Inspection on 05/03/09 for Hampden Hall Care Centre

This inspection was carried out on 5th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Winton House

Newbeech House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hampden Hall Care Centre Tamarisk Way Weston Turville Aylesbury Buckinghamshire HP22 5ZB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Browne     Date: 0 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Hampden Hall Care Centre Tamarisk Way Weston Turville Aylesbury Buckinghamshire HP22 5ZB Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Westgate Healthcare Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 120 Number of places (if applicable): Under 65 Over 65 40 40 40 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Hampden Hall Care Centre is a purpose built nursing home, registerd to provide nursing care for up to 120 persons within the category of elderly frail, physically disabled and dementia. The home is owned and managed by Westgate Healthcare Ltd. Accomodation is provided in single rooms. Each room has its own en-suite facility and is fitted with television and telephone points. Internet access is available if requested. The home is divided into three units, each with its own sitting room, dining room and kitchenette. There are safe accessible gardens including a sensory garden to the rear of the property and car parking to the front. Care Homes for Older People Page 4 of 27 Brief description of the care home The home is situated in a residential area of Weston Turville approximately 1.8 miles from Aylesbury town centre and has good commuter links. Service users are registered with general (GP) practitioner practices and all service users have access to local national health services through GP referrals. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced site visit which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection (CSCI) was undertaken by Sandra Lemon Regulatory Manager and Joan Browne Regulatory Inspector on 5 March 2009 and lasted for approximately seven hours. The CSCI Inspecting for Better Lives (IBL) involves an annual quality assurance assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection process and is referred to in the report. The information contained in this report was gathered mainly from records kept at the service, service users surveys and information contained within the AQAA. We also looked at care plan documentation, staff recruitment files, training records, medication Care Homes for Older People Page 6 of 27 documentation and health and safety records. Discussions were held with service users, staff and four relatives who were visiting the home. Staffs practice was observed and a tour of the premises was conducted. Three requirements and three recommendations of good practice were issued on this visit. Please see outcome areas for health and personal care and complaints and protection for full disclosure. Feedback was given to the manager, the operations manager and the proprietors at the end of the inspection. We (The Commission) would like to thank all staff and service users who made the visit so productive and pleasant on the day. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a service users guide and statement of purpose to enable service users and their relatives to access information about the service. Improvement in the preadmission assessment process is needed to ensure that individuals diverse needs are identified and planned for before they move to the home. Evidence: The home has a statement of purpose and service users guide to ensure that prospective service users have the information they need to know about the service. On the day of the inspection work was in progress to update the documents to reflect changes that had recently taken place. The annual quality assurance assessment (AQAA) stated that service users who pay for all or part of their care are given a written contract setting out their rights and responsibilities. Evidence seen in the care plan documentation confirmed that the home has a preCare Homes for Older People Page 10 of 27 Evidence: admission assessment tool in place and pre-admission assessments are undertaken prior to admission. Case tracking identified that some individuals assessments may have been process driven and not particularly personalised resulting in some needs not being recording on the pre-admission documentation. Information recorded in the care plan documentation for service users whose care was case tracked indicated that some people were presenting challenging behaviour which was having an effect on the placement. The home is aware of this shortfall and has reflected in the AQAA that in future it intends to admit only those service users whose needs they can meet. Information in the AQAA reflected that the home offers a settling in period where both parties can reassess the placement. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that service users have access to health care services within the home and in the local community. Improvement in the homes medication system is needed as they do not always follow good practice or safe practice. Evidence: Five care plans were randomly selected to be examined. There was evidence in the care plans of health care treatment and intervention being provided but there were some gaps in information. For example, behavioural charts were in place for some people who were displaying challenging and aggressive behaviours but when incidents occurred staffs practice was not always consistent and sometimes they would record incidents in the behavioural charts and not in the daily notes or vice versa. Staffs recording practice should be reviewed to ensure that recording practices are consistent and there is a clear audit trail of recorded information. We noted that there was no care plan in place for a particular service user with challenging behaviour. A requirement is made to ensure that care plans are developed for all service users Care Homes for Older People Page 12 of 27 Evidence: displaying challenging behaviour detailing how staff should be meeting the identified need. Evidence was seen in the five care plans examined confirming that individuals weights were being monitored. Risk assessments relating to falls, moving and handling, tissue viability and nutrition were in place.The annual quality assurance assessment (AQAA) stated that service users were able to access the services of the optician and podiatrist. The home is also able to access expert advice from the services of the local multi-disciplinary team such as, the community psychiatric nurse, the tissue viability nurse, the community physiotherapist, the dentist, dietitian and speech therapist as and when needed. The medication administration records, supplies and storage were looked at for the forty people who were living in the home on the day of the inspection. There were a number of occasions when there were gaps on the MAR charts for medicines prescribed to be given regularly. This means that it was not possible to tell if service users got their medicines on these occasions. No records were kept of the actual dose given when a variable dose of medicine was prescribed, such as one or two tablets. This means that it was not possible to tell how much medication people were receiving. The records showed that one medicine for a particular person had been out of stock for two days. A service user was prescribed to have a particular medicine twice daily but the medicine was not being offered on Saturdays. No information was recorded on the MAR sheet to reflect why the medicine was not being offered. People who use the service have their medicines given to them by designated registered nurses. A sample of staffs signatures who administer medication was kept in the medication folder. All service users have a recent photograph included in their medication record, to minimise the risks of errors occurring during medication administration. No one was looking after their own medicines when we visited. This can be arranged if individuals wish to do so. All medicines were stored securely and at the correct temperatures. A controlled drugs cupboard was available on each unit to provide extra security for these medicines. The stock balances of controlled drugs were checked and corresponded with records. We noted that mobile trolleys used to store medicines were not fixed to the wall when not used for medicine administration. A requirement is made for staffs practice in the recording, handling, safekeeping, safe administration and disposal of medicines in the home must be consistent. We observed service users being treated in a friendly but respectful manner by staff. Visitors and service users spoken to during the visit rated the care provision as very good. Individuals who responded to the Commissions survey said that staff listen and act on what they say. End of life care plans were seen in care plan documentation for those service users whose care was case tracked. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides facilities for service users to take part in cultural and age appropriate activities. Meals provided are healthy, well presented to stimulate appetite and are served in pleasing surroundings. Evidence: The home employs an activity co-ordinator to manage the activity programme.The weekly activities programme was displayed in areas of the home in a format suited for service users capacities. The home provides an activity room, sensory room, gymnasium and a licensed cinema room that offers a loop system for the hearing impaired which was being well utilised. There is also a hairdressing salon and the hairdresser visits on a Monday and Tuesday and individuals are expected to pay for this service. There is a sensory garden with raised flower beds with a relaxing water feature. It is hoped that those service users who are interested in gardening will grow their own vegetables weather permitting. The activity person was spoken to and she confirmed that activities provided were discussed and agreed with individuals to include the following: board games, quizzes, crafts, knitting, reminiscence therapy, bingo and skittle. One to one time is provided to individuals who are bed bound or do not wish to participate in group activities. We were told that the home has good Care Homes for Older People Page 14 of 27 Evidence: contact with religious denominations and Holy Communion is provided monthly to service users who wish to promote their spiritual needs. The AQAA informed us that important events and birthdays were recognised and celebrated. The chef ensures that all service users have a birthday cake. Individuals who responded to the Commissions survey said that there were always activities arranged by the home that they can take part in. The home does not have any restrictions on visiting. Family and friends can visit at any time and there are tea making facilities for visitors to make drinks. Service users can entertain their visitors in their bedrooms in private or in the spacious communal areas of the home. Visitors spoken to during the inspection confirmed that the homes staff always make them feel welcome and they are provided with refreshments. The homes staff support service users to exercise choice and control over their lives. Some service users spoken to confirmed that they choose their own clothes. Over all service users attire was clean and tidy with attention to detail. Individuals are made aware that they can bring in personal belongings if they wished to and are encouraged to handle their own financial affairs for as long as they wish to and have the capacity to do so. Service users are provided with three meals daily and hot and cold drinks and snacks were available at regular intervals. The chef operates a four-week menu and there is always a choice of a continental or English breakfast daily. There is a choice of two hot meals for lunch and the evening meal or sandwiches. Special diets can be provided for if required. Service users spoken to confirmed that the chef would provide them with an alternative if they did not like what was on offer. One particular service user said that they would like to have a choice of more roast dinners and puddings served with custard such as, sponge pudding, spotted dick and apple pie. This information was passed on to the chef who we were told will be attending the next service users meeting. We observed jugs of fruit juices and glasses were placed in the lounges so that service users could help themselves if they wished. Lunch was observed on the first floor and was presented in an attractive manner to stimulate appetite. A relative joined service users for lunch and was complimentary about the food. Staff assisted those service users who needed assistance discretely and sensitively. We observed that staff was using a bucket to dispose of the waste food in the dining area. This practice could be perceived as institutionalised and should be reviewed. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure, which should ensure that service users and their relatives are confident that their complaints would be listened to and taken seriously. Policies and procedures for safeguarding people who use the service are in place but they are not always put into practice, which could mean that individuals may be put at risk of harm or neglect. Evidence: The annual quality assurance assessment (AQAA) informed us that the home has a complaints procedure which specifies how complaints may be made and are dealt with. A copy of the homes complaints procedure was displayed in service users bedrooms. The homes complaints record folder was examined and two complaints were recorded, which were investigated by the home. We noted that the homes complaints form did not have a section detailing the nature of the complaint. Consideration should be made for the form to be amended to detail the nature of the complaint. Service users who responded to the Commissions survey said that they knew how to make a complaint. The Commission has been made aware of a complaint which was subject to a safeguarding of vulnerable adult investigation. We noted that staff were not proactive in reporting safeguarding matters. For example, drug errors. It could be that there is a lack of understanding of safeguarding procedures and how they work. The AQAA informed us that most staff had undertaken training in the safeguarding of vulnerable adults. A requirement is made to ensure that Care Homes for Older People Page 16 of 27 Evidence: all staff undertake training in the safeguarding of vulnerable adults. This is to ensure that knowledge and practice in safeguarding matters within the service is consistent. The Commission has been made aware of two safeguarding referrals which were currently being investigated by the local Social Services department who takes the lead on all safeguarding matters. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home that is safe and able to meet their changing needs along with their cultural and specialist care needs. Evidence: Hampden Hall Care Centre is a new purpose built home which was opened in November 2008. The location and layout of the home is suitable for its stated purpose and meets service users individual and collective needs. The building complies fully with the requirements of the local fire service and environmental health department. The home is situated on three floors and access to floors is via the stairs or a passenger lift which is large enough to fit an ambulance bed. There is a selection of communal areas on each floor where service users can sit quietly, meet with family and friends or be actively engaged with other people who use the service. Furnishings of communal rooms were domestic in character and of good quality and suitable for the range of interests and activities preferred by service users. On each floor there are toilets for service users and visitors and they were clearly marked and situated close to lounges and dining areas. All bedrooms are single occupancy and have en-suite facilities. Bedrooms are also fitted with television and telephone points and internet facility is available in rooms if requested. Separate staff washroom and changing/shower facilities are available for male and female staff. There is a separate shower /washroom facility for kitchen staff. Bathrooms, toilets and bedrooms were Care Homes for Older People Page 18 of 27 Evidence: fitted with hoists and grab rails to promote independence and to ensure that individuals dignity is upheld. All rooms are centrally heated and the heating can be controlled by service users. The height of the windows in bedrooms enables service users to see out of them when seated or in bed. The lighting throughout the home meets recognised standards and is domestic in character. The home on the day of the inspection was clean, pleasant, hygienic and free from offensive odours. Systems were in place to control the spread of infection. Hand gels were situated discretely in areas of the building. The laundry room is situated away from where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry area was equipped with three driers and washing machines, which were fitted with the specified programming ability to meet disinfection standards. The main kitchen area has stainless steel units and modern equipment to promote high standards of food handling and hygiene. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to ensure that all staff receive relevant training that is focussed on delivering improved outcomes for service users. Evidence: The home employs a mulitcultural staff team to meet service users diverse needs. Prior to this key inspection concerns were raised about staffing levels and skills mix. The Commission has since agreed with the home that the staffing levels in the home should be seven staff on the first floor throughout the waking day and the number reduced to four at night. On the ground floor it was agreed that five staff should be available throughout the waking day and the number reduced to three at night. The staffing roster seen demonstrated that the staffing levels which had been agreed with the Commission was in place. There were two occasions when the staffing levels were reduced and the home had notified the Commission of the shortfall. Domestic staff were employed in sufficient number numbers to ensure that standards relating to food and meals are fully met and that the home is maintained in a clean and hygienic state. The manager said that work was in progress to ensure that staff undertake the relevant training focused on delivering improved outcomes for people using the service. The annual quality assurance assessment ( AQAA) informed us that seven staff had acquired the national qualification (NVQ) in direct care at level 2. We were told that six staff had started a distance learning training in palliative care and Care Homes for Older People Page 20 of 27 Evidence: dementia. Staff were due to undertake moving and handling training and medication training in-house. Four staff had been booked to undertake the deprivation of liberty safeguards training. There was evidence indicating that the service recognises the importance of training and tries to deliver a programme that meets the statutory requirements and the national minimum standards. However, there were some gaps in the training programme. The manager is aware of these gaps and was working to address the shortfalls. Examination of the recruitment records for staff members reflected that thorough recruitment processes had been followed with all the necessary checks undertaken. Service users who responded to the Commissions survey and those spoken to on the day of the site visit said that staff always respected their privacy and dignity and were available when needed Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home aims to provide a consistent service but weaknesses in the homes assessment process, medication practice and lack of staff training and supervision can impede service delivery and outcomes for people using the service. Evidence: There is an experienced manager in post. She is a qualified nurse and has the necessary experience to run the home. The home recently appointed an operations manager to support the manager in the day to day running of the home. Service users, staff and visitors spoken to on the day of the visit were complimentary about the manager and said that she was approachable. The annual quality assurance assessment (AQAA) informed us that monthly service users and relatives meetings take place to enable individuals to state their views on the service delivery . From discussion with the management team it was evident that they were aware of the need to promote safeguarding and had developed a health and safety policy that Care Homes for Older People Page 22 of 27 Evidence: generally meets health and safety requirements and legislation. Areas of improvement had been highlighted and an action plan for undertaking the work was in place. The manager was in the process of analysing the quality assurance survey which was sent to relatives. We were told that monthly health and safety audits are carried out by staff on the units. We saw evidence that one provider visit had taken place in February 2009. As a result of the visit an action plan had been put in place and the homes staff was working to addressing all concerns that have been highlighted in the action plan. The home does not manage service users financial affairs. Lockable storage cupboards were provided in bedrooms if individuals wished to keep small amounts of money or valuables with them. Gaps were noted in the homes supervision framework and the manager said that she was working to address the shortfall. The home started operating in November 2008. This means that all health and safety equipment in the home were in a good state of repair. The home employs a full time maintenance person to ensure that maintenance work in the home is undertaken as and when needed. The fire safety records examined were in good order. The annual quality assurance assessment (AQAA) was returned to us shortly after the due date. All sections of the AQAA were completed and the information gave a reasonable picture of the current situation within the service. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Service users identified with 14/04/2009 challenging behaviour must have a care plan in place detailing how staff should be meeting the identified need. This is to ensure that the care provided is not compromised. 2 9 13 Staffs practice in the recording, handling, safekeeping and safe administration of medicines in the home must be consistent. This is to ensure that service users health and welfare are not compromised. 14/04/2009 3 18 18 Arrangements must be made for all staff to undertake training in the safeguarding of vulnerable adults to enable them to be familiar with the local interagency safeguarding procedure. 14/04/2009 Care Homes for Older People Page 25 of 27 This is to ensure that knowledge and practice in safeguarding matters within the service is consistent. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 9 16 Recording practices should be reviewed to ensure consistency and a clear audit trail of recorded information. To comply with best practice guidelines the medicine trolleys must be fixed to the wall when not in use. Consideration should be made for the homes complaint form to be amended to detail the nature of the complaint. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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