Inspection on 20/02/06 for Friern Residential Care Home

This inspection was carried out on 20th February 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Friern Residential Care Home 02/06/09

Friern Residential Care Home 30/09/08

Friern Residential Care Home 29/04/08

Friern Residential Care Home 28/01/08

Friern Residential Care Home 12/06/07

Friern Residential Care Home 28/11/06

Friern Residential Care Home 26/06/06

Friern Residential Care Home 26/09/05

Friern Residential Care Home 07/01/05

Friern Residential Care Home 26/05/04

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

CARE HOME ADULTS 18-65 Friern Residential Care Home 26-30 Stanford Road Friern Barnet London N11 3HX Lead Inspector Anthony Lewis Unannounced Inspection 20th February 2006 09:20 Friern Residential Care Home DS0000010441.V271172.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 Friern Residential Care Home DS0000010441.V271172.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. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Friern Residential Care Home Address 26-30 Stanford Road Friern Barnet London N11 3HX 020 8368 6033 020 8368 6033 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) Mr Vevegananthan Thambirajah Mrs Bijaye Luxmi Thambirajah Mrs Bijaye Luxmi Thambirajah Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One exception for over 65 years Date of last inspection 26th September 2005 Brief Description of the Service: Friern Residential Care Home is a private care home, which opened in 1989 and is registered to provide care to eighteen adult men and women who have mental health problems. Mr & Mrs Thambirajah are the registered providers and jointly own the home. Mrs Thambirajah is the registered manager and Mr Thambirajah is the deputy manager. The stated aims of the service are to meet resident’s needs in a friendly and efficient way and to strive to preserve and maintain resident’s dignity, individuality and privacy. The premises have been converted from three adjoining houses. All bedrooms are on the ground and first floors. There are fourteen single and two double bedrooms. One of the single bedrooms on the ground floor and first floor have been arranged as self-contained flats with their own kitchen and bathroom. There are two kitchens, one of which is the main kitchen and the other for snacks. There are also two lounge areas and two dining rooms. To the rear is a garden and patio area. The home is in a quiet residential part of Friern Barnet, close to shops, and transport links. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Monday 20th February 2006 at 9.20 am and was completed at 4.30pm. The registered manager was available throughout the inspection and the deputy manager and a support care worker were available for part of the inspection. All were helpful. To gather information for this inspection, ten residents and four staff were spoken to privately. In addition, a variety of files, documents and certificates were viewed. An internal and external tour of the home was conducted with a support worker. Overall, the registered persons have started work on updating the fabric of the home, which has been in need of redecoration for some time. However, progress in this area seems slow at the moment. The staff team have a good rapport with the residents, many of whom are quite independent and assertive. Many of the residents have an active social life and their days are taken up with various activities. However, there are still some residents who are not as active as they could be and require staff support and encouragement to motivate them. In general, the majority of the residents are happy and content and well cared for. The registered person need to be more proactive in ensuring that any requirements made are met as soon as possible or within the timescale given. Some of the requirements in this report have been restated more than once. What the service does well: What has improved since the last inspection? The menu has improved in that residents and staff are ensuring that meals are more varied and appealing. Feedback from all residents regarding meals is positive. The television aerial in the lounge/conservatory has been repaired and Sky satellite television has been installed. Redecorating work has begun in the home and the registered providers have earmarked further work to improve and upgrade the décor of the home. All staff have two references. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 6 What they could do better: Eleven requirements have been made at this inspection, six of which have been restated. The requirements made cover four main themes, these are: the interior décor of the home, which gives the home a dowdy appearance. Administrative issues and recording of information, which is not completed consistently by staff, staff training is not as robust as it could be and does not ensure that staff are up to date with appropriate training and the residents are not being included in issues and decision making that impact on them in the home. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The statement of purpose must be upgraded and a service users’ guide must be produced to ensure that prospective residents to the home and interested parties have up to date and comprehensive information to make an informed choice. Residents must be involved in all aspects of the day-to-day running of the home to ensure that they are part of any decision making. The staff team along with residents must explore initiatives to motivate and empower all residents to take control of their own lives. To ensure that residents are being respected, staff must ensure that mail clearly identified, as belonging to a resident is not opened by staff. Staff must ensure that all medication administration is recorded correctly to ensure that residents are not put at risk. If residents administer their own medication, this should be recorded in their care plans to ensure that the resident is not put at risk. All complaints must be taken seriously and acted upon to ensure that residents are confident in the service and complaints procedure. If residents are to be protected from abuse, staff must receive appropriate training to enable them to support residents appropriately. All maintenance issues must be dealt with to ensure that residents live in a safe and homely environment. The staff team must ensure that all areas of the home are kept clean to ensure that residents live in a clean and tidy environment. Residents’ views regarding the quality of service delivery must be anonymous to ensure that there is no prejudice in the quality assurance procedures. All of the core standards have been inspected for this inspection year. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 7 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. Friern Residential Care Home DS0000010441.V271172.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 Friern Residential Care Home DS0000010441.V271172.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): 1 and 3. The staff are not ensuring that prospective residents to the home and other interested parties are provided with up to date and comprehensive information regarding the home and the service provided. Robust health care professional and staff input ensures that residents’ needs are being met. EVIDENCE: Although made a requirement at the previous inspection, the home’s service users’ guide has not been completed. The registered manager said that some work has begun and it will be finalised in the near future. This requirement is restated. Three of the residents spoken to, including one of the most recent to the home said that there is a lot of input into their mental health by health care professionals such as their Community Psychiatric Nurse (CPN), General Practitioner (GP) and psychiatrist. Residents’ care plans and information in the office on the wall and in the diary indicate that some progress has been made into staff looking into the social and domestic care needs of the residents’ as was a requirement at the previous inspection. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 10 On the day of the inspection a health care professional visited the home to meet with two residents. The health care professional was spoken to at length about the service provided to the home and stated that at the moment some residents are visited about twice to administer medication to some residents and to enquire into residents’ mental health and give advice and support when required. Friern Residential Care Home DS0000010441.V271172.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): 8. Limited progress has been made in consulting residents and residents are still being taken for granted. The staff team are not ensuring that residents have the opportunity to participate in all decision making and are able influenced changes within the home. EVIDENCE: The home has recently prohibited smoking anywhere in the home and added a letter pertaining to this to all residents’ files. The registered manager stated that the reason for the smoking prohibition was due to the governments no smoking ban being implemented in some public places and because the staff are concerned about passive smoking in the home. When asked about residents’ participation and consultation in drawing up the new policy, the registered persons stated that residents were told about the policy at a residents’ meeting on 19th January 2006, the contents of which was seen. Seven residents were spoken to about the smoking ban and all but two said that they were not happy with it. One resident was quite angry and said, “I don’t like being outside in the cold smoking”. Another resident said, “I don’t want to smoke in the garden”, A resident who was outside in the garden smoking said, “If we have to we have to, it doesn’t bother me”. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 12 When asked if they were consulted about prohibiting smoking in the home, all of the resident spoken to said that their views were not sought prior to the prohibition coming into effect. A requirement was made at the previous inspection that residents be consulted about the day-to-day running of the home has not been met. This requirement is restated and revised in that the registered persons must ensure that a review of the no smoking ban is undertaken with the residents to ascertain their views and the findings recorded. Friern Residential Care Home DS0000010441.V271172.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): 13, 16 and 17. Some residents are not being supported by the staff team to be active in their local community and all residents’ rights are not being totally respected. This leaves some residents unmotivated and lacking in confidence in the service. Residents are confident that they will receive nutritious and varied meals based on their choices. EVIDENCE: A requirement made at the previous inspection for residents to be more motivated to participate in activities in their local community has not entirely been met. Most of the residents enjoy a busy independent social life and on the day of the inspection, some residents were observed coming and going freely. However, one resident who was spoken to at the previous inspection and again at this inspection said that he does not go out much due to mobility difficulties. He stated that he spends most of his time in his bedroom. Another resident said that he likes going to the shop to buy cigarettes but does not go out to other places and does not like day centres. This requirement is restated. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 14 A requirement made at the previous two inspections for an alternative smoking room to be found has been dealt with by the registered persons prohibited in the home and residents and staff must smoke outside the home. A resident was spoken to at length. The resident said that on more than two occasions, staff have opened their letters even though they were clearly addressed to the resident. The resident said that on one occasion, a letter was very personal and staff had read it. When spoken to about residents’ mail, the deputy manager said that there had been occasions when one residents’ mail had been opened by mistake and an apology was given. A requirement is made that staff do not open residents’ mail without their prior consent. At the previous inspection, the menu and food provision within the home was discussed at length with the registered providers and a requirement was made accordingly. At this inspection there was evidence of much improvement. The menu for the past three weeks was viewed and contained a variety of nutritious meals such as, lasagne, fish, soup, salads and sausage and mash. The minutes of the residents’ meeting on 19th January 2006 were viewed and contained information on residents’ choices. Six residents were spoken to about the meals provided by the home. All were very positive about the meals. One residents said, “The meals are always nice”. A resident spoken to at the previous inspection and who was not happy with the food said, “The food has improved a lot, they don’t give me what they use to”. Friern Residential Care Home DS0000010441.V271172.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): 19 and 20. Although staff are proactive with regards to residents’ health care, robust medication administration procedures are still not being maintained by the staff team. This is putting residents at risk. EVIDENCE: The files of seven residents were viewed and all contained information regarding health care appointments. The staff have ensured that details of appointments are recorded with dates and comments. In addition, there is a notice board in the office with details of weekly health care appointments. A resident with mobility difficulties was spoken to at length. He said that he would like to go out more but due to his mobility difficulties, he is restricted and spends much time in his bedroom. When spoken to the registered manager stated that they are liaising with health care professionals regarding the best treatment for the resident and referral has been made to see a consultant. The registered manager went on to say that the resident would have been seen sooner if it were not for a mix up with the resident’s previous address, where the letter was sent. A letter sent to a consultant orthopaedic surgeon was seen and the registered manager said that they are trying to obtain an early appointment for the resident. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 16 Gaps found in the medication administration records (MAR) sheets at the previous inspection and made a requirement have again been found at this inspection. All of the (MAR) sheets were viewed and gaps were found at various times of the day. This requirement is restated. While discussing medication administration, the registered manager stated that two residents self administer cream for skin complaints yet when viewed, there was no information regarding them self administering the cream in their care plans. A requirement is made that the registered persons must ensure that where residents administer their own medication, it is recorded in their care plans. There were not signs of “Tipp-ex” being used on many (MAR) sheets, as was a requirement at the previous inspection. The registered persons have put up a large sign in the office, where the medication is stored to remind staff not to use Tipp-ex. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Some residents are not confident that their concerns will be taken seriously and residents are being put at risk due to some residents not feeling assured that their complaints will be taken seriously and that staff are appropriately trained to deal with allegations of abuse. EVIDENCE: On the day of the inspection, a health care professional was spoken to at length about the service they provide at the home and about the health and welfare of residents. The health care professional said that a resident has made a list of complaints and that the resident does not feel that the registered persons will take them seriously. The resident was spoken to in private and reiterated the list of complaints. The resident went on to say that complaints have been made to the registered providers in the past but not much had been done about them. Some of the issues were discussed with the registered persons who said that they were aware of some of the complaints and have been dealing with them. A requirement is made that the registered persons must ensure that all complaints are taken seriously and acted upon and that the details are recorded in accordance with their complaints policy and procedures. The training records of six staff were viewed and although the staff have undertaken many training courses, some have not undertaken the adult protection training. Two staff were spoken to about the training that they have received in the home, both said that they have not as yet undertaken the adult protection training. A requirement is made that the registered persons ensure that all staff receive training appropriate to the work that they undertake in the home. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Maintenance issues are not being dealt with robustly and all areas of the home are not being kept clean and tidy. This does not allow residents full and adequate use of all of the home’s facilities. EVIDENCE: A tour of the home was conducted with a support worker. All parts of the home were viewed including some residents’ bedrooms, with their consent. There were a number of maintenance, decorating and redecoration requirements made at the previous inspection. Of these, the TV aerial has been fixed and the home now has Sky satellite TV. It was also noticed that work has begun to redecorate the hall and other areas of the home. The contract for work to the home was seen and is in accordance with work required in the home. However, a number of other issues were identified whilst touring the home, such as: a broken cistern top, the dryer in the laundry room was not working, a metal cupboard door in the kitchen was broken off and the downstairs toilet/shower room ceiling was damaged due to a water leakage. A requirement is made that the registered persons must ensure that the identified maintenance issues are dealt with. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 19 While touring the home, a number of areas were either untidy or unclean. The carpets in the large lounge, dining room and conservatory were stained due to liquid spillages. In the “snack kitchen”, there were a lot of crumbs on the floor to the side of the fridge. A requirement is made that the registered persons ensure that all areas of the home are kept clean and tidy at all times. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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. Robust recruitment procedures are being followed and staff are receiving statutory training to ensure that residents are protected and supported by the staff team. EVIDENCE: The personnel files of six members of staff were viewed and all contained the necessary recruitment information such as a Criminal Records Bureau (CRB) check, proof of identity such as a recent photograph and passport, where applicable and two references. While viewing the staff’s files, all contained a variety of training certificates, such as health and safety, food hygiene and moving and handling. The two staff who were spoken to both had a good understanding of the training that they need to enhance their roles and responsibilities in supporting the residents. In addition, the home has a number of training and introductory videos, which, according to the registered persons, are shown to new staff as part of their induction. There were videos relating to fire awareness, health and safety, food hygiene and mental health. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39. Residents are confident about the management of the home. However, the home is not ensuring that anonymous and objective quality monitoring is taking place. This could result in a biased and distorted view of the quality of service provided. EVIDENCE: The registered manager demonstrated her knowledge and experience throughout the inspection. She has a good understanding of mental health issues and the support that the residents in the home require. Staff spoken to said that they felt that the home is being managed well. Two residents said that the registered manager is “ok” and a resident who was spoken to at the previous inspection and had some concerns said at this inspection, “Things are much better, the manager is fine, I’ve no complaints”. Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 22 Although the home has comprehensive quality assurance questionnaires in place to monitor the quality of service delivery to residents, the registered manager stated that some of the questionnaires are filled in by staff on behalf of residents. The issues surrounding staff filling in the questionnaire was discussed with the registered manager. A requirement was made in relations to this at the previous inspection. This requirement is restated. Friern Residential Care Home DS0000010441.V271172.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 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 1 X 3 X x Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 1 X x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 1 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Friern Residential Care Home Score X 3 1 x Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X x DS0000010441.V271172.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 YA1 Regulation 5 (1) (2) (3) Requirement Timescale for action 28/04/06 2 YA8 3 YA13 The registered persons must ensure that a service users’ guide is completed and a copy forwarded to the Commission. (Timescale of 28/10/05 not met). This requirement is restated. 24 (1) (2) The registered persons must (3) ensure that residents are consulted about the day-to-day running of the home. This requirement is restated and revised in that the registered persons must ensure that a review of the no smoking ban is undertaken with the residents to ascertain their views and the findings recorded. (Timescale of 25/11/05 not met). This requirement is revised and restated. 12(3),24(1) The registered persons must (a) (d) ensure that residents are motivated to participate in activities in their local community and all other aspects of their lives. (Timescale of 27/01/06 not met). This requirement is restated. DS0000010441.V271172.R01.S.doc 31/03/06 28/04/06 Friern Residential Care Home Version 5.0 Page 25 4 5 YA16 YA20 12 (3) (4) (a) 13 (2) 6 YA20 13 (2) 7 YA22 22 (3) (4) 8 YA23 18 (1) (c) (i) 9 YA24 16(2fg) 23(1,2) 23(2) (d) 24 (1a,b) (2) (3) 10 11 YA30 YA39 The registered persons must ensure that all residents’ rights are respected. The registered persons must ensure that the administration of all medicines is signed for on the (MAR) sheets and any nonadministration coded as to the reason why the medication was not administered. (Timescale of 07/01/06 not met). This requirement is restated. The registered persons must ensure that where residents self administer their own medication that it is recorded in their care plans. The registered persons must ensure that all complaints are taken seriously and acted upon and that the details are recorded. The registered persons must ensure that all staff receive training appropriate to the work that they perform in the home. (Timescale of 27/01/06 not met). This requirement is revised and restated. The registered persons must ensure that the identified maintenance issues are dealt with. The registered persons must ensure that all areas of the home are kept clean and tidy. The registered persons must ensure that a suitable method of obtaining residents’ views is established, with independent support where required. (Timescale of 07/01/06 not met). This requirement is restated. 28/04/06 17/03/06 17/03/06 31/03/06 28/04/06 28/04/06 17/03/06 28/04/06 Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Friern Residential Care Home DS0000010441.V271172.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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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