Inspection on 17/08/06 for Ashbridge Road (22)

This inspection was carried out on 17th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashbridge Road (22) 02/12/09

Ashbridge Road (22) 02/10/07

Ashbridge Road (22) 23/03/06

Ashbridge Road (22) 02/02/05

Ashbridge Road (22) 05/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashbridge Road (22) 22 Ashbridge Road Leytonstone London E11 1NH Lead Inspector Yemi Adegbite Unannounced Inspection 17th August 2006 10:50 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 Ashbridge Road (22) DS0000007277.V308537.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 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. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashbridge Road (22) Address 22 Ashbridge Road Leytonstone London E11 1NH 020 8989 1170 020 8530 5339 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) Mrs Shirlene Hasmat-Ali Ms Claire Thorne Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd March, 2006 Brief Description of the Service: Sable Care is part of Sherico Care Homes group and provides care, support and accommodation for four adults with a learning disability (inclusive of services for people with challenging behaviour and autism). The home is a four bedded, Victorian style house situated in a residential road in Leytonstone within easy reach of an underground station, bus routes, local shops and amenities. The home has two upper floors, containing four bedrooms, two bathrooms and an office. There is a lounge with an adjacent visitors room/quiet room, a kitchen/dining area and a laundry room on the ground floor. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced commencing at 10.50am and conducted over a period of two days; the first day at the home whilst the day second day of the inspection was conducted at the head office, inspecting staff personal files. The inspectors reviewed compliance with the 12 requirements and 5 recommendations made at the last inspection on the 23rd March 2006. The inspectors met 3 service users; spoke to 3 members of staff, the registered manager and the responsible person during the inspection. A tour of the environment was undertaken, service users care plans read, policies and procedures of the home reviewed and all National Minimum key Standards inspected. An unannounced inspection gives the Commission an opportunity to assess the home against the National Minimum standards applicable to the service without the home having notice of the visit. Verbal feedback was given to the registered manager after the inspection. The inspectors would therefore like to take this opportunity in thanking the registered manager and staff for their full cooperation. What the service does well: What has improved since the last inspection? All requirements in the last inspection have been met apart from the adult protection training, which is booked for September. On-going training for staff now taking place however the registered manager must ensure that ‘person centred planning’ must be reflected in service users care plan. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 6 The statement of purpose has been updated and service users contract printed in a pictorial format. Evidence was seen of annual portable appliances test and first aid box now well maintained. Services users now risk assessed in relations to having own keys however the registered manager must ensure that on-going risk assessment is carried out to reflect service users changing needs. Monthly progress reports on service users were quite detailed and well laid out however information from the reports could be further evaluated in helping the service users achieve more goals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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, 2 & 5 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. Evidence was seen that prospective service users have the necessary information required to make an informed decision about where to live. EVIDENCE: The home is fully occupied with the last service user admitted in 2003. Policies and procedures relating to admission were inspected and deemed to be appropriate in relation to the National Minimum Standards. The inspectors were shown the new up-to-date version of the service users guide, which is now printed in pictorial format (this is one of the requirements met from the last inspection). The registered manager stated that service users have regular family and social contact. It was also stated by the registered manager that service users attend day centres and at times, worship at the local church. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 9 It was noted that the home lacks a clear method of communication in relation to a non-verbal service user. Staff on duty both demonstrated and explained two different ways to the inspector when asked to demonstrate how they would prompt a non-verbal service user with autism to use the toilet. It was suggested to the registered manager that a clear guidelines with consistent approach should be implemented to ensure that all staff are consist with communicating method. It was positively noted however, that at times objects of references is used to aid more understanding in regards to communication e.g. a towel is shown to indicate bath time. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 10 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): 6,7,9, & 10 The quality in this outcome area is poor. This judgement had been made using available evidence including a visit to this service. Care plans were not adequately reviewed and at times lacking a comprehensive risk assessment. EVIDENCE: Recorded evidence on the care plans indicated that service users receive support from agencies such as: the community nurse, speech therapist and a psychotherapist. However during further review of a service users files, it was noted that this professional input has been stopped as registered manager stated that the service user was not benefiting from the service provided. Recorded evidence seen by the inspector suggested that medication was at times administered as the first line of action to a service user with challenging behaviours. It was suggested that the input of the psychotherapist should be re-instated for the service user, with all members of staff undertaking training in dealing with challenging behaviours at the work environment. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 11 Through cross-tracking of relevant information, the inspectors noted that a service user with challenging behaviour last had her risk assessed in February 2004 which does not reflect her changing needs. It was stated to the registered manager the importance of having up-to-date detailed risk assessment. It was the view of the inspector that a procedure/guidance should be implemented with a plan of intervention, highlighting ways of defusing challenging behaviour. For example, it was noted during file tracking that a service user with autism did not have appropriate risk assessment in place. The Registered manager stated that service users are encouraged to make personal choice and participant in the everyday living of the home. Service users are encouraged to undertake tasks such as helping with cleaning their bedroom and setting up the dining table. Service users are encouraged to maintain their own personal space; with service users being allowed to chose own daily clothing, preparation of drinks according to ability. However the inspectors advised that more achievable goals needs to be set and recognised with detailed risk assessment undertaken, which should be implemented and reflected in individual care plan for such activities. Records of service users finances was inspected and deemed accurate. However, evidence was seen by the inspector indication that staff are using their own personal ‘club card’ to collect points when using service users own money. This practise must be stopped and it was suggested to the registered manager that all service users have their own individual ‘club card’. The inspector saw evidence that confidential information relating to service users was recorded in the daily communication book. It was suggested to the registered manager that a secure practice should be implemented when recording confidential information relating to service users. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 & 17 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The home offers service users the opportunity to participate in daily living both in and outside of the home. EVIDENCE: As stated in the last inspection report, service users still continue to access and attend local resource centre in the community such as Mencap and the African and Afro Caribbean support network. The registered manager stated that service users are taken on holiday annually. It was also stated that service users are supported to access the local facilities, and accompanied/supervised when in the community. However emphasis should be placed on activities provided around the home as it was noted that all three service users present during the inspection were in the lounge for the whole duration watching television with little interaction from the staff. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 13 The registered manager stated that family contact is maintained and visitors are encouraged and allowed in the home. The inspector noted records of service users visiting relatives. Through direct observation, the inspector saw service users having free access to the home and entering their bedrooms freely. The registered manager stated that sexual health issues are dealt with in a caring and understanding manner. Community nurse to visit in the next couple of weeks in regards to offering advice and guidance with on-going sexual issues. The menu seen reflected cultural and individual choice with service users encouraged to help with the shopping, however all meal changes must be reflected on the menu (service users had a different filling sandwich to the one indicated on the menu but was not changed until after comment from the inspector). The inspector saw evidence that food was stored inappropriately. Food clearly marked as ‘to be refrigerated when opened’ was stored in the cupboard after it was opened, an out of date egg was stored amongst the good ones in the fridge. The inspectors noticed two functioning fridge/freezers in the kitchen but the record book indicated only one fridge temperature was recorded on a daily basis. It was also noted by the inspectors that although the fridge/freezer daily temperature were read and signed for, adequate measure was not taken when temperature exceeded required level. The second fridge also exceeded a safe level, the broken door seal must either be changed replaced as a matter of urgency. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 14 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 The quality in this outcome area is poor. This judgement had been made using available evidence including a visit to this service. The home was inspected on all key standards. Medication needs to be reviewed regularly and audited thoroughly. EVIDENCE: A requirement was issued in the last report in relation to surplus supplies of medication being returned to the pharmacist (this requirement now met). Medication is dispensed by pharmacist in a colour-coded monitored dosage system. The inspector noted that auditing of the PRN recording book were at times inaccurate. The registered manager was therefore advised to audit PRN book monthly for easy accountability as the inspector noted that 2 tablets of 1mg Lorazapem were unaccounted for between the 3rd and 4th of June 06. Two tablets of 5mg Haloperidol also unaccounted for, PRN book indicated 56 tablets left in box but only 54 available during inspection, again book was audited on the 20/3/06 and 4/6/06 but mistake not identified. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 15 Paracetamol was administered to a service user on the 31/7/06, which was signed for in the PRN book as given but signed as not required on the MAR sheet. It was suggested to the registered manager as good practise to record an indication of event leading up to PRN medication ‘Lorazepam’ been administered for easy tracking. All staff must be made aware of when to administer PRN medication to a service user who displays changeling behaviour, this was recorded as when service user becomes ‘upset’ but no evidence of risk assessment was seen on file to identify behaviour that might triggers service user to become ‘upset’ or what line of actions to be taken afterward. Changes in service users medication was recorded in the communication book. Cross tracking of evidence indicated this information was not transferred to the service users file. An increase of medication for a service users was written on a ‘post-it’ which, was stuck on the front MAR sheet with no explanation as to why medication had to be increased. The registered manager stated that service users benefit from the input of speech therapists and community nurse; evidence was also seen on file by the inspectors of visits to GP, which was well documented. However no records were maintained to indicate regular dental appointments were made, the last entry was made in 2004. An urgent referral for a Psychotherapist input has been recommended for a service user with changeling behaviour. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 16 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 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. Policies and procedure relating to complaints were seen and deemed to be appropriate. EVIDENCE: The home has appropriate complaints policy and procedure in place and there has been no complaint since the last inspection. However the registered manager must ensure that all adult protection issues are comprehensively investigated and reported to all necessary agencies as stated in the homes policy and procedure and in compliance with the National Minimum Standards. A previous requirement had been met relating to the whistle blowing policy but this needs to be further amended to reflect appropriate person in the organisation, the present policy refers to the ‘service manager’, ‘social work manager’ etc which does not equate with job titles or roles within the organisation according to structure outlined in the statement of purpose. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 the following standard(s): 24,25,27, &30 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. EVIDENCE: The inspector was satisfied that the premises is suitable for the stated purpose, it was observed to be clean and well maintained. The service users bedrooms are of adequate size. Requirements relating to this standard in the last inspection were met. However other minor issues relation to the environment were noticed by the inspector; the hinge on the garden door is very lose and unsecured which should either be secured or replaced and the stained dining chair in the kitchen to be cleaned. Two service users bedrooms were also inspected which looked homely and tidy. However, it was noticed by the inspector that a cupboard in the room on the top floor next to the office was broken. A hook protruding into the shower Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 18 over-bath on the top floor should be removed for reasons of health and safety. In the same bathroom, ceiling paper was ripped and should be made good. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 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): 31,32,34 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. 50 of staff have now acquired NVQs. There were sufficient numbers of staff on duty to meet the needs of the service users. The staff that received the inspectors was welcoming and professional in her duties. EVIDENCE: The registered manager stated that staffs are receiving on-going training, adult protection training was booked for all staff in September, food and hygiene and first aid training was booked for the 21st of August with eight staff members attending. As the home provides care to an autistic service user, it was suggested to the registered manager that more awareness and training should be undertaken in this area. The registered manager showed the inspectors a handbook on ‘person centred planning’, which she said was discussed at the staff meeting. Training have been booked for all staff on the 24th of August. The registered manager was advised to ensure that this is properly implemented in service users care plan. Personnel file of the recent staff employed together with the registered manager were inspected. The application form for the most recent staff employed showed gaps in employment history yet this was not investigated Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 20 during the interview process, relevant references were not seen from previous employer. Interview process needs to be more robust as evidence seen by the inspectors indicated relevant questions relating to the job applied for was not asked and gaps in employment history could have being further investigated during the interview process. Evidence of enhanced CRB was not filed in the individual folder but was faxed to the inspector by the responsible person. The responsible person was advised to ensure that all CRB forms must be filed and only destroyed after verified as seen by an inspector. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 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): 37,41, &42 The quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. EVIDENCE: Evidence of the monthly-unannounced visit by the responsible person was seen, however there was no evidence of a visit being conducted in July 2006. The responsible person stated that this inspection was carried out on the 10th of July, but the inspector was unable to verify this as the visitors book was not signed to indicate visit on the particular day in question. The responsible person was advised that it is good practise for all official visitors to the home to sign in the visitor’s book. The responsible person must ensure that the business plan is reviewed in accordance with the policy stated by the organisation. The business plan shown to the inspectors by the registered manager was out of date by two years. Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 22 The following health and safety checks are in place: Fire alarm system tested – 16/05/06 Portable electrical appliance tested – 12/07/06 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 1 3 X 4 X 5 3 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 2 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 X 34 1 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 1 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 2 X X X 1 3 X Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 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 YA2 Regulation 2 Requirement The registered manager must ensure that care plans are updated in accordance with the Nation Minimum Standards. The Registered manager must ensure that comprehensive risk assessment are undertaken to ensure that all unnecessary are identified. The registered manager must ensure that risk assessment easy achievable goals is set with risk for service users with The registered manager must ensure that personal loyalty cards registered to service users is used when making purchase with service users money. The registered manager must ensure that confidential information is recorded appropriately. The registered manager must ensure that change of meals is reflected on the menu. The registered manager must ensure food is stored appropriately. The registered manager must ensure that appropriate action is DS0000007277.V308537.R01.S.doc Timescale for action 20/12/06 2. YA9 12(a) 20/12/06 3. YA19 12(2) 20/12/06 4. YA23 7 30/11/06 5. YA10 17. (1) 30/11/06 6. 7. 8. YA17 YA17 YA42 16. (4) 16. (4) 23. (2)(c) 31/10/06 31/10/06 31/10/06 Ashbridge Road (22) Version 5.2 Page 25 9. 10. 11. 12. YA42 YA20 YA20 YA19 23. (2)(c) 13. (2) 13. (2) 17 13 YA22 21. (2) 14 15 YA42 YA42 13(4)(c) 13(4)(c) undertaken when fridge temperature exceed a safe level. The responsible person must ensure that the fridge door is either repaired or replaced. The registered manager must ensure that MAR sheet is appropriately signed. The registered manager must ensure that PRN medication record is accurately audited. The registered manager must ensure that service users health issues are evaluated and appropriate actions taken. The responsible person must ensure that the whistle blowing policy is amended to reflect the organisation job title as outlined in the Statement of Purpose. The responsible person must ensure that the garden door is either made safe or replaced. The responsible person must ensure that the following actions are taken: (1) The broken cupboard in bedroom next to the office be repaired or replaced. (2) Hook in top floor shower should be removed for health and safety reasons. The responsible person must ensure that the interview process is more robust with employment gaps properly investigated. 30/11/06 31/10/06 31/10/06 20/12/06 20/12/06 30/11/06 20/12/06 16 YA32 19. (1)(b) 20/12/06 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations The registered manager was advised to set easy achievable goals ensuring goals are risk assessed and implemented. The responsible person must ensure that the business plan is reviewed in accordance with the organisation’s policy. This is recommendation is repeated. 2. YA43 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Ashbridge Road (22) DS0000007277.V308537.R01.S.doc Version 5.2 Page 28 - 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!