Inspection on 31/10/05 for Greenfield Road 9

This inspection was carried out on 31st October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenfield Road 9 05/06/08

Greenfield Road 9 11/05/07

Greenfield Road 9 24/04/06

Greenfield Road 9 25/04/05

Greenfield Road 9 25/10/04

Greenfield Road 9 14/07/04

Greenfield Road 9 04/03/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Greenfield Road 9 London N15 5EP Lead Inspector Karen Malcolm Unannounced Inspection 31st October 2005 11.00a Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Greenfield Road 9 Address London N15 5EP 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) 020 8809 7044 020 8809 7044 Companion in Care Limited Mr John Ajumobi Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 3 people of either gender who have a mental disorder (MD) or who have a learning disability (LD) Date of last inspection 25th April 2005 Brief Description of the Service: Greenfield Road is registered as a care home for a maximum of three adults between the ages of 18 and 65 who may have mental health problems or learning difficulties. The home’s registered provider has been changed in October 2003 to “Companion in Care Ltd. The company owns two other homes in Brent and Newham. The home consists of a large three-storey town house situated in South Tottenham in the borough of Haringey. There are good public transport links to the area and a good variety of shops and other amenities are close by. On the ground floor, there is a kitchen/ lounge/diner, a toilet and bathroom, with access through the lounge to the garden and a laundry area. Two bedrooms and an office are situated on the first floor. A toilet and bathroom and two more bedrooms are located on the second floor. None of the bedrooms are en-suite. There is a small garden at the front of the property and a large paved garden at the rear. The home is not suitable for people with mobility problems. The stated aims of the home are to provide care, support and attention to service users to enable them to lead as normal a life as possible. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three and half hours. On duty was one care staff that assisted the inspector through a part of the inspection. The registered manager/provider assisted the inspector through the later part of the inspection process. Both parts of the inspection were very positive and open. Presently the home is fully occupied. The service users who live at the home are three men with mental health problems and have lived there for a number of years. The inspector spoke to two of the three service users individually and the feedback was positive and informative. One service user complained that the shower had been broken for a number of months. This was addressed with the manager in the main body of this report. The Pre Inspection Report was not submitted to the Commission prior to the inspection. What the service does well: What has improved since the last inspection? At the previous inspection there were eighteen areas of improvement. At this inspection it was evident that thirteen areas of improvement have been met by the home. These related to: • The statement of purpose, this is now amended to include that the home supplies service users with their own bed linen. • The risk assessment for one specific service user who smokes in their room was completed. • The home is now registered with the Data Protection body and a copy of the certificate was shown. • Records of appointments made with the CPN and GP regarding one specific service users medication was recorded on file. • A list of medication codes is displayed in the office. • Bed linen supplied by the home is now deemed more age appropriate. • The damp patch in the office area is now repaired and redecorated. • The handy persons CRB certificate is now on file. • Appropriate CRBs for care staff are now in place • Records of water temperature checks are maintained. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 6 • • The rota now clearly shows records of each staff shift pattern and time off. All personnel records are kept in the home. 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. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 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 Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 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): 1 The home has a statement of purpose however, prospective service users are not able to access the correct information needed to make a clear judgement on the types of rooms provided by the home. Therefore service users are not able to make an appropriate judgment on the suitability of the home for their individual needs. EVIDENCE: The Statement of Purpose was examined. Upon reading it was evident that the statement referring to service users providing their own individual bed linen has now been changed. The statement now states that bed linen is supplied by the home. The section within the document referring to room sizes remains unchanged. The room sizes listed are all the bedrooms, but the communal areas such as the lounge, kitchen, laundry area, bathroom and the downstairs toilet is not included. It was advised that the statement of purpose is amended to include these areas as stated in Regulation 4(1)(c) Schedule1.16. This requirement is restated from previous inspection. It is therefore a matter of concern that there is continued failure to ensure that the statement of purpose reflects the room sizes of the home. Any further failure may result in the Commission taking appropriate enforcement action. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 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): 7, 9 & 10 The manager has ensured that service users confidential information about them is handled appropriately. Service users are not always confident that they are consulted appropriately regarding to their care. Therefore service users may not be receiving the appropriate care pertaining to their individual needs. EVIDENCE: The specific service user’s care plan, whose care needs, was an issue at the previous inspection was examined. A comprehensive risk assessment addressing the specific service user’s needs and support around inappropriate smoking and the risks it involved is in place. This was reviewed in May 05. The manager has now installed an appropriate smoke detector in this particular service user’s bedroom and this is monitored weekly. There was no evidence that the specific service user had been involved in the process of developing their risk assessment regarding this matter to ensure that the specific service user is aware of the potential risks involved when smoking in their own bedroom. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 10 Two other service users care plans were examined. It was evident that risk assessments were completed, along with weekly and monthly assessments. All service users receive their benefits weekly. Once received, all service users weekly allowances are kept by the home to enable and support individual’s to manage their personal money appropriately. It was evident that risk assessments and appropriate accounts are in place. One service user spoken to state that their clothing allowance is not enough and would like something done about it. The manager stated he is aware of this however, the placing authority for this specific service user, reviews clothing allowances for users every two years. On examining this particular service users care plan, there was evidence that this was discussed with the service users and how this area of concern is managed by the home. The inspector was shown a copy of the organisation’s Data Protection certificate. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 11 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): 16 Service users’ know that their rights are respected and their independence is supported. Therefore service users were found to be independent and supported appropriately. EVIDENCE: The manager stated that one service user has a voluntary job with Outreach Tower View, packing gifts into boxes. Another service user either attends the day centre or goes out to the local café or shops and one user spends most of his time in the local betting shop. The manager stated he has spoken to the user who gambles, as it is costly and the home has introduced a monitoring system to enable the user to manage their money appropriately through the week. Each service users has a named key worker. The inspector observed on the day of the inspection that the care staff on duty interact with the users appropriately. The home ensures that individual rights are respected and their independence is supported appropriately and monitored accordingly. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 12 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): 18, 19, 20 Service users receive personal support with their physical and emotional health needs in the way they prefer. Therefore service users health care and support needs are being addressed appropriately by the home. EVIDENCE: Service users are supported by the home in the way they prefer. All service users are independent with regards to personal care, but care staff stated that a number of the users need the occasional prompting from time to time. Healthcare needs are appropriately recorded and addressed by the home. The medication administration charts were examined. At the previous inspection it was required that the registered person ensures that the specific service user who does not take thier morning medication consistently has an appointment made with the GP or the CPN to review the specific service users current medication. The manager has discussed this issue with the CPN however, the CPN stated they were unable to review the medication and refered the manager to the GP. Two appointments were made with the GP and the service user refused to attend both a appointments. However, the records examined show that the service user now takes their medication. This was discussed with the care staff on shift, who confirmed that the service user is more willingly to take their medication in the morning after some Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 13 encouragement. It was advised that guidance notes are to be in place to ensure that all care staff follow the same practice to ensure that this specific service user takes their medication and this is to be reviewed accordingly. Displayed in the office on the notice board is clear guidance with regards to completing the MAR charts with the appropriate codes. Since the previous inspection there has been one Regulation 37 report submitted to the Commission. Relating to a specific service user who was admitted into hospital. The specific service user’s risk assessment has been updated, however, the manager requested from the inspector some advice on how the home could support this particular service user and other users appropriately if a similar incident occurs. It was advised that the manager must ensure all care staff undertake sexual awareness training. The course will equip and provide care staff with support and guidance they need to support service users appropriately. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 14 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 Service users know that their views are listened to, however, this is not consistently recorded and act upon within the allocated time. EVIDENCE: The home has in place a complaints policies and procedures. It was evident at this inspection that no complaints were recorded, however, one service user complained to the inspector that the shower on the top floor bathroom was not working. Further information regarding this complaint is addressed in the section under ‘Environment’. A requirement regarding this has been made in the table at the back of this report. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 15 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 & 30 The standard of décor has improved greatly therefore providing service users with a pleasant, warm and inviting environment in which to live. The home is clean and hygienic. EVIDENCE: The home is a large three-storey town house situated in South Tottenham in the borough of Haringey. There are good public transport links to the area and a good variety of shops and other amenities close by. On the ground floor, there is a kitchen/ lounge/diner, with access through the lounge to the garden, a toliet downstairs, and a laundry area acessed through the garden. Two bedrooms and an office are situated on the first floor. A bathroom and a toliet and two more bedrooms located on the second floor. None of the bedrooms are en-suite. There is a small garden at the front of the property and a large paved garden at the rear. It was evident during the tour of the building that the stair landings are now tiled and clean and the kitchen units have all been replaced. At the previous inspection it was required that the damp patch in the office was to be repaired and the handy person employed to carryout the work in the home to have a Criminal Record Bureau (CRB) check completed. These Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 16 requirements have been completed and the office area has also been redecorated. All service users have their own bedrooms. One bedroom was examined. It was evident that the bed linen placed on the individual bed was clean and age appropriate, meeting the service user’s needs. One service user spoken to stated that they were not happy that the shower was not working. The manintainace book examined confimrmed that this fault had been recorded on 24/04/05, however the shower remains broken. This was discussed with the manager, who stated that the shower has been repaired during this period, however, the shower is broken again. The home was found to be hygienic and clean at the time of this inspection. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 17 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): 33 & 34 A competent and effective staff team supports service users. The registered person however, has failed to review the staffing levels in the home. Therefore service users care needs might be potentially put at risk due to care staff not being able to support individuals appropriately due to over work. EVIDENCE: The staffing level in the home at the previous inspection was required to be monitored and reviewed. The action plan received by the Commission prior to this inspection stated that ‘the home is providing care to three people with low to medium needs. The staff levels in the home are reviewed regularly and the management that staffing level in the home reflect the need of the service user. There are records of this in the home. The manager is able to use the service of bank staff whenever there is any need for it.’ It was evident that the staffing levels in the home remains the same, consisting of three full time care staff one of which includes the manager and one part-time worker who covers approximately two shifts in a four week period. The rota examined showed that the two full-time care staff worked over ten shifts in a row without an appropriate break. The rota, shift patterns and staffing levels were discussed with the manager. It was advised that staffing levels must be reviewed. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 18 Personnel records of two care staff were examined. Both files contained Criminal Record Bureau (CRB) checks, however a second reference for one staff member was not in place. The registered provider/manager has organised a number of training courses for staff. The staff member spoken to stated that since starting they have undertaken number of training courses. However it was evident from this discussion that the staff member had not completed a first aide course. The shift patterns were also discussed with the member of staff. They believed that these were reasonable although they had worked a number of shifts in a row plus sleeping-in duties. The rota now indicates clearly when care staff undertake training or any other absences. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 19 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): 39 & 42 Service users are confident that their views are being monitored, however, this is not consistent. Service users health, safety, welfare and future are not being regularly reviewed and monitored. Therefore, the manager has failed to fully protect service users with regards to health and safety procedures. EVIDENCE: Health and safety checks were found to be in good order. Records of water temperatures are completed weekly. One service user spoken to complained that the water temperature of the bathroom/shower room was not always hot. Records examined showed that the temperature recorded was within the appropriate range of 43ºC. This was discussed with the manager and it was advised that the water temperature should be checked daily at the time when the specific service user requires a bath or shower to ensure that the temperature is appropriate for the service user’s needs. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 20 Displayed in the office was a leaflet regarding advocacy. It was advised that this leaflet must be made accessible to the service users and displayed in a more appropriate place such as the ‘resident’s notice board.’ Service users views have been sought by the home through the qualitymonitoring questionnaire, however this monitoring survey was last completed a year ago. It is therefore required that the registered person reviews this again and the results of the survey are made more accessible to all service users and their stakeholders. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. The purpose of the fire risk assessment was discussed with the manager. It was identified through the fire risk assessment that there were a number of good practices and some areas of concern. All the fire extinguishers are in place and the means of escape is clear. However, the lounge fire doors were wedged open. It is advised that the manager completes a environmental and fire risk assessment which is reviewed and monitored annually. Appropriate action must be taken in respect of fire doors that continue to be propped open, therefore rendering the selfclosing device inoperative. It was also advised that consultation with the London Fire Emergency Planning Authority (LFEPA) is to be sought. Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 2 X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Greenfield Road 9 Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000010810.V252287.R01.S.doc Version 5.0 Page 22 Yes 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. 2. Standard YA24 YA22 Regulation 23 Requirement Timescale for action 28/02/06 28/02/06 3. YA1 4. YA19 The registered person must repair or replace the shower unit in the top floor bathroom. 22 The registered person must ensure that all complaint/s whether verbal or written are fully investigated by the manager under the homes complaints procedure. A record of the complaint must be made with the action taken. (previous timescale of 30/06/05 not met.) 4(1)(c) Sch The registered person must 1.16 amend the homes Statement of Purpose to include the number and size of all rooms in the care home as set out in Regulation 4(1)(c ) Schedule 1.16 of the Care Homes Regulation 2001. (Previous timescale of 30 December 2004 not met.) 18(1)(c)(i) The registered person must ensure all care staff undertake an appropriate sexual awareness course. The registered person must obtain advice and support for the specific service user’s who 28/02/06 30/03/06 Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 23 5. YA33 18(1) WTD 1998 was admitted to A & E. evidence of this must be recorded on file. The registered person must 28/02/06 cease the practice of care staff working more than ten shifts in a row. The registered person must review the current staffing levels in the home. An action plan of the proposal must be submitted to the Commission. Working Time Directive 1998 The registered person must ensure that prior to a specific service user accessing the bathroom daily a record of the water temperature is to be kept. The registered person must have in place a ‘resident notice board’, which is easily accessible to service users and displays relevant information pertaining to individuals needs. The registered person must ensure that the quality assurance and quality monitoring systems are reviewed annually. Results of the surveys are published and made available to service users and their representative and other interested parties including the CSCI. The registered person must ensure that the specific service user who smokes in their bedroom is consulted with regards to risk assessment that is in place. Evidence of this must be recorded. The registered person must ensure all service users or their representative are consulted with regards to their care needs and a record of the consultation is to be kept on file and reviewed accordingly. DS0000010810.V252287.R01.S.doc 6. YA42 13(4) 28/02/06 7. YA39 15(1) 28/02/06 8. YA39 34 30/03/06 9. YA9 13(4) 30/01/06 10. YA7 15(1) 28/02/06 Greenfield Road 9 Version 5.0 Page 24 11. YA42 12. YA42 13(4)(a)(b) The registered person must 28/02/06 ensure that all fire doors are able to effectively self –close at all times and are not wedged open. (Previous timescale of 16/07/05 not met) 23(4) & Magnetic door hold or release 30/03/06 13(4) mechanisms must be fitted to any fire doors in the home that service users/staff members routinely prefer to leave open for extended periods of time during the day or night. Alternatively, the registered person must consult with the London Fire Emergency Planning Authority (LFEPA) fire officer with regards to risk assessment with regards to the safety aspect of fire doors and provide evidence that LFEPA are satisfied with fire doors being propped open. The registered person must complete an environmental risk assessment that includes a fire risk assessment. This is to be reivewed annually. The registered person must have in place clear guidance notes for all care staff to follow, for the specific service user who sometimes refuses to take their medication in the morning. The registered person must ensure that on each shift there is a qualified first aider. The named care staff must be indicated clearly on the rota. 13. YA20 13(2) 28/02/06 14. YA33 13(4) 28/02/06 Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 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. Refer to Standard Good Practice Recommendations Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenfield Road 9 DS0000010810.V252287.R01.S.doc Version 5.0 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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