were able to provide a verbal account of the care of people who use the service and described the individual and diverse care needs. Observations of the medication round, the documentation in use and discussions with staff suggest that good procedures are in place for the safe administration of medications. The supplying pharmacy continues to visit the home at regular intervals to audit and check the procedures. Throughout the inspection day staff were observed to be addressing people in an appropriate and respectful way. The acting manager documented in the Annual Quality Assurance Assessment that the privacy and dignity of people is paramount and has ensured this by • • • • Facility to privacy in individual bedrooms Personal care reflecting choices Identified service users preference for bathing and any gender sensitivity issues Enhanced facility for privacy by fitting locks to all bedroom doors The statement of purpose includes details for respecting privacy and dignity – ‘ All staff are instructed as part of their induction to respect service users and preserve their dignity at all times. Arrangements for ensuring that service users are treated with respect and dignity are clearly shown in all put policies, procedures and actions and supported by implementation of the GSCC ‘Code of Practice’. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 13 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): OP 12,13,14,15 Quality in this outcome area is good. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. The care home supports people to follow personal interests and activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care staff organise and facilitate the recreational activities that are provided within the home. A monthly programme of events is given to each person at the home and copies are displayed in various areas around the home. The acting manager stated that most in house activities occur during the mornings as this was suggested at a recent service users meeting. People felt more able to participate in activities at this time. During the morning of this inspection lots of activity was happening, the hairdresser was being kept busy attending to the needs of the ladies and The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 14 gentleman. Some people were being offered manicures and hand care. One person spoke of their enjoyment at watching sport on the television and had a lively debate about cricket. Another person stated that they had been visited by the local priest and had participated with Holy Communion. People living at the home discussed the recent acquisition of a new pet cat; one person in a particular appeared to be very affectionate and engrossed with looking after the cat’s welfare. The Annual Quality Assurance Assessment completed by the acting manager indicates some improvements made recently • • • Regular religious observance which includes interfaith service Developed activity programmes Purchased activity products With plans for further improving social, leisure and recreational activities during the next twelve months• • • • • Develop reminiscence area and relate activities Develop communal areas and ambience More outings and external activities including trip to seaside Continue to network with community contacts Develop ‘All About Me’ systems to promote individual care and communication for older people and those with reduced capacity Have your say surveys that were completed by people living at the home and their relatives’ indicated that there is – • • Plenty going on for those who want to participate, Plenty of things organised but I choose not to be involved. Visitors were popping in and out for most of the day and stated that they were very satisfied with the visiting arrangements. There is a selection of communal areas both inside and outside of the home, this means that people have a choice of place to sit quietly, to meet with family and friends or be actively engaged with other people who use the service. The statement of purpose includes a section on the arrangements for maintaining contact with relatives, friends and representatives. The main entrance door and doors leading out to the main road are kept locked for security reasons. Staff answer the door and allow access to visitors. A domestic type lock is used for exiting the building. There is open and unrestricted access to the back garden. No other doors in the home with the exception of some private bedrooms are locked. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 15 The home operates a rotational menu with the weekly fare being displayed on the notice board. The dining room is prepared in advance of the midday meal. Many people are encouraged to sit at the table but people can have their meal at their place of preference. The catering staff have a good knowledge of the likes and dislikes of people and prepare alternatives to the menu if required. People living at the home stated that they were satisfied with the meals provided and that the food is ‘good and well cooked’. Have your Say surveys completed by service users and/or their relatives made comments of – • • The food is very good but on occasions not happy when the cook is not here. The food is outstanding The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 16 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): OP 16,18. Quality in this outcome area is good. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service. Residents and others involved with the home generally understand how to make a complaint and are clear about what will happen if a complaint is made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to make a complaint are included in the statement of purpose and service user guide and a copy of the procedures is displayed at the entrance to the home. The acting manager stated that no concerns or complaints had been raised during the last six months but three incidents have been referred to the Safeguarding adults multi agency team. Two of the referrals have reached a satisfactory conclusion and the service has acted on the recommendations made by the multi agency team. The third referral is still yet to conclude but action has been taken by the home to reduce the risk of a reoccurrence of the incident. The acting manager offered their fullest cooperation with the investigations. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 17 We, the commission, have received no concerns directly during the past six months. Staff stated that they have seen the policies and procedures for safeguarding and discussed the action they would take if they had any suspicions and demonstrated an understanding of the whistle blowing procedures. Six of the seven Have Your Say surveys completed by people living at the home indicated that they were aware of the complaint procedure. However, one relative completing the survey indicated that they were not aware of how to make a complaint. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. The statement of purpose and service user guide has details of the safekeeping of money and valuables and states the maximum amount of cash that is held for an individual. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 18 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): OP 19,26 Quality in this outcome area is good. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection in October 2007, the home has greatly benefited from some redecoration, refurbishment and replacement of the fabric and fittings. Carpets have been replaced in the corridors, armchairs in the quiet lounge have been replaced and the bath/shower room has had a refit. Locks have been fitted to all bedroom doors and now offer people a true choice of whether they wish to lock their door or not. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 19 The acting manager has developed a plan for further improvements during the next twelve months and discussed the changes being made. The Annual Quality Assurance Assessment explains the plans• Replace shower room floor tiles • Provide floor covering in kitchen storage area and staff toilet • Replace dining room furniture • Replace damaged vinyl floor covering in some bedroom areas During the tour of the premises, the bedrooms appeared to be comfortable with an assortment of furniture either provided by the home or the persons own, so each bedroom was very different and personal to the occupant. People stated that they were very satisfied with their accommodation. Hand wash facilities have been provided in all communal areas and at the point of the delivery of care for general hygiene purposes and to ensure effective infection control. All areas of the home were clean, tidy and hygienic, the acting manager discussed the recent changes to the personnel responsible for this task. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 20 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): OP 27,28,29,30 Quality in this outcome area is good. There are currently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. Staff receive relevant training and a good recruitment procedure has been developed. The procedures ensure that suitable people are caring for people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels are maintained at three care staff during the day reducing to 2 care staff at night. A duty rota is maintained on a weekly basis to identify the people in the home at any one time. The acting manager stated that additional care staff are available during peak periods of activity. General observations of staff working practice and home life, discussions with people living and working at the home suggests that the staffing complement is satisfactory for the needs of the current resident population. The Annual Quality Assurance Assessment indicates that 70 of the current work force have a National Vocational Qualification in care. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 21 Staff spoken with either confirmed that they had gained the accreditation or it is planned for them to begin the training. Three staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. The acting manager demonstrated a good sound knowledge of the recruitment procedures and stated that recruitment is ongoing for care staff. A training matrix has been developed to identify each employee’s level of training and development needs. The Annual Quality Assurance Assessment identifies the improvements already made to staff development with further plans to – • Enhance training and development to include dementia and challenging behaviour. Staff discussed the training opportunities, with one person stating how useful they thought the induction programme was for someone new to working in the care sector. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 22 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): OP 31,33,35,38 Quality in this outcome area is good. The acting manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last key inspection of the service the registered manager resigned from the position. Another person was recruited in January 2008 as the acting manager. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 23 Mark Fuller has been in the care sector over a period of time and has previous experience of working in a care home. Mr Fuller has a National Vocational Qualification Level 4 and the Registered Managers Award, in addition to other relevant qualifications. Mr Fuller has yet to make a formal submission for the position of registered manager of the service but states that the application is ‘imminent’. Mr Fuller has made many improvements to the service since January and spoke of the plans for the future. Throughout this inspection Mr Fuller demonstrated a good knowledge of the aims and objectives of the service and the care needs of the people living at the home. People spoken with, residents, staff and visitors, all commented positively as to his style of management and stated ‘He has turned the home around in the short time he has been here’ ‘It is a very different place in which to work’ Mr Fuller completed all sections of the AQAA and the information gives a good picture of the current situation within the service. The AQAA gives us some detail about the areas where they still need to improve and the ways that they are planning to achieve this are explained. Quality assurance and monitoring of the service is ongoing with six monthly satisfaction surveys being distributed to relatives and representatives. Regular service users meetings are arranged giving people the opportunity to discuss how they perceive life at the home, with amendments being made to practices following suggestions made. The most recent being the timing of activities and improvements to meals. Staff meetings are also arranged at regular intervals. The registered provider of the service or a representative visits at monthly intervals as part of the monitoring process. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. The statement of purpose and service user guide has details of the safekeeping of money and valuables and states the maximum amount of cash that is held for an individual. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept and available for inspection. Policies and procedures, risk assessments and health and safety systems and audits relevant to the service have all been reviewed with the acting manager stating that this is an ongoing process. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 24 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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 X 18 3 3 X X X X X X 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 2 X 3 X 3 X X 3 The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP31 Good Practice Recommendations A formal application should be submitted for the position of registered manager to ensure an experienced competent person manages the home. The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 The Rubens DS0000064155.V369128.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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