Inspection on 26/10/06 for Cumberland Gardens (7)

This inspection was carried out on 26th October 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cumberland Gardens (7) 24/02/06

Cumberland Gardens (7) 30/08/05

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Cumberland Gardens (7) 7 Cumberland Gardens Off Great Perce Street Islington London WC1X 9AG Lead Inspector Mrs Pippa Canter Unannounced Inspection 26th October 2006 11:00 Cumberland Gardens (7) DS0000061532.V287334.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 Cumberland Gardens (7) DS0000061532.V287334.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. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Gardens (7) Address 7 Cumberland Gardens Off Great Perce Street Islington London WC1X 9AG 020 7278 4421 020 7837 9591 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) Camden & Islington Mental Health & Social Care NHS Trust Miss Lorna May Williams Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/02/2006 Brief Description of the Service: The Clerkenwell Project provides residential support for up to five service users who have mental health needs. Camden and Islington Mental Health and Social Care Trust operate the service. The lowest level of fee is £61.25 per week. The project is run along a communal living framework with service users sharing the homes day-to-day activities. The staff team work within a multi agency team to provide individual support for each service user to live as independently as their abilities will allow. The home links in with day centres, colleges, clubs and other community resources so that service users have the opportunity to become involved in the local community. The project is situated within a quiet residential area that is also a conservation area. There is easy access to transport links, shops and other local amenities. Accommodation for service users is provided over four floors. There is no shaft lift and service users must be mobile. There is a large kitchen/diner and a laundry at basement level. There is a lounge at ground floor level and the single rooms for service users are spread over all remaining floors. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of one day by one inspector. The visited lasted a total of four and a half hours, from mid morning to mid afternoon. The Manager was available and assisted the inspection along with additional input from the staff on duty and service users. Records such as care plans; daily logs as well as health and safety documentation were examined. A partial tour of the building was made with attention to the room of the service user being case tracked. Some service users were asked for their views of the running of the home and talked about their experiences of living there. Staff were observed carrying out their duties and were involved in general discussion with the inspector. Prior to the inspection we, looked at all the information we had about the home, including notifications of accidents or serious incidents, monthly reports about the conduct of the home sent in by the provider and previous inspection reports. The manager had sent in a pre-inspection questionnaire, which confirmed some very useful information about the home. Feedback forms were received from two General Practitioners and several Health and Social Care Professionals. Their comments are reflected in the main body of the report. We reviewed all this information and used it to develop an inspection plan to enable us to focus on the important outcomes for service users. At the time of compiling this report, feedback forms had not been received from the service users. If these arrive any comments will be included in the final report. At the end of the visit feedback was given to the Manager. A feedback form was sent to the manager following the visit so she could let us know how she felt about the inspection process. What the service does well: A comment from a service user was “This place is wonderful. The staff are wonderful. They treat the residents with respect.” The home is being effectively managed by an experienced manager who is keen to set good standards of care. The visiting professionals supported the view that the home is being well managed and the social and health care needs of the service users are looked after. Staff are competent and have the skills to meet the needs of the people they support. The principles of dignity, choice, privacy and rights underpin all aspects of the service. Service users are supported in accessing cultural and religious services. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 6 There are plans to implement a refurbishment programme. Service users have been fully involved. 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. The summary of this inspection report can be made available in other formats on request. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are admitted following an assessment and their needs and aspirations are regularly reviewed. EVIDENCE: All service users have been admitted through the Care Programme Approach. There are up-to-date CPA review meetings on all case files. Service users have the option to participate in the reviews. Cumberland Gardens (7) DS0000061532.V287334.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, & 9 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have care plans that are detailed but do not always reflect their long-term goals. EVIDENCE: All service users have been admitted through the Care Programme Approach. They have been living in the home for some time. The home promotes a recovery model of care with a focus on social care and independence. There is a move from writing standard care plans to developing recovery plans, which are intended to be more person centred. Each plan of care is designed to be as individual as the service user. The manager confirmed that as part of ownership, the service users’ receive a copy of their care plans to keep in their rooms. One service use was case tracked as part of the inspection and agreed to talk to the inspector. The service user confirmed that they had been living Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 10 in the home for more than a decade. Regular reviews are available on the care file as well as risk assessments. Comments received from the service users were “This place is wonderful. The staff are wonderful”. From discussion it is clear that the service user is kept well informed by the key worker. The care instructions are clear on managing key aspects of the person’s behaviour. There are always positive contacts. Risk assessments are in place and a management strategy is in place for noncompliance of medication. However the outcomes of the risk assessment are not reflected in the care plan. There is no written confirmation around budgeting and voluntary agreements for staff to look after a bankcard. The last documented mention of personal hygiene was several years ago, however it is clear that more input is required in this area. It is acknowledged that the staff team have been addressing a high profile immediate need and that this has overshadowed longer-term goals. Records and discussion show that the staff clearly understand the needs of the service users. Discussion with the manager highlighted that there should be short, medium and long-term goals identified. Please see requirement 1. The service user confirmed that they make their own decisions about their lives. Records clearly document that the service user has chosen to attend their review meetings but will not attend the house meetings. The care records showed a balance between strengths, areas of need, risks, rights and responsibilities. Cumberland Gardens (7) DS0000061532.V287334.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to follow their own preferred lifestyle EVIDENCE: Comments received from the service users were “This place is wonderful. The staff are wonderful”. The service user confirmed that any restrictions have been fully explained. They confirmed that service users are able to follow their own lifestyle and make choices about whether to join in joint activities or not. Activities both individual and in groups are arranged through consultation with the service users. Key working session clearly document where service users have chosen not to opt out of a programme of events. Activities are also being arranged in recognition of “Black History Month”. This has been discussed in the house meeting and service users have put forward their ideas. There are plans to ensure that one service user is able to meet with people from their own culture and be able to speak their own language. This person Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 12 has also been able to visit family and friends in their country of origin with the assistance of staff. This has been an annual event. The weekly menus are discussed at the house meetings. Menus are varied and cultural needs are taken into account. The feedback from the service users is positive. Cumberland Gardens (7) DS0000061532.V287334.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are arrangements in place to ensure that service users receive the personal and health care support they need. EVIDENCE: This service does not provide hands on personal care. Service users are supported to meet their own personal hygiene needs. This support can be gender specific if the service user chooses. An examination of one of the care plans found that personal hygiene; appearance and cleanliness of bedroom had not been included as a long-term goal. The bed had no bed sheets and the duvet cover was begrimed. Whilst it is acknowledged that bedrooms are the only personal space service users have and the individual choice of the service user is to be respected; and staff acknowledge that they have a responsibility to ensure that the home is clean and hygienic. There needs to be sufficient evidence through the care planning to demonstrate that there is a balance is being achieved. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 14 A comment from a service user was that “Staff are always respectful towards the residents”. Senior management deals with incidents of discrimination by service users towards staff. The likes and dislikes and individual needs of the service users are well known by the staff and recorded where appropriate. Service users are supported to access all available help. All of them are registered with a General Practitioner and have access to other health care professionals including a Psychiatrist, Community Psychiatric Nurse and an OT and Psychologist. The General Practitioners confirmed that staff have a good understanding of the service user’s needs and communicated well and worked in partnership with the surgery. Staff administer medication from blister packs. Service users have been assessed through a risk management strategy in order to self-medicate. There is clear evidence that work hard in conjunction with other health care professional in matters of non-compliance with medication. An inspection of the medication administration records (MARS) showed that these were not being kept according to best practice. Guidance recommends that “charts are printed to ensure that both charts and labels attached to medicines are produced from the same computer software and are therefore identical. Medication charts should not be constructed by sticking on duplicate labels, as they are not classed as “printed”. This can lead to error if the label is stuck to the person’s chart. (There are examples where this type of chart has been constructed by a pharmacist, despite professional advice against the practice issued by the Royal Pharmaceutical Society of Great Britain.)” Please see recommendation 1. There had been a hand written entry on one of the MARS charts. When alterations are made, the staff must amend the chart as follows: • Cancel the original direction • Write the new direction legibly and in ink on a new line of the MAR • Write the name of the doctor or other prescriber who gave the new instructions • Date the entry and sign (including a witness when this is possible) Please see requirement 2. The information on the MARS chart will be supplemented by the person’s care plan. As the care plan may include personal preferences, including ethnic issues such as should the care worker who gives the medicines be the same sex as the service user. In order to ensure that both records supplement each other, a recommendation has been made to develop medication profiles. These should include the medication that the person is taking, what it is being taken for and any side effects or special precautions that staff need to be aware of. Please recommendation 2. Cumberland Gardens (7) DS0000061532.V287334.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 & 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from harm, self-neglect and abuse. Their views are listened to and acted upon. EVIDENCE: There have been no recent complaints notified to the CSCI, although the preinspection information confirmed that two complaints had been received from service user. Both had been substantiated. The home has policies and procedures in place in relation to reporting and investigating complaints. The service user confirmed that they knew whom to approach if they had any concerns about the care they were receiving. They showed the inspector the complaints log kept in the lounge, which recorded the two complaints. Service users are able to raise concerns at house meetings, key-working meetings or during CPA reviews. This means that concerns are dealt with locally and effectively. The service users spoken knew they could approach the manager who was always responsive. The Care Manager’s and the GP’s who responded by returning comment cards recorded that they were satisfied with the standard of care in the home and had not received any complaints. The home has a copy of the Camden & Islington Protection of Vulnerable Adults policy and procedure. The staff handbook contains a copy of whistle blowing procedures. Staff have attended briefing sessions regarding adult protection. Privacy, dignity and choice are part of the aims and objectives of the project. Staff attend equality and diversity training. These policies and procedures and training opportunity are reflected in the care practice of the Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 16 staff. Staff have shown themselves to be responsive situations of potential abuse and have addressed concerns through the correct procedures. Risk assessments are in place when service users are vulnerable. There is a policy on handling service user’s finances and wherever risks have been identified, these are assessed and steps are taken to minimise the impact on service users. The home has a missing person procedure. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 & 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users will be living in an environment that will be attractive, comfortable and one, which meets their needs EVIDENCE: The inspector made a partial tour of the building, seeing the lounge, kitchen/diner a bathroom and a service user’s room (with their permission). There is an improvement programme planned. The manager has been involved in several site meetings but no date has been confirmed. The work is likely to be going for nine weeks. The manager has discuss a plan with the contractors to minimise the disruption for the service users, including scheduling a break for Christmas and New Year festivities as well as health and safety issues. The refurbishment programme has been discussed at the house meeting and service users are aware of what is happening. Service users are very knowledgeable about the refurbishment programme. They will be involved in choosing colour schemes for their own rooms as well as the communal areas. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 18 The areas of the house seen on the day of the inspection were noted to be clean and odour free. There has already been a reference to the condition of the bed for service user. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed by competent staff, which are trained and supported to meet the needs of the service users. EVIDENCE: This is a stable staff team but it is carrying vacancies. There is a 28-hour deputy post and 2.5 support worker posts to fill. These posts are frozen at present. As the manager does not have a deputy, this has slowed development work in the home. The manager strikes a balance between delegating tasks to the support workers but so as not to impinge on their work with service users. The vacant posts are covered by regular bank staff, one of whom who will be assimilated into a permanent post. At present the staff group are assigned to provide outreach support for up to four service users in the community. At present outreach services are provided for three service users, two of whom have been residents at the Clerkenwell Project. There are plans to increase the number of service users from 4 to 6. The service manager will be expected to put a proposal in writing to show how the staff will be deployed; how it is envisaged that the needs of the service users in the Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 20 home will be met; how often will support staff be expected to visit the outreach service users and what role and responsibilities will they have. All the permanent staff have achieved NVQ 3. Discussions with management highlighted that there is a training and development plan in place for all staff. This will focus on the need for staff to demonstrate evidence of their competence and this will be embedded in individual supervision. Staff receive both internal and external support and supervision in order to fulfil their roles. A look at a sample of care records including assessments, care plans and keyworking notes showed that staff are competent. Discussions with them highlighted that they knew the needs of the service users. The interaction between staff and service users was observed and showed that some staff are insightful. There was positive feedback from the service users about the staff and their approachability. The provider a robust policies and procedures for recruitment and selection, which is underpinned by equal opportunities. Copies of CRB checks are held in the home but other records are held centrally. The pre-inspection information also confirmed that all staff had CRB checks. The manager and a support worker confirmed that staff are in receipt of the GSCC code of conduct. The Commission is satisfied that the provider operates a thorough and robust recruitment and selection process. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a well run home, in which their views are sought and acted upon. EVIDENCE: The manager is competent and manages the service efficiently and effectively . She has successfully completed the fit person process to be become registered. She is aware of her accountability and responsibility under the law. She has relevant professional qualifications and has undertaken periodic training to assist her in her role as a manager of a care home. There is an open culture and service users felt able to address issues with the manager. The Interim Services Manager confirmed that a service user satisfaction survey had been carried and the when the results were collated, this would be Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 22 published and a copy sent to the CSCI. Service users are able to give feedback through key working sessions. The service has a robust health and safety policy in place and staff undertake appropriate training. Records show that equipment is serviced and there is a system in place to report repairs. During a tour of the premises there were no hazards observed. During the inspection the Project Line Manager raised concerns about the impact of the introduction of new food hygiene in January 2006, which insist on robust monitoring systems on food purchase, storage and preparation. The dilemma is how to implement the requirements in a residential unit based on the recovery model of care, that does not impinge on the development of service users to be independent. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 24 No 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 YA6 Regulation 15 Requirement Care plans must include short term as well medium and long term goals. The outcomes of risk assessments must be reflected in the care plan. When alterations are made to a medication administration record, the following actions must be taken:• • • Cancel the original direction Write the new direction legibly and in ink on a new line of the MAR Write the name of the doctor or other prescriber who gave the new instructions Date the entry and sign (including a witness when this is possible) Timescale for action 30/01/07 2 YA20 13(2) 30/11/06 • Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 25 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 YA20 YA20 Good Practice Recommendations It is recommended that the practice of sticking on pharmacist’s labels on medication administration records is stopped in favour of printed ones. It is recommended that medication profiles are developed for each service user. The profile should detail the medication, what it is used for and what side effects or special precautions should be taken. Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cumberland Gardens (7) DS0000061532.V287334.R01.S.doc Version 5.2 Page 27 - 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!