Care Home: The White House

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What the care home does well The manager understood the need to ensure that people could be cared for appropriately at the White House, before they moved in, she therefore carried out a comprehensive assessment on all prospective residents. Training records confirmed that the staff team had the individual and collective skills to care for the residents. The staff were confident and competent in their roles, and were able to talk in depth about individual residents needs and the care that they required. All staff had had some training to help them understand dementia and the needs of people using the service who had dementia. Staff were recruited safely and staff training was prioritised. Care records were well written and ensured that staff had clear instructions as to how care should be provided. Staff had a good relationship with the local GP surgery and with the community nurses. A robust complaints procedure and staff awareness of safeguarding ensured people were kept safe at all times. The manager had a clear understanding of the principles of the service and worked, with the staff team to improve it. What has improved since the last inspection? What the care home could do better: The requirements made as a result of this inspection were related to the activities provided by the home and the state of the environment. We believed that there was more stimulation offered to residents but staff were not recording this and could not show that they had taken account of people`s past interests and hobbies. We look forward to seeing that the builders have moved out and that the planned routine refurbishment of the home is continuing. CARE HOMES FOR OLDER PEOPLE The White House High Street Eggington Leighton Buzzard Bedfordshire LU7 9PQ Lead Inspector Mrs Sally Snelson Key Unannounced Inspection 23rd January 2009 08:20 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 White House DS0000054000.V373697.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 White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address High Street Eggington Leighton Buzzard Bedfordshire LU7 9PQ 01525 210322 01525 211925 knjanes@supanet.com 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) Janes Care Homes Ltd Miss Tracey O`Hara Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users over the age of 65 years not falling within any other category (OP) 23 Service users over the age of 65 years with dementia DE(E)) 23 The maximum number of service users that the home can accommodate at any time must not exceed 23 The home can accommodate service users of either sex Date of last inspection Brief Description of the Service: The White House is registered to provide for 23 older people who may also have dementia. The Home is located in an attractive semi-rural setting in Eggington Village, a short distance by road from the town centre of Leighton Buzzard. The premises are set back from the road and approached via a driveway and large front garden given over mainly to parking but affording a seating area for service users with views over pleasant shrubbery borders. Further parking spaces are situated to one side of the home. The accommodation is distributed over three floors that are accessed via staircases and a shaft lift. Seventeen single bedrooms and three double bedrooms are currently provided. One single room has an en suite toilet facility. Other rooms had washbasin fixtures. All rooms are connected to the call bell system. Toilet and bathing facilities are located for convenient access throughout the building. Communal accommodation is located on the ground floor and comprises of two lounges and a dining room. Kitchen, laundry and office facilities are also situated on the ground floor. At the time of this report the fees for this service range from £470.00 to £525.00 per week. The White House DS0000054000.V373697.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 inspection was carried out in accordance with the Commission for Social Care Inspections (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for older people. The methodology that takes account of resident’s views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. At the time of the inspection the AQAA was not due but a previous AQAA was available. Evidence used and judgements made within the main body of the report include information from this visit and a random inspection that took place in November 2007. Sally Snelson undertook this inspection of the White House. It was a key inspection, was unannounced, and took place from 08:20hrs on the 23rd January 2009. The manager Tracey O’Hara was present throughout and feedback was given during the inspection, and at the end. At the time of the inspection 16 people were living at the home. During the inspection the care of two people who use the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, visitors, and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. We would like to thank all those involved for their assistance with the inspection. What the service does well: The manager understood the need to ensure that people could be cared for appropriately at the White House, before they moved in, she therefore carried out a comprehensive assessment on all prospective residents. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 6 Training records confirmed that the staff team had the individual and collective skills to care for the residents. The staff were confident and competent in their roles, and were able to talk in depth about individual residents needs and the care that they required. All staff had had some training to help them understand dementia and the needs of people using the service who had dementia. Staff were recruited safely and staff training was prioritised. Care records were well written and ensured that staff had clear instructions as to how care should be provided. Staff had a good relationship with the local GP surgery and with the community nurses. A robust complaints procedure and staff awareness of safeguarding ensured people were kept safe at all times. The manager had a clear understanding of the principles of the service and worked, with the staff team to improve it. What has improved since the last inspection? What they could do better: The requirements made as a result of this inspection were related to the activities provided by the home and the state of the environment. We believed that there was more stimulation offered to residents but staff were not recording this and could not show that they had taken account of people’s past interests and hobbies. We look forward to seeing that the builders have moved out and that the planned routine refurbishment of the home is continuing. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 7 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 White House DS0000054000.V373697.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 White House DS0000054000.V373697.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): 1,3,5 People who use this service experience good quality outcomes in this area. The manager understood the need to ensure that people could be cared for appropriately at the White House, before they moved in. To this end she and/or the deputy carried out a comprehensive assessment on all prospective residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide was a combined document that was kept under review. The manager was planning to update these documents when the building work was completed so that they reflected the change in the size of the home and the numbers of staff and residents. The documents were available in the home and had been produced in large print. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 10 Following the last inspection it was recommended that Statement of Purpose and Service User Guide be placed in the hallway to make it available to all. This had been done. We tracked the care of two people using the service as part of this inspection. One person had been admitted after the last inspection. It was apparent that the manager had visited the resident and identified his needs before admission. The manager confirmed that people were encouraged to look around the home before deciding that it would meet their needs. The staff team had the individual and collective skills to care for the residents. This will be discussed in detail in the staffing section of this report. At the time of the inspection the home did not provide an intermediate care service, but did offer respite care. The White House DS0000054000.V373697.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): 7,8,9,10,11 People who use this service experience good quality outcomes in this area. Care records were well written and ensured that staff had clear instructions as to how care should be provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans had been written for all the activities of daily living. They were written in sufficient detail to ensure that staff had enough information about how to provide care. The care plans identified the need, and detailed how the care should be provided. The reader was pointed to any associated risk assessments when reading the care plan. Although there was a signature page that provided residents, or someone on their behalf, the opportunity to sign the care plan, to confirm acceptance, The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 12 these had not been completed in the files we sampled. We did note that where the local authority had not reviewed a resident annually the home had set up this facility, and invited the family to attend. The deputy manager printed off electronic copies of each care plan after they had been reviewed. This meant that the plans looked neat and tidy and there was no problem with reading the information. Care plans were reviewed monthly and alterations were made as necessary. Daily logs were also kept. We felt that some of the care folders included information that was old, and could be archived, and was therefore not pertinent to the current care needs and could lead to confusion. Staff had a good relationship with the local GP surgery and with the community nurses who visited daily to administer an insulin injection. The nurse would offer advice during these visits if the staff had any problems. Risk assessments were in place and resulted in appropriate equipment being sought for people, such as pressure relieving mattresses and hoists. During the inspection we witnessed staff moving and handling people correctly and using the correct equipment to do so. We were disappointed that weights had not been recorded for a number of months because the scales were not considered to be accurate. We were told that that the company were waiting for a part to make the necessary repair. Consent forms were appropriately completed and in place for the use of bed rails where necessary. Following the random inspection in November 2007 it was reported that, ‘It was apparent that people were offered the choice of when to get up and go to bed, and also when to have their meals. At the start of the inspection some service users were having breakfast in the newly refurbished dining room, while others were having breakfast taken to their bedrooms and some had obviously eaten earlier. A number of the people sitting at the dining tables were wearing dressing gowns and staff reported this was because they liked a slower start and a bath or a shower before dressing. This gave a very homely feel to the room.’ These comments remained current. Medication records confirmed that staff administered the medications correctly and signed the Medication records (MAR) correctly. However because staff did not carry ‘stock’ medication forward from one MAR sheet to another, it was not possible to reconcile the medications held by the home. To do this we would normally check when the medication had commenced and count the number of signatures on the record and tally it with the number/amount of medication held in stock. A recent audit by the supplying pharmacy had also highlighted the need for this. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 13 Throughout the inspection we saw resident’s being treated with respect and dignity at all times. End of life plans had been completed and included information about end of life wishes and relatives preferred time of contact in an emergency. We witnessed a GP taking account of a family’s end of life wishes. Where possible staff should secure capacity documentation to support end of life wishes. The White House DS0000054000.V373697.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): 12,13,14,15 People who use this service experience adequate quality outcomes in this area. Staff had identified some social activities that would please and stimulate the people using the service, but these were not planned and relied on the staff on duty having the time and inclination. Meals were freshly prepared and there was a choice available. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During the inspection we did not see much evidence of activities, although there were a number of games and jig-saw puzzles in the home. The manager told us that there was no formal activity plan and that no one member of staff had been detailed to co-ordinate the activities in the home. Staff were expected to complete an activity record when a resident participated in an The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 15 activity, but it was apparent that this was not routinely happening, as occasions such as the monthly communion service, had not been recoded. We would hope that staff could produce activity plans to the same high standard as the other plans they created. Staff must also consider those people using the service with dementia, and impaired vision and hearing, when planning an activity programme to suit all. Since the last key inspection the kitchen had been repositioned and upgraded and the cook had altered. The cook was combining the work with training and was altering menus gradually as he got to know the residents. We noted that the cook spent time with the residents talking to them about their menu choices for the next meal. In addition to preparing breakfast and lunch the chef would also make cakes, and do some of the preparation towards tea. At lunchtime assistance and encouragement was being offered in a dignified manner appropriate to the service users individual needs. During the random inspection one resident said to us, “the carers are all lovely, they look after all our wants.” There was a choice of hot meals available each day although as the inspection took place on a Friday the choice was limited to fish in batter and chips and mushy peas or fish in a sauce and mashed potatoes. However we did see that one resident had a jacket potato for her lunch. The menus confirmed that usually the variation between the choices was greater. A resident said, “the meals are always good, if you don’t like something you just have to say”. At this inspection, as at other inspections we noted that people had their breakfast where and when they wanted it and that some choose to have breakfast before getting washed and dressed. The White House DS0000054000.V373697.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): 16,18 People who use this service experience good quality outcomes in this area. A robust complaints procedure and staff awareness of safeguarding ensured people were kept safe at all times. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This homes’ complaints policy was displayed and was easily accessible to residents and visitors to the home. It confirmed the expected timescales for responses, and advised people of the process if they were dissatisfied with the outcome. Staff were aware of the complaints policy and how they should respond if the manager was, and was not, available to take the complaints personally. There had been one complaint made to the home since the last inspection. The manager showed us the record she had made of the investigation process and how she had responded to the complainant. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 17 We were shown a training record that confirmed that all the staff had undertaken some training around safeguarding vulnerable adults (SOVA). Recent safeguarding issues have been referred and acted upon appropriately There was an on-going incident involving a member of staff that was currently being investigated under the SOVA procedure. The White House DS0000054000.V373697.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): 19,21,26 People who use this service experience adequate quality outcomes in this area. There had been building works and alterations going on in the home for many months and this had impacted on the general cleanliness and homeliness of the premises. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last key inspection the home had increased the amount of communal space by adding a dining room and new kitchen and decking had been erected to the front of the home; this provided disabled access to the front door. We The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 19 were however concerned that when wet the wood of the decking was slippery and needed treating. Building work to provide more bedrooms and additional office space was on going. We were told that it was proposed that the work should be completed in April 2009. Because of the building work some doorways and hallway’s were boarded up and some area’s felt draughty. On the whole despite all the work the home was free of dust, but we did note that tables tops and legs and some carpets looked grubby. We appreciate that the main area of the home will be refurbished once the major construction work has been completed but care must be taken that the home is kept as clean as possible and spills are cleaned up and carpets kept as clean as possible. Bedrooms were kept clean and tidy and the people that we spoke to that lived at White House appeared to be unaffected by the work in progress. One resident was particularly grateful to see her grandson regularly as he was working on the home. As part of the tour of the home we saw one toilet with no soap available for residents to wash their hands, a bathroom where the bath was being used to soak the commodes ‘pails’, and the rack that was used to go over the bath was very grubby. We saw bathroom bins that were overflowing and a torn blind at a bathroom window. The manager told us that staff were allocated to empty the bins and this had yet to be done, she also told us the bath would be sterilised before being used again. During the period of refurbishment much of the laundry was being sent to another home. White House managed some personal laundry and the very soiled laundry. The manager confirmed that there had not been any major problems related to this process. The White House DS0000054000.V373697.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): 27,28,29,30 People who use this service experience good quality outcomes in this area. Staff were recruited safely and staff training was prioritised. This ensured that the staff team were safe and competent to perform their duties. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the time of this inspection there were only 16 residents living at the White House. Staff rotas, which were prepared for a number of weeks in advance, confirmed that three care staff supported the manager and often the deputy manager, who were supernumerary. In addition to care staff the home employed a cook and a cleaner. The manager was recruiting for a part-time carer, but had sufficient staff to cover the duties in the home, with staff willingly accepting some extra hours. We examined the personal files of two members of staff, one who had recently been employed. Both contained application forms, although one had not been fully completed, however the missing information related to the persons time at school. Appropriate references, Criminal Record Bureau (CRB) checks, and The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 21 home office paperwork was present where required. A new recruit had not started work until all her checks were successfully completed. Training was prioritised and the manager kept a record of the mandatory and additional training that staff completed. She also held copies of any certificated they were awarded. A new member of staff, who had not worked in care previously, was satisfied that the induction provided her with the necessary information to carry out her role. The manager told us that staff could cover their induction at their own pace, and followed a recognised induction programme. The staff that we spoke to during this visit were confident and competent in their roles, and were able to talk in depth about individual residents needs and the care that they require. All staff had had some training to help them understand dementia and the needs of people using the service who had dementia. The White House DS0000054000.V373697.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): 31,32,33,35,36,38 People who use this service experience good quality outcomes in this area. The manager had a clear understanding of the principles of the service and worked, with the staff team to improve it. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager had been working at the home for a number of years and had managed the home for the last three years, under the previous and current owners. The staff team respected her, and she was able to lead the staff and support development of the home. She kept staff informed by having regular The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 23 meetings and it was apparent that she had a good relationship with the people using the service and their families. We reported in the random report that, ‘since the last inspection the manager had produced a summary of the annual quality assurance survey, which the home had sent out to a variety of stakeholders during the year. Therefore this requirement had been met. However the manager must be mindful that this should be repeated annually.’ We were happy that this was a now an established method to check the quality of the care and service provided’. Regulation 26 visits were undertaken on behalf of the owner and the manager reported that these were useful in helping her plan her service. The home would hold small amounts of money on behalf of some of the residents so that they could pay to have their hair done or for chiropody visit. We checked the records of the money held and confirmed the balances and receipts were correct. Also at the random inspection it had been recorded that all staff were currently receiving regular supervision with the manager and there were plans for the deputy to also be trained as a supervisor’. This had been put in place and we saw records to support staff having regular supervision sessions. We looked at health and safety documentation, including the fire log and maintenance book. There was evidence to indicate that fire call points and the emergency lighting were being tested on a regular basis, and that fire drills were carried out periodically. The White House DS0000054000.V373697.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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 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 3 3 X 3 3 X 3 The White House DS0000054000.V373697.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. 1 Standard OP9 Regulation 13 (2) Timescale for action The home must have a system in 01/03/09 place to monitor exactly how much of a persons medication is held by the home. There must be evidence that 01/04/09 people living at the home have the opportunity to pursue leisure and social activities of their choice and a record is kept of their involvement. Care must be taken that spills 01/04/09 are cleaned up and that the home is kept as clean as possible. This also refers to the badly stained carpets in the lounge. Bathrooms must be kept clean 01/03/09 and the risk of infection minimised. Requirement 2 OP12 12 (2) 3 OP19 23 4 OP21 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 26 No. 1 Refer to Standard OP12 Good Practice Recommendations An activity programme should be made available. The White House DS0000054000.V373697.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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