Inspection on 09/05/06 for Brandley Residential Home (Sunflower House)

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brandley Residential Home... 11/11/05

Brandley Residential Home... 01/06/05

Brandley Residential Home... 06/10/04

Brandley Residential Home... 03/06/04

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

CARE HOME ADULTS 18-65 Brandley Residential Home (Sunflower House) Sunflower House 102 Durham Road Manor Park London E12 5AX Lead Inspector Anne Chamberlain Unannounced Inspection 9th May 2006 13:00 Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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 Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brandley Residential Home (Sunflower House) Address Sunflower House 102 Durham Road Manor Park London E12 5AX 020 8478 6233 020 8478 6367 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) Mr Andrew Garner Ms Beverley Beaupierre Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Can include one named service user with MH needs. To allow the home to provide continuous care for a named service user, who is now over the age of 65 years. 11th November 2005 Date of last inspection Brief Description of the Service: Sunflower house is run by Brandley Residential Homes. It is a four bedroomed property in a residential road in the borough of Newham. The home is registered for three adults between the ages of 18 and 65. However variations have been obtained for residents who are now over 65 years. Residents have learning disability and related mental health issues. The home aims to offer quality care services in a well-kept homely, non institutionalised establishment. The ground floor has a good sized kitchen diner, reception room, toilet and shower room and laundry room. The office is located downstairs. There is also a small courtyard garden and a small garden beyond the laundry room. There are currently three individuals living at Sunflower house and they are supported by a total of six staff including the manager. There is a sleep in member of staff. Residents have access to day services and are enabled to participate in community leisure activities. They are supported and encouraged to be as independent as possible. The range of fees for the present residents is between £850 and £950 per week. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two short days, eight hours in total. All key standards were inspected and requirements from the previous inspection were revisited. The inspector spoke to all three residents and interviewed the manager and deputy manager. She also spoke to a new member of staff who was being inducted. She viewed the three residents folders and three staff personnel files as well as other key records and documentation. The inspector toured most of the premises including the rear garden. The inspector would like to take this opportunity to thank residents, staff and the manager at Sunflower House for their co-operation and assistance with the inspection. What the service does well: What has improved since the last inspection? The home has responded well to the requirements and recommendations of the previous inspection. There are no restated requirements. The statement of purpose has been amended. Documentation and record keeping for staff has improved with staff code of conduct and annual appraisal. The manager now keeps records of staff annual and sick leave. Staff training profiles have been introduced. Recording evidences regular supervision. The home was able to produce documentary evidence of consulting with residents to obtain their views. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 6 The staff have better adult protection guidance. The home is now displaying a current insurance certificate. 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. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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 Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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 and 2. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The information provided by the home is good and the manager has the skills to assess prospective residents. EVIDENCE: There was a requirement at the previous inspection that the statement of purpose be amended to include the qualifications of the manager. This has been done and the requirement is met. The home has not admitted any new residents since the last inspection. However the inspector is satisfied that the manager is skilled in assessment and no resident would be offered a place at the home unless their aspirations and needs had been fully assessed. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9. Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. A requirement has been made regarding key documentation. EVIDENCE: The inspector viewed the individual care plans on the files. They were not of a standard format, one being much older than the other two. One care plan had no service information and the manager explained that this plan had to be read in conjunction with an earlier plan, although this was not stated on the document. The manager stated that the service also uses care plan adjustment sheets to record changes. The inspector suggested and the manager and deputy manager agreed, that one standardised, stand alone care plan document containing all the information needed to deliver the care, and updated after significant changes or once a year, would be an improvement on the above. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 10 The manager and deputy manager agreed to replace the existing documentation with the above described single comprehensive, updateable care plan. A requirement has been made to this effect with a realistic timescale to reflect the work which will be involved. The manager must ensure that each resident has a standardised, stand alone up-to-date care plan. There was a previous recommendation that the manager support and enable residents in their choice of holidays. The manager reported that there has been discussion with the resident who has expressed an interest in having a holiday abroad, but the resident is quite ambivalent. The deputy manager has secured a passport for a resident who does not have a birth certificate. This is a real achievement and she is commended on it. The deputy manger said that residents make decisions about what activities they want to undertake and what they want to eat. The deputy manager said that she gets the the films currently showing at the cinema up on the computer and residents choose what they would like to see. The inspector saw documentary evidence of a cinema trip, also menus which showed that residents choose dishes. There was a requirement at the previous inspection to evidence the collecting of service users views about the running of the home. The inspector saw a record of a residents meeting on 22/01/06 and was told that there had been a meeting in between and a meeting cancelled on 29/04/06. The inspector accepts that residents are often not communicative in the setting of meetings and the most valuable exchanges often occur at odd moments. She is satisfied that staff relay to each other the views expressed to them by residents. The inspector encourages the home to record residents views when they express them, to ensure that so that they are considered, and also that they are available for inspection purposes. In addition to the above the home has undertaken some surveys with residents. These are discussed under the outcome area Conduct and Management of the home. Risk assessments are filed on residents files. A resident has recently had a fall which will impact on her mobility risk assessment. The deputy manager said that once the full medical picture is understood she will be updating the risk assessment. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. Activities are resident led and the approach is relaxed and empowering. EVIDENCE: One resident attends a day centre three times a week. On another day he attends a music group. The remaining weekday he spends at home or with his sister. The other two residents are both of retirement age and prefer to be based at home although they undertake various community trips and have a range of social activities to attend. On the day of the inspection one resident was looking forward to dancing at a disco party she would be attending in the evening. All the residents socialise regularly with the residents of their local sister home. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 12 Recently staff attempted to contact the daughter of a resident and found that the only telephone number they have for her is now not her contact number. Another resident sent her sister a Christmas card and it was returned. The sister did not visit at Christmas and staff are concerned that they may lose contact with her. Family contact is an ongoing issue for two of the residents. They have lost contact with members of their families and have little contact with others. The staff are sensitive to the pain of separation felt by residents. They do all they can to trace relatives and encourage and support contact with them. One resident has good family contact and the home supports this well. The inspector felt that the rights and responsibilities of residents were respected. She noted in the daily logs that there are opportunities to get involved in domestic tasks. All residents had been offered the opportunity to vote at the recent local elections. One resident keeps her room locked. The mail of residents is handed to them unopened. The residents at Sunflower House all have speech which is a little hard to understand, until one knows them. The deputy manager was able to explain to the inspector how to facilitate communication with one resident. She said that staff working at the home pick this skill up quickly. The inspector observed positive interaction between residents and staff. The residents looked relaxed and comfortable with staff and demonstrated trust in them. One resident was having her nails painted by the member of staff who was being inducted, and they were getting to know each other. The deputy manager stated that all residents eat well. They have an evening meal together and this is prepared from fresh ingredients. She said that residents also enjoy meals out, particularly pub lunches. One resident has been following a cholesterol lowering regime and has lost weight. The deputy manager said that this has resulted in a significant increase in her agility. The whole house has benefited from a reduction in treat food and an increase in healthy eating! Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The service has a robust approach to meeting the health needs of the residents. EVIDENCE: The deputy manager was able to describe in detail the personal care needs of the residents. During the course of the inspection a new member of staff was being inducted. The inspector noted that in addition to studying files and policies, the inductee was being given detailed information on the personal care preferences of residents. The inspector is satisfied that residents receive their personal care support in the way they prefer but will be pleased to see the needs documented in the aforesaid new care plans. As previously mentioned one of the residents has recently had a fall. She is quite fragile and the home are very aware of this. The resident has had a full assessment at Plaistow Day Hospital. Another resident has behavioural issues. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 14 The deputy manager reported that these have improved and the inspector herself saw a change on the day of the inspection. This resident has had a change in his medication recently. Another resident who as previously mentioned has been following a low cholesterol diet, has lost a stone in weight and is feeling very well. She is about to have a reduction in her medication due to the improvement in her health. All the residents had seen the dentist the day before the inspection. The inspector felt that the residents need quite a lot of health care support and the managers show great commitment to this. The inspector viewed the arrangements for the administration of medication including balancing a sample of three medications to ensure no discrepancies between the drugs held and those recorded. There were no discrepancies. The deputy manager said that when medications are returned to the pharmacist an entry is made on the back of the MAR sheet and the pharmacist signs this. A resident had had a change in medication but this had not been amended on her care plan. The manager must ensure that when a medication is changed all necessary documentation is changed. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. There have been no complaints to process but the manager has demonstrated innovation in the area of adult protection. EVIDENCE: The inspector viewed the complaints folder. No complaints have been made since the last inspection. The home has a Listening Book but this is without entries. The inspector also saw the complaints sheets which are for making a complaint. She saw the complaints policy which has been updated in February 2006. The last inspection required the manager to develop a simple step by step adult protection procedure for staff to follow. This has been well done and the manager is commended on it. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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 and 30. Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to the service. The home has an inclusive atmosphere but there is room for improvement in the standard of presentation. EVIDENCE: One resident showed the inspector her room, and the inspector viewed the rest of the house, excluding the other bedrooms. The residents live in a homely, comfortable and safe environment. The inspector acknowledges that the property is old and difficult to maintain to a high standard. The inspector also accepts that the needs of residents can affect the presentation of the home. Notwithstanding this the inspector recommends that the following be addressed by the manager: Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 17 The windows in the home need cleaning. At the time of the inspection there was a large dead plant in the sitting room. The gardens front and rear have no flowers and look rather neglected and untidy. The first floor bathroom has wallpaper which is starting to peel, the paintwork is in poor condition and in some places not clean. Cleaning paraphernalia (buckets, brushes etc.) are stored on a rack in the bathroom making it feel less than luxurious. Residents toothbrushes lay loose on a painted wooden window ledge. When the inspector visited the bathroom there was no hand towel (although there was a roll of kitchen paper) and no toilet paper. The home is clean and hygienic. There are no unpleasant odours. Each resident has a washing basket and also a bowl. The staff launder soiled articles. The deputy manager stated soiled laundry does not have to be carried through the kitchen area, but is taken to the laundry room through the courtyard and washed at 95 degrees Celsius. Staff wear gloves and wash their hands not in the kitchen sink, but at a wash hand basin in the nearby shower room. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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): 32,34,35 and 36. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. Overall the level of training is high but basic training must be renewed regularly. EVIDENCE: The staff group at the home is culturally diverse and residents benefit from the variety of input. The level of qualification within the group is quite hig. The deputy manager now has the registered managers award, and care workers have NVQ level 2 or 3 and substantial experience. The inspector discussed with the manager and deputy manager their recent recruitment of a new care worker, quite a long process. The inspector was satisfied that the service is careful in their selection of staff. In addition Staff files evidenced a robust recruitment procedure. The service now has training profiles for staff. These evidenced staff induction, but in two cases some basic training had not been undertaken. One staff had been recently inducted and so had covered the basics then, but the other staff member had been in post longer and had not done any training in 2006. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 19 The manager must ensure that all staff regularly renew their basic training. There was a requirement at the previous inspection relating to the management of staff. Staff files evidenced code of conduct and appraisal. Training profiles had been introduced and staff absences and leave are now being recorded. A separate folder evidenced regular supervision. However one staff member had two supervision sessions with different dates but identical recording. The inspector accepted that this was an administrative error. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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): 37,39,41,42 and 43. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the service. The findings for this area were mixed but the manager is generally taking a pro-active approach to improving the management of the service, for the benefit of the residents. EVIDENCE: In addition to her other qualifications the manager now has the registered managers award. She is involved in the day to day running of the local sister home and the deputy manager takes substantial responsibility for Sunflower House. The managers are mutually supportive. The previous inspection resulted in a requirement to expand the quality assurance system at the home. As previously mentioned the home has undertaken surveys with residents. These relate to specific topics. The Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 21 inspector noted that on one survey a resident had written its nice here. The inspector saw the record of proprietor visits which are monthly. The deputy manager reported the verbal feedback of the general practitioner of one resident. He said that the service she had at the home was excellent. The previous inspection resulted in two requirements regarding the updating of care plans and risk assessments. The inspector was not able to see a clear example of the meeting of this requirement but did see evidence of good record keeping in other areas, for example the daily logs and accident report book. She was told that the care plan and risk assessment for the individual who had the fall will be updated as soon as it is clear what needs to be done. The inspector looks forward to seeing these updates along with the other new care plans at the next inspection. The home are working with a quality assurance company on COSHH. The inspector viewed the contents of the COSHH cupboard. She viewed the COSHH policy and inventory of materials. The home now has generic product information for a number of items, like washing up liquid. The COSHH work reflects much effort but is not yet completed. The products in the cupboard could not be all matched to the list of products used, or the product information available. The manager must ensure that the list of COSHH products used reflects the products present in the cupboard. For each product there must be product information. No other products should be stored. The inspector also viewed the arrangements for fire safety, including checking that the fire extinguishers had been maintained. An outside contractor had issued a certificate of maintenance on 31/05/05. Four fire drills had been held during 2005 and one in 2006. However only one member of staff had been present for a drill. The manager must ensure that future fire drills be arranged to involve members of staff. The record of fire alarm tests could not be located and must be made available for inspection. A certificate of gas inspection was issued on 27/04/06, electrical lights and power were checked on 26/05/05, portable appliance testing was carried out on 19/05/04. The previous inspection resulted in a requirement that a current certificate of insurance be displayed in the home. This requirement has now been met. The inspector viewed the four year plan for the home which runs until 2008 and which was satisfactory. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x 3 2 3 Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 23 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 YA6 Regulation 15 Requirement The manager must ensure that each resident has a standardised, stand alone up-todate care plan. The manager must ensure that when a medication is changed all relevant documentation is changed. The manager must ensure that all staff regularly update their basic training. The manager must ensure that the list of COSHH products used reflects the products present in the cupboard. For each product there must be product information. No other products should be stored. The manager must ensure that future fire drills be arranged to involve members of staff. The manager must ensure that the record of fire alarm tests be made available for inspection. Timescale for action 01/08/06 2. YA20 13 (2) 01/06/06 3. 4. YA35 YA42 18 13 01/09/06 01/09/06 5. 6. YA42 YA42 23 23 01/06/06 01/06/06 Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 24 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 YA24 Good Practice Recommendations The manager should address the shortcomings detailed in the main body of the report. Brandley Residential Home (Sunflower House) DS0000022856.V293442.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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