Inspection on 06/03/06 for 3 The Droveway

This inspection was carried out on 6th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 The Droveway 20/11/08

3 The Droveway 31/01/08

3 The Droveway 19/06/07

3 The Droveway 12/10/06

3 The Droveway 17/08/05

3 The Droveway 27/01/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 3 The Droveway Hove East Sussex BN3 6LF Lead Inspector Jennie Williams Unannounced Inspection 6th March 2006 09:30 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 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 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 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 Adults 18-65. 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. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 3 The Droveway Address Hove East Sussex BN3 6LF 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) 01273 563935 www.caremanagementgroup.com Care Management Group Limited Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is six (6). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability who may also have an associated physical disability, can only be accommodated. 17th August 2005 Date of last inspection Brief Description of the Service: 3 The Droveway is one of many homes owned by Care Management Group (CMG). 3 The Droveway is registered to provide accommodation for six residents with learning disabilities. Residents at this establishment have profound learning and physical disabilities. The home is located on the outskirts of Brighton/Hove. There is nearby access to some local amenities and public transport. There is no parking available at the home, but parking is permitted on the street. The home has access to its own transport. Residents are provided with an opportunity to attend a day centre provided through the use of the organisations development centre. All rooms are for single occupancy. Rooms are located on ground floor and there is level access throughout the home. All rooms are for single occupancy. There are suitable communal space and bathing and toilet facilities provided to meet the needs of the residents. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 3 The Droveway will be referred to as ‘residents’. This unannounced inspection took place over five and a half hours on the 6 March 2006. Care plans, staff files, some policies and procedures and medication procedures were inspected. The environment and some individual rooms were spot-checked. Due to the disability of the residents, the Inspector had limited verbal communication with them. Staff were spoken with throughout the inspection process. There were five residents residing at the home on the day of the inspection. Three were out for the day and two residents remained at the home. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection report of 17 August 2005. The acting manager and a registered manager from another CMG home facilitated this inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans, risk assessments and monitoring forms need to provide consistent and accurate information to ensure staff have clear guidance. Staff must ensure that monitoring charts in use are accurately completed to reflect actual current practices. The recruitment procedures and induction procedures need to be more robust. The Protection of Vulnerable Adults (POVA) procedures 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 6 need to provide clearer guidance for staff. The complaints procedure needs to contain the contact details of the CSCI. 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. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&4 The home has information available to prospective residents and their representatives to make an informed decision if the home is suitable for their needs. EVIDENCE: The Statement of Purpose has been amended to reflect the changes in the environment and management. This document incorporates the use of pictures and symbols. The home is still awaiting a reprinted version from the head office of CMG. The organisation has a central assessment team based in Wimbledon who undertake the initial assessment of prospective residents. There have been no new admissions since the last inspection. Emergency admissions and shortterm placements are avoided where possible. The home has implemented a transition plan for a respite resident. It was discussed with the acting manager that if respite is going to be provided on a regular basis, the Statement of Purpose and Service User Guide will require amending to accurately reflect services provided at the home. Copies of previous care plans are taken wherever applicable. The home had obtained a copy of the care manager’s care plan and risk assessments for the respite resident. Prospective residents/representatives are encouraged to visit the home prior to moving in. Due to the disability of the residents, admissions are generally well planned and the transitional phase into the home takes as long as needed. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 & 9 Clear accurate recording of information will ensure that residents’ assessed needs are being met. EVIDENCE: All residents have a care plan implemented, titled ‘all about me’, that provides detailed information on the assessed needs of the resident. It was noted that information contained in the care plan, risk assessments and monitoring charts were not always consistent and complimenting each other with information. A care plan and risk assessments demonstrated that chest physiotherapy was needed four times a day, where the Chest Physio Chart stated two to three times per day. The recording by staff demonstrated that on some days this was only done once. Staff must ensure that all information pertaining to an individual’s care is consistent and reflects actual current practice. All residents have daily diaries that are kept with the individual to record daily activities and any changes in the needs of the individual. Keeping these diaries with the individual encourages good communication between the home care staff and the day centre staff and promotes continuity of care. The content of these were not read. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 10 CMG have developed a new Health Booklet that will include all relevant information about an individual. It was confirmed that they contain comprehensive information on an individual’s health needs. These booklets condense all the information regarding an individual and will assist in providing clear accessible information regarding an individual’s needs. A care plan spotchecked demonstrated that it was just outside of the six-month review period. Care plans will be updated when the new health booklet is implemented. This has not been reflected as an outstanding requirement but will be reassessed at the next inspection. Residents have complex needs and verbal communication is limited. Staff working at the home are able to interpret an individual’s subtle level of communication and will include residents in most daily routines of the home wherever possible. Residents require supervision in all activities they participate in, so taking risks is very limited. There are suitable risk assessments in place to safeguard residents and staff in the activities of daily living. There was evidence that most risk assessments are being reviewed on a regular basis. Personal information is stored securely at the home. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 16 & 17 Residents are provided with opportunities for personal development and to be involved in the local community. Visitors are welcomed at the home. EVIDENCE: Residents are provided with a range of activities they are able to participate in. The development centre provided by the organisation provides opportunities for residents to engage in informative and creative activities should they wish. There is currently no one involved in employment. Activities take place within the home on evenings and weekends. The home has access to a mini bus that is used amongst other CMG homes. Two residents were assisted in making mother day cards on the day of the inspection. All residents have a daily routine. These routines are flexible, but due to the complex needs of the individuals’, residents respond better when there is a familiar routine in place. Visitors are welcomed at the home. Residents may see visitors in their own rooms if they wish. There is a visitor’s book kept at the entrance of the home that is now being signed by all visitors, as required from the last inspection. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 12 The home has reviewed the system for the provision of meals. It was previously prepared at another establishment and transferred to the home, limiting the level of choice and diversity for the residents. This had been outstanding for the past two inspections. The home now undertakes in house cooking. Staff confirmed that in house cooking has been of benefit to the residents. It was confirmed that residents assist with the preparation of the food and the appetite has increased of individuals since in house cooking has been commenced. A menu is planned on a four weekly rota. Residents are not currently involved in this process. It is required that residents are provided with opportunities to participate in the menu planning and shopping for food. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Residents’ needs are being met with the number of staff on duty and the good support network throughout the CMG organisation. EVIDENCE: Throughout the ‘all about me’ there are clear instructions on the preferred way an individual receives personal support. All residents require full personal care due to the complex needs. The home does not provide nursing care. Due to the complex needs of residents, staff are required to have a clear understanding of all needs. Health needs are also met with a good support network throughout the organisation. CMG is currently employing a new physiotherapist. It is anticipated that this person will commence work in April 2006. It was confirmed that the previous physiotherapist gave a thorough handover of all individual physiotherapy programmes. Residents’ postural management programmes are still being undertaken. There is no one capable of self-medicating at the home. There are policies and procedures in place to deal with all aspects of handling medication. MAR charts inspected demonstrated that medication was being signed for at the time of administration. It is recommended that all handwritten MAR charts are 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 14 double signed by two staff who are trained in medication procedures and that any handwritten amendments are signed by the person amending the MAR chart. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Residents/representatives are provided with opportunities to air their views. Clear written policies will provide staff with clearer guidance on adult protection procedures. EVIDENCE: There is a complaints procedure available at the home. This needs amending to include the contact details of the local CSCI office. This is an outstanding requirement. There is a pictorial complaints procedure that residents have access to. There have been no complaints made since the last inspection. Staff are familiar with the residents residing at the home and are aware how individuals communicate if they are unhappy about anything. The adult protection policy and procedure needs to clearly state that all allegations of abuse must be referred to social services, who are the lead agency. Information regarding the POVA list needs to be included in this policy. This remains an outstanding requirement. It was discussed with the acting manager that these policies and procedures are amended at local level until an update is forwarded from the CMG head office. There is one person within CMG who is the designated appointee for residents’ finances. The home holds personal allowances securely at the home. Personal monies spot-checked demonstrated that there are suitable procedures in place for handling residents’ personal allowances. Receipts are kept of all financial transactions. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 & 30 Residents live in a home whose location and layout is suitable for its stated purpose. EVIDENCE: The home has recently undergone building works to increase the number of places to six. Rooms spot-checked were seen to be personalised to reflect the individuals’ choice and character. There is suitable communal areas to accommodate all residents. Thermostatic valves have been fitted to the hot water taps to ensure hot water is delivered around the recommended 43°C, as required from the last inspection. A new bathroom has been installed as part of the recent building works. This was not functional on the day of the inspection. Additional work is needed to be undertaken. The current bathroom in use is meeting the needs of the residents. The home was clean and free from offensive odours on the day of the inspection. There are suitable laundry facilities provided at the home. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & & 35 Robust recruitment and induction programmes will better safeguard residents and staff. EVIDENCE: There are three staff currently undertaking NVQ level 2 studies. There are no staff that have completed any NVQ studies. Priority must be given to ensure the home meets the required ratio of staff with NVQ studies. This remains an outstanding requirement. Head office of the CMG is offering incentives for all their employees by offering a prize to the staff member who completes the most units within a month period. Staff spoken with stated that they felt there were always sufficient numbers of staff on duty, unless there was short notice due to illness. There were some shortfalls in staff files that were discussed with the acting manager at the inspection. There was information missing from some of the files. It was confirmed that some of this information was still being held at the head office of CMG. Some references were noted to be within a friend capacity and there were no interview notes to evidence why the home found this individual suitable for employment. All staff files must comply with Schedule 2. This is an outstanding requirement. It is recommended that interview notes be maintained. Head office of CMG need to ensure that information regarding a prospective employee is promptly forwarded to the home prior to the person commencing employment. It is recommended that information 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 18 regarding a prospective employees’ mental health status be expanded. This remains an outstanding recommendation. The acting manager must ensure that new staff undertake and complete suitable induction. Staff confirmed that they are kept up to date with mandatory training, although records inspected did not demonstrate this. It was confirmed that training had been undertaken, but head office of CMG have not forwarded on the training certificates. There were no records kept at the home to confirm that training has been undertaken. It is required that evidence be kept at the home of staff training. Staff are provided with opportunities to attend training sessions relevant to their duties. Head office of the CMG organisation arranges the training schedule and sends this to the home on a regular basis. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40 & 42 Residents and staff will be better safeguarded when action is taken to address the shortfalls identified in the health and safety procedures. EVIDENCE: The previous registered manager has let employment at the home since that last inspection. The deputy manager, who has been employed at the home for nine months, is currently the acting manager. CMG are currently advertising for a registered manager. An experienced registered manager from another home is currently overseeing 3 The Droveway. CMG need to ensure that an application for a registered manager is forwarded to CSCI for processing. Staff were complimentary about the acting manager at the home. Not all policies and procedures were inspected. Any shortfalls in policies and procedures have been highlighted in the relevant section of the report. The home receives policies and procedures from the head office of CMG. It is recommended that a quick reference guide be implemented so staff can quickly access the relevant policy they require. This is an outstanding recommendation. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 20 Inventories are kept of individuals’ personal belongings. It is recommended that inventories for residents’ personal belongings be updated following the Christmas period. Health and safety procedures are in place and the home undertakes monthly risk assessments of the premises. Fire alarm testing is completed every week. There was no indication which point was used and additional information needs to be recorded. The registered manager of the other home assured the inspector that she would provide the acting manager with a copy of the fire recording forms that is used at the other home. It is required that all staff are kept up to date with fire training. One file inspected demonstrated that a staff member last received fire training in June 2003. Windows were noted to be unrestricted. It is required that window restrictors be installed. This is to promote the security for staff and residents, working and residing at the home. The shower in the bathroom was noted to fluctuate in temperature. Temperatures fluctuate between 19°C and 55°C. There was a notice on the wall advising staff of this. It was made an Immediate Requirement that a risk assessment be implemented for this shower and that action is taken to address this shortfall to safeguard staff and residents. The laundry is kept unlocked and there were hazardous substances noted to be stored on shelves. It was discussed with the registered manager that consideration be given to keeping this door locked at all times. A risk assessment needs to be put in place to identify if there is a risk to residents/visitors and further action be taken if identified. The health and safety poster on display still reflects the previous registered manager as the appointed health and safety person. This information must be changed to reflect who the appointed person is. 3 The Droveway is one of many homes within a growing organisation. The home has given no cause of concern regarding financial viability to date. 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 3 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X X 2 X 2 X 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement That information pertaining to an individuals’ care is consistent and reflects actual current practice. That service users are provided with opportunities to participate in menu planning and shopping for food. That the complaints policy includes the contact details of the CSCI office. (Timescale 31.10.05 not met) That the adult protection policy clearly states that all allegations of abuse must be referred to social services. Information about the POVA list needs to be included. (Timescale 31.10.05 not met) That the home commences working towards the 50 ratio of care staff with NVQ level 2 or equivalent qualifications. (Timescale 31.12.05 not met) That staff files comply with Schedule 2. (Timescale 31.10.06 not met) That evidence be kept at the home of staff training. Timescale for action 30/04/06 2. YA17 12(3) 30/04/06 3. YA22 22.7(a) 30/04/06 4. YA23 13.6 30/04/06 5. YA32 18 30/09/06 6. 7. YA34 YA35 19 Schedule 2 18(1)(c) 30/04/06 30/04/06 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 23 8. YA37 8&9 9. 10. 11. YA42 YA42 YA42 23(4)(d) 13(4)(a) 13(4) 12. YA42 13(4)(a) 13. YA42 13(4) That an application for a registered manager be forwarded to CSCI for processing. That all staff are kept up to date with fire training. That window restrictors be installed. That a risk assessment be implemented for the shower delivering hot water above the recommended 43°C. (Immediate Requirement) That a thermostatic temperature control is installed at the shower delivering hot water above the recommended 43°C. (Immediate Requirement) That a risk assessment be undertaken regarding the storage of hazardous substances and further action taken if identified. 30/06/06 30/04/06 31/05/06 07/03/06 10/03/06 30/04/06 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. 2. 3. 4. 5. 6. Refer to Standard YA1 YA20 YA20 YA34 YA41 YA42 Good Practice Recommendations That the Statement of Purpose and Service User Guide be amended to accurately reflect services provided at the home if respite care is to be offered on a regular basis. That two staff who are trained in medication procedures sign all hand written MAR charts. That any hand written amendments to MAR charts are signed. That information regarding a prospective employees mental health status be expanded. (Outstanding recommendation) That inventories for service users personal belongings are updated following the Christmas period. That the health and safety poster reflects whom the appointed person is. DS0000060763.V267164.R01.S.doc Version 5.1 Page 24 3 The Droveway Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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 3 The Droveway DS0000060763.V267164.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!