Inspection on 28/04/05 for Hermitage Lane (4)

This inspection was carried out on 28th April 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hermitage Lane (4) 13/06/07

Hermitage Lane (4) 19/07/06

Hermitage Lane (4) 12/10/05

Hermitage Lane (4) 14/10/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hermitage Lane (4) 4 Hermitage Lane Upper Stratton SWINDON Wiltshire SN2 6QS Lead Inspector Bernard McDonald Unannounced 28th April 2005 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 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 Stationary 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. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hermitage Lane (4) Address 4 Hermitage Lane Upper Stratton SWINDON Wiltshire SN2 6QS 01793 727790 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Services Limited Mrs Alison Turner Care Home 6 Category(ies) of LD Learning disability - 6 registration, with number of places Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14/10/04 Brief Description of the Service: 4 Hermitage Lane is one of number of homes owned and managed by Millbury Care Services. The property is a large detached house located down a quiet lane and within easy reach of local amenities, public transport and Swindon Centre. The home provides accommodation for six service users with learning disabilities with the philosophy of care underpinned by John O’Brien’s five accomplishments.The emphasis of care is to promote independence and support service users enjoyment in experiencing the wider community.The accommodation provides single bedroom en suite facilities for all service users that exceed the National Minimum Standards for communal and living space. Staffing arrangements ensures there is a minimum of three staff on duty at all times Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over eight and a half hours. The inspector viewed all areas of the home and met six-service users and six care staff. A number of records were examined including four service users care plans, risk assessments, health and safety records and three staff recruitment files. The CSCI pharmacist inspector examined medication records, policies and safe storage of medication. The inspector met with all service users but was only able to obtain the views of one service user regarding the service they receive. The requirements from the last inspection had been met. What the service does well: What has improved since the last inspection? The home now ensures community care assessments are received prior to admission to ensure the needs of service users can be safely and appropriately met. Environmental risk assessments have been updated to ensure service users can be kept safe in their environment. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 6 There has been a significant reduction in the use of agency staff, which has resulted in a more confident staff team who are committed to the needs of service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 standard(s) 2 and 4 There is a clear admission procedure that provides service users with the opportunity to visit the home and further ensures the needs of service users being referred to the home can be safely met. EVIDENCE: The home has admitted one service user since the last inspection. Documentation confirmed the home had received a full community care assessment prior to admission and a review of the placement had taken place. The assessment covered all areas of personal and health care needs. Records demonstrated the service user was fully involved in the process and the outcomes of trial visits and the service users reactions were clearly noted. The inspector met with the service user but was unable to effectively communicate with the service user regarding their involvement in the transition process. Discussion with management and care staff confirmed the service user had opportunity to visit the home, meet with staff and service users and stay overnight prior to admission. The inspector found the home is currently using the care plan developed at the service users previous residential placement. The manager stated the home is Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 9 continuing to follow these care plans in the interim to provide a consistent approach in meeting the needs of the service user. The assessment and care plans were comprehensive and care staff had signed to demonstrate an awareness and understanding of the service users needs and how these needs are to be met at the home. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 standard(s) 6,7 and 9 The standard of record keeping in relation to care plans and risk assessment needs to be improved. Care plans did not clearly demonstrate how service users needs are being safely met in the home. EVIDENCE: Other than the care plan of the service user recently admitted to the home of the four care plans examined only one had been reviewed in the past six months. The care plans examined did not fully reflect the needs of service users. One service user was exhibiting behaviour that was challenging the service and on occasions had threatened and assaulted staff. The manager stated they have now involved the behaviour therapist to develop strategies for managing this behaviour. The service users care plans did not provide staff with any clear guidelines for managing this service users care and risk assessments had not been completed. These deficits were brought to the attention of the manager who confirmed these matters would be corrected over the coming week. The inspector did meet with the service user and although clearly agitated and verbally abusive in the morning the service users behaviour in the afternoon was relaxed, cheerful and complimentary about the staff at the home. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 11 The inspector was concerned to read the service users morning report that had been completed during the inspection. The report stated the service user had a quiet morning and their behaviour was settled. This record directly conflicted with observations made by the inspector and this was raised with the manager and the member of staff who completed the report. There was evidence in service users records to demonstrate there was a framework for developing good practice in meeting service users needs. The inspector met with all service users during the inspection but was unable to communicate effectively with them to fully obtain their views on the care they receive. Communication passports had been developed to assist staff in communicating with service users. In addition individual support plans gave a clear indication on how service users wanted their needs to be met. Discussion with staff demonstrated an awareness of the needs service users and how communication difficulties are overcome at the home. Discussion with the manager and staff confirmed service users are able to make decisions about their daily lives. Less evident were records to demonstrate how the home supports service users in making decisions. Advocacy information is held in the home although no service users are currently using the service. The use of advocacy services would provide service users with additional support in being able to make choices and decisions about their life. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 standard(s) 12, 13, 15, 16 and 17 Service users are enabled to enjoy a varied and active lifestyle that includes opportunities to make choices in accessing their local community. Service users contact with friends and relatives are being actively supported at the home. EVIDENCE: All service users have a weekly activity planner that involves accessing community resources such as swimming, horse riding and gymnasium. No service users attend local specialist day services. Transport is available to support service users in accessing the wider community. Discussion with staff confirmed they see their role as supporting service users in the community and this practice was observed during the inspection with staff taking service users out on a 1.1 basis and in small groups. Further examples of staff supporting service users were observed during the inspection. Staff were responsive to service users who wished to go out for a walk or to the shop and were also aware of the need for service users to spend time on their own. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 13 The community focus provides service users with opportunities to meet with people who do not share their disability. The manager confirmed service users are registered to vote but are unable to participate in the electoral process due to the support required from staff. Discussion with one-service user confirmed they are supported to maintain contact with their friends and relatives and has regular weekend visits. This practice was observed on the day of the inspection when one service user was being supported to visit their relative. The manager confirmed all service users receive their mail unopened and where necessary the contents are explained. Service users have unrestricted access to all parts of the home except for the kitchen area. This restriction is underpinned by a risk assessment. The inspector shared the lunchtime meal with service users. Examination of the menu demonstrated a choice is offered at breakfast and lunch. The main meal of the day is in the evening when a choice is not normally provided, however if service users did not like the meal then an alternative would be provided. The manager confirmed that the menu is developed using observations of service users’ likes and dislikes and take away meals are provided at weekends. One service user confirmed they were satisfied with the meals provided at the home. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 18,19 and 20 The health and personal care needs of service users are being appropriately met. EVIDENCE: Discussion with staff confirmed all personal care is provided in the privacy of service users bedrooms or bathroom. Cross gender risk assessments have been completed regarding personal care being provided by members of the opposite sex. Where ever possible service users personal care needs are met by staff of the same gender. At the present time services users require no aids or adaptations to maximise independence. Examination of records confirm service users are supported by staff to attend health care appointments. Records confirmed visits to opticians, dentists G.P’s and specialist health care appointments. The pharmacist inspector found medication is stored in a locked cupboard; the temperature in this cupboard is regularly recorded. Printed medication administration records are used with some written additions, which were not Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 15 signed. A record is maintained of medication received and returned to the pharmacy or given to parents for weekend visits. Staff have received training in the homes policy and procedures and further training from their pharmacist is booked. Residents who are unable to swallow tablets are supplied with liquid medication. A protocol exists for the use of an ‘as required’ medication, but this is undated and shows no evidence of review. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 standard(s) 22 and 23 The home is ensuring service users are being protected from abuse and neglect. Less evident is the homes ability to ensure service users are able to raise concerns about the service they receive. EVIDENCE: The complaints procedure has been updated since the last inspection in a format more suited to the needs of service users. The complaints procedure needs to be slightly amended to reflect the change from NCSC to CSCI. Complaints leaflets were on display at the entrance to the home. Examination of the complaints book demonstrated the home has not received any complaints since the last inspection. However the challenge for the home is how service users are being enabled to make complaints about the service they receive in view of the communication difficulties they experience. The manager confirmed they do not act as agent for any service users benefits, but was holding personal money on behalf of service users. The records of money being held reflected service users were paying for meals taken out of the home. Discussion with the manager confirmed these were meals bought by service users in place of the meals that would normally be provided by the home. The manager confirmed it was Millbury policy that service user have to pay for meals away from the home although staff have their meals paid for. It is a requirement that a policy is developed regarding provision of meals taken outside the home. Discussion with staff demonstrated an awareness of what constitutes abuse and what action they would take to report any concerns regarding the welfare Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 17 of service users. A whistle blowing policy was in place and staff confirmed they had received a copy of Wiltshire and Swindon “no secrets” guidance for staff. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 standard(s) 24, 25, 26, 27, 28, 29, 30. The home provides a safe and secure living environment that meets the needs of service users in a comfortable and homely way. EVIDENCE: The inspector viewed all areas of the home including all service users bedrooms. The home was clean tidy and well maintained. The carpet in the hallway was showing signs of wear and was stained in several places. The manager advised they made numerous attempts to clean the carpet without success. In view of the high standard of décor and furnishings in other areas of the home it is recommended that the carpet be replaced. There are two service users bedrooms sited on the ground floor and four bedrooms on the first floor. Bedrooms had been decorated to a high standard and also personalised to reflect the individual taste of service users. One service user commented that they were very happy with their bedroom and had everything they needed. All service users bedrooms had the benefit of en suite facilities that included toilet, wash hand basin and either shower or bath. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 19 The home has two separate communal living areas and a breakfast bar in the kitchen. At the rear of the property there is a large conservatory that is used as a dining area and also provides additional communal living space. The home has a large enclosed rear garden that is accessed through the conservatory. Service users are able to access all areas of the home except for the kitchen area. This restriction is underpinned by a risk assessment. There are no aids or adaptations in place to support service users independence and the manager confirmed that none are required. There is a separate laundry room that is sited well away from any food preparation area. The laundry facilities include a commercial washer and dryer, sufficient for the needs of the home. Laundry floors and walls were readily cleanable to reduce any risk of infection. Staff are responsible for washing service users laundry as part of their care duties. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36 The home has sufficient and suitably trained staff to meet the needs of service users. Safe recruitment practices are being followed at the home. EVIDENCE: Observation made during the inspection and discussion with staff demonstrated staff had a clear understanding of the needs of service users. All staff have been registered on the Learning Disability Award Framework (LDAF) training which is used as a stepping stone to NVQ training. At the present time two staff have completed NVQ level 2 and three staff have completed NVQ level 3. In addition to NVQ training staff have access to specialist training through Millbury care services. Staff confirmed they had received training in crisis invention, risk assessment and caring for people with learning disabilities. Since the last inspection the home has reduced the high number agency staff being employed, which has resulted in a more cohesive staff team. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 21 Examination of the rota demonstrated a minimum of four members of staff on duty in the morning and a minimum of three members of staff in the afternoon and evening. Additional staff are used at peak times or to cover for service users appointments or visits to their families. Discussion with staff confirmed staff meetings are normally held once a month and that they feel supported at work. There is evidence to demonstrate some staff are receiving supervision at the required interval but not all. The manager is aware of the deficit and has delegated supervision responsibility to senior care staff who have now completed their supervision training and formal supervision is to commence for all staff in the coming month. The inspector examined the recruitment records of three members of staff. Records demonstrated the home was following safe recruitment practices. There was one minor deficit in the records of one member of staff, which did not contain a second written reference. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The staff and service users have adapted well to the recent management change and overall the home is providing a safe and secure living environment for service users. EVIDENCE: Since the last inspection a new manager has been appointed who now needs to apply to the Commission for formal registration. The manager has extensive experience of social care and has eight years management experience in a similar setting. The manager hopes to complete the registered managers award by September 2005. The manager advised she is currently working off rota for 20 hours a week. In view of the significant work to be completed in areas of care plans, risk assessment and supervision it is recommended these hours are extended in the short term to enable the home to respond to the requirements and recommendations made in this report. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 23 Since the last inspection two additional care staff have complete first aid training. All staff have received training in moving and handling and fire safety but have yet to receive training in infection control. It is recommended this training deficit be addressed. The last recorded fire practice was held in April 2005 and records demonstrate fire safety drills are being completed every three months. COSHH risk assessments are in place and to ensure the safety of service users cleaning products are securely held in the home. Portable appliance testing needs to be completed. As a matter of good practice the manager has developed an emergency plan to cover all eventualities including where to find shut off valves and who to contact in an emergency. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 Hermitage Lane (4) Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 2 Standard No Score Version 1.20 Page 24 D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 x Score 24 25 26 27 28 29 30 STAFFING 2 3 3 4 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 3 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement The registered person must ensure service user care plans reflect how the needs of service users are being met at the home. The registered person must ensure service users care plans are reviewed every six months or earlier if the needs of the service user changes. The registered person must ensure risk assessments are completed to minimise identified hazards to service users The registered person must develop a policy on the provision of meals and associated costs. The policy must be fair and equitable and take into consideration the cost saved by the home on not providing meals in house. The manager must make application to the CSCI for registration as manager. The registered person must ensure staff receive training in infection control. Timescale for action 01/07/05 2. 6 15(2)(b) 01/07/05 3. 9 13(4)(b) (c) 5(1)(c ) 16(2)(i) 01/07/05 4. 23 01/08/05 5. 6. 37 42 CSA Sect 12 13(3) 18(1)(i) 01/06/05 01/09/05 Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 26 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. 3. 4. 5. 6. 7. 8. 9. Refer to Standard 22 20 20 23 22 24 36 37 42 Good Practice Recommendations The registered person should consider the use of advocacy services to support service users in making decisions abot their lives The registered person should ensure all written additions to the printed medication record is signed, dated and checked by a second member of staff. The registered person should ensure protocols for medication to be used on an as required basis should be incorporated into the care plan and regularly reviewed. The registered person should consider reimbursing service users the money they have paid for meals taken away from the home. The registered person should ensure service users have a understanding of how they can make a complaint. The registered person should replace the carpet in the hallway The registered person should ensure staff recive formal supervison a minimum of six times a year. The registered person should increase the number of hours allocated to the manger off rota. The registered person should ensure Portable Appliance testing is completed annually. Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 Page 27 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road CHIPPENHAM Wiltshire SN15 2BB 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 Hermitage Lane (4) D51 D01 S61405 Hermitage Lane V221292 280405 Stage 4.doc Version 1.20 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!