Inspection on 02/08/06 for Greenacre

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Greenacre 03/05/07

Greenacre 13/12/05

Greenacre 20/01/05

Greenacre 20/05/04

Greenacre 14/07/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOMES FOR OLDER PEOPLE Greenacre Brewers Hill Road Dunstable Bedfordshire LU6 1UU Lead Inspector Leonorah Milton Unannounced Inspection 2nd August 2006 10.30 02/08/06 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 Greenacre DS0000014904.V304521.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. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacre Address Brewers Hill Road Dunstable Bedfordshire LU6 1UU 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) 01582 603029 BUPA Care Homes (Bedfordshire) Ltd Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Learning registration, with number disability (1), Learning disability over 65 years of places of age (42), Old age, not falling within any other category (42), Physical disability over 65 years of age (42) Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Addition of category LD The home can provide care for one service user who is under 65 years and has a learning disability. This condition applies only to the one service user who has been identified to the National Care Standards Commission. At such time as that identified service user ceases to live at the home, the NCSC must be informed immediately and the category LD and this condition of registration will be removed. 13th December 2005 Date of last inspection Brief Description of the Service: Greenacre is a large purpose-built home for older people, situated in a residential area on the outskirts of Dunstable. It is close to local amenities such as schools local shops and places of worship, but too far from the town centre for service users to be able to walk there. The home is on a bus route. The registered provider is BUPA Care Homes (Bedfordshire) Ltd. The post of registered manager was vacant. The home is organised around a central quadrangle that has an enclosed garden area that is well maintained and contains a bird aviary and a fishpond. The building is laid out to provide into five separate living units. The home is registered to provide services to forty-one service users over the age of sixty-five who may have dementia and/or physical disabilities or learning difficulties and one temporary arrangement for a service user with learning difficulties under this age range. It was noted at this inspection that these conditions of registration were not a true reflection of the service provision. The Commission is currently consulting with the provider about these issues. Fees for those of private means are between £501 36 to 535 weekly. Those funded by the local authority are via a block purchase arrangement that is subject to a needs assessment. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care (CSCI) since the last visit to and public report on, the home’s service provision in December 2005. Reports from the home, other statutory agencies, and information gathered at the site visit to the home, which was carried out on 2nd August 2006 between 10.30 and 17.30, were taken into account. The visit to the home included a review of the case files for three service users, conversations with six service users, three visitors to the home, and five members of staff. Much of the time was spent with service users in an upper floor lounge, where the daily lifestyle was observed. A partial tour of the building was carried out and other records were reviewed. The recently appointed manager was absent on the day of the inspection visit but the deputy, who had worked in the home for a number of years and who had carried out the acting manager role previously, was on site to assist with the inspection process. What the service does well: What has improved since the last inspection? Employment of additional catering staff and a review of the menus had improved the provision for meals. Action had been taken to ensure consistent supplies of hot water throughout the home. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 6 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. Greenacre DS0000014904.V304521.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 Greenacre DS0000014904.V304521.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Thorough assessments of need had taken place prior to admission to ensure that the home had the capability to meet service users’ needs. EVIDENCE: Three case files were assessed during the visit to the home. Each contained a comprehensive pre-admission assessment of need that included involvement with the service user, or where necessary, their representative, and relevant details in relation to healthcare needs. The home did not provide a rehabilitation service. Greenacre DS0000014904.V304521.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Care planning arrangements had omitted details in relation to skincare, dietary preferences and spiritual needs. There was a risk therefore that such needs would not be met. Medication procedures were unsafe and had put service users at risk. EVIDENCE: The care plan for one service user who had been recently admitted to the home had not taken account of the assessment of need on admission. The assessment identified that a pureed diet and dietary supplements were required because of weight loss. Dietary needs were recorded as normal in the care plan and did not show individual preferences. It was explained that this person did not require the pureed diet and was eating well. There was however no recognition of the need for the dietary supplements. Given that only seven days had elapsed between the pre-admission assessment of need and the date of the care plan, it was unclear why food supplements were no longer required. The plan also showed that the service user had a urinary Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 10 catheter, which needed checking and emptying on a regular basis. Timescales should be added to the plan to ensure that these tasks are not overlooked. The pre-assessment of need also referred to the service users’ spiritual needs. The care plan made no reference to these. The plan contained an assessment of risks to tissue viability that showed a score equivalent to “very high risk”. There was no corresponding plan of care in place. Records indicated that service users had been referred to their doctors and other health care practitioners as need be. A service user stated that they had received regular routine chiropody treatment and had been seen by an optician. The service user was concerned however, that since admission to the home, they had not been able to access community health services but had been referred to private practitioners. It was explained that there was a long waiting list to access community services and that the home had previously complained about the service shortfall. It was suggested that the service user be referred again and, if necessary, and in accordance with their wishes, the service user be supported to access the healthcare service’s complaints procedures. The Commission had received three notifications from the home since the last inspection in respect of medication errors. These included the suspension of a member of staff for falsification of records, failure to administer medication as prescribed and administering medication to a service user that had been prescribed for another. At the site visit it was noted that regular audits of medication procedures were in place. A local pharmacist had carried out a review of the home’s medication procedures in June 2006. The subsequent report raised no issues of concern and identified that eight staff were trained to administer medications. However at the inspection visit to the home the medication record for one service user showed the following: The record for one medication had been signed as given in the morning, and lunchtime of the 25th July 2006 and also at lunchtime on the 30th July 2006 but the medicines were still in place in the monitored dosage packaging for these dates. The record for another service user showed that none of the three prescribed medications had been signed as given throughout the day until teatime on 31st July 2006. Other records showed medicines had not been given because the service user was asleep. There must be evidence to show that the doctor who prescribed medicines has authorized the withholding of medicines if the service user is asleep. It was noted that the medicine trolley on the upper floor was not large enough to properly house the medicines used on that floor. Some had fallen out as the trolley was opened. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 11 Service users in the main stated that they had been treated well by staff. Comments included, “They are good to me here”, “I get on well with all of them”, “Staff treat me well” and “staff are nice”. One service user was less positive and said, “Some staff are OK but others can be rude and dismissive.” The service user also stated that they “felt unpopular and penalized because they were outspoken”. They also said that things had improved a little since management had been informed. (Please see standard 16 for further comment). Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Service user had been supported to experience a lifestyle that where practical and safe, met their expectations. EVIDENCE: There was evidence to show that service users had been provided with a range of activities for recreation and relaxation. Given the diverse abilities and needs of the service users, effort had been made to tailor activities to individual needs. There were regular in house group activities such as weekly coffee mornings and afternoon flower arranging sessions. Evidence was noted of activities in individual units that involved handicraft, board games and video entertainment, and one to one chatting with a member of staff. The quarterly newsletter for the Summer 2006 mentioned events on Valentine’s Day, a trip to the Downs in May and advertised future events. A service user stated that they had enjoyed trips out for shopping with a carer and described these outings as, “Good fun”. Another stated that they were Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 13 aware of activities, but that they were content to remain in their bedroom. The service user evidently did not feel compelled to join in. Three visitors to the home confirmed that they had been welcomed into the home. The two relatives of one service user stated, that they visited every week and that the staff, “could not be faulted”. They said that they had been kept fully informed about their relative’s progress and any changes in condition. Another visitor described staff as “fantastic” and said they, “would recommend the home to anyone”. Service users had been enabled to bring private possessions into the home. Many of the bedrooms contained a plethora of personal items and memorabilia. One of the service users who contributed to the inspection stated that they held their monies in safekeeping in their bedroom. Another held small sums of money. Others were not able to hold money or valuables and relied on their families or the home to take this responsibility. Catering arrangements had improved significantly. There was evidence to show that service users had been consulted about menus choices and that these had been revised in accordance with the consultation. Menus demonstrated a nutritious choice. Service users confirmed that they enjoyed their meals and that they had enough to eat and drink. One service user described the meals as “lovely”. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Procedures were in place to enable service users to complain and for their protection from abuse. However there was a need to assess when comments are really complaints, and to act on them in accordance with the home’s procedures, so that service users are ensured that their concerns have been properly dealt with. EVIDENCE: Previous inspections had established that the home had robust written complaints and protection procedures. Information forwarded to the Commission by the home showed that a complaint received since the last inspection in relation to the bathing of a service user in water that was too cool had been upheld. The member of staff concerned had received additional instruction to ensure there would be no re-occurrence. At the site visit there was no other information in relation to complaints, there being no central log of complaints. A service user had raised concerns about the conduct of staff as detailed in section 2 of this report. Minutes of a staff meeting showed that the team had been collectively informed about the service user’s comments. There was Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 15 however no record of this issue as a complaint, investigation of the circumstances or formal response to the service user. Whilst records indicated that only six care staff had received training in procedures for the protection of vulnerable people other members of staff confirmed that they had received an overview of these matters during their induction to the home They demonstrated that they understood the definitions of abuse and their responsibility to inform senior personnel of any concerns. It was not possible to access recruitment records at this inspection in order to assess whether satisfactory checks had been obtained before new members of the team had commenced duties. It was noted however that previous inspections had identified recruitment practice was satisfactory. A recent employee described her recruitment to the home and stated that she had not commenced duties in the home until a check had been obtained from the Criminal Record Bureau. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality outcome in this area is good. This judgment has been made using all available evidence including a visit to the home. The premises provided a clean, comfortable and well-adapted environment that was suitable for the assessed needs of service users currently accommodated in the home. EVIDENCE: A tour of the building showed that it had been designed to promote the ethos of small group living. The home therefore had been able to accommodate service users with diverse needs. The building had been purpose built to meet safety requirements for the provision of a residential care service to frail people. Suitable equipment and aids were in place to assist those with physical disabilities. The standard of décor and furnishings was good throughout. Visual checks on equipment showed that regular checks/maintenance had been carried out. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 17 Hygiene arrangements were well managed including authorised access to the kitchen and the laundry facilities. It was noted that the dishwasher in one unit had been broken since 28th June 2006. The inspector was informed that this was being dealt with. It was noted that the handy person’s work materials including was stored in the room that housed the batteries for the emergency lighting system and also the electrical fuse boxes. A risk assessment must be carried out about the substances stored in this area to take account of any implications for fire safety. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 18 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 Quality outcome in this area is adequate. This judgement has been made using all available evidence including a visit to the home. Whilst there were some gaps in essential training the team as a whole had sufficient skills to care for service users properly. EVIDENCE: Staffing schedules were seen and showed that minimum staffing levels had been provided to care for this large group of people who had diverse needs. and in the layout of the building which with its five units, was a challenge. Additional personnel had been scheduled at peak times of the day to ensure that sufficient numbers of staff were available to assist service users. Rotas indicated that senior personnel were available on day shifts to support and direct staff. The home had a comprehensive central training log. This document identified that the staff had received statutory training unless they were relatively new to the home and were still undertaking induction training. The record indicated a high percentage of personnel had achieved a National Vocational qualification in care. Omissions to training were protection from abuse procedures as previously noted and understanding the needs of those with dementia and how these can be best met. There was also a need to ensure that all personnel were aware of safe moving and handling practice. The inspector noted the Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 19 practice used when a service user was transferred on two separate occasions. At the first a hoist with two carers was used for the transfer. At the second a lone carer manually transferred the service user. The inspector was informed that the service user’s risk assessment stated that a hoist must be used to transfer the service user. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality outcome in this area is poor. This judgement has been made using all available evidence including a visit to the home. Inconsistent management of the home had resulted in a breach of the legal conditions for its operation. The lack of consistent action to rectify medication errors and ensure safe systems of work had put service users at risk of harm. EVIDENCE: The reports of the visits carried out under Regulation 26 referred to the appointment of a new manager. There had however been no notification to the Commission of this change or application by the individual to be registered as the manager. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 21 The inspector was informed that the service user aged under 65years in residence on the day of the inspection visit was not the named person who is referred to in the conditions of registration. That person had left the home sometime before the visit. The second service user under the age of 65 years had been admitted without any application to the Commission for a change in the conditions of registration. The inspector was shown an analysis dated February 2006 of the quality audit of the service that had been carried out in the autumn of 2005. The report did not include an action plan to show how issues identified by the review would be resolved. Given that this included 22 of responses that judged activities/events to be poor and 13 who judged the smell in the home to be poor, there was a need for evidence of written feedback to service users on actions to be taken in response to their opinions. Records in relation to monies held on behalf of service users were sampled. The documents showed that, on the whole record keeping, in this area had been satisfactory. It was noted that some receipts for income were not double signed and did not show the source of the income, as is best practice to safeguard both the service user and the home. The inspector was informed that change from trips for shopping had been handed to service users. Whilst these had only involved small amounts, there was a risk that, if larger amounts were to be involved, it could lead to misunderstandings. The tour of the building showed that 2 cupboards marked “keep locked” because they housed hazardous substances, were unlocked. The deputy was informed so that urgent action could be taken to remove this hazard. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 22 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 2 x x 1 Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 23 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 12(1)(a) 15 Requirement Care plans must show how assessed needs will be met. This must include nutritional, spiritual and skin care needs. Timescale for action 31/10/06 2. OP8 12(2) 13 (1) 12(1)(4) (a)(5)(b) 16 Service users must be supported 31/10/06 to receive healthcare treatments from practitioners of their choice. Service users must be treated with dignity and respect at all times. 31/08/06 3. OP10 4. OP14 5. OP16 12(1)(a) 22 The home must arrange and 30/11/06 record private possessions brought into the home by service users and keep these records up to date for all service users, not only for those recently admitted. Not assessed in full at this inspection. The previous action date of 30/01/06 is therefore extended. Complaints must be recorded 31/08/06 and investigated in accordance with the home’s procedures. Complainants must receive a written response about the outcome of the investigation of DS0000014904.V304521.R01.S.doc Version 5.2 Page 24 Greenacre their complaint. The home must maintain a summary of complaints that is available for inspection purposes. A risk assessment must be carried out about the substances/materials stored in the room that houses the emergency lighting equipment, to take account of any implications for fire safety. Training must be provided in the following: Understanding the needs of those with dementia and how these can be best met and how to protect service users from abuse. The registered person must ensure that the management of the home complies with all legal requirements for the operation of a care service that includes compliance with the conditions of registration. The registered person must notify the CSCI in writing about any changes in the management arrangements for the home The person appointed to manage the home must submit to the CSCI an application to register as the manager of the home. The report on the outcomes of the quality review of the service must show how issues raised will be dealt with. Moving and handling of service users must be done safely and in accordance with their individual assessments of need. Service users must not have access to hazardous substances. 6. OP19 12(1)(a) 23(4)(a) 31/08/06 7. OP30 12(1)(a) 18(2)(c) (i) 30/11/06 8. OP31 10(1) 12(1)(a) 31/08/06 9. OP31 12(1)(a) 8(2) 39 CSA 2000 Part 2, 11(1) 12(1)(a) 24(1)(b) (2) 12(1)(a) 13(4)(5) 14 31/08/06 10. OP31 30/09/06 11 OP33 30/11/06 12 OP38 31/08/06 Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP35 Good Practice Recommendations It is recommended that the medicine trolley for the upper floor be replaced by one that is large enough to store all of the medicines used on that floor properly It is recommended that receipts for money received on behalf of service users identify the source of the income and where possible these records are double signed. Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenacre DS0000014904.V304521.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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