Inspection on 03/10/07 for Greenheys (52)

This inspection was carried out on 3rd October 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenheys (52) 19/02/09

Greenheys (52) 15/08/06

Greenheys (52) 08/03/06

Greenheys (52) 16/12/05

Greenheys (52) 20/10/04

Greenheys (52) 10/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Greenheys (52) 52 Greenheys Road Wallasey Wirral CH44 5UP Lead Inspector Beate Field Unannounced Inspection 3 and 8 October 2007 10:30 rd th Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 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 Greenheys (52) DS0000018890.V346791.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 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. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenheys (52) Address 52 Greenheys Road Wallasey Wirral CH44 5UP 0151 638 8248 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) Alternative Futures Limited Miss Gail Alison Pascall Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD. The maximum number of service users who can be accommodated is: 5. Date of last inspection 20th February 2007 Brief Description of the Service: 52 Greenheys Road is registered with the CSCI to provide personal care for 5 adults with a learning disability. Alternative Futures Limited, a registered charity operating in the North West, operates and manages the home, with the premises being owned by Alternative Housing Association. The home is a purpose built detached bungalow with a large garden, close to Central Park in Liscard, Wirral and is within walking distance of local shops. There is car parking at the front of the home. Communal areas comprise a large lounge, with doors to the garden, and folding doors to the adjacent dining room. A domestic style kitchen and separate laundry facilities are provided. The home benefits from having a bathroom with W.C and separate shower room with W.C on the main corridor leading to the bedrooms. There is a separate toilet next to the lounge. There are five single bedrooms each with a wash hand basin. The fees for the home are £1118.83 per week. Items not covered by this fee include chiropody, haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services offered at 52 Greenheys Road, are available for potential residents and their relatives and social workers to refer to. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on two site visits to the home, information received about the service since the last inspection and by questionnaires completed by the manager, a health care professional, an advocate and relatives. During the first site visit to the home time was spent in the office looking at a sample of records and policies and procedures, talking to the staff and making observations of the care being delivered to the residents. A tour of the home was also undertaken. A second site visit was made to speak to the manager and to view records that were unavailable during the first visit. What the service does well: What has improved since the last inspection? Since the last inspection the care plans have been reviewed and updated. The medication practices have been reviewed and there is an improved system for auditing the medication. Medication records are accurately maintained. Greenheys (52) DS0000018890.V346791.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. The summary of this inspection report can be made available in other formats on request. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 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 Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The contracts/terms and conditions could better support the interests of residents. EVIDENCE: No new residents have come to live at the home since the last inspection. Since the residents came to live at the home the assessment process has changed. The assessment process that would be used for new residents is comprehensive and would ensure a thorough assessment of an individuals needs. Opportunities for potential residents to visit the home to see if it is right for them would be made available. Tenancy agreements with Alternative Housing and support agreements (contracts) with Alternative Futures are available. The agreements seen for two residents had been signed by a representative from Alternative Futures but not by anyone acting on behalf of the resident. It is recommended that where residents are unable to understand contracts, where appropriate, a Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 9 representative of the residents who is an individual independent of the home agrees the contract meets the residents’ best interests. It was noted that holidays are included in the fees; however, one resident due to their physical and mental health worsening had not been on holiday. The home should ensure that either the resident goes on holiday, or regular day trips or a refund in their fees is made. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The assessed needs of residents are not being fully met at the home. EVIDENCE: The records relating to one resident show that they are not appropriately placed at the home due to their abilities and their age. Staff said and records showed that this residents needs are also not compatible with the needs of the other residents. It is understood that attempts have been made to identify a more suitable placement. However, this situation has continued since an independent assessment indicated that the placement was unsuitable in 2004. A further assessment is in the process of being undertaken. An assessment of the compatibility of the residents at the home needs to take place with a view to ensuring that the needs of all residents are fully met at the home. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 11 The care files include a pen picture of the resident, the person centred plan, daily routines, risk assessments, what makes a good day for the resident, activity planner and a personal dictionary. The personal dictionary is a good tool to use when communicating with residents and is in the process of being further developed. Each resident has a separate file for daily records. In general staff have access to clear up to date information to enable them to appropriately support the residents. One resident has recently returned to the home from hospital. The care plans in use at the hospital are available for staff to refer to as well as the care plan developed at the home. Staff reported that some aspects of these care plans are not relevant. It is confusing to have two sets of care plans to refer to and staff reported that some of the care plans from the hospital are not workable due to the different environments. Clear care planning information needs to be made available in order to appropriately support the resident. Not all the support given to residents by staff was documented in the care plans. Such as the action staff take when a resident undresses in a public area. The removal of toilet paper and hand washing soaps/liquid form the bathrooms and the action taken to promote hygiene. There was evidence of reviews taking place of care plans. Residents could be better supported by the arrangements for reviewing their care plans as social and health professional from the placing authority or an advocate are not routinely invited to attend a review or asked to comment on all the residents current care plans. This is in the process of being addressed and dates for these reviews have been arranged. Care needs to be taken to ensure that records are signed and dated by staff on a consistent basis. The records and a discussion with staff indicated that residents are assisted to make decisions about their lives in accordance with their abilities. Communication guidelines assist in this process. Records of residents likes and dislikes, routines and preferences around daily living, such as what time they like to get up and the activities they enjoy also ensures their choices are respected. It is recommended that the home expand this and use photographs to further aid the decision making process. The 3 staff spoken with were very knowledgeable about the needs of the residents and appeared to have a good relationship with them. Residents appeared relaxed and content when with the staff. Questionnaires returned by relatives indicated that they consider that the care needed is always or usually given and that the residents are supported to live the life they choose. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 12 Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have a lifestyle that in general meets their needs and provides opportunities for their social and personal development. EVIDENCE: Suitable activities are provided to suit the residents’ choices, needs and abilities. A daily diary report is completed for each resident, which, details what the resident has done each day. Records showed and staff spoken with said that the residents where possible, make use of community facilities such as local pubs, shops and public transport. The home is located close to shops and other community resources. The home has its own transport, which enables community participation. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 14 One resident is more able than the other residents who live at the home. This resident is provided with appropriate activities to promote their social and personal skills, they have access to college courses and volunteer at a local gardening scheme. However, this resident is not appropriately placed at the home and would benefit from living in an environment where he has the opportunity to develop appropriate relationships. Family contact is promoted where this is possible. 3 relatives who completed a questionnaire said that the home always helps their relative to keep in touch. The records of menus showed that three meals a day are provided that are balanced, offer choice and variety and meet the residents’ cultural backgrounds. A record of residents likes and dislikes and dietary needs is available. Advice is obtained from a dietician if this is required. Residents are helped to eat their meals and there are support guidelines for staff to follow around this. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of residents are appropriately supported. EVIDENCE: Personal care tasks are undertaken by care staff of the same gender where possible. There are appropriate arrangements in place to ensure that personal care tasks are undertaken with privacy and dignity. There is clear information available for staff on residents’ personal care routines that indicate their preferences. Care planning records and guidelines in place indicate that residents’ independence is promoted. Observations indicated that staff promote the dignity of residents and that they are supportive and caring towards them. Staff interviewed were very aware of the support needs of residents. Residents have access to medical/health care professionals as needed. Procedures for managing specific health needs are available. Training is provided to staff around meeting specific health needs. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 16 A questionnaire completed by a health care professional indicated that the home “strives” to meet the residents needs and that staff seek appropriate healthcare support when needed. None of the current residents are able to self medicate. The home has a medication policy and procedure in place. Staff who administer medication have all received training around the safe handling of medication and have undertaken additional training since the last inspection. The home receives advice and guidance from the local pharmacy as necessary. The medication administration records and corresponding medication were inspected and were found to be accurately maintained. The storage arrangements for the medication should be reviewed. There is no access to a table for recording or checking medication. The room where medication is stored is a communal room and can be accessed by residents. The storage arrangements also raise issues about privacy and access to medication. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of the residents could be better supported. EVIDENCE: Relatives, advocates and health and social care professionals have access to a suitable complaints procedure, which gives them a clear picture of how to raise a concern or complaint on behalf of a resident. There has been one complaint since the last inspection, which, was investigated by Alternative Futures and remains ongoing. The staff spoken with were aware of the content of the complaint procedure and how to respond to complaints. Relatives and a social and a healthcare professional who returned questionnaires were aware of the process of making a complaint about the home. The home has a detailed policy and procedure with regard to the protection of vulnerable adults and the procedure for whistle blowing by staff. The 3 staff spoken with demonstrated an awareness of how to ensure residents were protected from abuse. The residents care plans showed that physical intervention is used to manage aggressive behaviour as a last resort when distraction methods have failed. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 18 The staff spoken with were able to demonstrate a good understanding of the procedures to be followed to manage aggressive behaviour. Staff have received training around the management of challenging behaviour from an accredited trainer. There have been some incidents of residents bossing and shouting at other residents and some incidents of physical aggression between the residents at the home and physical aggression by residents towards staff. Most incidents relate to the decline of a residents mental and physical health. Staff spoken with reported that the needs of some residents are not compatible and records seen supported this. An assessment needs to be undertaken of the needs of all residents with a view to ensuring that their needs are compatible and that they are fully safeguarded by their placement at the home. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe, comfortable surroundings. EVIDENCE: Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 20 The home has been purpose built and adapted over the years to meet the needs of the residents. The home provides a comfortable environment and is overall well maintained and furnished. Some areas are in need of minor attention. The residents’ bedrooms are personalised where this has been possible. The bedrooms are suitably furnished and provide enough space. Communal space is provided in a large lounge area with a connecting dining room. Bathrooms and toilets are within easy reach of bedrooms and communal areas. The home provides a secure, well-maintained and good size rear garden. One resident particularly enjoys spending time in the garden. Areas of the home inspected during the visit were clean and tidy and free from offensive odours. Support workers carry out both domestic and catering duties as part of their role. There is a laundry room with a washing machine and drier and sluicing facilities. Records and a tour of the home showed that steps have been taken to ensure the safety of residents at the home. Cleaning products were appropriately stored at the time of the visit. Hot water temperature regulators have been fitted to the hand basins, bath and shower. A record is made of checks of the water temperature. All radiators seen had been covered with radiator covers. Records show that the gas, electrical wiring and portable electrical appliances are safe. The fire alarm and emergency lighting are tested by staff at the home to make sure they are working properly. Staff take part in fire drills and fire safety training. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents’ are supported and safeguarded by the recruitment practices and the training provided to staff. EVIDENCE: The service provides a high level of staff support. There are three staff on duty during the day, on some shifts four staff, with two staff one waking and one sleeping during the night time periods. The 3 staff spoken with considered that there are sufficient numbers of staff available to meet the needs of the residents. Comprehensive induction and foundation training is provided to staff. Staff are then encouraged to undertake an NVQ 2 in Care, which includes training around caring for people with a learning disability. The home has 11 care staff and one manager. 8 of the care staff have completed the NVQ level 2 and 3 staff are working towards this qualification. In addition, Alternative Futures Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 22 has a training development plan and training for staff around meeting residents’ needs is provided on an ongoing basis. Training around equality and diversity is provided to staff at the induction and during the NVQ. Further training in this area is planned. Staff spoken with could give examples of how to promote the rights of residents. An examination of a sample of staff records indicated that all staff had two references, enhanced CRB checks, statements of terms and conditions on their personnel file. Staff spoken to on the day of the visit said they enjoy working at the home and that the residents are well looked after and they get a good service. Relatives who returned questionnaires said that the staff always keep them up to date with important issues affecting their relative. Records supported this. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home supports the interests of the residents. EVIDENCE: The manager has several years experience of working with adults with a learning disability. They have completed the Registered Managers Award and the NVQ 4 in care. Staff said and records showed that they have regular supervision. Staff spoken with said the manager is very supportive. There are regular team meetings. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 24 Staff spoken with said that their views regarding the running of the home are sought and listened to. The staff were very knowledgeable about the needs of the residents. They had a good understanding of the home’s policies and procedures and the general operation of the home. The responsible individual visits monthly and writes a report and sends this to the CSCI office. One resident has an advocate; it would be beneficial if this could be extended to all the residents where appropriate. This could assist the residents give feedback to the home. Training around safe working practices is made available to staff as part of their induction. There is a rolling programme of training opportunities provided and refresher courses are undertaken when needed. There are policies and procedures and risk assessments available that promote safe working practices. Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 25 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 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 26 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 YA15 YA23 Regulation 14 Timescale for action The registered persons must 08/01/08 ensure that an assessment of the compatibility of all the residents’ needs takes place with a view to ensuring that the needs of all residents are fully met at the home. The placing authorities are to be consulted regarding these assessments. The registered persons must ensure that the care plans and risk assessments are clear and provide sufficient information to staff as to how they are to support the residents. 08/11/07 Requirement 2. YA6 15 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations It is recommended that an individual independent of the home agree that the contract/statement of terms and DS0000018890.V346791.R01.S.doc Version 5.2 Page 27 Greenheys (52) conditions meets the interests of the residents in accordance with their wishes and abilities. 2. YA5 Where a resident does not have an annual holiday as covered in the fees payable steps should be taken to ensure that if a holiday is not possible regular day trips are undertaken or the resident/purchasing authority has a refund in their fees. It is recommended that a full signature and a time and date is made to prevent any confusion over when care has been given. It is recommended that the arrangements for the storage of medication be reviewed. 3. YA6 4. YA13 Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenheys (52) DS0000018890.V346791.R01.S.doc Version 5.2 Page 29 - 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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