Inspection on 01/11/05 for Haddon (32a)

This inspection was carried out on 1st November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Haddon (32a) 03/01/08

Haddon (32a) 09/05/06

Haddon (32a) 25/07/05

Haddon (32a) 14/02/05

Haddon (32a) 19/07/04

Haddon (32a) 08/12/03

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

CARE HOME ADULTS 18-65 32a Haddon 32a Haddon Great Holm Milton Keynes Bucks MK8 9HP Lead Inspector Unannounced Inspection 1st November 2005 10:00 32a Haddon DS0000048436.V263510.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 32a Haddon DS0000048436.V263510.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. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 32a Haddon Address 32a Haddon Great Holm Milton Keynes Bucks MK8 9HP 01908 262814 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) Macintyre Care Mrs Claire Helen Dove Care Home 14 Category(ies) of Learning disability (14) registration, with number of places 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: Set on the edge of Great Holm, no.32a Haddon, owned by MacIntyre Care, is located within a campus style complex, in amongst private housing. It provides accommodation to adults with learning disabilities. 32a Haddon is situated within walking distance of the local shops, church and local pubs. The building itself contains five self contained flats and a small garden area. There is a further complex of buildings that comprise of no. 42a and no. 52a Haddon, the organisations day care services, a hall, a nursery and garden centre, a craft shop, a coffee shop, bakery and an administration office.. The coffee shop and bakery occupy the corner of the site and this provides occupational opportunities for service users and enables local residents to visit the shop. The nursery, garden centre and craft shop also provide occupational activities for service users and are open to the public.The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Service users are encouraged and supported to use public transport to which they have access. 32a Haddon DS0000048436.V263510.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 on 1ST November 2005 at 10.00am on a Tuesday morning. The visit consisted of discussions with the registered manager and records, policies and procedures were examined. Most service users were out at their respective places of work and so permission to observe personal bedrooms was not sought. Therefore the inspector only looked at communal areas of the service users flats. What the service does well: What has improved since the last inspection? What they could do better: Each service user has an excess of documentation, making it difficult to access relevant and important information. Care plans do not appear to be working documents due to the extent of their contents. The newest admission to the unit did not have a plan of care. It is a requirement of the report that all service user plans contain a detailed action plan that sets out the action needed to be taken by staff, to ensure that all aspects of the service users needs are met. This needs to include the provision of personal care. It is recommended that care plans are made more user friendly by reducing their contents to necessary information only. This will then make it easier for care staff to access information and make the care plans working documents. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 6 There is a lack of POVA training for newly appointed staff within their first six months of employment, leaving service users at risk of abuse and harm and their rights to be safe are not protected. This has been made a requirement of the report. There are on-going environmental improvements that need to be completed to enhance the shared and individual living areas of the flats. Serious consideration needs to be given to suitable storage facilities for service users in their flats to prevent them from being cluttered and to the storage facilities available for the storage of old/archived records. Staffing levels are not at their maximum and recruitment needs to continue to ensure the unit is fully staffed. 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. 32a Haddon DS0000048436.V263510.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 32a Haddon DS0000048436.V263510.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, 2, 3, 4 and 5. The homes Statement of Purpose and Service Users Guide provide service users and prospective service users with details of the services the home provides. Pictorial guidance is included to make both documents suitable for the people for whom the home is intended. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. The opportunity to visit the home prior to admission is an integral part of the admission process, which means that service users are orientated to the environment and have met and are familiar with staff and other service users beforehand. Each service user has an individual written statement of terms and conditions with the home that needs to be signed by service users, relative or relevant third party and the registered manager. EVIDENCE: 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 9 The Service Users Guide is well presented and informative and this document covers all the necessary information as detailed in standard 1. The Statement of Purpose covers all areas as detailed in Schedule 1. The assessment tool used by the home is called “Moving into Macintyre Care” and is very comprehensive and detailed. This is dated June 2003. Pictures are included alongside written information to enable the potential service users to understand the process. One service user was admitted on 5th August 2005. The completed preassessment was examined and was found to be detailed and informative. The home has a policy called “Moving in and Moving out guidelines”. This is dated June 2003. This gives details of trial visits to the home, day-to-day support service users can expect and details of how and when a review of the placement will occur. This is not in a different format suitable for service users. All specialised services offered are accessed through the Learning Disabilities Community Team. Religious and social and/or cultural needs of service can be facilitated if requested. Service Users are informed about independent/self advocacy groups, and examples given were of Milton Keynes Advocacy and People First. Within the policy called “Moving in and Moving out guidelines” there is information regarding trial visits. This includes visiting the unit for a meal, staying overnight and a three-month settling in period. Following this the potential service user will have a review. If this is successful the service user will sign a contract/statement of terms and conditions. The unit does not accept emergency admissions. Service users contracts/statements of term and conditions were looked at during the visit. These covered all areas detailed in Standard 5. All contracts looked at have been updated and signed by service users. The home does not take emergency admissions nor is intermediate care offered. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 AND 8 There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. These records need to be made more user friendly to make them working documents. Service users make decisions about their lives, with assistance and communication support, that allows them to influence their lifestyle and participate in all aspects of life in the unit. EVIDENCE: A random selection of care plans were looked at for service users. These are informative and cover a wide range of needs. However, each service user has an excess of documentation, making it difficult to access information. Care plans do not appear to be working documents due to the extent of their contents. The newest admission to the unit did not have a plan of care. It is a requirement of the report that all service user plans contain a detailed action plan that sets out the action needed to be taken by staff, to ensure that all aspects of the service users needs are met. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 11 It is recommended that care plans are made more user friendly by reducing their contents to necessary information only. This will then make it easier for care staff to access information and make the care plans working documents. There is evidence that service user’s families are involved in the care-planning process if the service user wishes them to be. Service users are given opportunities to make decisions about their lives, with assistance as needed. This includes help to make decisions regarding their choice of activity, daily routines, menu planning and preferred daily routines. The head of service stated that service users are given a choice about colour schemes for communal areas of their flats and their own bedrooms. Service users are offered opportunities to participate in the day-to-day running of their flats as far as they are able to. There is a key worker system in place that works well. Most service users are able to manage their own finances and risk assessments are in place for this. Limitations on facilities, choice or human rights to prevent self-harm or selfneglect, are documented in the service users care plans. The organisation holds a service users forum on a fortnightly basis. These are used to discuss any issues the service users feel are important. This is also an opportunity for guest speakers to provide service users with relevant information. An example of this is the local police officer presented information about “stranger danger”. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 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): These standards were not assessed during this inspection. EVIDENCE: 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 13 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 and 21. Personal support is offered in such a way as to promote and protect service users’ privacy, dignity and independence. The systems for the administration of medication are generally well managed protecting service users and ensuring their medication needs are met. However appropriate training of staff regarding the administration of rectal diazepam needs to be implemented. The physical, emotional and health care needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. There are good policies/procedures in place to ensure that the ageing, illness and death of a service user will be handled with respect and as the individual would wish. EVIDENCE: Information regarding personal care is recorded in the service users care plans on a form called intimate care policy. However this information was not available in all care plans looked at during the inspection. A requirement has been made under Standard 6 Care Homes for Younger Adults Regulations that care plans contain a detailed action plan that sets out the action needed to be 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 14 taken by staff, to ensure that all aspects of the service users needs are met. This must include the provision of personal care. Service users are very independent and they choose the times they wish to go to bed, bath, have their meals and take part in other activities. It is also evident through discussions with service users that clothes, hairstyles, make up and appearance are the service users choice. Service users receive additional support through the Learning Disabilities Community Team, where they can access physiotherapists, occupational therapists, speech therapists and other specialist service they may require. The unit operates a link worker system. The care plans set out in detail the service users preferred routines, likes and dislikes and partnerships with families, friends and relevant professionals outside of the unit. Visits to service users in their own flats take place in the privacy of their own rooms. Service users are supported and facilitated to manage their own healthcare where practicable. Service users visit their G.P. on a needs only basis. Service users locally access chiropody services. Specialist service such as physiotherapy can be accessed via a referral through the G.P. or via the Community Team for People with Learning Disabilities. Staff provide support to service users needing to attend outpatient and other appointments. Service users are encouraged to self-administer their own medication, and risk assessments were observed to be in place for this. Lockable, metal cupboards were seen in individual bedrooms for the safe storage of medications. Some medications were kept in the staff office, and this was stored in a lockable metal cupboard. The home uses a monitored dosage system. Medication records for the unit were looked at and found to be excellent. Each service user has their individual medication file. Photographs are used for identification purposes. These records contain a description of the medicines that the service user takes, possible side effects, how the individual best takes their medicines and a description of what the medicine looks like. Unused medication is disposed of via the pharmacy. At the time of the inspection no controlled drugs are in use. Service users records show that there are no omissions. Service users consent to medication is obtained and recorded in care plans. There are no individuals who self-administer their own medication and risk assessments are in place. If a service user becomes ill, an assessment will be carried out, with the involvement of their family, and the service users wishes regarding terminal care and death will be discussed and carried out. Bereavement counselling has been offered to service users in the past following the death of a service user. There are guidelines regarding the death of a service user and this is dated April 2004. These include the expected, sudden or unexpected death of a service user and a last wishes questionnaire. Service users with deteriorating conditions or dementia will be referred to their G.P. or the Learning Disabilities Community Team for personal support or technical aids. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 15 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 16 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 and 23. The home has effective complaints procedures to ensure that service users or their representatives are listened to. Policies and procedures to protect service users from abuse are in place, but there is a lack of POVA training for newly appointed staff within their first six months of employment, leaving service users at risk of abuse and harm and their rights to be safe are not protected. EVIDENCE: 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 17 The home use the Milton Keynes “Protecting Vulnerable Adults from Abuse” policy and a MacIntyre Care policy called “Protecting Vulnerable Adults from Abuse” dated September 2003 There are guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. There is a public disclosure policy dated Sept 2003. All permanent staff receive training about Adult Abuse and this forms part of their induction. However newly appointed staff who had been in post for over six months had still not received POVA training. This is a requirement of the report. There is a Whistle Blowing policy and a Physical Intervention Policy dated September 2002. The homes policies regarding service users money and financial affairs ensure service users access to their money, valuables and safe storage is safe guarded. There is a gifts procedure that provides staff with guidelines about receiving personal gifts from service users. The complaints policy includes guidelines for relatives and service users to make complaints, and who to contact if the complaint cannot be resolved. A summary of the complaints procedure is included in the Statement of Purpose and the Service Users Guide. This includes information on how to refer a complaint to the Commission. The home has a dedicated book for the recording of complaints and has received one complaint in the previous twelve months. This was well recorded and responded to within timescales. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 18 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, 27, 28, 29 and 30. The standard of the environment within the flats is adequate, providing service users with an attractive and homely place to live. However, prompt attention to repairs and maintenance of the flats needs to be sustained, to ensure they remain safe, comfortable and accessible to the people living there. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. EVIDENCE: 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 19 32a Haddon consists of 5 flats. Each flat was visited during the inspection. Flat 28 is nicely decorated, homely, bright and cheerful. However, there has recently been a burst pipe and consequently a leak in one of the service users bedrooms. There is a very strong smell of damp and the service user is having to sleep on the sofa in the lounge. The head of service said that the problem of the damp should be resolved shortly. However, the inspector requests to be notified if this continues for longer that a week. It is pleasing to see that the kitchen has been replaced. The carpet in the lounge is grubby and requires cleaning. The bathroom is due to be replaced shortly due to changing needs of service users. Flat 30 is nicely decorated, homely, bright and cheerful. The carpets in the lounge and the hallway are grubby and require a clean. A previous requirements for the radiator in the bathroom to be covered has not been met and will be a requirement of this report. It was a requirement of the previous announced inspection for the kitchen to be replaced and the head of service said this is due to take place in the near future. Flat 32 is pleasantly decorated and is bright and spacious. However there is a strong smell of damp coming from the bathroom and a requirement was made following the previous announced inspection to eliminate the strong odour of damp. There is mildew around the tiled areas of the shower and bath. The head of service stated that one service user has excessive amounts of baths and this leads to problems with condensation. The extractor fan, although working, is ineffective and the problem of damp may be improved if a more adequate extractor fan is installed. This will be a requirement of the report. It is pleasing to see that a new kitchen, worktops and flooring have been installed. Flat 24 is a 1 bedroom flat. The lounge was nicely decorated. A requirement was made following the previous announced inspection that the bath and toilet were replaced due to damage. The head of service stated that the bath is due to be replaced with a shower and the existing toilet with a closimat toilet. The inspector noted that several kitchen cupboards were damaged and the worktops were worn and need to be replaced. This was a requirement of the previous announced inspection report. Flat 26 is home to two service users. The kitchen was noted to have broken cupboards, worn worktops and flooring and needs to be replaced. The carpets in the lounge and the hallway require cleaning. Many flat are cluttered due to a lack of storage space. In some areas this poses a hazard to staff and service users. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 20 The facilities for staff are also very cluttered and pose a health and safety risk to care staff. It is a requirement of the report that suitable storage facilities are provided for the use of service users and staff. It is pleasing to see all the environmental changes that have been made to the individual flats. These have enhanced the living environment for service users and improved access. The unit has a planned maintenance and renewal programme for the fabric and decoration of the premises. There are no CCTV cameras in use at the time of the inspection. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34. There are effective recruitment procedures in place to ensure service users are protected from harm, however it is intended that staff files be stored at a central office. This will not make them available at all times for inspection purposes. EVIDENCE: A random selection of staff files were looked at during the visit. A request was made to look at files of the most recently employed care worker. The inspector was informed that all documentation for these individuals are kept at a central office and this is to be the practice of the organisation. Staff records need to available for inspection purposes and it is a requirement of the report that suitable arrangements are made to make certain that personnel records are available for inspection at all times. All remaining staff files contain the necessary details as detailed in standard 34 and schedule 2. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 22 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): These standards were not assessed during this inspection. EVIDENCE: 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 32a Haddon Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score X X X X X X x DS0000048436.V263510.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 6 Regulation 15 Requirement The registered manager is required to ensure that service user plans contain a detailed action plan that sets out the action needed to be taken by staff, to ensure that all aspects of the service users needs are met. This is to include the provision of personal care. The registered manager is required to ensure that POVA training for newly appointed staff is undertaken within their first six months of employment. The registered manager is required to ensure that all dirty/grubby carpets are cleaned. The registered provider is required to ensure that the radiator in the bathroom of flat 30 is covered with a low temperature surface cover. (previous timescale of 30/05/05 not met) The registered provider is required to ensure that the kitchen in flat 30 is replaced. The registered provider is DS0000048436.V263510.R01.S.doc Timescale for action 30/03/06 23 2 13 30/03/06 30 3 24 4 23 30/01/06 23 30/01/06 5 6 24 24 23 23 30/06/06 32a Haddon Version 5.0 Page 25 7 24 23 8 24 23 24 9 23 10 24 24 23 23 11 41 12 Schedule 4 required to ensure that the extractor fan is replaced in the bathroom of flat 32. The registered manager is required to ensure that the mildew in the shower of flat 32 and the smell of damp is removed/eliminated. (previous timescale of 30/05/20005 not met) The registered provider is required to ensure that the toilet and bath are replaced in flat 24. (previous timescale of 30/07/2005 not met) The registered provider is required to ensure that the kitchen in flat 24 is replaced. (previous timescale of 30/08/2005 not met.) The registered provider is required to ensure that the kitchen in flat 26 is replaced. The registered provider is required to ensure that suitable storage facilities are provided for the use of service users. The registered provider is required to ensure that suitable arrangements are made to make certain that personnel records are available for inspection at all times. 30/12/06 30/12/05 30/04/06 30/07/06 30/09/06 30/05/06 30/11/06 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 41 Refer to Standard 6 Good Practice Recommendations It is recommended that care plans are made more user friendly by reducing their contents to necessary information only. It is recommended that the registered provider gives DS0000048436.V263510.R01.S.doc Version 5.0 Page 26 32a Haddon serious consideration to suitable storage facilities for the storage of old/archived records. 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 27 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 32a Haddon DS0000048436.V263510.R01.S.doc Version 5.0 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!