Inspection on 21/10/05 for Hartwood Lodge

This inspection was carried out on 21st October 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hartwood Lodge 10/01/08

Hartwood Lodge 29/06/07

Hartwood Lodge 27/03/07

Hartwood Lodge 12/05/06

Hartwood Lodge 15/02/06

Hartwood Lodge 20/09/04

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

CARE HOME ADULTS 18-65 Hartwood Lodge 14 Bushwood Leytonstone London E11 3AY Lead Inspector Zita McCarry Unannounced Inspection 21st October 2005 10:00 Hartwood Lodge DS0000007249.V261344.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 Hartwood Lodge DS0000007249.V261344.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. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hartwood Lodge Address 14 Bushwood Leytonstone London E11 3AY 020 8518 8988 020 8532 9842 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2004 Brief Description of the Service: Hartwood Lodge is owned and managed by Care UK. The home is situated in a residential area of Leytonstone with good access to local shops, community facilities and transport links. The home provides personal care and support for up to 17 service users between the ages of 18 and 65 years, who have been diagnosed with mental health problems. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the result of an unannounced inspection in late October 2005. Two inspectors spent the day in the service reading documents, observing life in the home and speaking with service users and staff. The inspectors would like to thank service users and staff for their co-operation in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The home needs to improve on its housekeeping and general cleanliness. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 6 The organisation needs to put in place a system to monitor practices in the home in respect of confidentiality, privacy and communication skills. The staff at the home failed to demonstrate to the inspectors that they would take appropriate action in the event of the fire alarm sounding despite a previous requirement. The Commission will therefore take enforcement action to ensure compliance and that service users and staff will be better protected from fire. The service will have to improve on it’s admission processes, care planning and risk assessing. Work will have to be undertaken to ensure service users are provided with care in a positive inclusive service. 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. Hartwood Lodge DS0000007249.V261344.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 Hartwood Lodge DS0000007249.V261344.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): 2, 3, 4, 5 The service fails to follow satisfactory admission procedures and ensure staff are fully aware of service users needs before they are admitted. EVIDENCE: The inspector reviewed the file of the most recently admitted service user and was very concerned about the lack of information about their needs. The inspector could find no evidence that the staff from the home had met with the service user to undertake a preadmission assessment to be sure they could safely meet the needs of the service user. This was confirmed by the service user who told the inspector that no one from the home came to meet her or to discuss her admission back into the service. The service user was unable to identify her keyworker or named person who had supported her through the admission process. The service user also told the inspector that she did not visit the service before being admitted so did not meet with staff and plan her admission. It was of concern that this was a planned admission and despite this not only did the home not take steps to ensure it could meet needs but had not secured any assessment form the placing authority. It was confirmed by the deputy manager that the previous placement had failed. The deputy manager stated the service user had been previously placed in the home and transferred to another home in the same organisation approximately six months earlier. However that placement was unsuccessful and the service user was re-admitted back to Hartwood Lodge. The deputy manager advised the documentation pertaining to the service user was still at the previous Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 9 placement. Subsequently staff had no information about the service users identified needs in respect of physical and mental health, cultural, social communication and emotional needs. There was evidence that the stress of the admission to the previous service had undermined on the wellbeing of the service user. The Deputy Manager confirmed he was unaware of this information. When the staff team are not kept informed of relevant histories/needs then the service is not in a position to support service users or alleviate any stresses. Hartwood Lodge DS0000007249.V261344.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, 8, 9, 10 The home fails to explain to service users or staff exactly how it plans to meet all aspects of the service users needs. Staff do not always handle information about service users care needs confidentially. EVIDENCE: The service had failed to put a care plan in place for one service user nor was there a risk assessment in place. The lack of planning for the service user’s care was evident she told the inspector “I don’t do anything much, there’s just nothing to do here”. Daily records verified the service user’s perception recording that she spent most of the day isolated in her bedroom with little or no stimulation. The was a contingency plan on file for the service user however this in itself was negative and evidence of rather than supporting a service user in dealing with an issue would wait until the issue was out of control before acting. It was of particular concern because the deputy manager told the inspector that this issue was the reason behind the service users admission. From daily records there was little evidence that staff were closely monitoring this issue. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 11 Three other care plans were inspected where there was an identified concern or problem then there was a plan of care to address it. These offered a good level of detail on how to manage behaviours or presenting problems. However the care plans did not deal with all the care needs of the service users such as social and leisure needs dwelling on management of problems only. These will need further development to ensure they are person centred and are comprehensive in how they address needs. The daily recordings made by staff were good observations which were both factual and concise. The inspector did note some good clear strategies, which were the result of risk assessments, particularly in relation to self-harm and the protection of other service users. The home prohibits the consumption of alcohol or drugs in the premises, the inspector spoke to one member of staff who described the action he took when a service users attempted to take alcohol into the home. The action was appropriate, made in the service users best interest and well documented and managed. However other staff were less clear how they would respond if such an event arose in the absence of the manager. The home has developed local procedures to guide them in just such an event but one staff member did not appear familiar with these when asked by the inspector. The inspector read the notes of the four service users meetings that had been held in the past twelve months. The minutes failed to evidence effective consultation particularly around change, for example minutes noted “residents are to make their own lunches as of today 1/9/05, most in agreement some not sure”. There were no negotiations around service users getting support to prepare their own food, or notice given to consider the change, or explanation given. A member of staff later confirmed to the inspector that not all service users prepare their own lunches and support is given to frailer residents. The inspector observed several instances when staff did not pay due attention to confidentiality and individual service users personal care needs were discussed. There was also an instance when was personal care was being delivered and a second member of staff stood in the open doorway and talked to her colleague during the process. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 12 Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 15, 16 The service fails to take sufficient steps to support and motivate service users in appropriate and social leisure activities. EVIDENCE: There was one service user who has for some time been involved in training and is currently undertaking an NVQ. However no other service users were involved in any education or training. One young person the inspector spoke with said she would enjoy, shopping and going to the cinema. She also confirmed she could cook some pasta dishes, but has not had to opportunity to do any of these since admission. There were no plans to develop daily living skills, or social or emotional needs to be met. Another service user confirmed that she was supported by staff to get out to the local shops. Service users confirmed that family and friends are encouraged to visit and that they can see visitors in private. From inspection of records there was evidence that the home had asked some visitors who broke the homes rules to leave. The service pays out most service users personal allowances. Service users informed the inspector that they had for some time been dissatisfied that they Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 14 did not receive their personal allowance regularly. It is the practice that personal allowances are paid out on Fridays, however service users stated that they frequently have to wait to the following Monday or Tuesday for their allowance. It is most unsatisfactory that service users budget for their allowance to last over seven days and find out on the seventh day that they will not be receiving their personal monies and have to wait another three days. Review of service users meetings demonstrated the homes failure to actively consult with service users about the allocation of domestic tasks and responsibilities. The inspectors were concerned that “little jobs will be allocated to clients to ensure the house is kept clean”. The allocation of domestic chores should be agreed with individual service users and be reflected in their care plan. On several occasions the inspector observed the staff on duty to be interacting exclusively with each other and not the service users. For example the home has a pool table in the smoking room this is a valuable resource because if it is used appropriately it will enable service users and staff to interact with each other. However the inspector observed three care staff playing pool and chatting to each other with a service user standing some distance observing the interaction. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 The home does not sufficiently take service users individual preferences into account when delivering care. EVIDENCE: The inspector was concerned to observe two instances where staff failed to respect service users right to privacy when delivering personal care. On reading the minutes of service users meetings it was noted that a service user raised an issue about how is personal care was delivered, his preference was noted assurances were made. However on tracking this information there was no evidence that the service followed through or attempted to deliver on these assurances. It was also confirmed by a staff that a service user had a bath at a set day and time because this was when his keyworker was on duty. This is an example of a lack of flexibility in providing personal support. Arrangements were in place for medication to be appropriately secured in a locked cabinet. Inspection of records evidenced a failure to sign for medication, which had been given earlier. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 16 However there was good evidence that the home monitors and keeps under review service users compliance in accepting their medication. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23, 23 The home fails to respond appropriately to service users concerns. EVIDENCE: In the course of the inspection it was evident that service users had complained about some issues such as a broken pay phone that had been out of order for nine weeks and lack of regular personal allowances. However neither of these issues were recorded in the home’s record of complaints and there was no evidence that that home had taken any steps to address the issues to improve the situation for the service users. The managing organisation has provided the home with a guidelines which offer no procedural guidance to staff for action to take in the event of actual or suspected abuse. The home had developed its own local guidance to support staff however as a procedure it is insufficient. It does not offer staff any information on what constitutes abuse or the various definitions of abuse. From inspection of records it was evident that most staff had received training in adult protection. However from discussion with a member of staff the inspector was not satisfied that an appropriate response would be made to an actual or suspect abuse of a service user. The Commission has required the service to put in place an adequate procedure and it has failed to do so the Commission is now considering enforcement action to ensure compliance and the protection of vulnerable adults. Hartwood Lodge DS0000007249.V261344.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, 30 Some areas of the home are not sufficiently clean. EVIDENCE: There was little evidence of a recent refurbishment. Many areas of the home were shabby and unclean in appearance. The carpet on the main stairs had been removed and the carpet at the top of the stairs was not secured presenting a major tripping hazard. Many surfaces throughout the home were grubby and unclean, new flooring had been laid but these were unfinished, between the dining room and conservatory there was no door saddle again presenting a tripping hazard. The home has made changes to contain the high level of cigarette smoke to one lounge and this is an improvement as is the new furniture in the room. Throughout the home the radiator guards were damaged and in various states of disrepair. These need to be made good. In a lobby area on the first floor the walls had been stripped back to the plaster and not been made good. Toilets seen on the ground and first floor require regular cleaning and extensive descaling. The privacy in toilets and bathrooms were insufficient, bathrooms numbers 1 and 2 on the first floor had Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 19 no window coverings to afford privacy, and bathroom 2 was missing tiles from the wall. The toilet opposite bedroom 10 had no locking mechanism at all. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 36 Staff do not consistently put their training experiences into daily practice. EVIDENCE: The files of two staff were inspected. Each file contained a pro-forma signed off by head office’s human resource department confirming required preemployment checks had been undertaken. Where a CRB disclosure was less than satisfactory the home failed to fully explore the issues within it before confirming appointment. On two files checked for staff in post over three and four months there was evidence they only had one supervision session. There was no evidence that staff had had an induction into the home. On other files there was evidence that some supervision did take place although this was irregular and insufficient. A training scheduled provided information on training staff had attended over the past 12 months such as, administration of medication, managing challenging behaviour and de-escalation techniques, moving and handling, protection of vulnerable adults, health and safety food hygiene and fire safety. From observations made during the inspection it was evident that training has not stopped unsafe practice. The service has recently introduced long day shifts for care staff working thirteen and quarter hours per day with no breaks. The deputy manager Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 21 explained that staff actually take their breaks and meals with service users however this practice was not observed during the inspection. Staff spoken to confirmed that they were satisfied with the new working arrangements. Both the manager and deputy manager work office hours Monday to Friday as does the homes domestic. This means that from 4pm on a Friday the home drops to a minimum staff team currently three who in addition to providing all care are also undertaking cooking and cleaning responsibilities. Hartwood Lodge DS0000007249.V261344.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): 37, 38, 42 The service fails to take appropriate action in respect of fire safety. EVIDENCE: The home currently has no registered manager although there is an acting manager in post. The inspectors noted evidence that senior staff’s negative perception of a service user and shared the view openly with more junior staff. The Commission has concerns about the impact such a negative view has on both the care of the service user and influence on the staff team. Combined with homes failure to appropriately respond to service users concerns is evidence that the home is currently failing to create a positive or inclusive atmosphere for service users. The home has developed some very useful and detailed guidance for staff in relation to the action they should take in the event of an incident. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 23 During the inspection there were several incidents observed by the inspectors which provided evidence that staff failed to take reasonable steps to ensure the health, safety and welfare of service users. It was observed that food hygiene practices were poor in the defrosting of cooked meat. During the inspection the fire alarm was sounded and staff failed to respond to the alarm as directed in the homes fire procedures. This is a major concern particularly in light of the high number of smokers in the home. The Commission had previously required the service to ensure staff followed procedure when the fire alarm is sounded this requirement is unmet. The Commission is now considering enforcement action to ensure compliance and ensure service users and staff safety in the event fire. Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 24 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 X 1 2 2 3 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 2 2 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 2 X X 2 LIFESTYLES Standard No Score 11 2 12 2 13 X 14 X 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score X X 2 2 X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hartwood Lodge Score 2 X 2 x Standard No 37 38 39 40 41 42 43 Score 2 2 X X X 1 x DS0000007249.V261344.R01.S.doc Version 5.0 Page 25 3 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 YA2 Regulation 14 Requirement The registered provider must ensure that the home undertakes a pre-admission assessment and has obtained the placing authorities assessment of need before any admissions are made to the home. The registered person must ensure information is appropriately shared with staff to enable them to meet service users needs safely. The registered person must ensure the prospective service user who have a planned admission have the opportunity to visit the service play an active role in their admission planning. The registered person must ensure all service users have a care plan underpinned by a comprehensive risk assessment. The registered person must ensure service users are consulted about issues that affect their daily lives. The registered person must ensure that staff are familiar with the local procedures and guidance. DS0000007249.V261344.R01.S.doc Timescale for action 15/01/06 2 YA3 15 15/01/06 3 YA4 12 15/01/06 4 YA9YA6 15 15/02/06 5 YA8 15 & 16 15/02/06 6 YA7 18 15/02/06 Hartwood Lodge Version 5.0 Page 26 7 8 YA10 YA12YA11 18 12&15 9 YA16 12 10 11 YA16 YA18 18 15 12 YA20 13 13 YA22 16 14 YA22 22 15 YA27 23 16 YA24 23 17 YA33 18 The registered person must ensure all staff receive training on confidentiality. The registered person must ensure that service users have opportunities for personal development and care plans reflect the actions of staff to ensure these. The registered person must ensure that the service users receive their personal allowances on a regular basis and this is agreed with them. The registered person must ensure staff receive training on communication skills. The registered provider must ensure that the care delivered to service users reflect their preferences and this is recorded in the service users care plan. The registered person must ensure that the home accurately records medication administered. The registered provider must ensure service users have access to phone without recourse to staff. The registered person must ensure that service users concerns/complaints are recorded and responded to appropriately. The registered person must ensure appropriate locking mechanisms are fitted to all toilet and bathroom doors. The registered person must make arrangement to have remedied the following issues, repair/replace radiator covers; descale toilets; secure carpeting, finish flooring, decorate areas identified. The registered person must provide additional staff to DS0000007249.V261344.R01.S.doc 15/02/06 15/03/06 15/01/06 15/02/06 15/01/06 15/01/06 15/01/06 15/01/06 15/01/06 15/03/06 15/03/06 Page 27 Hartwood Lodge Version 5.0 18 19 YA36 18 19 YA34 20 20 21 YA38 . YA9 18 . 13 22 YA20 20 undertake cleaning duties at the weekends. The registered person must ensure all staff receive regular supervision. The registered person must ensure that less than satisfactory CRB disclosures are fully explored before appointment. The registered person must ensure all staff receive training in positive care. Requirements unmet from September 2004 inspection. The registered manager must ensure that thorough risk assessments underpin care planning. The Registered Manager must ensure staff follow the home’s procedures in dealing with medications. 15/02/06 15/02/06 15/03/06 15/02/06 15/02/06 15/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Hartwood Lodge DS0000007249.V261344.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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