Inspection on 20/12/05 for Copse Lea

This inspection was carried out on 20th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Copse Lea 11/10/08

Copse Lea 18/10/07

Copse Lea 06/03/07

Copse Lea 04/05/06

Copse Lea 11/08/05

Copse Lea 17/11/04

Copse Lea 26/05/04

Copse Lea 18/02/04

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

CARE HOME ADULTS 18-65 Copse Lea Copse Lea Tringham Close Ottershaw Surrey KT16 0NF Lead Inspector Sandra Holland Unannounced Inspection 20th December 2005 10:30 Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Copse Lea Address Copse Lea Tringham Close Ottershaw Surrey KT16 0NF 01932 873802 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) Welmede Housing Association Ltd Mr Suresh Bidessie Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (3) of places Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be 49 - 65 YEARS, AND WITHIN THE TOTAL NUMBERS UP TO 3 MAY BE OVER THE AGE OF 65 YEARS 17th November 2004 Date of last inspection Brief Description of the Service: Copse Lea is a residential home for up to 6 adults who have learning disabilities, three of whom may be over 65 years of age. The service is managed by Welmede Housing Association and the staff are employed by the North Surrey Primary Care Trust (NSPCT). The property is owned and maintained by Hyde Housing. The service is a detached property and the facilities and accommodation are set on two floors. There is no mechanical means to access the upper floor and none is required for the existing service users. All service users have a single bedroom and access to a separate lounge, dining room and kitchen. There is a large garden to the rear of the house and other garden areas to the front and side. The home is situated in a residential cul-de-sac in Ottershaw, which has a range of local facilities, including shops, post office, pubs and public transport. Copse Lea is adjacent to another home in the Welmede group (Pinewood), which is also managed by the registered manager of Copse Lea. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The inspection was carried out over six hours by Mrs. Sandra Holland, Lead Inspector for the service. Mr. Suresh Bidessie, Registered Manager was present representing the service. A tour of the premises took place and a number of records and documents were examined, including individual plans, medication administration records (MAR), staff files and service user financial records. All six of the residents and two members of staff were spoken with. The inspector wishes to thank the residents and staff for their hospitality and assistance. The people living at Copse Lea prefer to be known as residents and that is the term that will be used throughout this report. What the service does well: What has improved since the last inspection? Service user plans have been reviewed, but some essential information is still required. Items that are only used according to the season were being stored appropriately. Supervision of staff is now being carried out. Files of policies and procedures have been removed from the resident’s lounge. Items that are hazardous to health were being stored in locked cupboards. Fire doors were not being propped open. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 6 The window restrictor which was not working properly has been made fully operational. Paper towels were available and in use instead of fabric towels. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 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 the following standard(s): 2, 4 and 5. Prospective residents are assessed before admission and would have the opportunity of trial visits before moving in. EVIDENCE: The manager stated that the present group of residents have lived together at the home for many years and that there have been few changes. He explained the process that would take place, in the event of a vacancy occurring. As most residents are sponsored by local authorities a thorough assessment by a care manager would be carried out for any prospective resident, to fully assess their needs. A copy of the assessment would be supplied to the home for review by the manager and staff. The manager explained that the most recently admitted resident visited the home on a number of occasions, prior to moving in. This is arranged to ensure that the home can assess the prospective resident and for the prospective resident to meet the other people living at the home and staff. Any prospective resident is introduced gradually to avoid unsettling the existing resident group. A requirement was made at the inspection carried out on 11th August 2005, that the registered person must produce a statement of the terms and conditions in respect of accommodation to be provided for residents, including Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 10 as to the amount and method of payment of fees; and a standard form of contract for the provision of services and facilities by the registered provider to residents; this statement/contract to be specific to each individual resident. A timescale of 11th November 2005 was given for this requirement to be met, but it has not been met. It is recommended that residents sign their contract or statement of terms and conditions, if they are able. For residents who are not able, their representative should be asked to sign on their behalf and the reasons for this should be recorded in the individual plan. A requirement and a recommendation have been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 11 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. Residents are supported to make decisions about their lives. It is of concern that assessments of risks to residents have not been carried out. EVIDENCE: A requirement was made that the registered person must keep the residents’ plans under review and a timescale of 9th September 2005 was given for the requirement to be met. This has not been met. The individual plans that were seen had not been effectively reviewed and did not contain the information required to guide staff to the support needs of the residents. Staff advised that the more dependent residents are supported to make choices, such as what to wear and what to eat. Other residents who are more able are supported to choose their activities and holidays. Two residents work with local employers and attend churches of their choice. Staff support these residents in these choices and assist with transport. It was clear from the records seen, that assessments have not been carried out in respect of risks that are known. For one resident who requires assistance with all activities of daily living and who has limited mobility, no assessment has been carried out regarding moving and handling. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 12 The resident was assessed by an external assessor in March 2005 and the assessment stated that the resident was to be assisted using a hoist, slide sheet and toilet sling. The assessment stated that two staff were to assist the resident because of his unpredictable moods and deteriorating condition. The assessment recommended a wheelchair assessment for the resident, to include pressure relieving seating. The manager stated that the resident was able to stand for very short periods only. A risk assessment dated December 2005 is held on file for a resident who is known to be physically aggressive to staff at times. This stated that there is “no risk” and referred to action taken as “observation as before”. As there are no other risk assessments available, it is not possible to know what “as before” referred to. Assessments of resident’s abilities to manage their finances or the risk of financial abuse have not been updated or have not been carried out. For one resident, the review of her ability to manage her money, had not been reviewed since March 2003 and for another, very dependent resident, no assessment was available. An immediate requirement was made at the inspection carried out on 11th August 2005 that the registered person must ensure that unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. This has not been met. The lack of risk assessments place the residents and the staff at risk. An immediate requirement has been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 13 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): 14, 15 and 16. Residents are supported to have appropriate relationships. Some residents require more stimulation and an activities schedule to be arranged. EVIDENCE: The manager stated that most of the residents have family and are supported to maintain contact and promote the relationships. Three residents have contact with their families to varying degrees and one resident makes visits to parents. Two residents have jobs outside the home and attend local churches and have made friends through these. Staff were observed to address residents in a friendly but appropriate way, although it was noted that staff did not engage with residents or provide opportunities for stimulation. One resident was seen to be sitting in the same position for most of the inspection period and two other residents were seated in the lounge with the television on for the inspection period. Staff were not seen in active involvement with residents. Those residents who were able, Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 14 were seen to have access to their bedrooms and could choose where to spend their time. It was also noted that few or the residents have an effective, planned activities schedule. The activities plan for one resident only listed the working hours that are undertaken, with no leisure or activities of interests listed. A requirement has been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 15 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): 20. Medication administration has improved, but not all staff are following the system that has been introduced to monitor stock levels. EVIDENCE: The standard of medication administration has improved since the last inspection. A new system of marking the medication administration record sheets has been introduced to indicate when a new supply of medication has been started. This enables checking of stock levels of medication and an audit trail to be followed. It is recommended that all staff follow the system consistently. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 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 the following standard(s): 23. The record keeping in relation to residents’ finances needs to be improved to protect service users from risk of abuse. EVIDENCE: The manager stated that five of the six residents are supported to sign for withdrawals of their monies from their accounts. Money that is withdrawn is then held for safekeeping and a record kept. Staff advised that they check these monies at each shift changeover and sign the record to accept responsibility for the amounts present. On checking that the record held matched the amount held, it was noted that for one resident, a sum of money had been removed and a piece of paper had been left, stating that the money had been “locked away”. This piece of paper had been signed by the deputy manager, but did not state where the money had been placed and had not been dated. It was seen that staff had signed the shift handover book, for money that was not present. A requirement was made at the inspection on 11th August 2005 that the records specified in Schedule 4, 9 (a) and (b) in respect of resident’s monies held for safekeeping, must be accurately maintained. A timescale of 9th September 2005 was given for this to be met, but this has not been met. This poor recording practice continues to place the residents at risk of financial abuse. A requirement has been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35. Criminal Records Bureau (CRB) disclosure checks were not held for the majority of staff at the home. An effective staff training plan needs to be developed. EVIDENCE: It is of serious concern that for the majority of staff working at the home, a CRB has not been obtained, or if obtained, there is no record held in the home. A CRB for one member of staff was held in a file in the home and was presented by the staff member, although the manager had not known the whereabouts of the CRB. An immediate requirement was made at the unannounced inspection carried out on the 11th August 2005 that the registered person must not employ a person to work at the care home unless- (a) The person is fit to work at the care home and (b) The information and documents specified in Schedule 2 have been obtained in respect of that person. Specifically, no person must be permitted to work unsupervised if a CRB clearance has not been obtained in respect of that person. This requirement has not been met. From the records seen , it was clear that staff have undertaken a number of training courses, but these have not been carried out according to a planned schedule of training and development. Training for staff has not been carried Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 19 out to the required frequencies and some training required to meet the needs of residents, such as moving and handling, has not been carried out. An immediate requirement and another requirement have been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. EVIDENCE: It remains of serious concern that a high number of requirements from the last inspection have not been met. The management of the home is not robust and effective and there is still no sense of leadership or direction. The seriousness of the poor standards of management was not acknowledged by the manager and this potentially places the residents and staff at risk. A requirement was made at the inspection carried out on 11th August 2005 that a person is not fit to manage to manage a care home unless, having regard to the size of the care home, the statement of purpose, and the number and needs of residents, he has the qualifications, skills and experience necessary for managing the care home. The registered manager shall undertake from time to time such training as is appropriate to ensure that he has the experience and skills necessary for managing the care home. A timescale of 11th November 2005 was given for this requirement to be met. The requirement has not been met. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 21 Assessments of risks to residents and staff have not been carried out. A requirement was made at the unannounced inspection carried out on 11th August 2005 that the registered person shall ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. A timescale of 9th September 2005 was given for this requirement to be met, but it has not been met. The manager stated that an assessment of the risks to a member of staff being alone at night with a resident group that includes a potentially aggressive resident, had not been carried out. The use by residents, of the toilet on the stairs, was discussed at the previous inspection, as a resident had fallen down the stairs after using the toilet and been seriously injured. The manager had stated that the toilet would be locked. On arrival at this inspection, the manager again stated that the toilet was kept locked, but when checked, was not locked. An assessment of the risks associated with residents using the toilet on the stairs, had been carried out but was dated October 2005, which was two months after the inspection during which it was required. The manager stated that he had advised night staff that residents should not use the toilet on the stairs, but this had not been recorded anywhere. The manager stated that quality assurance surveys are carried out every two years by Welmede, the organisation that runs Copse Lea, but no records were available to confirm this. The manager stated that he would expect residents’ families to advise him if they were unhappy or had any problems. No procedure regarding a quality assurance system was available in the home. An immediate requirement and other rquirements have been made. Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 2 Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 1 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x x x 1 1 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Copse Lea Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x x x DS0000013610.V271702.R01.S.doc Version 5.0 Page 23 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 YA5 Regulation Requirement Timescale for action 10/03/06 5(1)(b)&17(2)Sch4(8) The registered person must produce a statement of the terms and conditions in respect of accommodation to be provided for residents, including as to the amount and method of payment of fees; and a standard form of contract for the provision of services and facilities by the registered provider to residents. A record of the care home’s charges to service users, including any extra amounts payable for additional services not covered by those charges, and the amounts paid by or in respect of each service user. UNMET FROM 11/08/05 15(2)(b) The registered person must keep the residents plans under review. DS0000013610.V271702.R01.S.doc 2 YA6 20/01/06 Copse Lea Version 5.0 Page 24 UNMET FROM 09/09/05 3 YA9 13 (4) The registered person must ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated. UNMET FROM 09/09/05 The registered person must, having regard to the size of the care home and the number and needs of service users, consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends. The registered person must maintain in the care home the records specified in Schedule 4. A record of all money or other valuables deposited by a service user for safekeeping or received on the service users behalf, which (a) shall state the date on which the money or valuables were deposited or received, the date on which any money or valuables were returned to a service user or used, at the request of the service user, on his behalf and, where applicable, the purpose for which the money or valuables were used; 20/12/05 4 YA14 16(2) (m) 10/03/06 5 YA23 17 (2) Schedule 4 20/01/06 Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 25 6 YA34 19 (1)(a & b) 7 YA35 18(c) (1)(i) 8 YA37 9(2)(b)(i&ii) &10(3) and (b) shall include the written acknowledgement of the return of the money or valuables. UNMET FROM 09/09/05 The registered person 20/12/05 shall not employ a person to work at the care home unless- (a) The person is fit to work at the care home and (b) The information and documents specified in Schedule 2 have been obtained in respect of that person. Specifically, no person must be permitted to work unsupervised if a CRB clearance has not been obtained in respect of that person. The registered person 10/03/06 shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. 10/03/06 A person is not fit to manage to manage a care home unless, having regard to the size of the care home, the statement of purpose, and the number and needs of residents, (i) he has the qualifications, skills and experience necessary for managing the care home Version 5.0 Page 26 Copse Lea DS0000013610.V271702.R01.S.doc 9 YA39 24(1)(a)& (b)-(3) and (ii) he is physically and mentally fit to manage the care home. The registered manager must undertake from time to time such training as is appropriate to ensure that he has the experience and skills necessary for managing the care home. UNMET FROM 09/09/05 (1) The registered person shall establish and maintain a system for - (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. 10/03/06 Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 27 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 YA5 Good Practice Recommendations It is recommended that residents sign their contracts or statement of terms and conditions if they are able. For those residents who are not able, their representative should be asked to sign on their behalf and the reasons for this should be recorded in the individual plan. The system of marking the medication administration record sheets when a new supply of medication is started, should be consistently followed by all staff. 2 YA20 Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Surrey Area Office 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 © 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 Copse Lea DS0000013610.V271702.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!