Inspection on 05/04/05 for Buxton Street (131-133)

This inspection was carried out on 5th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Buxton Street (131-133) 10/07/07

Buxton Street (131-133) 10/04/06

Buxton Street (131-133) 02/08/05

Buxton Street (131-133) 28/09/04

Buxton Street (131-133) 08/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 131-133 Buxton Street Whitechapel London E1 5AR Lead Inspector Anne Chamberlain Announced Inspection 5th April 2005 10:00am 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 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 Stationary 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. 131-133 Buxton Street Version 1.10 Page 3 SERVICE INFORMATION Name of service 131-133 Buxton Street Address 131-133 Buxton Street, Whitechapel, London, E1 5AR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7247 2004 020 7247 2004 csavill@outward.org.uk Outward Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 131-133 Buxton Street Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2004 Brief Description of the Service: 131-133 Buxton Street is a 24 hour residential service for people with learning disabilities and complex needs. It is situated in Tower Hamlets in a central location close to public transport links and with local shops and a market. The home is located in two terraced cottages which have been converted to provide two independent flats -131 and 131. The flats have separate front doors but there is an intercommunicating door inside. The upper flat is occupied by three more independent service users and the lower flat is occupied by two service users who have rather higher needs. The provisions share a small but pleasant and private garden. The two provisions are run separately from one office which is located on the ground floor in number 133. The staff team currently consists of a deputy manager and eight care staff, the managers post being vacant. A new manager has been appointed and should start during April 2005. 131-133 Buxton Street Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over nine and a half hours. A tour of the two flats and the rear garden was made. The inspector spoke very informally to service users and had a group discussion with three members of staff. The inspector viewed a sample of service user files and also viewed staff files and various records. What the service does well: What has improved since the last inspection? Two major works have been done since the last inspection in the downstairs bathroom and the upstairs kitchen. The manager has amended the Statement of Purpose so that it now meets the standard. 131-133 Buxton Street Version 1.10 Page 6 Work has been done with service users in recording their wishes with regard to death and dying. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 131-133 Buxton Street Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 131-133 Buxton Street Version 1.10 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 standard(s) 1 and 2 The inspector felt that the deputy manager should be commended for his updating of the Statement of Purpose. However the other key document, the Service User Guide still fails to include all the necessary information. The Inspector was satisfied that prospective service users would have their needs assessed thoroughly prior to being offered a placement at the home. EVIDENCE: The inspector viewed the Statement of Purpose which now contains all the necessary information. The Service User Guide is in a user friendly format but still lacks a significant amount of information. It must be expanded to contain the additional information to comply with the standard. This is a reqirement. There have been no new service users admitted to the project since October 2003. However the inspector was satisfied in discussion with the deputy manager, that a thorough and systematic assessment of need would be undertaken for any prospective service user. 131-133 Buxton Street Version 1.10 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 standard(s) 6,7,9 and 10 The inspector was satisfied that assessment and care planning are conscientiously and sensitively undertaken. The home provides good care based on thorough assessment and sound care planning. However staff should have the opportunity to contribute to reviews of care plans. The staff group aspire to better understand and manage behaviours via the autism accreditation programme. The home demonstrates a strong commitment to empowering clients and supporting independent choice. Confidentiality is observed. EVIDENCE: The inspector viewed a sample of service user’s files. She was satisfied that detailed care plans and risk assessments are in place. The inspector noted that documented in her care plan, the words used by a service user to indicate her needs. This supports her communication with any unfamiliar staff and is an example of good practice. Service users and others involved in drawing up care planning documents, are now signing them off. 131-133 Buxton Street Version 1.10 Page 10 The inspector felt that individual service users were supported to undertake a range of activities and that these were thoroughly risk assessed. The inspector felt that an ethos empowerment underpinned the work at the home and there were many examples of service users making choices. For example service user’s had taken up activities and then dropped them after a while in favour of something else. One service user had a sewing machine in her room which she had purchased when she joined a sewing class. One service user is autistic, another has a possible diagnosis of Asperger’s syndrome. The deputy manager is leading the home in pursuing accreditation for autism. This will involve helpful training and add to the skills of the staff. The inspector had a group discussion with some members of the staff group. They felt that their views were not always sought when care plans are reviewed. The staff group felt that they could report usefully on changes in service users needs and they wished to be consulted more. The inspector viewed a policy for the upholding of service users rights. The manager stated that correspondence is delivered unopened to service users and they are supported to access their own mail. He said that the three more able service users are aware that staff will respect their confidences and one lady is particularly close with her key worker. 131-133 Buxton Street Version 1.10 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 standard(s) 12,13,15,16 and 17 Service users have opportunities for self development through access to a wide range of social and community activities. Also to friends, family, and the circle of Outward service users and staff. Independence is promoted in a safe environment. The attitude towards food in general is very relaxed with service users being given the widest possible choices. The proposed solution to the problem of the diabetic service user’s overnight snacking is based in good practice. EVIDENCE: Each service user has weekly plan of activities and the inspector viewed documentary evidence of this. The inspector was satisfied that the plans were individualised, varied, and updated to take account of changing needs. The inspector was concerned that should one particular service user refuse his usual day service there was no ‘plan B’ in place. He spent the day of the inspection at home apparently without meaningful activity. The manager 131-133 Buxton Street Version 1.10 Page 12 stated that he is aware of this shortfall and he and others are working on a programme of alternative activities for the service user. The service user has a motobility car which broadens his scope of recreational activities, when staff are available to drive him. Service users lifestyles appear to include good use of community facilities and one service user, for whom English is her second language, attends a club where her first language is spoken. This service user is also routinely provided with an interpreter for appointments and meetings (including the monthly tenants meeting). Service users enjoy visits to and from family and friends. They are also part of the Outward family network and socialise with service users from other homes for birthday parties etc. The weekly activities programmes provided documentary evidence that service users are supported to be improve their skills of independence and undertake housekeeping tasks. The manager advised that with one exception all residents have a front door key and keys to their rooms. One service user has a pet cat. The inspector discussed all aspects of food, meals and eating with the deputy manager and viewed the menus. These are planned for six weeks but are very flexible. Service users discuss meal choices at their monthly meetings. The home has one service user who is diabetic and not fully compliant with the diet prescribed by her dietician. She sometimes accesses unwholesome food overnight. The deputy manager would like to purchase two small refrigerators for the two service users who share a flat with the individual, so that staff can better regulate service user access to snacks overnight. The inspector supports this strategy. This is a recommendation. 131-133 Buxton Street Version 1.10 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 standard(s) 18,19,20 and 21. Service users individual support choices are understood and respected. Their physical and emotional health needs are studied and supported. Arrangements for the administration of medication were safe but the inspector identified a number of necessary improvements to the system. Staff are willing to discuss with service users their wishes and feelings in relation to dying. They need to extend these discussions, and the policy, to encompass the topics of illness and ageing. EVIDENCE: The deputy manager was able to speak knowledgeably about the service users individual and varied needs in terms of personal care support. He stated that he is working (as part of the autism accreditation programme) on a step by step plan for one individual. The service users in the home have quite complex needs including varied health needs. These appear to be well understood by staff. Service users are supported to access a number of health professionals including dietician, 131-133 Buxton Street Version 1.10 Page 14 psychologist and community psychiatric nurse as well as dentist, optician, chiropodist and G.P. The inspector viewed the arrangements for the administration of medication. The medications for the two flats are kept separately in two locked metal cupboards with a third locked cupboard where additional stock is kept. The keys to the medications cupboards are on a very large bunch which is kept in the safe. They must be separated off and kept on the designated care person at all times. This is a a requirement. The inspector found there was old unused medications being stored and these must be returned to the pharmacy and signed for by the pharmacist. This is a requirement. The home is not keeping a record book of medications received into the home and disposed of. They must do this. This is a requirement. There is a system in place in the home for the countersigning of the measurement of liquid medications but this had not been kept up since February 2005. Countersigning of liquid medications measured should be resumed. This is a requirement. The manager could place with the MAR sheets a copy of the home’s medications policy and a copy of specimen signatures for members of staff. This is a recommendation. The home has demonstrated a pro-active approach to discussing death and dying with service users. This was evidenced by recording on service users files of their wishes regarding funeral arrangements etc. The deputy manager acknowledged that the home’s policy needs to be expanded to encompass issues of ageing. Draft changes are being worked on currently. 131-133 Buxton Street Version 1.10 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 standard(s) 22 and 23 The home has an adequate complaints procedure although it needs to update information regarding the Commission for Social Care (CSCI). There is a robust policy and procedure in place for the protection of vulnerable adults and this is followed. The financial arrangements protect service users and work well. EVIDENCE: The home keeps books of formal and informal complaints. Informal complaints are usually resolved quite easily and there have been no formal complaints since the last inspection. The contact details for the CSCI are not recorded accurately on the complaints policy, or the guide to complaining and these must both be updated. The documents must also state that complaints can come direct to the commission at any time. This is a requirement. The home has a robust policy and procedure for adult protection. The manager stated that staff have ongoing training in supervision and in team meetings. A senior manager explained to the inspector that an allegation has been made recently against a member of staff, in the form of an anonymous telephone call to the mother of a service user. The inspector was satisfied that the correct course of actions are being followed by the organisation. They are working 131-133 Buxton Street Version 1.10 Page 16 with social services and the care manager, and the matter is being thoroughly investigated. The inspector ascertained from the deputy manager the arrangements for service users to access their monies. She was satisfied that vulnerable service users are protected from risk of financial abuse. The inspector checked records and cash balances for service users, which were correct. 131-133 Buxton Street Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28 and 30 The two flats are well maintained, decorated and furnished. Safety in the home appeared good apart from a requirement to regularly clean the filter of the tumble drier. EVIDENCE: The inspector toured the two flats. Since the last inspection major works have been undertaken in both flats and minor repairs have also been carried out. The flats are pleasantly decorated and there are decent fixtures, fittings and soft furnishings. The downstairs flat has some particularly nice and very practical flooring in the communal spaces. The ground floor bathroom has been refurbished to good standard and includes two lockable cupboards for toiletries. A new kitchen has been fitted in number 133 and the flooring fitted is excellent. The inspector was invited into the bedroom of a service user. There were many personal possessions and photographs. The room was comfortable, light and bright and has plenty of storage space. All the areas viewed in the two flats appeared clean and hygienic and there were no unpleasant odours. 131-133 Buxton Street Version 1.10 Page 18 One service user is experiencing compromised mobility and at a future point may need a walk in shower. The community occupational therapy team have not assessed her as a priority need and ultimately the provider is responsible for meeting the need. The inspector noted that cleaning materials were locked away in accordance with Control of Substances Hazardous to Health (COSHH) policy. She checked the filter of the tumble drier which had a thick layer of fluff. This is a fire hazard. The filter of the tumble drier must be regularly de-fluffed. This is a requirement. The manager advised that two exterior works outstanding at the last inspection a leaky pipe and a missing gravel board have both been rectified. There is scaffolding to the rear of the building following roof repairs. If it is not removed promptly the manager may need to put pressure on through the appropriate channels to expedite this. 131-133 Buxton Street Version 1.10 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 Recruitment practice is not adequately safe. Staff training, supervision and apraisal are not adequate. Two requirements have been made. EVIDENCE: The inspector viewed the staff files and Criminal Records Bureau (CRB) disclosures which had been brought to the home from the human resources office, for this purpose. The inspector found that three members of staff were without CRB disclosures for Outward. One of these three had an old disclosure from Middlesex University on his file. Another worker assured the inspector personally that he sent off for his disclosure three months ago. Three members of staff are without CRB checks from their current employer. An immediate requirement was made for these to be sought and POVA first checks to be requested. The manager and the senior manager undertook to ensure that these workers will not work unsupervised with service users until clear disclosures are received. This is a requirement. On viewing a sample of staff files the inspected found that supervision has not been taking place regularly or once a month. There was little evidence to 131-133 Buxton Street Version 1.10 Page 20 support annual appraisal, staff induction or other types of training. The inspector viewed the staff training profile which also failed to evidence ongoing training. The inspector viewed a list of relevant training projected for April – September 2005. In group discussion with members of staff the inspector was told that staff felt they were not receiving adequate training for their duties. The staff believe that there is a need for regular bank staff to have the same opportunities for training as their permanently employed colleagues. The manager must ensure that all staff receive induction training and regular ongoing training and must be able to evidence this in documentation. Training should be also offered to regular bank staff. Records relating to training i.e. staff file and staff training profile must match. The manager must ensure that staff have regular monthly supervision and annual appraisal. Arrangements must be made for regular bank staff to have supervisory guidance from the manager and deputy manager. This is a requirement. The deputy manager and general manager agreed that supervision, appraisal, training and development had slipped in the protracted absence of a full time manager at the home and needed to be prioritised by the incoming manager. 131-133 Buxton Street Version 1.10 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39, 40, 42 and 43 The home has been reasonably well run but has suffered in various ways from a lengthy period without a full time manager. A requirement has been made. Safety in the home is good but some minor deficiencies were identified. A requirement has been made. EVIDENCE: Outward have appointed a qualified (NVQ level 4) and experienced manager for the home and he is due to start on April 19th 2005. The present deputy will remain in post. The record for the February and March person in charge visits were not available for inspection. Person in charge visits must be made and the actions identified undertaken promptly. Records of the visits must be available for inspection. This is a requirement. 131-133 Buxton Street Version 1.10 Page 22 Outward collects quality assurance information in a number of ways. Service user meetings had lapsed but have been reinstated. This was evidenced in the minutes also the fact that the interpreter for one service user attends, which is good practice. It has been agreed that these meetings will not be cancelled or delayed because a particular relative is not able to attend. The manager stated that the participation officer has been surveying service users and is producing a report. Service users also attend a quarterly forum. The inspector viewed the policies and procedures manuals which were in good order with no policies more than three years old. She was satisfied that staff are advised of updates to policies and that they and the service users have access to them. The complaints policy must have the contact information for the CSCI updated appropriately. This is a requirement. Action has been taken to improve fire safety in the home. The front door has to be locked due to risk of a particular service user leaving unaccompanied. However the lock will now release automatically if the fire alarm sounds. Staff test this mechanism regularly as part of their fire safety procedures. The deputy manager was not able to provide evidence of fire equipment manufacturers last check, and electrical wiring certificate. The manager must either obtain evidence of the above or arrange testing. This is a a requirement. The home now displays a current certificate of employers liability insurance. The business plan was viewed. It includes financial projections and there are budgets specific to the home. The budgets need to be updated quarterly so that managers can have up-to-date information on which to base their spending. 131-133 Buxton Street Version 1.10 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 3 x 3 Standard No 11 12 13 14 15 131-133 Buxton Street x 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x 1 2 x Version 1.10 Page 24 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 2 x 3 2 x 2 3 131-133 Buxton Street Version 1.10 Page 25 YES 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 1 Regulation 5 Requirement The service user guide must be expanded to include all the necessary information to comply with the standard. (Previous timescales of 1st September 2004 and 1st December 2004 not met) The keys to the medication cupboard should be kept disignated care person at all times Unused medication must be disposed of appropriately A record must be kept of all medications received into and dispose of by the home The practice of countersigning the measurement of liquid medicines should be resumed The complaints policy and guide to complaining must be amended with thecorrect contact details for the CSCI and the commission can be contacted directly. Fluff must not be allowed to accumulate in the filter of the tumble drier. An immediate requirement was issued : The deputy manager must confirm in writing that CRB disclosures have been requested Version 1.10 Timescale for action 01 August 2005 2. 20 13(2) 01 May 2005 01 May 2005 01 May 2005 01 May 2005 01 August 2005 3. 4. 5. 6. 20 20 20 22 13 (2) 17 (1) (a) 12 (1) (b 22 (7) 7. 8. 24 34 23 19 01 May 2005 Immediate requirement 131-133 Buxton Street Page 26 9. 10. 35 37 18 26 11. 12. 40 42 22 (7) 23 for three particular members of staff. Whilst the disclosures are awaited POVA first checks must be obtained and the staff must not work unsupervised with service users. The deputy manager must ensure that staff receive supervision and training. Person in charge visits must take place and records of the visits and responses must be made available. The complaints policy must be amended as detailed under requirement number 6. The deputy manager must make available a recent fire equipment check and electrical wiring certificates. 01 July 2005 01 July 2005 01 August 2005 01 July 2005 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. 2. Refer to Standard 16 20 Good Practice Recommendations Two small refrigerators to be purchased for two service users to store snacks in their rooms. A copy of the policy for the administration of medication to be placed with the MAR sheets, also specimen signatures for staff 131-133 Buxton Street Version 1.10 Page 27 Commission for Social Care Inspection 4th Floor, 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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