Inspection on 01/06/06 for Carlton Bridge

This inspection was carried out on 1st June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Bridge 07/04/08

Carlton Bridge 30/04/07

Carlton Bridge 11/12/06

Carlton Bridge 19/12/05

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 Carlton Bridge 42 Woodfield Road London W9 2BE Lead Inspector Tony Lawrence Unannounced Inspection 1st June 2006 09:15 Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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 Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Bridge Address 42 Woodfield Road London W9 2BE 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) 020 7286 4032 020 7286 4032 The Westminster Society Ms Mary Josephine Blake Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Carlton Bridge is a residential care home for eight men with a learning disability. There are currently 6 men with significant care needs living in the home. Stadium Housing Trust owns the property and the care and staff are provided by Westminster Society, a voluntary organisation who took over as providers in August 2005. The home is located near the Harrow Road, close to shops and other community facilities. Transport links are very good with both tube and buses near by. Carlton Bridge is a modern, terraced four-storey property. The service users’ rooms are arranged over the first, third and fourth floor. Lounge/dining rooms and kitchens are situated on the ground and second floors. There is a spacious lift to all floors and all parts of the home are accessible to wheelchair users. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Thursday 1st June 2006 from 09:15 – 15:30. The Inspector spoke to service users and staff, checked care records and toured the building. The care received by two service users was looked at in detail. The Inspector felt that the home provides adequate standards of care and accommodation. Staff on duty worked well together to meet service users’ personal care needs and supported them to take part in appropriate activities. The inspector would like to thank staff for their help during this visit. Five of the eleven requirements made at the last inspection have been met. The home’s Manager and Deputy Manager were not on duty during this inspection. Staff on duty were not able to produce evidence to show that other requirements have been met and these have been repeated in this report. The weekly fee for the service is £1,304. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 6 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 Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 7 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, 2, 4 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home has clear admission procedures and excellent transition plans for new service users. There is a need to make sure that essential information is obtained about new people before they move into the home. Each service user must also have a contract that details the care and support they will receive. EVIDENCE: During this visit the inspector reviewed the care of two service users. One person has lived at Carlton Bridge for ten years. The second person moved into the home a few weeks before this inspection. Files kept in the home contained a lot of information about each person. The health care records for one person were very detailed and showed how these needs are met in the home. The records for the person who moved into the home recently also included good information, including an excellent transition plan. This details the stages and events that needed to happen to enable this person to move from another Westminster Society home to Carlton Bridge. The plan includes a number of visits to meet service users and staff and view the home and staff confirmed that this had happened as planned. As well as daytime visits, overnight and weekend stays were also arranged. Care planning information and risk assessments were also passed on by the home the person moved from. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 8 Despite these examples of very good practice, there is a need to make sure that essential information is available to staff before the person moves into the home. The care plan file did not include a current full care needs assessment that is required to meet these Standards and staff said that they had not seen this information. The Inspector saw good guidelines for staff on how they should support the service user, but staff said that these had only recently been provided. There are plans to move another two new service users into the home in the near future and the Society must make sure that all of the information required to meet these Standards is obtained as part of the admission process. There is also a need to make sure that the home’s Statement of Purpose is updated to reflect changes in the service. Staff on duty during this visit were unaware of the Statement and there was no evidence that this is a working document that is used by Manager and staff to make sure the home can provide the levels of care needed by individual service users. The two service users’ files checked during this visit did not include a contract or statement of terms and conditions and staff were unable to produce these. The Society must make sure that each person living in the home has a contract that includes all of the information detailed in Standard 5 of the National Minimum Standards. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has good standards of care planning, care recording and risk management that reflect the wishes and aspirations of service users. EVIDENCE: During this visit the Inspector reviewed the care plan files of two people living in the home. Both care plan files included a service user plan. One plan had been reviewed by staff from Carlton Bridge in April 2006. The other plan had been reviewed by staff from the service user’s former home shortly before he moved to Carlton Bridge. The service user plans clearly identified the main care needs of each person and how these would be met by those responsible for their care, including staff from the home and other health and social care professionals. During each shift, staff in the home complete a daily log book for each service user. The log books provide some good evidence that service users are taking part in activities that are identified in their care plan. The Inspector observed some very good interaction between staff and service users during this visit. Staff on duty knew the care needs of each person well and individual service users spent a lot of time during the day talking with Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 10 staff. Throughout the day, the Inspector saw staff offering service users choices about the care and support they receive and this was always done using the method of communication preferred by the service user, including signs from the Makaton Vocabulary. There is a need to review the way service users’ personal money is managed in the home and this is covered in Standard 23. Care plan files also included excellent communication plans, a review of day service goals, guidelines for staff on supporting a service user with their personal and health care. An example of good progress was the production of the day service’s review on DVD, enabling the service user to watch this at any time. Both care plan files included risk assessments that had been reviewed and updated in January and April 2006. The assessments identified possible risks and included appropriate strategies to make sure these are minimised. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People living in the home are supported to take part in a range of age appropriate activities, in the home and the wider community. EVIDENCE: Service users told the Inspector that they enjoyed outings in the local area. Individuals mentioned local cafes and pubs and trips to parks and the cinema. Daly log books included good evidence of activities for individual service users. Staff told the Inspector that three people go to a local day service for 5 days a week. On the day of this inspection, the other three service users were at home, although one person could choose to go to the day service in the afternoon. The staff rota for the day was arranged to provide one member of staff on duty from 12:00 – 7:00 pm to support people who were not going to the day service. This person supported service users to go out in the local area and all six people spent some time out of the home during the day. In the home there are two TV lounges, one with a large screen TV and some service users also have a TV and/or stereo music system in their rooms. The Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 12 home has a selection of books and games and staff said that service users can also become involved in looking after the home’s fish and four rabbits. An example of best practice is that the home provides a selection of music and videos from the 1930’s and 1940’s that are of interest to the older people living in the home. During this visit the Inspector saw one person obviously enjoying an old black and white film on the large screen TV. The details of relatives, friends and other significant people were well recorded in the two care plans files reviewed. One service user also told the Inspector that he regularly visits an old friend who used to live at Carlton Bridge. Staff also told the Inspector that they hoped to support these two gentlemen to visit Blackpool for a short break later in the year. Plans for this are uncertain as staff are unsure of the funding arrangements for service users’ holidays. Staff said that none of the people living at Carlton Bridge had a holiday in 2005, as money was not available. The costed contract that is needed to meet Standard 5 should include a paid for holiday and this must be agreed with the funding authorities when individual contracts are introduced. The Inspector saw that the home’s routines are flexible, enabling service users to make choices about when they get up and go to bed, how they are supported with their personal care and whether or not they take part in activities. Throughout the day the Inspector saw staff interacting well with all the service users who were at home. Service users have unrestricted access to all parts of the home and care plans and risk assessments include any restrictions that have been agreed, usually for health and safety reasons. Menus provided by the home’s manager before this inspection show that the home provides a good variety of nutritious meals. Staff said that service users could eat their meals in the comfortable dining rooms or in their rooms if they prefer. Service users also told the Inspector that they order meals from local take aways and also visit local cafes and restaurants. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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. This judgement has been made using available evidence, including a visit to this service. Although the home has good links with relevant health care professionals, there is a need to improve the management of medication. EVIDENCE: Service users’ personal care needs were well recorded in the care plans the Inspector reviewed during this visit. One file had been updated regularly as the person has lived in the home for more than ten years. As noted in Standard 2, there is a need to make sure that a full care needs assessment is completed before new service users move into the home. Although good personal care guidelines were available for staff, these should have been available with a full care needs assessment for staff reference before the person moved in. The care plans reviewed during this visit included some good evidence of good links with health and social care professionals involved in the care of individual service users. These included speech and language therapists, psychologists, occupational therapists, social workers/care managers and physiotherapists. One file also included excellent information about the service user’s complex health care needs and hospital appointments / treatments. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 14 During this visit the Inspector checked the Medication Administration Record (MAR) sheets for all six people living in the home. The home uses the Boots Monitored Dosage System and prescribed medication is delivered to the home every 28 days. All prescribed medication is securely stored in a lockable metal cabinet. Five of the six MAR sheets checked by the Inspector were well completed and there were no errors or omissions. The MAR sheet records for the sixth person had not been initialled by staff on a number of occasions and staff on duty were not able to say how this had happened. The record also includes codes for staff to record the reason when medication is not given to service users, but the meaning of the codes and the reason for their use need to be explained on the record. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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 poor. This judgement has been made using available evidence, including a visit to this service. While service users are cared for safely and their views and opinions are listened to, there is a need to review the management of service users’ finances. EVIDENCE: The Inspector saw good evidence of regular service user meetings where individuals are asked for their views and opinions. Topics covered at the most recent meeting included holidays, meals, outings and activities. The home has a clear complaints procedure and information provided by the manager before this inspection shows that there have been two substantiated complaints since the last inspection. The Inspector checked the home’s complaints record and this shows that complaints have been well investigated and recorded. Staff working in the home show a good understanding of the local authority’s adult protection procedures and appropriate referrals are made to social services if there are concerns about the care of people living in the home. There is a need to clarify the arrangements for managing service users’ personal finances. During this visit, the Inspector checked the finance records for four people living in the home. While the records are well maintained, there is no evidence of service users’ income or savings. The Society’s Head of Registered Care told the Inspector that service users’ finances have not yet been transferred to the Society following the takeover of the home in August 2005. This delay in enabling people to access their own money is unacceptable and this must be resolved without further delay. People living in the home and staff working with them should know how much money individual service users have to enable them to plan how this money is used. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 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, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides a good standard of private and shared accommodation that is fully accessible to people with mobility problems. EVIDENCE: Carlton Bridge is located in a residential part of Westbourne Park, close to shops, cafes, pubs, bus routes and an underground station. The accommodation is arranged over four floors. There is a passenger lift and all parts of the home are accessible to people in wheelchairs and those with limited mobility. During this visit the Inspector saw all 8 bedrooms and all communal areas. Standards in service users’ bedrooms are very good. Rooms are well decorated and furnished and contain many personal items that reflect the service users’ interests. There is a sufficient number of toilets and bathrooms close to bedrooms and communal areas. Bathrooms would benefit from some refurbishment to make them more pleasant for service users. Kitchens are well equipped and dining rooms and lounges are comfortable. There is a small patio area with barbecue. Light shades need to be provided in some rooms. All parts of the home were clean, tidy and hygienic during this visit. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 17 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, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are supported by a team of experienced and committed staff. EVIDENCE: When the Inspector arrived at the home for this visit, one Senior Support Worker and two Support Workers were on duty. All three staff started their shifts at 07:30. Two more staff came on duty at 12:00, with one of these people employed to work 1:1 with an individual service user. It was the responsibility of the second member of staff who started at 12:00 to make sure that service users not attending day services were given the opportunity to spend time out of the home, if they wished. Throughout this inspection, staff worked well together as a team to meet service users’ need and the Inspector observed many examples of excellent interactions between staff and people living in the home. Information provided by the home’s Manager before this inspection shows that all staff obtained an Enhanced Disclosure from the Criminal Records Bureau when the service transferred to the Westminster Society in August 2005. Although only 33 of staff have completed their NVQ qualification training, three staff are currently completing the training. The home should achieve the required target of 50 qualified staff during 2006. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 18 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, 40, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has a permanent manager and service users are consulted about the care and support they receive. EVIDENCE: The home has a permanent Manager who has been registered by the Commission. Service users and staff were able to tell the Inspector about the management arrangements within the home and also the Westminster Society. There is evidence of regular house meetings where service users’ views are sought about the care and support they receive. There are effective quality assurance systems that operate in other homes managed by the Westminster Society and these have also been introduced at Carlton Bridge. Senior managers from the Society make monthly unannounced monitoring visits to the home but there is a need to make sure that copies of reports written after each visit are sent to the Commission for information. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 19 The Society has developed all of the policies and procedures required to meet these Standards and copies are available in the home for staff reference. Standards of record keeping are generally good. Three health and safety issues need to be addressed. Fire alarm tests must be carried out weekly. A broken door closer on one bedroom door must be repaired and fridge and food storage temperatures in fridges and freezers must be recorded daily. Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 20 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 2 2 2 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 3 2 2 Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 21 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 YA1 Regulation 4 Requirement The Society must produce a Statement of Purpose that sets out the services provided at Carlton Bridge. Staff must make sure they are familiar with the home’s aims, objectives and philosophy and the terms and conditions of residence. A current care needs assessment must be completed for each person before they move into the home. Each person living in the home must have a written and costed contract or statement of terms and conditions. The management of medication must be improved to make sure that there are no errors and omissions in the records. The arrangements for managing service users’ finances must be resolved without further delay. Light shades must be provided throughout the home. The timescale for putting a lock on the inner door of the home must be sent to the commission. This is a repeat requirement. Original timescale of DS0000065284.V291693.R01.S.doc Timescale for action 30/09/06 2. YA2 14 31/08/06 3. YA5 5 30/09/06 4. YA20 13 31/08/06 5. 6. 7. YA23 YA28 YA42 20 23 13 31/08/06 31/08/06 31/08/06 Carlton Bridge Version 5.2 Page 22 31/01/06 not met. 8. YA42 23 Fire alarm tests must be carried out weekly. A broken door closer on one bedroom door must be repaired and fridge and food storage temperatures in fridges and freezers must be recorded daily. Copies of the Society’s monthly monitoring reports must be sent to the Commission for information. 31/08/06 9. YA43 26 31/08/06 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 YA14 Good Practice Recommendations The costed contract that is needed to meet Standard 5 should include a paid for holiday and this must be agreed with the funding authorities when individual contracts are agreed. When code letters are used in medication records, the meaning of, and reason for, the use of the code should be explained. Bathrooms should be refurbished to make them more pleasant places for service users. 2. 3. YA20 YA27 Carlton Bridge DS0000065284.V291693.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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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