Inspection on 19/10/05 for Franklin House

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Franklin House 07/01/08

Franklin House 20/11/06

Franklin House 07/06/05

Franklin House 11/01/05

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

CARE HOMES FOR OLDER PEOPLE Franklin House The Green Swan Road West Drayton Middlesex UB7 7PW Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 19th October 2005 10:00 X10015.doc Version 1.40 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 Franklin House DS0000056134.V257374.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 Older People. 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. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Franklin House Address The Green Swan Road West Drayton Middlesex UB7 7PW 01895 452 480 01895 448 132 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) Care UK Ms Fiona Lawrence Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The ground floor accommodates the 21 bedded intermediate care unit. The middle floor will accommodate a 31 bedded general nursing unit. The top floor will accommodate the 14 bedded continuing care unit. Staffing levels as agreed at point of registration must be maintained unless negotiated with the Regulation Authority, prior to any changes being made. For Charlie Chaplin Unit, the following staffing levels: A.M Shift: 17-21 service users, one Registered Nurse and Five Care Assistants 13-16 service users, one Registered Nurse and Four Care Assistants 9-12 service users, one Registered Nurse and three Care Assistants 8-0 service users, one Registered Nurse and two Care Assistants P.M shift: 17-21 service users, one Registered Nurse and Four Care Assistants 13-16 service users, one Registered Nurse and three Care Assistants 9-12 service users, one Registered Nurse and two Care Assistants 8-0 service users, one Registered Nurse and two Care Assistants Nocte shift: 17-21 service users, one Registered Nurse and 1.5 Care Assistants (.5 CA to be employed between 8pm and 12am). 13-16 service users, one Registered Nurse and one Care Assistant 9-12 service users, one Registered Nurse and one Care Assistant 8-0 service users, one Registered Nurse and one Care Assistant. Date of last inspection 7th June 2005 Brief Description of the Service: Franklin House is a purpose built 66-bedded nursing home situated in West Drayton. There are 66 single en-suite bedrooms. The home has three units: the intermediate care unit, frail elderly nursing unit and a continuing care unit. Each unit is located on a separate floor and have their own team of staff. On the intermediate care unit there is also a physiotherapist, nurse consultant and occupational therapist. A kitchenette is available in each unit and there is a main kitchen and laundry on the ground floor. There is a rear garden, which can be Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 5 accessed by service users. Each unit has a dining room and two lounges.There are two lifts in the home, one is a passenger lift and the other is a service list.The home is close to local shops and West Drayton High Street. All referrals to the home are made through the Care Management Team. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 7.05hours were spent on the inspection process. During the previous inspection conducted in June 2005 all but four of the National Minimum Standards (NMS) were assessed. The main focus of this inspection was therefore to assess the four standards not assessed at the last inspection and to follow up the requirements and recommendations from the previous inspection including the pharmacy inspection. The Inspector undertook a tour of the premises and inspected staff records, service user plans/records and records in the kitchen. 6 Service users and 12 staff were spoken to as part of the inspection process. This included the physiotherapist and occupational therapist and two occupational therapy assistants on the intermediate care unit. At the time of the inspection there were sixty service users accommodated at the home. Since the last inspection Care UK has employed a new Manager for the home. She had been managing the home since August 2005. The Manager Designate was undertaking the registration process. What the service does well: What has improved since the last inspection? Some improvements have been noted in the management of medication. This inspection also identified that some requirements from the last pharmacy inspection have not been addressed. Systems are in place for service users, staff and relatives to share their views, give opinions and raise any concerns. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 7 Staff recruitment procedures have improved and the required information was available. The completion and updates of service users assessments had also improved. 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. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Service users and their representatives are provided with information about the home in order that they can make an informed choice about where they want to live. The pre-admission assessment process for prospective service users enables the home to ensure it can meet the needs to include specialist care needs of each individual. The service users are served well by the facilities and team work on the intermediate care unit which promotes their independence. EVIDENCE: The Statement of Purpose had been updated to include the details of the Manager designate. This was freely available and a copy was also available in the foyer of the home. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 10 Needs led assessments were available on the files viewed. There had been some improvements in the signing and dating of the homes own pre-admission assessment tool. The home has an intermediate care unit, which is purpose built. Feedback from the multidisciplinary team confirmed that the unit was well supported and that staff from the PCT and social services were working well together. Feedback also indicated that the Manager Designate was proactive in the unit and had purchased new equipment for rehab. The Occupational Therapist reported that the unit continued to get inappropriate referrals from Hillingdon Hospital. These included referrals for service users that would not benefit from the intermediate care unit. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 11 Service users individual needs were not always identified and information held was not always up to date, and this can place service users at risk of not having their needs fully met. Shortfalls in the management of medications potentially place service users at risk. The changing needs of service users are met with sensitivity, care and respect. EVIDENCE: Sample of care plans viewed on each of the units. The home is currently in the process of implementing an electronic record system, which will initially cover service user plans, assessments and staff records. At the time of the inspection the staff were also continuing to maintain paper records as there were teething problems with the IT system. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 12 On the intermediate care unit (Charlie Chaplin unit) one service user had a wound, which was being dressed. There was no associated care plan detailing the dressing and product being used. For another service user a wound care plan was in place but this again did not detail the dressing to be used or the frequency of changes. Care plan training had been booked for all trained staff for the 28/10/05. On Charlie Chaplin unit one care plan had been half written, was incomplete, not dated or signed by the Registered Nurse. There was evidence in the files viewed that care plans were being reviewed monthly. All these areas were discussed with the Manager Designate at the time of the inspection. Two Registered Nurses were undertaking the tissue viability course at Thames Valley University. There was no other evidence that the remaining staff had received any wound care training. Moving and handling, Waterlow pressure sore assessments, risk of falls and nutritional assessments were available on the files viewed. The Inspector noted that one service user was a diabetic but this had not been taken into consideration with the final score on their Waterlow pressure sore assessment. Waterlow pressure sore assessments did not identify the type of mattress that was to be used. A number of pressure sores have been acquired within the home. Wound audits do not take place and this was an area that the Manager Designate stated that she wanted to improve. Pressure relieving mattresses for the first floor had been ordered and were awaiting delivery. Records viewed confirmed that the tissue viability nurse was involved in the management of some wounds. Bedrail assessments were available and had been discussed with the service user/representative. The Manager Designate reported that she had undertaken a review of the number of bedrails in use within the home. Peg feeding training had been planned. Since the last inspection the first and second floor have a physiotherapist attend to the service users twice a week. The Registered Nurses reported that this had benefited the service users. The home has weekly visits from the GP and the Consultant Geriatrician at Hillingdon Hospital. Service users have access to all relevant professionals in the community this includes, the dietician, tissue viability nurse, stoma nurse, optician, dentist and occupational therapist. Any visits undertaken by a visiting professional are recorded in the service users notes. Evidence of this was seen on the files viewed. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 13 The home does not provide palliative care. The changing needs of service users are met by the home. Where possible the family is involved. Many of the service users are unable to express their wishes regarding death and dying, as a result the home works closely with relatives and representatives. Policies and Procedures for handling death and dying are in place. Any pain relief required for a service user with a deteriorating condition would be discussed with the GP. The Registered Nurses reported that some families do not wish to discuss areas concerning death and dying. Where wishes are known than this is recorded. Where service users refuse to go to hospital they are nursed in the home. Armchairs and facilities are available for relatives to stay with the service user. The Controlled Drugs register was checked on all three units. All recorded a zero balance. On Charlie Chaplin unit staff were still not recording the variable dose of Paracetamol. Liquid medications had the date of opening recorded. Medication storage cabinets had been purchased for Charlie Chaplin unit and these were to be mounted to the wall in the clinic room. There were gaps in the recording of some medicines on Judy Garland and Audrey Hepburn units. Medication fridge temperatures and clinic room temperatures were being recorded on all three units. The system for the disposal of medication was in place but was not being used. The Manager Designate reported that staff were still to be trained in the new system and that once this training had been undertaken the disposal system would be used. The medication policy and procedure had been updated to include the new disposal system. On Audrey Hepburn the Inspector met one service user who had a Cerebro Vascular Accident. This service user was unable to communicate their needs verbally. No other system was in place for the service user to communicate. The Inspector recommended that the staff investigate alternative methods of communication and involve the Occupational Therapist Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 & 15 Social activities are in place in accordance with the service users wishes. Generally the meal provision in the home is good offering choices, variety and catering for special dietary needs. This would be further enhanced if a cooked breakfast were offered to service users. Shortfalls in the storage of food, wedging the kitchen door open and lack of training for the cook potentially place service users at risk. EVIDENCE: There are two activities co-ordinators in the home. A wide range of activities is offered to suit individual and group needs of service users. Records on activities undertaken were not viewed. Visits from the clergy are arranged as required by service users wishes. At the time of the inspection a Church service was taking place. No progress has been made with providing service users with a cooked breakfast. The Manager Designate reported that she was due to visit the Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 15 factory where the ‘cook chill’ meals are prepared in order to expand the meal choices that are available to service users. The menus viewed reflected two choices. Where service users do not choose either of the two choices a sandwich would be prepared. The cook in the home has not undertaken any food hygiene training. Records on food temperatures and fridge/freezer temperatures were available. Unused tinned food was being stored in the tins, which were in the fridge. This is poor practice. The kitchen door was wedged open, and menus were not displayed on the units. The ‘cook chill’ provider had attended the relatives/service users meeting and a food tasting evening was held. The Inspector observed lunch. Pureed meals were available and the individual food items were pureed separately. The service users who spoke with the Inspector confirmed that they enjoyed the meals. Each unit has a small kitchenette where small snacks can be prepared along with tea and coffee. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has a satisfactory complaints system with evidence that service users and representatives are listened to and acted upon. Systems are in place for the protection of vulnerable adults, so as to protect service users from possible risk of harm or abuse. EVIDENCE: Information on how to make a complaint is detailed in the Statement of Purpose and the Service User Guide. The Manager Designate reported that relatives are encouraged to voice their concerns either individually or at relatives meetings. Two complaints had been received by the home since the last inspection. Both of these had been recorded, investigated and the outcomes of the investigations were available. There have been no Protection of Vulnerable Adults issues since the last inspection. Staff have received training in the Protection of Vulnerable Adults. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, & 26 The home was clean and tidy and the environment was safe for the service users, this provides service users with a comfortable and safe environment for those living in the home and visiting. Equipment and adaptations to meet service users needs are in place. Systems were in place for the prevention of the spread of infection and were being adhered to. Thus safeguarding service users. EVIDENCE: Franklin House is a purpose built nursing home. The home was clean and hygienic on the day of the inspection. The home was well maintained, safe and secure for the service users. There was some evidence of wear and tear to the paintwork. The maintenance man was addressing this. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 18 Suitable adaptations were available throughout the home, including bathrooms and toilets. A passenger lift is available and the corridors allow for service users to self propel their wheelchairs. The premises were clean, hygienic and odour free on the day of the inspection. Policies and procedures were in place in relation to infection. Gloves, soap and paper towels were available throughout the home. The laundry room was viewed and found to be satisfactory. Bags for foul laundry and clinical waste were available. The Manager Designate reported that staff had received training in infection control. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 The home was adequately staffed to meet the needs of the service users. Staff training is ongoing to ensure that staff have the skills to meet the needs of the service users. The systems for the recruitment of staff were robust and safeguarded service users. Staff training is ongoing to ensure that staff have the skills to meet the needs of the service users. EVIDENCE: The staffing levels on Audrey Hepburn and Judy Garland unit have not change since the last inspection. On Charlie Chaplin unit staffing levels on a sliding scale are operated as the occupancy level on this unit varies. This has been agreed with the CSCI. The Registered Nurses who spoke with the Inspector reported that staff were working better as a team. Any shortfalls with the number of staff on duty were reported to the Manager Designate, who would then try to cover the shift. One staff file was viewed during the inspection. This contained the information as required by Schedule 2 of the Care Homes Regulations 2001. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 20 The Manager Designate confirmed that NVQ training for care staff was due to start at the beginning of November 2005. She is also a NVQ assessor. Staff confirmed that they had been receiving training, infection control, peg feeding, two staff had been trained as moving and handling instructors. Care planning, first aid. A training matrix was in place, and this detailed the training undertaken by staff, and also which training staff required. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 & 38 A new permanent manager has been recruited and is working hard to provide a clear consistent way of working which will enhance the lives of service users. Improved systems for quality assurance are in place and should enhance the quality of life for service users. Staff supervision is under review and a robust system will help improve teamwork, identify training needs and ensure that staff are appropriately supervised. EVIDENCE: The Manager Designate has been in post since the beginning of August 2005. An application for registration has been submitted to the CSCI. She has several years of experience in managing care homes with nursing and is a First Level Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 22 Registered Nurse, NVQ assessor, is qualified in Health and Safety, has a Certificate in Management Studies and has completed her NVQ level four in Health and Social Care. Staff spoken with commented on the fact that the Manager Designate manages the home well, has good leadership and communication skills and maintains a regular presence throughout the home. The Manager Designate reported that she has an open door style of management and is open to suggestions and opinions. The Manager Designate is also keen on developing an inclusive style of management in that staff take ownership for the changes that take place within the home. A system for holding staff (night and day), service users and relatives meetings had been implemented. Minutes of these meetings were available. A system for staff supervision was not in place. The Manager Designate reported that she would have in place a system for staff supervision by the end of November 2005. This standard will be revisited at the next inspection to see what progress has been achieved. Regulation 26 Visits had been taking place and the Commission had been receiving the reports of these visits. At the time of the inspection the home only undertook medication audits. Care plan audits, wound care audits and environmental audits were not taking place. The Manager Designate reported that this is an area that she will be developing. Feedback questionnaires have been undertaken with the service users in relation to the food provided. A feedback folder is also available in the main entrance of the home. Statutory training has been arranged for staff and there is evidence that the rolling programme is being carried out. Two staff were undertaking the Moving and Handling trainers training. Since the last inspection a Health and Safety Committee has been established. The Manager Designate reported that generic and specific risk assessments were available. The home has policies and procedures for health and safety and related topics in place. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15(1)(2), 17(3) Requirement Service users care plans must be completed in full, dated and signed. Records must be maintained in keeping with the NMC’s guidance on records and record keeping. Care plans must be available and comprehensively reflect individual needs that have been identified through the assessment process and must detail clearly the interventions that are required to meet those needs. All Registered Nurses must receive wound management training. Records of the training undertaken must be available for inspection. Pressure sore risk assessments must include details of the service users medical condition and details of any pressure relieving equipment in use. All medicines must be recorded when administered including variable doses. (timescale of 1/7/05 not met) PRN or as required medicines DS0000056134.V257374.R01.S.doc Timescale for action 21/11/05 2 OP7 15(1)(2) 21/11/05 3 OP8 18 06/02/06 4 OP8 13(4)c 21/11/05 5 OP9 13(2) 11/11/05 6 OP9 13(2) Franklin House Version 5.0 Page 25 7 OP14 12(4) 8 OP15 18(1) 9 OP15 16(2)g 10 11 OP15 OP36 12(1)a 18(2) must be included on the MAR and full instructions for use must be available. (timescale of 1/7/05 not met) The Manager Designate must investigate and provide for service users alternative communication tools that meet the assessed needs of the individual service user. The cook must undertaken Food Hygiene training. Records of the training undertaken must be available for inspection. The Manager Designate must ensure that food is stored in accordance with Food Hygiene Regulations. The Kitchen door must not be wedged open. Formal Supervision must be implemented for every staff member at a frequency of six times annually. 11/11/05 19/12/05 09/01/06 07/11/05 07/11/05 30/11/05 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 OP8 OP14 Good Practice Recommendations It is strongly recommended that an internal audit system of service users records and equipment is developed It is strongly recommended that menus are displayed in each dining room, in print which is appropriate to the needs of the service user. Franklin House DS0000056134.V257374.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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