Inspection on 16/05/07 for Granby Rose SDU

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Granby Rose SDU 04/10/05

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

CARE HOMES FOR OLDER PEOPLE Granby Rose SDU Highgate Park Harrogate North Yorkshire HG1 4SR Lead Inspector Jo Bell Key Unannounced Inspection 16th May 2007 09:15 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 DS0000065470.V333717.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 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. DS0000065470.V333717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granby Rose SDU Address Highgate Park Harrogate North Yorkshire HG1 4SR 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) 01423 505533 01423 562831 www.fshc.co.uk Granby Holdings Limited Mrs Bernadette Mossman Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places DS0000065470.V333717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: Granby Rose is a care home for up to 25 people with dementia. The home is situated close to Granby Court and Granby Extended Care, and close to the town centre of Harrogate. The home is purpose built to a high standard. The fees per week are £810 upwards. There are additional charges for chiropody, hairdressing, toiletries and newspapers. The home supports clients and their families in coping with dementia, to live an independent and dignified life. DS0000065470.V333717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection of the service took place on Wednesday 16th May 2007. Prior to the visit a pre-inspection questionnaire was completed. Fifteen surveys were received from relatives, two from healthcare professionals and six surveys from people who use the service. One inspector spent six hours visiting the service, during which time observations of care practices, discussion with people who use the service, their relatives and staff took place and aspects of the environment and health and safety were examined. The lunchtime meal was observed and the arrangements regarding food and drink were discussed. Three individual care plans were inspected, along with the medication system. Staffing issues were discussed and the operations manager spent time discussing the philosophy of the service with the inspector. What the service does well: What has improved since the last inspection? What they could do better: The medication system needs to be more robustly audited to ensure the risk of error is minimised. DS0000065470.V333717.R01.S.doc Version 5.2 Page 6 The catering staff should liaise more closely with people who use the service, this will ensure the views and opinions regarding the food served are made clear. The moving and handling technique used for one person could be improved, to ensure they are not put at risk. 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. DS0000065470.V333717.R01.S.doc Version 5.2 Page 7 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 DS0000065470.V333717.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People who use this service experience excellent quality outcomes in this area. Individual needs are robustly assessed to ensure needs can be met. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager or the deputy of the service carry out an extremely detailed assessment regarding mental health, personal and social care needs prior to a person being admitted to the service. Three assessments were inspected and it was evident that all aspects of a person’s life is taken into account when an assessment is completed. The manager and deputy are extremely knowledgeable regarding dementia care needs, and there is a strong emphasis on meeting individual needs. Surveys returned confirmed that these assessments have been carried out and people who use the service and one relative discussed the procedure which took place when they first entered the home. DS0000065470.V333717.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. People receive a high standard of care, and health and personal care needs are routinely met, although some aspects of medication could be improved. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People receive a high standard of care. Observations of practices confirmed that privacy and dignity is maintained, people are treated with the utmost respect and staff have an excellent relationship with people who use the service and any visitors entering the home. Care and attention is given to personal appearances with people looking clean and well cared for. Individuals can have their hair attended to and extra attention is given to nails, make-up, glasses and teeth. One gentleman was wearing a very smart shirt and tie which was his preference, he said ‘the staff are wonderful’. One relative said staff are lovely and always have time to talk to everyone’. Surveys received commented positively on the high standard of care given, with many comments including words such as ‘excellent, special, and wonderful’. DS0000065470.V333717.R01.S.doc Version 5.2 Page 10 Three care plans were examined and these all had detailed information in, risk assessments for moving and handling, the prevention of pressure sores and nutrition were all in place and regular reviews were evident. On one occasion a person was moved using the hoist and sling in a potentially unsafe way. The sling did not fully support the person, and though no incident occurred this could have been managed more appropriately. The service is currently changing aspects of the documentation and therefore some plans were in the process of being transferred to the new system. One person’s care plan which had the new documentation in was not completed fully. For example, some of the nutritional information on the prevention of pressure sore chart was not completed, and care staff are asked to record when they have completed different aspects of personal care. During one week this was left blank, although the progress notes were in place. The manager confirmed that auditing of this system takes place and immediate action will be taken to rectify this. The home is keen to highlight nutritional needs, a robust assessment tool is in use and staff were clearly aware of the action to take if an individual is under or overweight. The community dietician is available, and specific care plans were in place with the interventions needed to promote nutrition. The GP, specialist nurses, chiropodist, dentist and optician are all easily accessible And evidence if these visits was available in the communication part of the care plans. A range of risk assessments were in place regarding falls, use of bed rails and managing challenging behaviour. The manager is aware of how to report incidents and accidents to CSCI and to Health and Safety executives. The medication system was examined. People are given medication in a discreet manner and generally not at mealtimes. Staff have attended medication training which one registered nurse confirmed. The medication room is secure with drug trolleys being stored and maintained correctly. Fridge temperatures are taken daily and staff are knowledgeable in administering and disposing of medication. Controlled drugs are dealt with appropriately and the home has robust medication procedures in place. The home uses a blister pack system to dispense medication, whilst these were stored correctly many of them were not sealed securely, and the packaging was damaged. Medication charts were checked and it was evident that when a tablet is not administered it was difficult to understand the rationale for this. One person had a signature and a code, however the rationale recorded for this was ‘not given due to error’. This is unclear and needs to be rectified. The manager confirmed that medication audits take place routinely and whilst weekly stock balances of most medication takes place, the blister pack stock balance was not documented. DS0000065470.V333717.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good quality outcomes in this area. People are offered an excellent range of activities and relatives and friends are encouraged to be involved with the service. The food and drink provided is of a high standard. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People using this service have the opportunity to participate in some excellent activities. A full time organiser works in the home and has been involved in specific training relating to activities for people with dementia needs. A baking session had taken place in the kitchen and four people were observed having tea and coffee with the homemade biscuits. The organiser keeps her own records and is very aware of which activities would be suitable for particular people. A sensory room and garden are available, and reminiscence therapy is used. Some people were reading current affairs magazines and two people had copies of past times types reading. A website with a range of magazines is available and different newspapers are delivered to individuals. The home have use of a pool car which means people can access local cinema, coffee shops, public houses or general shops. One lady was out having a walk with a carer and as the home is located in a beautiful area of Harrogate, people can enjoy pleasant views and surroundings. Details regarding social history are DS0000065470.V333717.R01.S.doc Version 5.2 Page 12 completed and staff have a good understanding of the life people have had prior to coming into this service. One relative said her father enjoys playing cards or dominoes, the television and music are available, and staff are able to interact on a one to one basis. Visitors are able to enter the home as they wish, staff always ensure that people are in a dignified state and are ready to receive visitors prior to being allowed into the home. (there is a reception area for visitors to sing in and wait). The home is keen to promote a range of cultural and religious needs, this is discussed on an individual basis. Visits from local clergy, priests and from the Eucharist church are evident. People are able to receive communion if they wish. Comment cards generally confirmed that these needs are addressed, although one relative felt this was not the case. People are encouraged to be autonomous within their own limitations, the daily routine is decided through looking at individual needs. For example, people can get up and go to bed when they wish, mealtimes are flexible and participation in activities is optional. Staff and the manager spend a lot of time with relatives offering them support and advice when needed. The lunchtime meal was observed, the standard of the food provided is high. There is a choice offered throughout the day and meals can be served in one of the communal areas or in a person’s own room. A budget is set per person and this is sufficient to ensure good quality food is obtained, prepared and served. The dining area is pleasant with material and paper napkins available. Plate guards and suitable crockery is used and assistance is given in a dignified manner. There is a range of fresh vegetables and home-baking offered and food is stored in an appropriate manner. People were observed enjoying the food provided, a starter, main course and pudding were offered at lunchtime with two separate dining times available. The catering staff were spoken with and observed. Meals which needed to be pureed were done so separately. For example the meat/fish was pureed, then the vegetables were pureed and placed on the plate individually. Whilst the cook was aware of how to puree food correctly she did not appear to understand why it was beneficial to have food served separately instead of being blended together. The home have previously used ‘moulded foods, this is where shapes are used to make the food look more appealing. The cook said this was tried but did not work as the food became ‘watery’. However, instead of seeking further advice as to the reason for this, the practice was discontinued. This was discussed with the manager who will address this issue. The cook has completed food hygiene training along with all the catering staff, and is a representative at a food forum. The menus have changed recently and they rotate on a four weekly basis to reflect different seasons. This ensures a wide range of food is offered. DS0000065470.V333717.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. Complaints are listened to and robustly acted upon, and people feel safe and protected in their environment. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: All people spoken with including relatives, staff and the people who use the service were aware of how to make a complaint. A robust procedure is available which is reflected in the statement of purpose, and this information is given to everybody when they enter the service. Surveys returned confirmed that people are aware of this procedure. There are no complaints currently being investigated and the CSCI has not received any formal complaints. The staff have an open, friendly and professional manner. Discussions regarding any aspects of the service that people are not happy with are encouraged, and action is promptly taken by the manager to make any minor or major improvements which will benefit the client group. The risk of abuse to people is minimised through robust protection procedures being in place. Everyone spoken with said they felt safe and protected from harm. There are clear whistle-blowing policies and staff are aware of how to respond if there is an incident or an allegation made. Practices observed confirmed that staff have a good rapport with people who use the service and the attitude and manner of staff is kind and courteous. Currently the protection of vulnerable adults training is not mandatory, and therefore some staff have not received up to date training for over a year. The manager confirmed that this could be rectified. DS0000065470.V333717.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience excellent quality outcomes in this area. The clean and well maintained environment has a positive impact on quality of life for people. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: This service is an excellent example of how the design and décor of a home can have a positive impact on the clients living there. For example consideration has been given to the colour of the walls, floors, curtains, bedding, and to the layout and design of the communal areas. Photographs of people are evident and items are located in certain places so people can pick out their own rooms. Rooms are kept unlocked to ensure if a person is looking for a room they can access it immediately (unless the risk assessment suggests otherwise). There are a range of small lounges and a big dining room with pictorial information available at a height relevant to this client group. Staff, other than those required to help during this time do not enter the dining room when people are dining, this encourages a calmer and more relaxing atmosphere. The bathroom areas are easy to locate and these are only locked DS0000065470.V333717.R01.S.doc Version 5.2 Page 15 when in use. All areas of the home inspected smelt clean and fresh, the home can utilise extra domestic staff when there are unpleasant odours. There is a sensory garden for people to spend time in and a maintenance person is responsible for ensuring the building is kept safe and secure. The laundry area was examined and the assistant in this area was spoken to. Washing and ironing is carried out on the premises. There are two washing machines and one tumble drier, although one machine was broken, but this has been reported to the manager and action has been taken. Clothes are labelled and people were observed wearing clean and well ironed clothes. One member of staff felt the products used in the laundry do not get the clothes clean, and often clothes have to be re-washed to prevent them from smelling. This was passed onto the manager who would look into this. Staff have previously received infection control training, the sluice was clean and tidy and staff were observed using protective clothing when entering the kitchen, in the dining room and when dealing with personal care. This practice reduces the risk of cross contamination. DS0000065470.V333717.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience good quality outcomes in this area. There are plenty of staff to meet individual needs, and they who are trained and recruited appropriately which helps protect people from harm. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: People in this service are cared for by sufficient staff who are extremely competent, skilled and knowledgeable in the area of dementia care. There is the opportunity for one to one interactions between the client group and staff and there is a commitment by the home to offer a range of training to further develop the skills needed to care for these individuals. During the visit there was the deputy manager and another registered nurse working with four care staff, this was for twenty five people. The manager is supernumerary. Observations showed call bells being answered promptly and regular supervision taking place in the communal area of people who may not have been able to use the call bell system. Staff are aware of individuals mental capacity and are keen to make people as independent as possible but also act as advocates where necessary. All the surveys received by clients and their relatives had positive comments regarding the high standard of care. Many staff have completed an NVQ Level 2 or 3 in care and the standards expected from staff are consistently high. The manager and deputy oversee the recruitment procedure, an application form, two written references a police check and a protection of vulnerable check are undertaken prior to a person starting employment. The risk of harm DS0000065470.V333717.R01.S.doc Version 5.2 Page 17 to people is minimised due to the stringent procedures in place. Two registered mental nurses have recently been recruited which will be beneficial, as this is a specialised area which requires expert knowledge in mental health. Three staff files were inspected, and these were found to be up to date. A recruitment procedure is in place and the manager is very clear about the calibre of staff she wishes to recruit in order to be able to meet individual needs. Staff are all given induction training when they start working in the service. Four Seasons Healthcare have a comprehensive induction pack which staff work through over a number of weeks. This looks at care practices, expectations of staff and covers mandatory training. Staff spoken with confirmed this training had taken place, and individual training files were available to evidence this. DS0000065470.V333717.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People who use the service experience excellent quality outcomes in this area. The philosophy of the home is excellent and it is clearly run in the best interests of the people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The registered manager of this service is an excellent individual with a philosophy of caring for people with dementia where person centred care is of paramount importance, and the needs of individuals and their families are considered and reflected upon in detail. The manager is also the operations manager for the organisation and is completely supernumerary. The deputy has sixteen hours which are supernumerary although it would be beneficial if this was increased. The manager has completed a range of courses and is an experienced mental health nurse who is continually developing and moving the service forward. DS0000065470.V333717.R01.S.doc Version 5.2 Page 19 The service has a quality assurance system in place, and has received an ‘Investors in People’ award, along with being certified as having a high standard of quality audit systems in place. Relatives meetings take place on a regular basis, and large amounts of time are spent supporting clients and their families. Annual surveys are completed and audits of a range of systems including care plans, medication, kitchen, the whole building, and accidents and incidents takes place. It would be beneficial if the cook was involved in some of the relatives meetings, because currently information regarding whether food is liked or disliked is passed on through the care staff. The manager is aware of the annual quality assurance assessment which will need to be completed on a yearly basis for the CSCI. Finances were discussed with the manager. Currently the home does not deal with any personal monies. A relative or other responsible person is designated to deal with individual’s finances where there is a mental capacity issue. If an individual visits the hairdresser, chiropodist or needs toiletries an invoice is sent to the person concerned. The pre-inspection questionnaire confirmed this information and this is discussed with people when they first move into the service. A policy is in place relating to finances and the manager is aware of the Mental Capacity Act. This helps to protect people from financial abuse. The health and safety of people in the service is extremely important. There are designated fire officers and maintenance staff who are responsible for minimising risk of harm to people. Weekly fire drills take place and a fire risk assessment has been completed. Doors automatically close if the fire alarm goes off, and staff are becoming familiar with the new Four Seasons fire procedure. Water temperatures were checked and on one occasion the temperature stayed at 22 degrees centigrade then rose to 33 degrees centigrade after 4 minutes. It would be more comfortable for the person in this room having a wash in warmer water. A range of certificates were highlighted in the pre-inspection questionnaire and contracts are in place for maintenance of the call bells, emergency lighting, fire safety equipment and portable appliance testing. Mandatory training was discussed, evidence in individual files of moving and handling, fire safety and infection control was evident. Members of staff confirmed training is offered and flexibility is offered regarding days and times to attend the training. The manager had a training matrix which reflected the training due, it was unclear from this who had attended infection control training, first aid and food hygiene training. It would be beneficial having this data relating to training completed and the date when the next training is due. Otherwise individual files have to be checked. This would ensure no member of staff is missed when training is offered. DS0000065470.V333717.R01.S.doc Version 5.2 Page 20 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 x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 4 x x 3 DS0000065470.V333717.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should observe the moving and handling technique used by care staff regarding one identified individual. This will ensure the person is moved safely from chair to wheelchair. Any medication that is not administered must be detailed correctly using a readable code, or a recorded rationale for the action taken. Medication in the blister packs needs to be kept secure, and consideration of completing a weekly stock balance of this should be considered. The chef should take a more active role in seeking the views of people regarding the range/variety/choice of food provided. Involvement in the relatives meetings would be beneficial. Staff should receive regular updates on the procedure regarding safeguarding adults. DS0000065470.V333717.R01.S.doc Version 5.2 Page 22 2. OP9 3. OP15 OP33 4. OP18 5. OP38 The water temperature of one room where the water temperature was too low needs to be adjusted. The training matrix needs to be fully completed to ensure there is evidence that all staff have received mandatory training. DS0000065470.V333717.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 DS0000065470.V333717.R01.S.doc Version 5.2 Page 24 - 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. 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