Inspection on 29/11/05 for Birchwood Bungalow

This inspection was carried out on 29th November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Birchwood Bungalow 30/04/07

Birchwood Bungalow 16/05/06

Birchwood Bungalow 04/08/05

Birchwood Bungalow 25/10/04

Birchwood Bungalow 26/04/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Birchwood Bungalow The Bridle Path, Off How Wood Park Street St. Albans Hertfordshire AL2 2QZ Lead Inspector Hazel Wynn Unannounced Inspection 29th November 2005 10:00 Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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 Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Birchwood Bungalow Address The Bridle Path, Off How Wood Park Street St. Albans Hertfordshire AL2 2QZ 01727 874776 01727 874776 kthornber@hotmail.com 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) Milbury Care Services Limited Karen Thornber Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: Birchwood Bungalow is a small home, purpose built home providing personal and social care and accommodation for 7 people who have a learning disability. Milbury Care Services Limited owns the home. The property is a chalet style detached bungalow, which has been extended to provide its present accommodation and is set in two thirds of an acre of land; it is reached via a bridle path, one hundred yards long, which provides it with privacy whilst being close to local shops in a quiet residential area of St Albans. St Albans is an historic town, which boasts a lively town centre with various and wide ranging amenities. The town centre is a short car journey from the home. The home provides single bedrooms, each with a hand basin, for its occupants The home provides residential care in a family style environment for people who have a learning disability. The home has extensive and well-maintained, furnished and accessible gardens, and its own mini-bus to support service users to access their community. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 29th November 2005 and this report provides a snapshot of the CSCI view of the home on that day. The outcomes of the National Minimum Key Standards inspected were very satisfactory with the exception of some medication that had not been dated on opening and a requirement was made in this respect. Generally, the home was well maintained and care and protection well managed by a competent staff team. The CSCI looked at records, met with the service users and staff team who were preparing for their staff meeting at the commencement of this inspection and made a general tour of parts of the home including all of the communal areas and two bedrooms. On the day of this inspection the service appeared to be well run and outcomes for the service user were very satisfactory. What the service does well: What has improved since the last inspection? What they could do better: Medication must be dated on opening. Although the medication storage area was cool on the day of the inspection, this may vary in warmer weather and it is recommended that a thermometer be placed in this area and the temperature recorded and not allowed to rise above 20°C or the temperature recommended by the pharmaceutical company producing the medication. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 6 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. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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 Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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): 1-5 The statement of purpose and service user guide together with visits provides prospective service users with support to make (in as far as is possible) an informed choice about where to live. The home will not admit Service Users for who they do not have the capacity to meet needs. All needs are fully assessed by a competent person in conjunction with the Service User and all significant others. A copy of the agreement is provided. EVIDENCE: A Service User Guide is provided to the advocates of this group of service and a user-friendly format is maintained on the service users file; the service users have profound learning disabilities. The Service User guide had been updated. Prospective Service users make frequent visits to the home (including overnight/weekend stays) as part of the assessment and transition process. The care plans and progress notes for two Service User were seen. The CSCI saw full and comprehensive assessments in place on individual files and these included needs and wishes and were kept reviewed regularly. New assessment and care planning tools are being introduced and a sample of these were seen; these will further improve assessing and planning care within a person centred approach. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 9 Whole life reviews are held annually and individual risk assessment documents had been updated. Care progress is reviewed with the keyworker and kept tracked each month as part of the supervision process. Contracts are with the Local Authority purchasing the service and Service Users have a copy of the Agreement on their individual files. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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 - 10 Service Users can be assured that their assessed and changing needs and personal needs, goals/aspirations are reflected in the individual plan. Service Users are supported with an individual approach to make decisions. Service users views are obtained and they are encouraged to participate as fully as possible in all aspects of life in the home and they influences how the home is run. Risk management is conducted within a risk management framework to promote independence. Information about Service Users is securely stored and confidentiality is protected. EVIDENCE: A sample of care plans were scrutinised at this inspection and these contained clear information and guidance in order to meet needs, goals and known wishes. Individual Risk Assessments had been updated and were current. The registered manager explained the various methods used in supporting the service users to make decisions and some decision making support was observed during this inspection when a service user decided she wanted to participate as fully as possible in this inspection. The rota is planned around the needs of the service users and the staff team were planning the rota Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 11 around the service user’s needs for the Christmas period during the process of this inspection. The individual service users’ care plans scrutinised contained current risk assessment with guidance for staff, designed to support service users to live as independent lifestyle as possible within a risk management framework. The CSCI observed personal information records were securely stored; data protection policies are in place and staff are introduced to these as part of their induction. Part of the induction process includes training in confidentiality and a policy and procedure is in place. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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): 11 - 17 Personal development opportunities for each individual are evident. The service users take part in age, peer and culturally appropriate activities and are part of their local community; engaging in appropriate leisure activities locally and further afield. Appropriate family and personal relationships and sexuality are respected and supported. The service users’ rights and responsibilities are recognised and respected. A healthy and varied diet of choice is enjoyed at suitable and preferred times. EVIDENCE: The service users were at home and were enjoying leisure activity; some were watching TV and one of the service users enjoyed participating in this inspection and was interested in the CSCI presence. The service users had enjoyed holidays at appropriate venues had been tried before and the service users had seemingly enjoyed themselves and in this way the staff were able to ascertain that it would be their choice and that they would be able to take part in challenging activities of their choice whilst maintaining a reasonable level of safety. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 13 Service users are supported to benefit from appropriate day care activities and the care team are working well to ensure that appropriate day care services are provided; the care team, using a nearby venue, provides some of the day care services whilst other service users attend a day care centre. Various providers input to the day care at the alternative venue; the following services have been purchased to enhance the day care programme: music facilitators, Art Therapist, Life Enhancers (which aids communication skills) and a magician is providing sessions with a slant on the provision of perception, tactile and sensory stimuli – these sessions are interactive. The service users have easy access, with support, to their very local shops and enjoy access to the numerous facilities and resources of nearby St Albans, as evidenced in the care plans and progress notes. Family and personal relationships are supported and records of contact were maintained. All of the service users have very profound learning disabilities and do not have an enduring sexual relationship; sexuality and the right to enjoy a sexual relationship is acknowledged and this was covered in the care plans. Rights and responsibilities are recognised and respected as evidenced in the guidance to staff in the care plans and also in the progress notes seen at this inspection. The dietician visits each month and provides advice, support and monitors individual weights. The menu see at this inspection offered a varied and nutritious diet; this inspection took place between mealtimes, lunch had just finished but at the last inspection the meal served looked very appetising and the service users were obviously enjoying their meal. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 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 - 21 Personal support is provided according to preference of the individual. Emotional and physical needs are met. Medication is generally well managed but there is room for improvement. Ageing illness and death would be handled with respect and according to individual wishes. EVIDENCE: The sample of care plans scrutinised at this inspection, together with the progress notes provide evidence that personal support is provided according to individual preference and further evidence was also gained from discussions with staff. Evidence of the meeting of physical and emotional needs is evidenced in the appropriate sections of the care plan and in the progress notes; whole life review meetings also provide monitoring and support. None of the service users are yet able to retain or self-administer their own medication. The care staff team manages medication; there were no gaps on the Medication Administration Record and a check of the blister packs showed that medication had been administered as prescribed. Medication separate to the blister packs had not been dated on opening and a requirement was made. There is a policy and procedure in place for the care and support of service users who are ageing, become ill and in the event of death. The service users wishes are clearly covered on the care plans scrutinised at this inspection. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service Users views are listened to and acted on. Service Users are protected from abuse, neglect and self-harm. EVIDENCE: During this inspection the CSCI observed service users being supported to air their views/express themselves and the staff were responding appropriately to provide a positive outcome. Behaviour Management Plans are in place to support the Service Users to express themselves in positive ways whilst respecting others. Policies and procedures were in place at the home and these support vulnerable adult protection strategies. During the August inspection it was noted that staff had attended non-violent crisis intervention courses and abuse awareness training. The policies and procedures in place together with training (evidence of training see at this inspection) provide safeguards to prevent all forms of abuse. Individual risk assessments provide guidance to staff to support service users from incidence of self-harm. A successful applicant is waiting to commence work once all of the appropriate checks have been carried out and her application and interview file was seen at this inspection. During the August 2005 inspection, evidence was seen of robust recruitment practices being conducted to provide protection to service users. Staff files (seen in August 2005) contained CRB (Criminal Records Bureau Checks) POVA (Protection of Vulnerable Adult Check, where recruited since July 2004) and employment references. Finances are well managed and a sample of these was checked by the CSCI at this inspection and found to be transparent and accurate. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 - 30 The Service Users benefit from living in a clean and comfortable home. The home is well maintained and a safe environment is managed. Service users bedrooms provide privacy, promote independence and meet individual needs. Communal space complements and supplements the very adequate space of the service users own rooms. Specialist equipment is in place for those requiring this to maximise independence. The home is clean and hygienic. EVIDENCE: The CSCI observed at this inspection that the home was clean and comfortable; some of the service uses were relaxing in the comfort of the large and homely lounge. During a tour of parts of the home, including two bedrooms and all communal areas of the home, we observed it to be clean, homely throughout and inviting. The Service Users own rooms are personalised and reflect the personalities, needs and interests of the Individual Service users. There are and large well-maintained and secure gardens that are well utilised by the service users in fairer weather conditions. The control of substances hazardous to health (COSHH) is very well managed by a member of staff dedicated to ensuring adherence to the legislation; the records were seen to be up to date and the systems were being implemented. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 17 Fire safety records showed that regular points testing and drills are taking place appropriately and that servicing of fire safety equipment is managed in accordance with the contract of the fire safety management company. All staff attend fire training and up dates as evidenced on the training planner. The homes risk assessment file was seen and all general risk assessments for environmental safety had been reviewed in October 2005. Individual risk assessments on the sample of care plans seen had also been reviewed very recently. Adequate bathing facilities and toilets are provided were hygiene and personal needs can be met in privacy and safety, bathing aids to aid independence are serviced regularly. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 18 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 - 36 The service users benefit from the clarity of staff roles. The home is adequately staffed and staff are appropriately trained to be qualified to carry out their role, competent and effective. The recruitment policies and procedures ensure service users are provided with safeguards to offer protection and reliable support. The staff team are well supported and supervised. EVIDENCE: All new employees receive a staff handbook that contains their job description and a flow chart that shows the roles and responsibilities of others in the organisation. A copy of the staff handbook was seen at this inspection and the new recruit who will start work as soon as all clearance checks have been found to be satisfactory will be provided with such at the start of her employment. Staff files were seen during the August 2005 inspection and these contained the application form with any gaps explored, at least two professional references, a medical declaration, and appropriate forms of ID and CRB/POVA checks. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 19 An induction programme is in place for all new care staff (the Learning Disability Award Framework) this is completed during the probationary period and staff are encouraged to follow on with National Vocational Qualifications. Evidence was also seen that the home is on track to achieve employing at least 50 of care staff with National Vocational Qualifications. The staff training plans were seen to contain all mandatory and additional training needs and these included: NVQ at various levels, Person Centred Planning and autism courses, fire awareness training, manual handling, emergency first aid in the workplace, updates in management training, disciplinary and grievance, abuse awareness, food hygiene, updates in management training, Health and safety at work, OT degree, NCI non-violent crisis intervention, epilepsy training. A record was seen of who had attended the courses provided and when. The CSCI met briefly with the staff team who were all at the home for a meeting. The staff stated that they are well supported and receive monthly formal supervision and annual appraisal and that they were happy with their jobs at Birchwood. There meeting was to include reaching agreements how they would meet the service users needs during the Christmas period. The CSCI scrutinised recent and current rotas observing that these showed that the home is consistently adequately covered and that rotas were planed ahead and as stated above, during the day of the inspection the team were planning the Christmas rota together. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 20 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 - 43 The service users benefit from a well run home; there is a healthy ethos, good leadership and management approach. The service users views underpin all self-monitoring and development by the home. Safeguards are in place, by way of policies, procedures, protocols and staff training for the protection of and well being of Service Users and Staff and these cover rights, responsibilities and best interests. The health, safety and welfare of service users are promoted and protected and they are further benefited from competent and accountable management of the service. EVIDENCE: Throughout this report evidence from the findings of this inspection has been reported and provides confirmation that this is a well run home. The CSCI met with the registered manager during this meeting and it was clearly ascertained that she is enthusiastic and dedicated to providing a good quality service that supports and benefits the service uses and staff. Records pertaining to the Service Users, health, personal and social care needs were well maintained. Health and Safety records were up to date including: emergency lighting and Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 21 call point testing in case of fire and other safety checks which included COSHH (which is extremely well maintained by one of the care staff). Fire safety equipment had been checked and serviced by a contractor and the records were checked at this inspection. Staff training records were scrutinised at this inspection, and training is provided through accredited and recognised resources (this is reported more fully in the staffing section of this report). Records were seen to provide evidence that formal supervision and staff appraisal is in place and staff confirmed that this is provided monthly (appraisal annually). The organisation carries out a monthly audit of the service, progress of service users, and of the records in place and forwards a copy of the Regulation 26 report to the CSCI regularly. The policy, procedures, care plans and progress notes together with staff training all provide evidence of how service users’ views influence the running of the home and that their rights, responsibilities and best interests matter and are responded to and promoted appropriately. Policies and procedures are covered fully earlier in this report and are in place to the benefit of the service users and staff. Risk Assessments have been carried out in respect of all known risks both regarding the environment and the health, safety and welfare of both Service Users and Staff regarding work, the environment and daily living activities and these had all been very recently reviewed and updated where needed. The communication book was well utilised and contained positive communication between the team members, messages to staff were clear and professional. We looked at a sample of Service User financial records and saw that these were be transparent and accurate. There was one requirement made for all medication to be dated on opening and one recommendation that a thermometer be obtained and the temperature of the medication storage room to be monitored and recorded daily to ensure that the correct temperature is maintained for the storage of medication at the pharmaceutical company’s guidance (e.g. lactulose must be stored at a temperature not exceeding 20° centigrade). Throughout this report evidence is provided that this home the service users benefit from the competent and accountable management of the service. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Birchwood Bungalow Score 3 3 1 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000019294.V270069.R01.S.doc Version 5.0 Page 23 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 YA20 Regulation 13(2) Requirement All medication must be dated on opening. All new stock opened must be dated on opening (It is not possible to date medication already opened and used and not dated). Timescale for action 29/11/05 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 YA20 Good Practice Recommendations A thermometer be provided so that the temperature of the medication storage room can be monitored and recorded daily to ensure that the correct temperature is maintained for the storage of medication at the pharmaceutical company’s guidance (e.g. lactulose must be stored at a temperature not exceeding 20° centigrade). The storage area appeared to be quite cool but the temperature was not able to be checked. Birchwood Bungalow DS0000019294.V270069.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. 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