Inspection on 06/09/07 for Avondene

This inspection was carried out on 6th September 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

Avondene 17/07/06

Avondene 30/01/06

Avondene 09/09/05

Avondene 15/11/04

Avondene 20/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Avondene 171 Stanpit Mudeford Christchurch Dorset BH23 3LY Lead Inspector Carol Payne Key Unannounced Inspection 6th September 2007 09:30 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 Avondene DS0000026761.V350133.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. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avondene Address 171 Stanpit Mudeford Christchurch Dorset BH23 3LY 01202 483991 F/P01202 483991 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) Christchurch Housing Society Mavis Groombridge Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th July 2006 Brief Description of the Service: Avondene is registered with the Commission to accommodate a maximum of 11 residents in the category OP (old age). Christchurch Housing Society, a local charity, own and manage several other registered services in the area as well as Avondene. The home is a detached property occupying a corner plot close to Mudeford Quay and the local amenities of Stanpit. Christchurch town centre is a short journey away. There is access via public transport. There is a bus route past the home. All 11 bedrooms in the home are single with over half having en-suite facilities. There is a lounge, sun lounge and dining room. There is a sun porch at the entrance to the home. There are bathrooms on the ground and first floor. Current fees are £415 to £430. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_peop le_choos.aspx Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on the 6th September and took a total of 9 hours, including time spent in planning the visit. The inspector was made to feel welcome in the home during the visit. This was a statutory inspection and was carried out to ensure that the eleven residents who are living at Avondene are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit and key standards met at the last inspection on 17th July 2006 were also reviewed. The premises were inspected, records examined and the daily routine observed. Time was spent in discussion with three residents living in the home and two staff members on duty. Comment cards were received in April 2007 from eight residents, two General Practitioners and seven relatives or representatives. The home also returned a pre-inspection questionnaire at this time. Throughout and since the inspection the management and staff team have demonstrated a positive and proactive commitment to addressing any issues raised and continuously improving the quality of life for people living at Avondene. What the service does well: One resident said ‘this is my home now.’ Comments were received from people involved with the life of the service in April 2007 and reflect the positive feedback received during the visit. A person visiting the home regularly and completing a comment card said that it is a ‘happy home.’ A relative returning a comment card said that ‘The care of their residents is paramount.’ A General Practitioner returning a comment card said that it is ‘a well run home.’ Detailed pre-admission assessments ensure that no resident moves into the home without having their needs assessed, and being assured that they will be met. Personalised care planning, communication and contact with relatives and external professionals ensures that residents’ physical, health and social care Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 6 needs are met in a sensitive and supportive manner by the staff team working at Avondene. A varied activities programme is provided, which meets the individual needs and choices of people living in the home, enabling them to continue to enjoy relationships that are meaningful to them and experience a varied quality of life, which includes the provision of well presented and nutritious meals. Complaints and adult protection procedures in the home protect residents from harm, and enable them to raise any concerns, with confidence that they will be listened and responded to. Avondene benefits from a well-maintained and homely environment, which is kept clean and hygienic. This provides residents with comfortable and generally safe surroundings. The home benefits from satisfactory recruitment procedures which support the home’s commitment to ensure that there at all times sufficient numbers of staff working in the home with the skills that they need to meet residents’ needs. Avondene is well managed; audits and quality assurance support safe practice in relation to the health and safety of residents and staff working in the home. What has improved since the last inspection? What they could do better: Residents must be protected by the safe practices at all times in respect of the handling and administration of medicines. Medicines must be administered prior to signing to confirm that the resident has taken medication. When medicines have been administered or are refused, or not needed, this must be recorded. The reason for refusal of any medication must be made clear. Hazardous substances must be stored securely, protecting residents from the risk of harm. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed pre-admission assessments ensure that no resident moves into the home without having their needs assessed, and being assured that they will be met. EVIDENCE: Pre-admission assessments were viewed for two residents who had recently moved into the service. From records seen and discussion with the manager, she endeavours to visit prospective residents prior to making a decision as to whether the home is able to meet residents’ needs. The assessments were detailed and included, as appropriate, information from other health and social care professionals, who had been involved in care and support. Information included details of pre-existing conditions, physical and social needs and important details regarding people’s wishes and preferences regarding daily Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 10 life. A letter was seen on one of the files confirming that, according to the assessment carried out the home was able to meet the resident’s needs. The letter was personalised and welcoming. One of the residents who had recently moved into the home was spending time with other people living in the home during the inspection and said that they felt ‘settled and well looked after.’ When a new resident moves into the home an admission assessment is completed enabling staff to be aware of residents’ needs when they move in. All survey forms returned by, or on behalf of residents, said that they had received sufficient information about the home before they had moved in. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personalised care planning, communication and contact with relatives and external professionals ensures that residents’ physical, health and social care needs are met in a sensitive and supportive manner by the staff team working at Avondene. Although safe practice with regard to medication handling is generally good, the home is developing auditing in order to support the protection of residents by safe procedures at all times. EVIDENCE: Detailed assessments and care plans are completed, alongside details of daily routine. Care plans include reference to all aspects of daily living and there is evidence of consultation with residents, or their relatives, as appropriate. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 12 One resident’s care plan required updating as the resident’s needs had changed and the manager was aware of this and intended to review and update the plan. Regular reviews of care plans are recorded. Thorough daily records had been completed and showed that if there are any concerns regarding the resident’s health or well-being external health care professionals are consulted. In the case of one resident who, it was noted, required monitoring in terms of a health need, the manager immediately went to consult with staff to determine the resident’s current condition, so that she could ensure that their health and well being was monitored appropriately. Care records include details regarding medical conditions. Assessments include risk assessments of physical needs and details of contacts with external health and social care professionals. It was advised that body maps, which included details of any wounds or bruises are updated, or discontinued when problems are resolved. The manager has confirmed that this has been completed since the inspection. At the time of the inspection the home was not monitoring the temperature of the fridge to store residents’ medication on a daily basis. The manager has confirmed that monitoring now takes place each day. Medication Administration Records seen contained omissions; three on one resident’s record seen, where the person administering medicines had failed to sign to state if a medicine had been given, or the reason for omission had not been recorded. The manager was aware of the issue and taking action to ensure that members of staff understand their responsibilities to keep accurate records. Records are maintained of individual medicines prescribed and there were details of reasons for changes to medication in one record seen. One resident had tablets left on their table and the staff member giving out medication had left them unattended. The manager said that she intended to review this practice so that the resident is able to make choices about how they receive medicines, but ensuring that the resident also receives medicine at the time that it is prescribed. The staff member had signed that the medicine had been taken when it had not; she agreed that this practice must not reoccur. The manager confirmed that the home was not keeping any controlled drugs at the time of the visit. It was, however, recommended that the service consider obtaining suitable storage and a register in the event that a resident is prescribed a controlled drug, so that they can be safely held and recorded. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 13 Accurate records are maintained of the receipt and disposal of medicines. Throughout the visit staff members were observed providing support to residents with sensitivity and care. Residents’ privacy is respected. A relative was visiting a resident and enjoying spending time with them in their own room. Staff members knocked on doors before entering. Staff members did not make assumptions about what people living in the home would like to do and consulted them about if they would like to go outside, what they would like to do, and in asking if they needed any support, promoting residents’ dignity. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A varied activities programme is provided, which meets the individual needs and choices of people living in the home, enabling them to continue to enjoy relationships that are meaningful to them and experience a varied quality of life, which includes the provision of well presented and nutritious meals. EVIDENCE: Records are maintained of activities taking place in the home. Activities are planned for late morning and afternoon at times to suit residents. Activities include visits from the library, which one resident said that they always look forward to, music and movement and quizzes. One resident said that they still enjoy going out. Other residents prefer to stay in and records include social care plans and details regarding whether the resident has chosen to join in with activities happening in the home. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 15 On the morning of the visit some residents went to sit outside and enjoy the sunshine. Residents came into the lounge and conservatory in search of friends that they have made in the home. During the afternoon one resident was sat in their own room, they prefer to stay in their own room, watch television and have lots of books to read. Staff members respect the individual wishes of residents. One relative was visiting their family member. They said that they are always made welcome and never have to worry when they leave, as they know that their relative is well cared for. Comment cards from relatives stated that they always feel welcome in the home. Throughout the visit residents were offered choices about what they would like to do. One resident said ‘I prefer to stay in my room. I know the staff are there if I need them. A new staff member, who was serving drinks were careful to ask residents whether they liked sugar in their hot drinks. Care plans also reflected residents’ choices regarding the care and support that they need and how they like to spend their days. The manager has produced care routines for each resident, so that staff members are fully aware of what residents like to do and when, and how they can best support them and enable them to enjoy a good quality of life at the home. An agency chef was on duty at the time of the visit. Lunch was well presented and appetising. Fresh vegetables are used whenever possible. Home cooked puddings and cakes were seen. Residents in the dining room at lunchtime said that they had enjoyed their meal. One resident said ‘the food is very good. I have no complaints.’ Another resident said that if they don’t like what is on the menu they are offered an alternative. At the time of the visit the chef confirmed that no specialist dietary requirements were being met. One relative said in a survey form that there are ‘huge boxes of fresh vegetables.’ Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and adult protection procedures in the home protect residents from harm, and enable them to raise any concerns confident that they will be listened and responded to. EVIDENCE: One relative said that they had ‘no complaints’ about the home. From discussion with the manager and observation, she communicates regularly with all staff and residents working in the home, so that people feel that they can come to her with any concerns that they may have and feel confident that she will support them. The manager confirmed that no complaints had been received since the last inspection. Since the inspection the manager has clarified the home’s adult protection policy so that it clearly states the appropriate routes for referral of any allegations under the local No Secrets adult protection protocol. Training in adult protection takes place as part of the home’s mandatory training Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 17 programme. The home has demonstrated since the last inspection that any bad practices, which may affect residents, will not be tolerated. Avondene, from comment cards, is a place where people feel safe and well cared for. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Avondene benefits from a well-maintained and homely environment, which is kept clean and hygienic. This provides residents with comfortable and generally safe surroundings. EVIDENCE: The home benefits from a reception area where residents can sit and watch what is going on outside. There is also a grass frontage to the home and some residents were sitting outside in the fine weather during the visit. The home has a spacious lounge and conservatory, which provide pleasant communal areas. There is also a dining room, which is well decorated and reflects the homely environment of the service. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 19 There is a toilet near the lounge, which does not contain a wash hand basin. There is another toilet along the corridor, which is used by residents. The manager confirmed that staff members use the toilet near the lounge and then go down the corridor to wash their hands. The kitchen is nearer in terms of hand washing facilities. However, it was discussed that it would be inappropriate to use the kitchen due to the risk of cross infection. Two residents commented on the standard of their individual rooms. One resident spends a lot of time in their room and says it contains everything they need and has lots of personal items, which makes it their own. Another resident said ‘This is my home now and I don’t think I could do better.’ The washing machine was not working at the time of the visit. However it has been confirmed that a new machine has been installed, and is working since the inspection. Interim measures had been put in place to ensure that clothing and bedding is washed and returned to the home. Staff members were observed adopting good practices in relation to infection control during the visit. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from satisfactory recruitment procedures which support the home’s commitment to ensure that there at all times sufficient numbers of staff working in the home with the skills that they need to meet residents’ needs. EVIDENCE: A clear staff roster is maintained detailing the shift pattern of staff members working in the home. This reflected accurately the staff on duty at the time of the inspection. There is normally three staff on duty in the morning and two in the afternoon in addition to the manager. Staff members undertake cleaning and laundry duties as part of their roles. A maintenance manager was present in the home during the visit carrying out routine maintenance work. An agency chef was on duty covering for the full-time cook and there was an agency care staff member working in the home. The agency carer said that she comes to the home a lot and knew the residents’ needs well. The manager confirmed that there are presently six members of staff with a National Vocational Qualification (NVQ) in Care at level 2 and two members of Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 21 staff with an NVQ level 3 out of the eleven care staff members working in the home. Records were viewed for two members of staff who had recently started work in the home. One member of staff was on duty at the time of the visit. She was very sensitive and supportive in meeting the needs of residents. Recruitment records seen demonstrated that the home undertakes thorough checks prior to employing staff members to work in the home. The manager confirmed that the home is revising recruitment records to ensure that the service’s commitment to carry out detailed checks of applicants is clearly evidenced, ensuring that residents are protected by the home’s recruitment procedures. For example one application form seen stated the years that the applicant had worked at previous places of employment. It is intended that the new documentation highlight gaps in employment history, which are explained. The manager has compiled a list of training needs so that mandatory training is regularly updated. Certificates, or copies of certificates were seen on staff members’ files seen. An example of the induction programme was seen, which is thorough and detailed. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Avondene is well managed; audits and quality assurance support safe practice in relation to the health and safety of residents and staff working in the home. The home has proactive systems in place to respond to any issues, which may affect the health and safety of residents. EVIDENCE: The manager holds a Registered Manager’s Award and possesses strong management experience, supporting her to carry out her role efficiently and in the best interests of people living in the home. During the visit the home was well organised and staff worked efficiently and in the best interests of people living in the home. The manager has introduced new systems since the last Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 23 inspection, in order to ensure that the quality of service continuously improves for people living in the home. The manager has worked hard to develop and implement a quality assurance process. Questionnaires have been sent out to people involved with the life of the home; the findings summarised and a development plan produced regarding future improvements planned to enhance the quality of service delivered. The manager confirmed that the home does not hold any monies on behalf of residents, nor acts as an appointee for anyone living in the home. Hazardous substances, which were not locked away in the laundry, were moved to the lockable shed at the time of the inspection, protecting residents’ from harm. Training in areas of health and safety takes place as part of the home’s mandatory training programme. The manager has compiled a list of training required and intends to ensure that it takes place within required timescales. The manager had a certificate qualifying her to teach manual handling at the time of the visit. One resident’s needs had changed in relation to mobility and the manager had sought external guidance and appropriate equipment was being put in place in order to ensure that the resident could be assisted to move safely about the home. Testing of portable electrical appliances was due at the time of the visit and has been confirmed as now completed. Maintenance records seen showed that equipment and services, including regular fire checks take place in the home. Regular monthly checks are now carried out and records held relating to the visual checking of fire fighting equipment and contractual arrangements are in place for the six monthly servicing of the emergency lighting system. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 X X X X X 2 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 2 Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Residents must be protected by the safe practices in respect of the handling and administration of medicines at all times. Hazardous substances must be stored securely, protecting residents from the risk of harm. Timescale for action 31/10/07 2. OP38 13 03/10/07 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 OP25 Good Practice Recommendations It is recommended that radiators and exposed pipe-work are guarded. Not met. 2. OP33 It is recommended that the registered persons consider establishing a development programme from their quality audits in line with the expectations of the Commission’s DS0000026761.V350133.R01.S.doc Version 5.2 Page 26 Avondene ‘Inspecting for Better Lives’ programme. Avondene DS0000026761.V350133.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avondene DS0000026761.V350133.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. 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