Inspection on 04/01/06 for Heslam Homes Limited

This inspection was carried out on 4th January 2006.

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

Other inspections for this house

Heslam Homes Limited 19/08/08

Heslam Homes Limited 29/08/07

Heslam Homes Limited 25/07/06

Heslam Homes Limited 09/08/05

Heslam Homes Limited 18/10/04

Heslam Homes Limited 19/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Heslam Homes Limited Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ Lead Inspector Jane Craig Unannounced Inspection 4th January 2006 09:00 X10015.doc Version 1.40 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 Heslam Homes Limited DS0000005825.V270719.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 Older People. 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. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heslam Homes Limited Address Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ 01254 201513 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) Mrs Carina Lamb Mr Philip Richard Lamb Miss Linda McCallion Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered provider should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection The service shall at all times ensure that the minimum staffing levels in the home comply with the formula detailed below. The service must also ensure that as and when service users dependency levels increase the staffing levels are closely monitored and if necessary adjusted in response to any change. Up to and including 15 Service Users 08:00hrs - 22:00 hrs Managerment - 1 person on duty at all times Care Staff - 1 person on duty at all times 22:00hrs - 08:00 hrs 1 person on waking watch whose duties may include a small percentage of domestic work. 1 person on call in the vicinity (on the Campus or within approximately 3 minutes travelling distance) Ancillary Staff: Domestic - 25 hours per week Cook - 35 hours per week Up to and including 16-19 Service Users 08:00hrs - 18:00 hrs Management - 1 person on duty at all times Care Staff - 2 persons on duty at all times 18:00hrs - 22:00hrs Management - 1 person on duty at all times Care staff - 1 person on duty at all times A member of the management team to be on call at all times and clearly identified on the staff roster. 22:00hrs - 08:00hrs Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 5 2 persons on waking watch whose duties may include a small percentage of domestic work. One of the above to be designated as a senior person. Ancillary Staff: Domestic - 25 hours per week Cook - 35 hours per week Up to and including 20-24 Service Users 08:00hrs - 13:00hrs Management - 1 person on duty at all times Care Staff - 3 persons on duty at all times 13:00hrs - 18:00 hrs Management - 1 person on duty at all times Care Staff - 2 persons on duty at all times 18:00hrs - 22:00hrs Management - 1 person on duty at all times Care Staff - 1 person on duty at all times A member of the management team to be on call at all times and clearly identified on the staff roster. 22:00hrs - 8:00hrs 2 persons on waking watch whose duties may include a small percentage of domestic work. One of the above to be designated as a senior person. Ancillary Staff: Domestic - 35 hours per week Cook - 35 hours per week Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 6 Date of last inspection 9th August 2005 Brief Description of the Service: Heslam House is registered to provide personal care to a maximum of 24 older adults. The home is a large detached property set in its own established and well-maintained grounds. There is a large enclosed garden and patio area with seating for residents. Parking space is provided at the front and side of the building. Heslam House is located in a residential area of Blackburn, within easy reach of shops and other local amenities. The home has three lounges and one dining room. Bedroom accommodation is provided on two floors, the upper floor is accessed by a stair lift. All rooms are currently used for single occupancy. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 7 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. The previous statutory inspection was done on 9th August 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of the inspection there were 18 residents accommodated. The inspector met most of the residents and five agreed to talk about their experience of living in the home. Their views and comments are included in this report. Discussions were held with one of the registered managers. A partial tour of the premises took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: Residents said they were happy with the home. They said they had plenty of choice about their daily routines and wherever possible staff tried to accommodate personal preferences. One resident said, “I’m very happy here.” Another said, “everyone seems satisfied, we have nothing to complain about.” The home was in good repair and the decoration and furnishings were homely and comfortable. One resident said, “it’s a very nice place.” Residents were able to bring in pieces of their own furniture and ornaments. All the residents spoken with were happy with their rooms. There were enough staff on duty to meet the needs of the residents. Residents were very complimentary about the staff. Comments included: “we have good staff, they will do anything for you”, “the staff are very nice, they look after me well” and “very likeable.” The manager made sure that new staff had thorough checks before they started work at the home, which provided protection for residents. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 8 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Not all residents had a thorough assessment before admission to the home. This may result in their needs not being understood or met. EVIDENCE: Care management or hospital discharge assessments were on the residents’ care files but the manager stated that these were not always available until after the resident moved into the home. Prospective residents were also assessed by one of the managers before being offered a place. However, the depth of the assessments varied. One assessment did not include important information about the resident’s needs, which, if known, could have influenced the decision as to whether their needs could be best met at the home. There was no evidence on residents’ files that they had received written confirmation that their needs could be met. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Care plans did not contain sufficient, up to date information to ensure that residents’ needs were identified and met. The lack of appropriate risk assessments and management strategies meant that residents’ health care needs might not be identified as early as they should. There were some shortfalls in the management of medicines, which may place residents at risk of harm. EVIDENCE: The care records for three residents were inspected and others were viewed in less detail. Two residents admitted since the previous inspection did not have a care plan. Another resident’s needs had changed recently but their care plan had not been updated and it contained inaccurate information. The care plan format in use did not allow for the resident’s individual needs to be documented and addressed. Directions were not always detailed enough to ensure that staff provided consistent care. Discussions took place with regard to changing the format of the care records. Residents’ daily notes, relating to care provided and progress, were entered into one book, which meant that confidentiality was breached if a resident or relative wished to see their notes. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 12 There were no specific risk assessments for falls or moving and handling. Following a previous requirement the manager was seeking specialist advice with regard to assessment of pressure sore risk and prevention strategies. Nothing had been put into place at the time of the inspection. Two residents were using pressure relieving equipment but this was not recorded and there were no other directions for staff in prevention techniques. All residents had a nutritional risk assessment but information was not always transferred to the resident’s care plan. Despite the lack of records it was evident that residents healthcare needs were monitored and appropriate referrals were made. District Nurses visited the home regularly. Residents were accompanied to hospital appointments and specialist advice was acted upon. Residents said that staff looked after them well. One said, “they always get the doctor if I am not well.” Staff had access to the Royal Pharmaceutical Society guidelines but the medication policy for the home was incomplete. Records were kept of medication entering and leaving the home. Medication Administration Record (MAR) charts were generally complete and up to date. However, one handwritten addition to a MAR chart did not correspond accurately with the medication label. Handwritten annotations were not signed and witnessed. Medication was stored in the office in a locked trolley or cupboard. The keys were accessible to all staff. The storage area was clean and tidy, with hand washing facilities. Storage temperatures were not checked to ensure that medication was stored in accordance with manufacturers instructions. A number of residents were prescribed medication to be taken only ‘when required’. Criteria for the administration of this medication should be clearly defined and recorded. This will ensure that medication is given only in the correct circumstances and this may help to reduce the risk of over- or undermedication. The manager stated that a number of staff were awaiting places on an accredited medication training course. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Residents were able to exercise choice and control over their daily lives. The routines of the home revolved around the residents. The programme of activities was not sufficient to meet the needs of all residents. EVIDENCE: All of the residents spoken with said they liked the home and the staff. One resident said “I’m very happy here”, another said “everyone seems satisfied, we have nothing to complain about.” A visitor to the home said, “this is a nice place, one of the best.” Residents who were able to make their wishes and feelings known said they made choices and decisions about what happened in their daily life. One resident said everyone had choices about when to get up and go to bed. Another said they could please themselves about whether they stayed in their room or went into the lounge. Other residents talked about choices in meals and how to spend their day. One resident had his meals at different times from others and staff talked about how residents’ individual preferences were accommodated wherever possible. Information about routines, likes and dislikes were usually recorded. During the course of the inspection staff were seen to consult with residents about their care and routines. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 14 Some residents were able to occupy themselves with puzzles, reading and other interests. Two residents who spent most of the time in their rooms said staff made an effort to go in and have a chat with them, which they valued. Two residents said there wasn’t enough to keep them occupied. One said, “staff don’t always have the time.” Another resident said there were activities once or twice a week and she was satisfied with this. The manager stated that a new programme of activities was due to commence with an extra member of staff on duty two afternoons a week. Part of the plan was to provide one to one activities outside the home for residents in an effort to meet individual needs. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the above standards were assessed during this inspection. The key standards were assessed and met during the inspection of 09/08/05. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 25 The environment was comfortable and homely and suited residents tastes. The absence of radiator guards may place residents at risk of harm. EVIDENCE: A tour of the premises evidenced that the home was in a good state of repair. The plan of maintenance and renewal included timescales that were generally met. The patio had been re-laid to provide a safe area for residents. The tops of some bedside cabinets were scratched and shabby but otherwise the décor and furnishings were of a good standard. Residents said they liked the home. One resident said “it’s a lovely place”, another said “it’s very comfortable.” The communal areas were suitable and residents were happy with their bedrooms, some of which were personalised to a high degree. Following the last inspection, staff call leads had been fitted in all bedrooms to ensure that residents were able to summon assistance when necessary. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 17 None of the radiators were guarded. Following a previous requirement a risk assessment had been conducted but this was inadequate and did not take into account individual resident’s vulnerability or the position of radiators. Most of the radiators were turned on at the time of the inspection and were hot to the touch. This meant that should a resident fall against an unguarded radiator and be unable to summon assistance for any length of time, they may sustain serious burns. There were plans to fit radiator covers in high risk areas but the work had not started at the time of the inspection. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 There were sufficient numbers of staff on duty to meet the needs of the residents. Recruitment practices provided safeguards for residents. Health and safety training for new staff was not completed within recommended timescales, which may result in residents’ needs not being met, or cause risks to their safety. EVIDENCE: Examination of duty rosters showed that staffing numbers complied with those on the certificate of registration. The levels were usually exceeded for the morning shift. Staff said that levels were sufficient to meet the current needs of the residents. Discussions with residents seemed to confirm this. One resident said that staff were busy but always had time for her. Other residents said their call bells were always answered quickly. New duty rosters had been put into place that clearly showed what staff were on duty at any given time. Residents spoke highly of the staff. One resident said, “we have good staff, they will do anything for you”, another said “the staff are very nice, they look after me well.” Other residents said that staff were, “willing to help with anything” and “very likeable.” One new member of staff had been employed since the last inspection. All pre-employment checks were carried out and all the required information and documents were present on the staff file. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 19 The new member of staff had commenced the initial induction training, which included orientation to the home, fire and emergency procedures. Induction training for another member of staff showed that awareness training in safe working practice topics was still not covered in a timely fashion. The induction-training programme needs further development to ensure it meets the current standards of the National Training Organisation and leads into the NVQ training programme. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 and 38 Appropriately qualified and experienced staff managed the home. Shortfalls in record keeping meant that residents’ best interests were not safeguarded. The lack of up to date health and safety training may place residents and staff at risk of harm. EVIDENCE: One of the registered managers was qualified to NVQ level 4 in care and held the Registered Manager’s Award. The other manager, who took on the role of deputy, was qualified to NVQ level 3. Both managers took short courses to update their knowledge and skills. At the time of the inspection the manager showed herself to be knowledgeable about her role and responsibilities. Residents said the home was well managed and they found all the staff approachable. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 21 Despite a previous requirement, accidents and injuries to residents were not always recorded appropriately. One resident had a fall, which necessitated admission to Accident and Emergency department. This had not been recorded on the appropriate forms. The registered provider had ceased to forward reports of her unannounced visits to the home. The Commission had received none since the last inspection. There were no copies of the reports in the home. Some of the policies and procedures in the home were dated 2003 and there was no evidence they had been reviewed since then. Not all staff had received update training in moving and handling, first aid and food hygiene. Full fire safety training had been updated in 2005 and the manager discussed the fire procedure with staff on a regular basis. Fire drills were carried out every two weeks. Fire equipment, alarms and emergency lighting were checked and maintained. Servicing and maintenance of gas and electrical installations were up to date. Testing of portable electrical appliances was overdue but booked. After consultation with residents the manager had removed potentially hazardous items from residents’ rooms. Following a previous recommendation the manager had developed risk assessments for the environment and safe working practices. Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 3 X X 2 X STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X 2 2 Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(d) Requirement The registered person must provide written confirmation to the resident that, following assessment, their needs can be met in the home. (Timescale of 30/09/05 not met) The registered person must ensure that all resident have a plan of care, which sets out their personal, health and social care needs and how they are to be met. (Timescale of 20/12/04 not met) The registered person must ensure that care plans are updated as and when changes in need occur. (Timescale of 30/09/05 not met) the registered person must ensure that care plans include risk assessments, with particular attention to falls. (Timescale of 20/12/04 not met) There must be a complete set of policies for the management of medicines. Instructions on MAR charts must correspond accurately with the labels on medication containers. DS0000005825.V270719.R01.S.doc Timescale for action 31/01/06 2. OP7 15 31/01/06 3. OP7 15 31/03/06 4. OP7 13 31/03/06 5. 6. OP9 OP9 13(2) 13(2) 31/03/06 31/01/06 Heslam Homes Limited Version 5.0 Page 24 7. OP25 13 8. OP30 18 9. OP37 17 Sch 4 10. OP37 26 11. OP38 18 Risk assessments must be carried out in respect of unguarded radiators. The assessments must take into account the individual needs of the residents who may be harmed. Guards must be fitted where a risk has been identified. New staff must receive awareness training in safe working practices during the first few weeks of employment. (Timescale of 30/09/05 not met) The registered person must ensure that appropriate records are kept of any accident or incident affecting a resident. (Timescale of 30/09/05 not met) The registered provider must complete a monthly report following an unannounced visit to the home. A copy of the report must be retained in the home and one forwarded to the Commission for Social Care Inspection. Staff must receive update training in safe working practice topics. 28/02/06 28/02/06 31/01/06 31/01/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Pre-admission assessments should be detailed enough to ensure that the resident’s needs are fully understood. Each resident should have an individual set of notes to record their daily care and progress. Care plans should include a risk assessment for development of pressure sores and directions for staff with regard to prevention techniques. DS0000005825.V270719.R01.S.doc Version 5.0 Page 25 Heslam Homes Limited 4. 5. 6. OP9 OP9 OP9 Criteria for the administration of when required and variable dose medication should be clearly defined and recorded. Handwritten amendments to MAR charts should be signed and witnessed. Access to medication storage should be restricted. The temperature of medication storage should be monitored and maintained below 250c The registered person should further develop the programme of activities to meet the social and recreational needs of the residents. The registered person should give consideration to replacing worn and shabby bedside cabinets. The induction-training programme should meet the current standards set by the National Training Organisation. Policies and procedures should be reviewed annually. 7. 8. 9. 10. OP12 OP19 OP30 OP37 Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Heslam Homes Limited DS0000005825.V270719.R01.S.doc Version 5.0 Page 27 - 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. 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