Inspection on 21/09/05 for 77 The Street

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

77 The Street 02/12/08

77 The Street 05/12/06

77 The Street 21/02/06

77 The Street 13/01/05

77 The Street 27/10/04

77 The Street 25/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Street (77 The) 77 The Street Kilmington Warminster Wiltshire BA12 6RW Lead Inspector Alison Duffy Announced 21st September 2005 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 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 Stationary 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. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Street (77 The) Address 77 The Street Kilmington, Warminster Wiltshire BA12 6RW 01985 844800 01722 716029 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ability Associates Limited Mr Andrew Nosko Care Home 2 Category(ies) of Learning Disability (2) registration, with number of places Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2005 Brief Description of the Service: 77 The Street is a residential care home registered to care for two adults with a learning disability. The home is situated in the village of Kilmington, 3 miles north of Mere and 8 miles south of the Somerset town of Frome. The home is known by service users and staff as Dalwood Cottage. It is surrounded by open countryside and does not have any immediate neighbours. The Registered Provider is Ability Associates Ltd and the Registered Manager is Mr Andrew Nosko. Mr Nosko also manages another small care home within the organisation known as Dalwood Farm. 77 The Street is a small cottage providing single room accommodation on the first floor. There is a homely sitting room, separate dining room, small kitchen and an upstairs bathroom. Due to its rural, tranquil positioning, the home has a company car for journeys as required. Staff generally lone work although additional staffing facilitates activity and general appointments. At night one member of staff provides sleeping in provision. An on call management system is in place and staff from Dalwood Farm are able to assist as required. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 77 The Street is one of two care homes managed by Ability Associates. The other service is Dalwood Farm, which is also registered to provide care to adults with a learning disability. As both homes are similar in nature it was agreed to undertake the announced inspections of both services over a period of two days. The inspection began at 10.15am at Dalwood Farm on 20th September 2005 and a visit was made to 77 The Street later in the day from 2.30 to 4.30pm. During this time the inspector met both service users and Mr Phil Nosko, support worker. Care planning and health and safety information were viewed and one service user gave the inspector a tour of the accommodation. On 21st September 2005 between 10am and 3.45pm, the inspector returned to Dalwood Farm and addressed key themes such as staffing. Mr Nosko, Registered Manager was available throughout the time at Dalwood Farm and received feedback regarding both services. As part of the inspection process one comment card was received. This was positive, as was feedback received from service users. What the service does well: What has improved since the last inspection? What they could do better: Some additions to care planning information by highlighting prominent matters would ensure individual needs are fully met. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 6 Although consultation takes place with professionals on a regular basis, agreements involving behavioural management strategies and consequences of actions need to be agreed and fully documented in written form. Despite risk assessments being in place, hot water temperatures need to be regularly monitored. Appropriate action must be taken in relation to exceedingly hot or unpredictable temperatures. 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. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 standard(s) These standards were not assessed on this occasion, as there are no expectations of any changes to the service users living within the home. EVIDENCE: Both service users have lived at the home for a number of years. Mr Nosko reported that service users are generally well and their needs are being met appropriately within the home and additional activities that are enjoyed. One service user confirmed this and spoke with enthusiasm regarding the home and the work that he undertakes. Although independence is promoted, placements may be long-term and therefore any changes are not expected. The above standards were therefore not inspected on this occasion. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 standard(s) 6, 7 and 9 Information regarding service users is detailed yet key themes would benefit from greater focus in order to demonstrate that individual needs are fully met. Risk taking is promoted and a number of documented risk assessments are in place. Consultation and decision-making processes are fully promoted within the home. EVIDENCE: Both service users have a file containing detailed information. The care plan format is portrayed within guidelines and a monthly key worker report gives clear monitoring and review. The guidelines are comprehensive and give a clear summary of need. However, matters of higher importance such as the management of specific conditions require greater emphasis. Mr Nosko was therefore advised to develop individual plans of care for key matters such as the management of diabetes. Discussion also took place regarding limitations, behaviour management and consequences of actions. It was agreed that such matters should be agreed with care managers and service users as appropriate. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 10 Appropriate risk taking is promoted and a number of written personal risk assessments are in place. Such matters include the use of equipment, camping and using the home’s vehicle. Through discussion with Mr Nosko it was evident that careful consideration is given to risk. If the risk appears too high, no chances are taken and the activity does not take place. Service users reported being fully able to make decisions about their daily lives. Preferred routines such as getting up and going to bed are followed and service users are able to choose matters such as activities within their free time. All are able to contribute to choices of decoration, purchasing, furnishing private accommodation and menu planning. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 standard(s) 12, 14, 15, 16 and 17 Service users undertake a range of activities that are linked to individual need and preference. Visitors are welcome and hospitality is evident. Healthy eating is promoted yet service users’ choice is fully respected. EVIDENCE: Both service users have a varied weekly programme, which is linked to individual need and wishes. One service user reported enjoying work at a local charity shop and undertaking jobs at the Farm. Within the programme, activities such as swimming are also included. During evenings and weekends, service users are able to choose their activity. This may include a visit to the pub, attendance at certain clubs, a trip out to places of interest or in house entertainment. All activities are individual in relation to need and interest and are undertaken with staff support as required. One service user reported that the local pub is an important part of the week. Mr Nosko has a mobile home on the coast, which is regularly used for holidays. Service users can also suggest Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 12 alternative destinations or undertake days out if a holiday is not wanted. One service user reported camping had recently been enjoyed. Service users reported they are able to have visitors when they wish and use communal areas or private accommodation as required. Regular contact with family members is encouraged and staff facilitate transport on a regular basis. During the inspection the home was relaxed and hospitality was evident. The home has a service user focus and individual rights are respected. One service user spoke of being able to stay in his room to watch videos when he wanted. During the inspection, cleaning the kitchen and individual rooms was in operation. Service users also assist with meal preparation and the development of the menus. Healthy eating is promoted yet this is balanced with individual choice. One service user reported that all meals are always eaten in the dining room and everyone eats together. The food was reported to be good and one diabetic diet is followed. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 standard(s) 18, 19 and 20 Service users’ health and personal care are well managed. Medication, although generally satisfactory, would benefit from greater review to ensure all medication is current and recorded accordingly. EVIDENCE: Service users require limited amounts of assistance with personal care routines. General support, prompting and encouragement are more appropriate and this is clearly recorded within each individual file. As both service users are male, gender is taken into account when planning the staffing rosters and generally male staff undertake shifts within the home. Documentation demonstrated regular intervention from health care professionals such as the GP, dentists and opticians. Hospital referrals had been made and specialised appointments are undertaken as required. Daily records demonstrated service users’ general well being. The home uses a monitored dosage system for medication administration. Service users do not at this time self-medicate. The medication is supplied on a monthly basis and records demonstrate such receipt. A separate book is designated to the return of medication. Medication administration sheets were signed appropriately although with lone working, countersigning any written instructions to the MAR sheets is not straightforward. Within the storage of Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 14 medication it was evident that a tube of cream was unnamed and a powder was not recorded. Attention is therefore required to address these matters. A homely remedy list signed by a GP is in place. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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 standard(s) 22 and 23 A written complaint procedure is in place, yet updating is required. Satisfactory systems are in place to minimise the risk of abuse to service users. EVIDENCE: There is a copy of the complaints procedure within each service users’ file. The procedure is in need of updating however, as the National Care Standards Commission is still stated. Mr Nosko reported that service users would be clearly able to raise issues if need be. One service user confirmed this by stating that he would tell a member of staff and ‘they would get it sorted.’ The complaint procedure has recently been discussed within supervision sessions with staff being encouraged to contact CSCI in the event of a complaint about management. There have been no complaints reported to CSCI. A copy of the ‘No Secrets’ documentation is clearly displayed on the notice board in the office and the home also has a copy of the Wiltshire and Swindon Vulnerable Adults protocol. Referrals have been appropriately made in relation to service user incidents. Mr Nosko reported that experience of the procedure has enhanced learning and some staff have covered adult protection within their NVQ training. Additional adult protection training is however planned. A small amount of service users’ personal money is kept in the home for safekeeping. A number of cash amounts were checked and balance sheets were viewed. All were found to correspond, with receipts numbered accordingly. At the last inspection it was noted that service users were paying for staff meals when out and car parking. A requirement was made to stop this practice and reimburse money accordingly. Mr Nosko reported that this Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 16 practice has since ceased and service users have been reimbursed. Balance sheets did not demonstrate any such expenditure. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 17 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 standard(s) 24, 25, 26 and 28 77 The Street is a small cottage, located in a rural village setting with no immediate neighbours. All areas are homely, comfortable and well maintained. Private accommodation is personalised to a high level demonstrating choice and individuality. EVIDENCE: 77 The Street is a small cottage within a very rural location in the village of Kilmington. The cottage is surrounded by open countryside and does not have any immediate neighbours. A service user gave the inspector a tour of the accommodation and all areas were noted to be clean, homely and well maintained. Communal areas consist of a small sitting room and a separate dining room. There is a small kitchen and upstairs bathroom. Both service users have a single room and there is a staff sleeping in room, which is also used as an office. One service user spoke with enthusiasm regarding his room, which he had just cleaned. The room was highly personalised with many possessions Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 18 and important home entertainment equipment. Within the bathroom it was evident that some tiling was in need of attention. Mr Nosko reported that this had been reported and was awaiting a visit. Risk assessments are in place regarding possible injury from radiators and as a result of such, covers have not been fitted. The home has a garden, its own driveway and an area for car parking. On the day of the inspection a service user was cutting the grass. He reported that grass cutting was his usual job. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 and 36 Staffing levels are maintained as agreed by the previous Registration Authority. Robust recruitment procedures are in place minimising the risk of inappropriate selection. Training and supervision systems have been developed and appear to be working well. EVIDENCE: Staffing rosters were viewed at Dalwood Farm and explained by the deputy manager on duty. It was evident that staffing rosters are viewed as a whole and therefore cover arrangements within both care homes. Staff at 77 The Street generally sole work although additional staffing is deployed in accordance to service users’ needs and general activities of the day. Mr Nosko, support worker, reported that service users also spend time at Dalwood Farm. This enables service users to have the benefits of a larger staff team. At night a member of staff provides sleeping in provision. An on call management system is also available. As stated earlier in this report, additional matters such as gender are taken into account when devising the staffing rosters. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 20 The home benefits from an established staff team. Since the last inspection there has been one new member of staff. This recruitment process and a number of personnel files were viewed and all contained the required information. Since the last inspection training and supervision systems have been considerably developed. A record of all training staff have undertaken is in place and courses required are identified. At the last inspection a requirement was made to ensure all staff have training regarding physical intervention. Mr Nosko reported that one training session had been undertaken and another is planned. Additional training has also included medication administration, first aid and infection control. The NVQ programme is progressing well and six staff within the team, including Mr Nosko, have NVQ level 3. One member of staff has NVQ level 2 and four are undertaking the qualification. One member is planning NVQ level 2 and another is planning level 3. The deputy manager is also undertaking the Registered Managers Award. Mr Nosko is planning diabetes, epilepsy and autism training for all staff. Supervision systems have recently been developed with Mr Nosko, the deputy manager and the senior support worker formally supervising. Sessions have taken place on a two monthly basis, are recorded and signed by both the supervisor and supervisee. Since the last inspection staff meetings, with the whole team have also been developed. These are recorded and demonstrate service user issues and the general running of both homes. It was recommended that all staff sign the staff meeting minutes. All staff appeared enthusiastic regarding their role and productive interactions were viewed. External activity and opportunity appeared paramount and staff spoke clearly of developing service users’ skills, confidence and achieving individual goals. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 Mr Nosko spends limited time within the home, yet meets with service users and staff during their time at Dalwood Farm. A system to monitor the quality of the home is in the process of being established. Health and safety systems minimise risks to service users yet monitoring of hot water temperatures is required to ensure protection. EVIDENCE: As stated earlier within this report, Mr Nosko is the Registered Manager of both Dalwood Farm and 77 The Street. Mr Nosko reported that as service users have varied programmes and are often out, he makes visits to check the environment and to view record keeping. A record of the visit is made. Mr Nosko, meets service users and staff, generally on a daily basis at Dalwood Farm. Staff also attend staff meetings and undertake supervision within Dalwood Farm. Mr Nosko confirmed that although his time at 77 The Street is limited, individuals from the home gain his time and attention appropriately. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 22 Mr Nosko was informed of the need however, to continue demonstrating his time within the home. Mr Nosko has previous experience of working with people with a learning disability and within discussion demonstrated a clear understanding of service user needs. Mr Nosko has NVQ level 3 and has recently submitted all work for the completion of the Registered Manager’s Award. Service users appeared relaxed around Mr Nosko and positive relationships were evident. At the last and previous inspections a requirement was made to develop and maintain a Quality Assurance system. Mr Nosko reported that in order to develop knowledge of the topic and introduce a system effective for the home, a manual with strategies has been purchased. The implementation of the manual is in its initial stages although questionnaires have been developed and given to service users’ family members and care managers. The questionnaires give good feedback including ‘We are very happy with the care our son is receiving.’ As further work is planned and some progress has been made in the area of Quality Assurance, a requirement was not set on this occasion. Further progress however, is expected to occur and will be viewed at the next inspection. The property is well maintained and attention is given to health and safety matters as required. Mr Nosko reported that maintenance work is generally undertaken efficiently following request. Risk assessments acknowledged that service users are not at risk from radiators and therefore covers have not been fitted. Due to the promotion of independence, hot water is currently unregulated although risk assessments are in place. Mr Nosko was informed of the need to monitor and record hot water temperatures and undertake any action as a result of unpredictable or exceedingly high temperatures. At present visual checks of the electrical appliances are undertaken although Mr Nosko reported that he is planning to formally train a member of staff to undertake PAT testing. Fire safety documentation was satisfactory with fire drills listing participants and the outcome of such. Documentation demonstrated vehicle checks although Mr Nosko was advised to make sure staff record when faults are rectified. A declaration notifying management of any driving offences was also recommended. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x 3 x x Standard No 11 12 13 14 15 16 17 x 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Street (77 The) Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15 Requirement The Registered Person must ensure that care plans give clear information regarding the management of prominent matters. Behavioural strategies must be agreed with relevant professionals, confirmed in writing and be regularly monitored and reviewed. The Registered Person must ensure that the medication administration sheet is an accurate record of all medication taken. Any medication which is no longer used must be disposed of appropriately. The Registered Person must ensure that hot water temperatures are monitored and recorded on a regular basis. Unpredictable or exceptionally high temperatures must be addressed accordingly. Timescale for action 16th December 2005 2. 20 13(2) From 20th September 2005 3. 42 13(4)(c) From 20th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 25 No. 1. 2. 3. 4. 5. 6. Refer to Standard 6 20 22 36 42 42 Good Practice Recommendations The Registered Person should ensure that limitations or consequences of actions are recorded, agreed with service users and their care managers and regularly reviewed. The Registered Person should ensure that a member of staff countersigns any written instruction to the medication administration sheets. The Registered Person should ensure that the Complaint Procedure is updated to include the CSCI. The Registered Person should ensure that all staff sign the staff meeting minutes. The Registered Person should ensure that all faults highlighted within vehicle checks are recorded when rectified. The Registered Person should ensure that staff sign a declaration notifying management of any driving offences. Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 Page 26 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Street (77 The) D51_D01_S28232_STREET(77)_v240706_210905_Stage4.doc Version 1.40 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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