Inspection on 31/01/06 for Greene House

This inspection was carried out on 31st January 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greene House 09/10/08

Greene House 16/10/06

Greene House 28/09/05

Greene House 02/03/05

Greene House 24/09/04

Greene House 25/02/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Greene House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ Lead Inspector Joan Browne Unannounced Inspection 31st January 2006 09:30 DS0000022973.V280405.R01.S.doc Version 5.1 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 DS0000022973.V280405.R01.S.doc Version 5.1 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. DS0000022973.V280405.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greene House Address 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) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 ORJ 01494 601426 01494 601300 martineau@epilepsynse.org.uk The National Society for Epilepsy Care Home 18 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000022973.V280405.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 Brief Description of the Service: Greene House is a care home that is registered to provide care, support and accommodation for up to seventeen residents with learning and physical disabilities. The home is situated on the National Society for Epilepsy’s campus in Chalfont St. Peter and constitutes a detached building that offers single room accommodation to residents. One bedroom has an en suite facility, and wash hand basins are fitted in the other bedrooms. There is ample communal space as the home is divided into five groups. Externally there is an enclosed communal garden as well as the grounds that encircle the campus. Residents are able to access the nearby towns of Amersham, Slough and High Wycombe by public transport. The village of Chalfont St. Peter has some amenities and there is a shop and a restaurant on campus. DS0000022973.V280405.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 31 January 2006. The inspection consisted of meeting with residents and staff, examination of care documentation and records. A tour of the communal areas and some bedrooms was carried out. The requirements and recommendations from the previous inspection were discussed. Residents spoken to were complimentary about staff members and felt that the provision of care was good. Staff members commented that there was a good team spirit within the team. It was also acknowledged that although staff members were from a diverse background the team was dynamic and residents and staff accepted and respected each other. Feedback was given to the management team on the findings of the inspection. What the service does well: What has improved since the last inspection? A new person centred care plan template had been developed. Residents’ care plans and daily record sheets are monitored on a regular basis. Residents are able to keep their daily log records in their bedrooms if they wished to. The complaints folder was reviewed to include clear actions of outcomes. Some residents were fully in control of their finances. Risk assessments relating to residents’ finances have been developed, which are kept in their bedrooms. All corridors and skirting boards have been re-painted. New pictures and paintings have been purchased. Toilets and shower facilities have been refurbished. Arrangements are in place to ensure that the works department regularly cleans ceiling lights in all areas of the building and skirting boards. Swing top DS0000022973.V280405.R01.S.doc Version 5.1 Page 6 bins have been replaced with the foot pedal type to prevent the spread of cross infection. The fire risk assessment for the building has been reviewed. The hot water temperatures in shower facilities and wash hand basins in residents’ bedrooms are checked and recorded weekly. The home’s service records are now kept on sight. 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. DS0000022973.V280405.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022973.V280405.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standard 2 was assessed at the previous inspection. DS0000022973.V280405.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 &7 There has been some improvement in the recording of detailed information in care plans. However, further improvement is needed to ensure that residents’ needs are fully met. Arrangements are in place to support residents to make their own decisions. EVIDENCE: Two care plans were examined. It is acknowledged that there has been some improvement in the detail of some of the identified needs in the care plans. It was also noted that a new care plan system had been developed, which was clear and easy to follow with a reference sheet attached. Each identified goal was evaluated. However, further improvement is required. For example, in a particular resident’s care plan it was identified that the individual required assistance with bathing. The information recorded was as follows: “Bathingneeds assistance.” The level of support and assistance required was not recorded. It was noted that only the first page of the person centred risk assessment was completed, and the author’s signature was not recorded. However, there was a detailed summary of the individual’s lifestyle with full background information on their family, friends and their likes and dislikes. DS0000022973.V280405.R01.S.doc Version 5.1 Page 10 Some needs identified were not always supported by an action plan. For example, it was noted that there were times when the individual suffered with bouts of depression and refused to eat. There was no action plan in place to support these needs. Some information recorded in relation to managing the individual’s challenging behaviour could be perceived as a restriction of liberty or a lack of duty of care by staff. It is recommended that risk assessments in place should be reviewed and discussed in a multidisciplinary forum with clear lines of accountability on a regular basis. It is acknowledged that detailed guidelines were in place to assist staff to care for the individual’s challenging behaviour. However, the guidelines were last reviewed sometime in November 2004. It is further recommended that the guidelines are kept under review and they are dated and signed. In one particular resident’s care plan it was recorded that a ‘baby’ monitor was installed in the individual’s bedroom. It was not evident that the resident or their relative were consulted and in agreement with the monitor being installed. As this could be perceived as an infringement on the individual’s privacy. It is recommended that a protocol be developed on how and when it should be used. Scribbled over entries were noted in the care plan. This practice must cease. Entries recorded in error should have a line drawn through and initialled by the author. Evidence was in place that auditing of care plans was taking place. It was noted in a particular resident’s care plan that a bruise was observed on the individual’s right arm. However, the information recorded was not detailed and there was insufficient evidence to substantiate that the incident was fully investigated. It is acknowledged that there was a record of the bruising, which was outlined on the individual’s body map chart. Further accredited training in person centred care planning for staff is required. On going support for staff in report writing and the concept of care planning is also required. Records of training undertaken must be maintained for inspection purposes. Staff were observed consulting with residents about choices such as, what they would like to eat, whether they wanted the radio on. The manager stated that an advocate from people’s voices had visited residents. However, no residents were currently using the services of an advocate. Some residents were able to manage their own finances and risk assessments were in place to support this. Copies of risk assessments were kept in individuals’ bedrooms. DS0000022973.V280405.R01.S.doc Version 5.1 Page 11 DS0000022973.V280405.R01.S.doc Version 5.1 Page 12 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 Staff support residents to participate in fulfilling activities thus enabling them to be part of the local community. Staff respect residents’ rights and residents are able to make their own decisions and take control over their lives. EVIDENCE: Staff arrange regular shopping trips for residents to the local village shop and visits to the local pub and leisure centre. The manager stated that spontaneous outings were limited because of the lack of transport facility. Some residents attend weekly church services escorted by staff members. Staff encourage residents to maintain their independence. Some residents attend work daily on the campus. Others choose to participate in daily household chores in the house such as, washing dishes and cooking. Staff are expected to knock on residents’ bedroom doors and wait for a reply before entering. DS0000022973.V280405.R01.S.doc Version 5.1 Page 13 Residents are offered a key to their bedroom doors. Their preferred term of address is recorded in their care plans. Staff were observed interacting with residents. Some residents choose to spend time on their own in their own surroundings. Visitors can visit residents in their bedrooms or in the communal sitting rooms provided. DS0000022973.V280405.R01.S.doc Version 5.1 Page 14 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): 20 Residents administer their own medication and there are systems and policies and procedures in place to protect them. EVIDENCE: It was noted that all residents apart from one were self-administering their medication. Residents are expected to undergo a nine-step assessment process that enables them to be deemed competent to self- administer their medication. They were on different stages of the assessment. Appropriate risk assessments were in place to support residents with self-administering. However, not all assessments were signed by residents and the manager. It is recommended that individuals and the manager sign risk assessments. Staff who have been appropriately trained in medication administration carry out medication spot checks on every shift. A recommendation for a protocol to be developed for the administration of Fosamax medication remains outstanding. DS0000022973.V280405.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 There is a complaints procedure in place to ensure that residents’ views are listened to and acted on. Prior to this inspection, information had been sent to the Commission from the home demonstrating that staff were being proactive and involving outside agencies where there were concerns of suspicion of abuse. EVIDENCE: A complaints folder had been developed. It was noted that the manager was in the process of investigating a complaint from a relative. Since the last inspection the Commission has not received any complaints about the service. Prior to this inspection information had been forwarded to the Commission relating to a protection of vulnerable adult (POVA) incident. Other outside agencies were involved including the police, and a psychiatrist. At the time of this inspection the investigation had not been concluded There was evidence that staff had undertaken training in the protection of vulnerable adult. Some residents were looking after their finances and were provided with the appropriate storage facilities in their bedrooms. It was noted that some had signed a disclaimer form to allow them to keep more than the maximum amount covered by the home’s insurance, which is £35.00 in their bedrooms. DS0000022973.V280405.R01.S.doc Version 5.1 Page 16 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, 25, 26, 27, 28, 29 & 30 Overall there has been an improvement in the environment at Greene House to ensure that residents live in an attractive and homely environment. However, some attention is needed to the extractor fan in the bathroom to eliminate the stale odour. EVIDENCE: Greene house is a two-storey building, centrally situated on the National Society for Epilepsy campus in Chalfont St Peter. The home is divided into five groups promoting group living. The groups provide flexible accommodation for various numbers of residents. There are single bedrooms, lounge diners and showering and toilet facilities. The communal areas, shower facilities and corridors in the house have been recently refurbished and repainted. Pictures and paintings have been replaced. The floor coverings in the main lounge and the front area of the building have been replaced with wooden floors, which has enhanced the ambience of the building. In the bathroom a stale odour was detected. It is required that the extractor fan in the bathroom is checked to ensure that it is working effectively. DS0000022973.V280405.R01.S.doc Version 5.1 Page 17 Residents’ bedrooms were personalised and moving and handling equipment and overhead tracking for hoists were in place where necessary. The building was clean and in good order at a busy time of the day. The laundry was under control. Hand washing facilities were prominently sited in areas of the building. DS0000022973.V280405.R01.S.doc Version 5.1 Page 18 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): 31, 32, 33, 34, 35 There is an effective and trained staff team in place to ensure that residents benefit from clarity of staff’s roles and responsibilities. The home has its full complement of staff to ensure that residents’ needs would be fully met. All necessary recruitment documentation is obtained prior to employees commencing their employment thus ensuring the safety of residents. EVIDENCE: Staff on duty were able to explain residents’ care needs and answer questions regarding changes to their needs. The manager stated that the home had its full complement of staff. The rota reflected that there were adequate staff on duty to meet residents’ needs. Work was in progress to ensure that 50 of the staff team achieved National Vocational Qualification (NVQ) in direct care at level 2 or 3. It was noted that two staff had achieved NVQ in level 2 and 3. The deputy manager was in the process of achieving the Assessor’s award certificate. DS0000022973.V280405.R01.S.doc Version 5.1 Page 19 The practice of staff carrying keys on them and how it could be perceived as being institutionalised was discussed during the inspection. It is recommended that this be discussed further at a staff meeting. It was noted that one staff member who was recently recruited was reluctant to talk to the inspectors. Senior staff confirmed that the staff member’s verbal communication skills were limited. It is a requirement in this report that all staff are suitably qualified and competent and have a good command of English to communicate effectively with the residents. Staff’s files were examined. It was noted that the manager signed off the personal information record sheets for all new members of staff. An inspection of the NSE’s centrally held recruitment records were recently carried out. All necessary documentation for compliance with Regulation 19 and Schedule 2 of the Care Homes Regulations 2001 was in place. All new members of staff have to undergo a structured induction training. The manager and deputy manager recently arranged an induction training session with newly appointed members of staff. Some of the residents were involved in the training session. Staff members were given information about them and they were expected to develop care plans to meet their needs. This practice is to be commended. All staff are expected to undertake mandatory training in care principles, first aid, challenging behaviour, epilepsy awareness, food hygiene, fire awareness, infection control, medication management, moving and handling and protection of vulnerable adults. There was a system in place to ensure that mandatory training for staff is regularly updated. DS0000022973.V280405.R01.S.doc Version 5.1 Page 20 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, 38, 39, 41 & 42 The home benefits from an effective management team, this ensures that residents’ health, and welfare and interests are protected. Monitoring systems are in place however, residents’ questionnaires need to be developed to target their views on the service delivery. The home’s handover record sheets need to be improved to ensure that residents’ confidentiality, rights and interests are safeguarded. The home has health and safety systems in place. However, these need to be improved further to ensure that residents’ safety is not compromised. EVIDENCE: The home has a manager who has been in post for seven months. He is waiting to undergo the fit person interview process and be registered with the Commission. He has clear objectives on how he intends to move the home forward, enhance the service delivery and safeguard the residents’ rights and DS0000022973.V280405.R01.S.doc Version 5.1 Page 21 interests. He is qualified and experienced to run the home and holds the National Vocational Qualification (NVQ) in level 4 and the registered manager’s award. Staff spoken to confirm that the management approach of the home is open and transparent. The manager’s door is always open and he communicates a clear sense of direction and leadership. Regular staff meetings take place and staff are encouraged to contribute and make suggestions. Staff felt that the culture of the home was changing and it was beginning to feel like a home and not an institution. Some staff spoken to were aware of the organisation’s commitment to equal opportunities. Members of the board of trustees undertake regular Regulation 26 visits. Reports have been very positive and staff’s hard work have been acknowledged. The manager has developed a system to ensure that care plans are monitored regularly. Work was in progress to develop a questionnaire for residents, relatives and staff to comment on the standard of the provision of care. Residents’ medication administration record (MAR) sheets were being monitored regularly. It was noted that handover sheets were in place. However, information on all residents is recorded on the same sheet and could create a breach in the Data Protection Act 1998. The manager is required to review the practice to ensure that staff are aware of the action that should be taken if a resident requests to look at any written information held on them. It was also noted that all staff have access to the computer, which has the potential of confidential information being breached. It is recommended that a computer be provided for the manager’s use only. All staff undergo yearly moving and handling and fire awareness training update. There was a matrix in place of all mandatory training that staff had undertaken. It was noted that the day staff had undertaken four fire drills. It was not evident that night staff had participated in fire drills it is required that all night staff must participate in a minimum of two fire drills. Evidence was available that the water tanks had been treated for the prevention of Legionella. A certificate to substantiate this was issued on 10 August 2005. The electrical hardwiring test certificate was issued on 2 June 2004. The service of the gas equipment and central heating system was carried out on 24 January 2006. The Portable appliance test for all electrical equipment used in the home was conducted in December 2005. It was noted that a door wedge was being used to keep the office door open. One particular bedroom door was propped open with a chair. This poses a DS0000022973.V280405.R01.S.doc Version 5.1 Page 22 safety hazard. It is required that the appropriate door holding devices or dorgards must be used to keep doors open. The manager is required to seek advice from the fire services department. DS0000022973.V280405.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 3 2 X 2 2 X DS0000022973.V280405.R01.S.doc Version 5.1 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 18(c)(i) Requirement The manager must ensure that all staff undertake accredited training in person centred care planning and report writing. The manager must ensure that scribbled over entries recorded in care plans is ceased. The manager must ensure that all staff are able to communicate effectively with residents and have a good command of English. The manager must review the practice in place regarding handover sheets as outlined in the body of this report. The manager must ensure that night staff undergo a minimum of two fire drills yearly. The manager must ensure that door wedges or other obstacles are not used to keep doors open. The appropriate door holding devices or dor-gards must be used if residents request to keep doors opened after consultation with the fire services department. Timescale for action 31/07/06 2 3 YA6 YA33 10(1) 10(1) 28/02/06 31/03/06 4 YA41 17(1)(b) 31/03/06 5 6 YA42 YA42 23(4)(d) 13(4)(c) 31/03/06 28/02/06 DS0000022973.V280405.R01.S.doc Version 5.1 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 YA6 YA6 Good Practice Recommendations It is recommended that the manager should ensure that risk assessments are dated, signed and reviewed regularly in a multi-disciplinary forum. It is recommended that the manager should ensure that the guidelines in place to support staff in caring for the resident with challenging behaviour be kept under review and they are signed and dated by the author(s). It is recommended that the manager should ensure that a protocol be developed on how and when the ‘baby alarm’ in the particular resident’s bedroom is used. It is recommended that the manager should ensure that medication risk assessments are signed and dated by the manager and the individual residents. It is recommended that the manager should ensure that a protocol be developed for the administration of Fosamax medication. It is recommended that the manager should review the practice of staff carrying keys on them. It is recommended that the responsible individual should provide a computer for the manager’s use only. 3 4 5 6 7 YA6 YA20 YA6 YA33 YA41 DS0000022973.V280405.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000022973.V280405.R01.S.doc Version 5.1 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. 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