Inspection on 29/01/07 for Averill House

This inspection was carried out on 29th January 2007.

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

Averill House 18/02/09

Averill House 08/10/08

Averill House 08/10/07

Averill House 17/01/06

Averill House 31/08/05

Averill House 15/12/04

Averill House 17/06/04

Averill House 06/01/04

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

CARE HOMES FOR OLDER PEOPLE Averill House Averill Street Newton Heath Manchester M40 1PD Lead Inspector Geraldine Blow Key Unannounced Inspection 10:00 29th January 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Averill House Address Averill Street Newton Heath Manchester M40 1PD 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) 0161 688 6690 0161 688 6602 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Ian Parker Care Home 48 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (48), Mental disorder, excluding learning of places disability or dementia (48), Mental Disorder, excluding learning disability or dementia - over 65 years of age (48) Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents shall be 48, of whom no more than 46 require nursing care. Residents requiring care by reason of dementia shall be aged 65 years or over with the exception of one named resident. Should this resident no longer reside at the home or their primary need for requiring care change, this place will revert to the category of dementia, over 65 years of age (DE(E)). Residents requiring care by reason of mental disorder, excluding learning disability or dementia, shall be 60 years of age or above with the exception of one named resident, who is currently below this age. 17th January 2006 3. Date of last inspection Brief Description of the Service: Averill House Nursing Home provides accommodation, with nursing care, for a maximum of 48 older people. The home is able to accommodate 45 residents assessed as requiring nursing care and 3 residents assessed as requiring personal care only. All residents had been assessed as having mental health needs. The premises are owned by Nursing Home Properties (NHP) PLC and are leased to Southern Cross Healthcare Limited. The home is situated in the Newton Heath area of Manchester close to a local market, shops, public houses, a park and other social areas and amenities. The home was first registered with the National Care Standards Commission, now the Commission for Social Care Inspection (CSCI), on 30 July 2002 and consists of a large purpose built home set in its own grounds, which was shared by its sister home operating on the same site. The home offered accommodation in 48 single, en-suite bedrooms. Accommodation for residents is provided on two floors accessed via a passenger lift and stairways. Each floor offers 2 lounges and one dining room. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 17 January 2006. The home did not submit the pre-inspection questionnaire, requested by the CSCI, for supporting information. This visit forms part of the overall inspection process and was conducted by 2 inspectors and took place on Monday 29 January 2007. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS) and the requirements made at the inspection on 17 January 2006. This inspection was also used to decide how often the home is to be visited to make sure that it meets the required standards. As part of the visit time was spent with the residents who live at the home, observing how staff work with residents, discussions with staff and the registered manager, assessing relevant documents and files and a tour of the premises was undertaken. What the service does well: The home offered a clean and pleasant environment for the residents who lived there. The atmosphere in the home felt relaxed. Staff were seen to be caring and sensitive in the way in which they carried out their duties. One member of staff was seen supporting a resident who was expressing some emotional difficulties and she provided quality time and appropriate intervention to comfort and reassure the resident. Residents’ spoken to said that they enjoyed living at the home and were complimentary about staff. A relative spoken to expressed satisfaction with the care provided and felt that staff were able to meet his relatives needs. He felt confident in approaching staff with any issued of concerns and said that they always responded positively. The home carried out a pre admission assessment before a resident was admitted to the home to make sure that the home could meet the person’s needs. A choice of meals was available at each mealtime and the manager said that any reasonable alternative to the menu could be provided. Residents were seen to be enjoying their lunch. During the meal time staff were seen Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 6 providing 1:1 support to those residents who required additional help. The meal of the day reflected the information on the menu board. The home employed a part time activity organiser and were in the process recruiting a second one. The home provided a variety of activities, which residents could participate in if they wished. The activities varied for example from a ‘winter warmer party’ to outside entertainers with a curry or potato pie evening. On the day of this visit some residents were seen to be enjoying a painting session and a poster was on display for a Valentines Day party. The home had an open visiting policy and visitors could be seen in the privacy of residents bedrooms or in any of the communal areas of the home. One relative spoken to said that “the staff always make me feel welcome”. The home offered and encouraged training for staff to ensure that they have the necessary skills to meet the needs of the residents accommodated. Systems were in place to support residents or visitors to make a complaint. What has improved since the last inspection? 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. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes an assessment of prospective residents ‘care needs prior to their admission. EVIDENCE: Prospective residents have a pre-admission assessment to ensure that the home can meet all of their assessed needs. The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. For residents referred through the care management arrangements, the home would obtain a summary of the care management assessment prior to admission. The manager said that all prospective residents and their relatives or representatives were informed verbally whether the home was able to meet their individual care needs. The manager said that with all future admissions, this information would be confirmed in writing to the resident. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, the health and personal care needs of the residents appeared to be met at the home. Staff were respectful in the way they delivered care to residents, and care plans provided staff with information on how residents wanted to be cared for. EVIDENCE: Random samples of files were inspected. Files were well organised and maintained, and divided into relevant sections which made them easy for staff to use daily as a working tool. Care plans included pre-admission assessments, which identified the needs of residents. There was a review sheet on each care plan to indicate that the care plan had been regularly reviewed to reflect any changes in care needs. Documentation provided evidence that care plans were reviewed at least once a month, and in some cases reviews had been carried out more frequently to reflect changing needs and to provide additional support to relatives. Care Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 10 plans included details of strategies and interventions required to meet individual needs with details of any planned action required. There was evidence of an ongoing evaluation of residents care needs and clear links from the initial assessment of identified need, to current evaluations of planned care. Instructions for staff on how to support residents and minimise risks were clear and detailed. Appropriate risk assessments were evidenced on file. Through the case tracking process, it was possible to evidence the care plan in action. Staff were observed delivering appropriate care and support to a number of residents in the home and it was evident that staff had a good understanding of individual care needs. Care plans included a relative communication record, which provided evidence that all issues of concern, which were raised by relatives, were taken seriously by the home. Information was well documented detailing any concern and the home’s response to the issues raised. This document could be cross referenced to the care plan, and showed that the home made every effort to include the resident and their relatives in developing their own care plan. Most of the Medication Administration Record Sheets (MAR) were clear and accurate and provided evidence that medicines were being administered as prescribed. The records showed that most medications could be accounted for by means of a clear audit trail. However, it was seen that some medication had been prescribed “as required”. As required is not sufficient information to enable nurses to administer medication as prescribed by the doctor and therefore the doctors’ instructions must be recorded. In addition, it was noted that one resident had been prescribed ‘Thick and Easy,’ which is an agent to thicken drinks/soups for people who have swallowing problems and a number of wound dressings. The MAR sheet did not clearly evidence that all drinks/soups had been thickened or that the dressing had been applied. In order to ensure that residents’ care needs are being met it is vital that a record is maintained of each drink / soup etc that has been thickened. Further to this any other liquid the residents have had to drink must be recorded and that a record must be kept of the prescribed dressings applied. It is essential that the person applying the dressing or making the drink signs a sheet, this does not have to be the nurse and it does not have to be signed on the MAR sheet, a separate sheet may be constructed for each resident and the MAR must clearly state where they are being signed for. It was noted that in one instance there was a hand written change to the MAR. There were 2 signatures but the change had not been backed up by a fax from the GP. The manager said that it was usual practice for a fax to be requested but this nurse appeared unaware of this. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 11 Waste medication was appropriately stored and there was a record of the medication, however it is recommended that 2 staff witness and sign for the disposal of waste medication. From observations made during the inspection it appeared that the nurses and care staff treated the residents with respect and dignity. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were encouraged to take control over their own lifestyle and encouraged to maintain contact with family and friends. EVIDENCE: There was an ‘open’ visiting policy in the home and visitors could be seen in the privacy of the resident’s own room or in any of the communal areas. Visitors were observed coming and going throughout the day and appeared relaxed and at home in the environment. One relative who was spoken to said he visited two or three times a week and said, “The staff always make me feel welcome”. It was clear from observations that residents appeared relaxed and settled in their environment and there was a calm atmosphere throughout the day during this visit to the home. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 13 From observations and discussions with staff it appeared that residents were encouraged to exercise choice and control with regard to their day-to-day lives. A number of staff had undertaken recognised Alzheimer’s training called, ‘Yesterday, Today and Tomorrow’ providing them with additional skills and expertise to assist them in supporting the residents in the home. Information and leaflets advertising independent advocacy services was made available in the entrance / reception area of the home. The manager of the home said that Citizens Advise Bureau made visits to the home and offered advocacy services. Several of the bedrooms had been personalised with residents’ belongings brought in from their own homes. All bedroom doors included a personalised door plate with the name of the resident occupying the room, a door knocker and letterbox, and a photograph of the resident to assist with orientation and to support residents in finding their way back to their own bedroom. Notice boards were located throughout the home, in the reception area, and on both floors of the building. The boards were clear and uncluttered which made it easy for residents to see what activities were on offer. The home employs an activity organiser for 18 hours per week, and the provider was in the process of recruiting a second activity organiser for the home. The activity organiser was spoken to during this visit, she had a good awareness of her job role and the importance of seeking the views of residents to obtain information on likes, dislikes and preferences with regard to activities. The activity organiser explained that she used information in the care plans to develop the activity programme and where possible consulted with residents and their relatives. During this visit to the home there was a painting activity taking place. A ‘winter warmer’ party had been organised the previous week, and there were plans to invite outside entertainers into the home. The activities organiser maintained a record of all activities. The lunchtime meal was a relaxed and social occasion. Staff were observed in providing appropriate and sensitive intervention and support to those residents who required additional help. Residents said they were offered a choice of menu and two resident’s spoken to were complementary about the quality of the meals served in the home. On the day of inspection there was a choice of main meal, which included egg and chips, beef stew, soup, sandwiches. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Polices and procedures were in place to protect residents from neglect and abuse, however, some staff lacked understanding of Adult Protection Procedures. EVIDENCE: The home used the Manchester Multi- Agency policy for the Protection of Vulnerable Adults from Abuse, including the Department of Health Guidance ‘No Secrets’. Most staff had completed training in Adult Protection and this was evidenced on the updated staff training record. Staff spoken to during this visit were aware of issues surrounding abuse and the importance of reporting any allegation of abuse, however, it was evident that some were not aware of the home’s policy and associated procedures. A recommendation has been made that the policies and procedures are drawn to the attention of the staff. If the home has residents placed from outside the Manchester area the adult protection policies and procedures need to include referral contacts of all those local authorities. The home had a complaints policy and maintained a record of all complaints made, and the action taken following the complaint. There was evidence in the Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 15 recordings that all complaints were taken seriously and were dealt with promptly and efficiently. There had been three complaints made directly to the home since the last inspection visit. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean well maintained environment is provided for residents. EVIDENCE: The home has a passenger lift and appropriate aids and adaptations to promote and encourage independence. The home is maintained to a good standard throughout. A handyman was employed to carry out routine maintenance work throughout the home. Accommodation is provided in single bedrooms with en suite facilities. All rooms are light, airy and can easily accommodate resident’s own furniture and fittings. The home provided ample toilet and bathroom facilities. Toilets were conveniently located in close proximity to bedrooms and communal areas. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 17 Bathroom and toilet doors were fitted with privacy locks. A variety of bathing facilities were provided to meet a range of needs. There was evidence of ongoing decoration and maintenance throughout the home. Some bedrooms had recently been re-decorated and the hallways and corridors were scheduled for re-decoration this year. There was a high standard of cleanliness throughout the home. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff available appeared sufficient to meet the residents assessed needs and the home’s recruitment procedure appeared to protect the residents accommodated. EVIDENCE: The numbers and skill mix of the staff appeared to be sufficient to meet the needs of the number of residents accommodated. Evidence was seen that extra staff were employed to cover for example, planned escort duties or if residents required individualised care. Evidence was seen of continued ongoing staff training and development in key topics of care practice for example Fire Training, Moving and Handling, Food Hygiene, COSHH, Health and Safety and Dementia Care. In addition evidence was seen that over 50 of care staff are trained to NVQ Level 2. A random selection of staff files were examined and were seen to contain all the appropriate documentation as required by Schedule 2 of The Care Homes Regulations 2001. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident were supported to influence the way the home is run, and to participate in developing the service. Systems were in place to safeguard and protect residents’ financial interests. EVIDENCE: Since the last inspection the home had developed a new system for managing residents’ finances. The manager said that this had taken place following consultation and agreement with CSCI’s Provider Relationship Manager (PRM). The new system enabled the administrator to update residents’ finance records on a day-to-day basis, and the new system provides access for the bank to apportion interest from savings to each individual resident using this method of saving. The manager said that the system complied with Data Protection. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 20 The manager said that this system was designed to protect the financial interests of residents in the home, but where possible, residents would be assisted to save in their own bank account, and that appropriate support would be given. At the time of this visit the manager had just returned from a 6 month secondment. During this period of absence he had maintained some contact with the home by providing staff training and ‘pop in’ visits. Staff spoke highly of the management style in the home, and said that the manager was fair and supportive. The manager carries out regular audits of care plans, supervision of staff, training, medication and all aspects of care practice within the home. Further audits of care practice are carried out monthly by the operations manager. The manager said that the views of residents and their families or friends were sought both formally and informally. Resident comment cards were available in the reception area of the home and the manager said that Quality surveys were sent out once a month. The manager also holds a regular weekly surgery where visitors can contact him to discuss or raise issues of concern. Some discussion took place about recording the findings from quality questionnaires and including them in resident information packs and the service user guide so that residents and their visitors can see how the home was performing in the delivery of care services within the home. Evidence was provided that the home had appropriate service contracts in place for equipment and installations used in the home and that servicing was undertaken at the required intervals to ensure the safely of residents. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13.2 Requirement The Registered Person must make arrangements for the recording and safe administration of medicines which are detailed below: 1. The home must have sufficient information to enable nurses to administer medication as prescribed by the doctor and therefore the doctors’ instructions must be recorded. 2. The MAR sheet must clearly state where prescribed medication such as drink thickeners and wound dressings are being signed for as given. Timescale for action 19/02/07 Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 23 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 OP9 Good Practice Recommendations 1.It is recommended that the MAR should clearly cross reference to where there is a signed accurate recording of thickened fluids and wound dressings. 2. It is recommended that all staff are made aware that any verbal changes of medication is supported by a fax. 3. It is recommended that 2 staff witness and sign for the disposal of waste medication. 2. OP18 It is strongly recommended that the policies and procedures relating to the Protection of Vulnerable Adults are drawn to the attention of the staff. Averill House DS0000021631.V313084.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection CSCI, Local office 11th Floor West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Averill House DS0000021631.V313084.R01.S.doc Version 5.2 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. 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