CARE HOME ADULTS 18-65
Combe House Castle Road Horsell Woking, Surrey Gu21 4ET Lead Inspector
Mrs Pauline Long Announced 23 June 2005
rd 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. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Combe House Address Castle Road Horsell Woking Surrey GU21 4ET 01483 755997 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) Brookhurst Care Ltd Valerie Jean Coomber Care Home 6 Category(ies) of LD - Learning Disability (6) registration, with number of places Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accomodated will be : 18-45 YEARS Date of last inspection First Inspection Brief Description of the Service: Combe House is suitated in a quiet residential area of Horsell Village, a short distance by car from Woking town centre. It is a new property which is tastefully developed and blends in well with the surrounding properties. This home provides care and accommodation for young adults with a learning disability. The accommodation consists of six individual en suite bedrooms, five of these being on the first floor and one on the ground floor. There is no lift access to the first floor. Communal areas consist of two bathrooms, a dining room, sitting room and easily accessible kitchen and laundry room. The dining room, kitchen and sitting room have doors leading directly onto a large terrace and medium sized secure back garden. The home has a good sized area for parking at the front of the building. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first Inspection of this home under the Care Standards Act 2000 and the CSCI year April 2005- March 2006 and was announced. The inspection was carried out by one inspector and lasted for five hours. CSCI would like to thank the residents, manager and staff or their hospitality and co-operation during the inspection. The service had a welcoming atmosphere. On the day of inspection three of the six rooms were occupied. Two residents were at home and one was out at day time activities. One of the residents and all of staff on duty were involved in the inspection process and were keen to talk about life in the home. It was very pleasing to note that, the newly appointed deputy manager on her sixth day in the home had an excellent knowledge of the resident’s care needs. During the inspection process, evidence was gathered in the following ways: • • • • • • • Discussions with the Manager. Discussions with the staff. Direct observation of interactions between the resident, manager and staff. Examination of records relating to resident’s, staff and the home. Information gleaned from the Pre Inspection Questionnaire. Information gleaned from Service user feedback cards. A tour of the home. The feedback from the resident at home on the day was limited, in view of the resident’s communication difficulties. What the service does well:
This home presents a homely environment and atmosphere for the residents. On the day of inspection the weather was very hot, however the residents and staff in the home presented a very comfortable and relaxed appearance. The manager’s approach was very open. All of the staff demonstrated an in-depth knowledge of the residents care needs and this was reflected in the wellbeing of the residents who were at the home on the day. The home is committed to ensuring that the residents maintain contact with family/friends and the local community. The deputy manager stated, that “ families are very involved in the home, some come to the home several times
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 6 a week”. There are various activities offered both in and outside the home. On the day, two of the three residents had planned activities out side the home. Comment cards received from resident’s families indicated satisfaction with the service. One stated “Whenever we visit we are greeted with warmth and smiling faces. Quite remarkable.” However one service user had concerns about the assessment process at the home. This was dealt with through the homes complaints procedure and has been satisfactorily resolved. It was observed that there are close relationships between the residents and staff. Interaction between staff and the residents was familiar yet respectful. It was positive to note that the home promoted the residents skills in relation to the preparation of the lunch. What has improved since the last inspection? What they could do better:
This is a new home and as such they should be commended on the standards achieved thus far. However there are a few areas for improvement. Whilst the senior staff have had Protection Of Vulnerable adult Training, the priority should be to ensure that all staff receive this training. This will ensure that all of the residents are protected from abuse. Recruitment is on an ongoing basis in the home. Several staff files were sampled during the inspection. The majority of the files reflected good recruitment and selection practice, however one file did not have all of the information required. To ensure that the safety and wellbeing of the residents The home must ensure that information held on staff files comply with Schedule 2 of The Care Homes Regulations 2001 (As amended). The home is developing their risk assessment process. On the day of inspection, several risk assessments were sampled. Files contained two different risk assessment formats. The inspector observed what was viewed as a restrictive practice. There was no documented evidence with regard to this practice. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 7 In order to avoid confusion and to ensure that residents are supported to take responsible risks, the risk assessment process at the home should be consistent and all risks documented. On the whole the system for administering medication was satisfactory. However the home’s medication policy does not include homily medication guidelines. The manager should seek information and advice from a pharmacist regarding the medication policy in the home. This will ensure that the residents and staff are protected by robust policies and procedures. The provider, manager and staff have worked hard to ensure that the home fulfils its aims and objectives since the home opened at the end of 2004. There was evidence of resident’s meetings, however the home has yet to implement a system in which service users can air their views, in order to ensure they are fully involved in the day to day running of the home. The manager must develop a system in which service users are able to give feedback on how the home is doing. Requirements and recommendations have been made in these areas. Please refer to pages 26 and 27 of this report. 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. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 8 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 Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 9 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) 2,4 Arrangements are in place to ensure a full needs assessment takes place before any new admission. The arrangements in place for prospective residents to “ test drive” the home are good. EVIDENCE: All of the resident’s files were sampled. Each resident had a comprehensive assessment of needs, which, in the first instance was carried out by the registered provider and the manager at the home. All aspects of daily living needs were assessed, indicating that the manager and care staff would be fully aware of individual residents care needs. Each prospective resident was offered the opportunity for several visits to the home prior to a trial assessment period. These periods range from a lunchtime visit, to a weekend stay. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 The manager and staff had a good understanding of the resident’s needs and choices, these were well met. On the day residents were involved in decisions around the day to day running of the home and were supported to take responsible risks. EVIDENCE: All of the residents had care plans and a detailed needs assessment. On the day of inspection a resident was observed being enabled to make choices safely. Risk assessments were in place and had been reviewed. However there were two risk assessment formats on file, which could potentially present a lack of clarity. This was discussed with the manager, who stated, that the care management team were not happy with the original risk assessment format and that the home was trying to develop another one. Care plans included all aspects of personal support and health care needs. One of the residents had a communication passport, which is carries around with in order that all of the staff involved in providing care can see at a glance likes
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 11 and dislikes. This document was developed by the Occupational Therapist with in put from the staff team at combe house. The manager was keen to ensure that a similar document could be developed for all of the residents in the home. The relationships between the residents and staff at the home enabled help and support with some tasks the resident found challenging. A resident was asked if he wished to help to prepare the lunch. He indicated that he was happy to do this by buttering the bread for the bacon sandwiches, chatting and talking to the staff about the afternoon cookery class he was going to. Whilst he was preparing lunch the inspector asked if he liked living at Combe House? He said that he did and that “ that is all you need to know” Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13,14,15,16,17 The Manager and staff enable the residents to maintain fulfilling lifestyles in and outside the home. The meals in the home are good, offering choice and catering for special dietary needs. The home promotes contact with family, friends and the local community. EVIDENCE: The residents at Combe House are not in paid employment. They do however go to individual day activities. This enables them to have a degree of independence, and the opportunity to meet with other day care users. As discussed earlier in this report, one resident was preparing to go to cookery classes at a local centre. The routines in the home are determined only by the timings of the visits to and from the various day time activities and appointments. The manager and care staff stated, that the residents who were able are encouraged to help with
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 13 some of the domestic tasks around the home and to help with the shopping. One resident had just returned from a shopping trip with one of the care staff. One of the residents in the home on the day was observed moving around the home with out restriction. Another resident was observed resting on the sofa in the sitting room. Staff were observed trying to encourage him to eat and drink. The home is committed to ensuring that the residents maintain their relationships with their family and friends. The majority of the residents receive regular visitors. Many of the families keep contact by phone. The deputy manager stated that the resident’s families were very involved in the home, some come into the home several times a week”. There were various flyers posted on a notice board in the quiet room, relating to possible future outings: for example, a flower planting class, a boat trip, a BBQ evening, bingo and a trip to Thorpe Park. The staff stated that, the residents are encouraged to visit the local pubs and the Wednesday night disco. The lunch was prepared by care staff and one of the residents, and consisted of bacon sandwiches and salad, with juice. The meal was served at the kitchen table which was nicely presented. The care staff stated that, the residents were able to choose their meals from pictorial and written menus. Special diets are arranged for residents with specific dietary needs. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 The manager and staff have a good understanding of the residents support needs. This was evident from the positive interactions and relationships observed. The health needs of the residents are well met. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Care plans included clear guidelines on any support each resident required with personal and health care. Physical and emotional needs of the residents were also detailed in the care plans and daily records, which included visits to the doctor, dietician, dentist and reviews of care. The home has a clear medication policies and procedures. None of the residents in the home administers their own medication. All of the care staff on duty were aware of the policies and procedures regarding medication. All of the medication record sheets were checked. Only one of the medication record sheets was type written by the chemist, the others were hand written. This was discussed with the manager, who explained that two of the residents were still in the transition stage of admission and therefore until they were admitted
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 15 on a permanent basis they would continue to be hand written. All of the record sheets were found to be properly completed. The manager had concerns around the administering of homely medication. Whilst there is a medication policy in the home, it does not include a policy on homely medication. There were records with regard to the activities and care given being. Each resident had a personal day to day file, in which the general activities of daily living in the home were recorded. A requirement has been made with regard to medication. Please refer to pages 26 and 27 of this report. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 16 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) 22,23 The home has satisfactory policies and procedures in place for dealing with concerns, complaints and the protection of the residents. EVIDENCE: CSCI has received one complaint about this home since it opened and have carried out an investigation. The complaint was partly upheld and related to the needs assessment process at the home. The home has a folder in which they record complaints and compliments. All of the residents are allocated key-workers. The manager and care staff stated “if the residents were unhappy with anything this would be communicated by body language, or facial expression if they were not able to verbalise their concerns”. The manager is aware of and has attended the Surrey Multi Agency Abuse training. Not all of the care staff have attended abuse training. One service user had concerns about the assessment process at the home. This was dealt with through the homes complaints procedure and has been satisfactorily resolved. A requirement has been made in this respect. Please refer to pages 26 and 27 of this report.
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 17 Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 18 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) 24,25,26,27,28,29,30. The standard of the environment within this home is good and meets the needs of the residents, providing an attractive and homely place to live. However areas for improvement were identified in relation to one of the ensuite bathroom doors. EVIDENCE: All of the resident’s bedrooms were personalised. They were clean bright and tidy. The quality of the furniture and decoration was good. There were many soft toys sitting around on the beds. There were photographs of family members and other personal items. Some of the rooms had colourful sensory pieces of equipment, for example lava lamps. The main sitting room was bright and airy and uncluttered. However it was noted that there were very few pictures and no photographs on the walls. This could be due to the fact that the home has recently opened.
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 19 The standard of decoration in the hallways and communal rooms was good. It was disappointing to note that one of en- suite bathroom doors had a lock placed quite high up on the door. This was seen as a restrictive practice and was discussed with the manager and staff. The bathrooms and communal toilet’s were bright, clean but somewhat clinical. The garden and terrace area were very pleasant clean and tidy. The garden furniture was out and had been used for breakfast. There were clothes drying on the washing line, this added another homely touch to the environment. Requirements were made in these areas. Please refer to pages 26 and 27 of this report. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 20 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) 31,32,33,34,35,36. The home employs an efficient staff team in sufficient numbers, who provide a good quality of care to the residents. However on the day some of the records did not reflect thorough recruitment and selection practice. EVIDENCE: The home has clear policies and procedures for staff recruitment. Staff files seen on the day did not demonstrate thorough recruitment and selection practice. All staff had satisfactory Criminal Records Bureau and POVA (The protection of Vulnerable Adults) checks. There were 3 care staff, and the manager on duty on the morning shift. There are no domestic or kitchen staff employed at the home. The cooking and cleaning is part of every one’s day-to-day work. The dependency levels of the residents on the day indicated that the present staffing ratio was adequate. Training in the home is given a high priority, in particular non-verbal communication skills. Staff talked about their job roles, there was clarity and awareness of the different roles and responsibilities within the home. They
Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 21 stated, “we work well as a team”. Staff also discussed the training opportunities in the home. Training to date included: • • • • • • • • • Manual handling. First Aid. Health and Safety. Fire Awareness. Food Hygiene. NVQ 2/3. Dementia in Downs Syndrome Training. Epilepsy awareness. LDAF. There is a staff supervision programme in the home. The Manager and Deputy Manager carry out the staff one to one formal supervisions. To date staff have received formal supervision with a manager on a month to six weekly basis. The whole staff team also meet as group on a monthly basis. A requirement has been made in this area. Please refer to pages 26 and 27 of this report. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 22 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) 37,38,39, 40,41,42 The home has clear Policies and Procedures and the standard of record keeping in the home is good. The Manager is experienced and qualified to run the home. Improvement was required in respect of obtaining residents views about how the home was doing. EVIDENCE: The manager has been in post since December 2004. She is at present undertaking The Registered Manager Award. The manager had a very open approach. From observation of her interactions with a resident and the staff, it was clear that there was an atmosphere of openness and respect. The staff expressed confidence that they could take any issue to the manager. All staff appeared confident and professional in their work. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 23 A number of policies were sampled, all were accurate and up to date and accessible to staff and residents. The homes medication policy will require further development. The manager explained that the home is presently working with the owners to develop a process, in which they can seek the views of the residents and others, as to how the home is doing. Health and safety checks are routinely carried out at the home. All equipment in use on the day of inspection was properly maintained. On the day of inspection water temperatures were checked and found to be satisfactory. Whilst the overall standard of recordkeeping at the home is good, resident’s accounts were sampled and there was a discrepancy with one of the accounts. This was discussed with the manager who was able to account for the discrepancy. Records are stored appropriately and securely and confidentially. Requirements have been made in these areas. Please refer to pages 26 and 27 of this report. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x N/A 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Combe House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 2 2 H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 25 Are there any outstanding requirements from the last inspection? This was the first inspection for this home. 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 YA 23 Regulation 13 (5) Requirement The registered person(s) must ensure that all staff receive protection of Vulernable Adults training. The registered person(s) must ensure that staff records contain all of the information required by the Care Homes Regulations 2001 schedule 2 and 4. The registered person(s) must ensure that any restrictive practices, in this instance, the location of the lock on the bathroom door with regard to safety are risk assessed and documented. The registered person(s) must ensure that a homely medications policy is produced for the home. The registered person(s) must ensure that an effective quality assurance system is developed and implemented in order to obtain residents views about the home. he registered person(s) must ensure that residents personal financial records are checked regularly and that any discrepancies are dealt with in a Timescale for action 23/8/2005 2. YA 34 19(1) (c )Schedule 2, 4 13 (4) (a(b(c ) 7,8 23/7/2005 3. YA 9, 23 23/7/2005 4. YA 20 13 (2) 23/7/2005 5. YA 39 24(1) (a(b) 2 23/8/2005 6. YA 23 13 (6) 17( 2) Schedule 4 23/7/2005 Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 26 timley fashion. 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 YA 28 YA 20 Good Practice Recommendations The manager could consider making the communal areas of the home more homely. By adding more pictures and or photographs to the walls. The registered person(s) should consult their local pharmacist for advice regarding a homely medication policy. Combe House H58_s62711_Combe House_v221758_230605_stage4.doc Version 1.30 Page 27 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey, GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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