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Inspection on 12/05/05 for Hillside Nursing and Residential Home

Also see our care home review for Hillside Nursing and Residential Home for more information

This inspection was carried out on 12th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents spoken to liked the staff who cared for them, they said staff were "always willing", "cheerful" and "friendly". Relatives are made to feel welcome, and can visit anytime. The relaxed atmosphere of the home supports residents to meet with other residents, their visitors and talk to staff. Staff are given clear guidance on how residents wish to be looked after.

What has improved since the last inspection?

The owners and staff have worked hard in redecorating and furnishing areas of the home, to make a more comfortable and safe environment for residents. New carpets have been fitted in some bedrooms, armchairs purchased and curtains ordered for the downstairs lounge. Work had started on the patio, which will give residents safe access to some of the garden. One resident said they "were looking forward" to using the new patio. Staff had put right the shortfalls identified in the last report. This included correction fluid not being used on medication records, and a cover put on a electrical box.

What the care home could do better:

Staff have been trained to give out medication safety. A check of tablets held, against the home`s records, identified that staff were not always giving medication out correctly. Staff must ensure that they give medication out as requested by their Doctor, and store medication held for residents safely. Although armchairs had been checked to ensure they were safe to use, checks had not been made of the dining room chairs and small tables. Six dining room chairs (upstairs dining room), and two small tables were found not be safe for residents to use. Although staff took action during the inspection to purchase new tables, and remove dining room chairs to be mended. It should not be left for a visitor to point out items that need repairing. Staff must check furniture regularly, to make sure it is safe to use, and meets the residents needs. Hot water from one resident`s wash hand basin was found to be very hot, which staff were asked to take immediate action, to reduce the risk of scolding.

CARE HOMES FOR OLDER PEOPLE Hillside Residential Home 20 Kings Hill Great Cornard Sudbury CO10 0EH Lead Inspector Jill Clarke Announced 12 May 2005 at 10.00hrs 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 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. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hillside Residential Home Address 20 Kings Hill, Great Cornard, Sudbury, Suffolk, CO10 0EH 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) 01787 372737 01787 319506 None Stour Sudbury Limited Mrs Janet Warner Registered Care Home 40 Category(ies) of Older People aged 65 or over [40]. registration, with number of places I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28/1/05 Brief Description of the Service: Hillside Residential Home is owned by Stour Sudbury Limited, part of the Caring Homes organisation. The home is a large detached building located in a residential area on the outskirts of Sudbury. There is a public house located close by, and the town of Sudbury offers a range of shops and amenities. The home is located on two floors, with bedrooms, communal toilets, bathrooms, lounge and dining room on each floor. There is a passenger lift and stairs to the first floor. There are a variety of aids and adaptions around the building to allow residents to move about independently. All forty single bedrooms have wash hand basins, with twently four also having an en-suite toilet. The home set on a hill has its own gardens which residents will be able to have access too, once the new patio has been completed. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection carried out over seven and half hours on a Thursday in May. Seventeen of the thirty-eight residents were spoken with, three in private. Time was spent with five members of staff, which included the registered manager and a representative from the company’s property services department. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home before the inspection. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the home was run, and level of service provided. Two relatives and six staff cards were returned. Comments made have been included in this report. A tour was made of the communal accommodation and sample of nine bedrooms, to check the condition of the décor, furniture and hot water temperatures. Records inspection included care plans, medication, staff rotas, menus, training, maintenance, and Fire drills. What the service does well: What has improved since the last inspection? The owners and staff have worked hard in redecorating and furnishing areas of the home, to make a more comfortable and safe environment for residents. New carpets have been fitted in some bedrooms, armchairs purchased and curtains ordered for the downstairs lounge. Work had started on the patio, which will give residents safe access to some of the garden. One resident said they “were looking forward” to using the new patio. Staff had put right the shortfalls identified in the last report. This included correction fluid not being used on medication records, and a cover put on a electrical box. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 6 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. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1, 3, 4 and 5. Standard 6 does not apply. The home has good pre-admission procedures in place. People can expect to be given sufficient information, to be able to decide if the home can meet their needs. EVIDENCE: One resident said that they visited the home with their social worker before deciding to move in. Another resident said their family visited on their behalf, and they were given information on the home, including costs. Information booklets given to residents were seen in bedrooms, and displayed on the notice board. Completed pre-assessments undertaken by the manager were held on file. These looked at all aspects of physical, medical, mental and social care needs. Information obtained, allowed the manager to identify if people requesting to move into the home, came within their registration category. The ‘Contract of Residence’ informed people moving into the home that ‘the first four weeks of admission shall be regarded as a trial period’. A resident confirmed that they had, had discussions after they moved in with the management, to ensure they were happy living at the home. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 9, and 10 Staff are not always following safe procedures for dispensing medication, which could potentially put residents at risk. Care plans gave clear guidance to staff on how residents wished to be looked after. EVIDENCE: Care records (care plans) contained information on resident’s social, physical, medical and mental health. Staff write daily updates on residents’ welfare, and all information is reviewed monthly, or earlier if service users care needs change. Time spent with three residents confirmed that their care needs were being met. One said that they were “happy” at the home, another said that staff were as “nice as you can get”, were “satisfied” with the care provided, and “would not want to go anywhere else”. Care plans showed action taken by staff to a review resident’s, changing mental health needs, by seeking advice from their doctor and a hospital specialist. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 10 Records used by the home to record medication given out to residents were looked at. This identified that staff were not following safe procedures. Medication for two residents had been signed as given but was still in the box. One resident who had been out for the day, had not been given their medication to take with them, or arrangements made to take on their return. One container for eye treatment had the date written when first opened, so staff knew to throw away after 28 days, which is safe practice. Staff had not written the date on the three other bottles/containers of eye drops. Staff kept records of all medication received into the home, and returned to the Pharmacy. The home has safe procedures in place to ensure two staff check all controlled medication, before they are given out. A separate book is then signed to confirm time and date given to the resident, and amount of medication left. The amount of tablets held, was checked against the home’s record. Two tablets were found to be missing. Records showed staff had signed to say the correct number had been locked away. The Manager searched the room and found a box in a waste bin containing the two missing tablets. An immediate requirement notice was issued to ensure that staff followed safe and legal practice. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 14 and 15. Although staff promote residents to be independent, they are let down by the environment, which restricts choice. Until the patio area is completed, and residents can access the gardens safely, they cannot go outside without supervision. Meals are nutritious and balanced, offering a healthy and varied diet for residents. The new activity co-ordinator is motivated and working to develop a varied range of activities for residents. Residents can expect to be offered more outings/activities outside the home this summer. EVIDENCE: A resident asked if they could have the chain removed from their French windows, to allow them to access the garden from their bedroom. Staff raised concerns for the safety of the resident, if they went into the garden without someone being with them. This was due to the steep slope of the grass bank, and narrow pathway outside the bedroom. Extra decking/patio areas are to be built during the next 3 to 4 years, as the owners continue to improve the environment. Once completed staff confirmed that residents will be able to use their French windows. Conversations with residents and watching the routines of the day showed that residents chose what they wanted to do. One resident said that they went to bed early by choice, as they liked to get up very early in the morning. Another I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 12 resident preferred to stay most of the day in their bedroom, reading and receiving their visitors. When asked if a resident felt free to choose what they wanted to do, they replied it was “very good here, they don’t give you any instructions”. A relative confirmed that they could visit at any time, saying staff always made them feel “welcome”. A newspaper cutting on the notice board, showed residents wearing the Easter Bonnets they had made, which looked very professional. Two residents upstairs were playing Dominoes. Notice Boards in lounges gave information on the weeks activities, which included Art and Crafts and sing-a-longs. Records kept, gave information on residents who joined in the different sessions. One record showed that a resident had stopped joining in the activities, although staff had written that they enjoyed the sessions. Time was spent with the resident to find out why they stopped going. They said that “one day they didn’t want to go” and now “they didn’t get asked anymore”, but would like to go again. It was agreed that their request would be fed back to the Manager, so they could ensure staff asked them in future. Staff said that they are looking to arrange outings in the summer, using the mini bus which they share with the residential home opposite. One resident who enjoyed reading said they used the mobile library before moving into the home, and would like to use the service again. This was fed back to the Manager who said that there was no service to the area at the moment, but they would look into it. Residents agreed that the standard of food was “good”, and they were given “choice” and “always found something they liked”. When asked if they received enough food, one resident replied they received “plenty, when it comes I always say I’ll never eat all that – but I do”. One resident felt that the vegetables and meat was not always cooked to the way they liked. They also said the recent change in serving breakfast, meant that they were not offered cooked breakfast as often as they would like. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 and 18. The home has clear procedures in place to deal with complaints, and allegations or suspicions of abuse. Recent events at the home confirm staff reported concerns using the appropriate procedures. EVIDENCE: The home’s complaint procedure is displayed in the entrance hall. A copy is also contained in the Home’s Statement of Purpose and Residents Guide. Residents spoken to, said if they were unhappy they would tell staff or their relative. A relative confirmed that they were aware how to make a complaint if they needed to. The home has a copy of the Protection of Vulnerable Adults (POVA) Policy (June 2004), as well as their own company procedures. The Manager carries out regular training of staff, and recent events confirmed that they know what action to take. Staff, to protect the interest of residents had made two referrals to the local Vulnerable Adult Protection Team during the last twelve months. POVA investigations were undertaken following one of the referrals, and no evidence of abuse was found. Staff and Social Services, in the best interest of the resident monitored the second situation closely, which has now been resolved. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,23,25 and 26. The standard of the environment continues to improve. However shortfalls identified during this inspection, showed a weakness in the home’s ability to maintain a safe environment. This could potentially put residents at risk of injury. EVIDENCE: Written comments made by relatives in the home’s book (March 2004) and to the CSCI (November 2005, May 2005) asked when the patio would be built to allow resident to go out into the gardens. During the inspection, work was seen to have started on the patio area. A resident said that work had started “2 days ago”. Plans were shown of the new wooden platform, which will extend out from the residents lounge, and along the side of the home. Ramped walkways will lead out into the garden, which will have small seating areas. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 15 Residents said it “would lovely when it is finished”, and looked forward to being able to sit out during the better weather. They were also worried that it may be “too hot” and hoped the home would put shades up. Residents said the new armchairs in the lounge made the room look more homely and were “comfortable”. The manager said curtains had been ordered, for the lounge window. One resident looked forward to the curtains being fitted, saying it “would be nice, as the lounge gets very hot”. This was confirmed by a resident sitting next to the window in full sun who felt “hot – but didn’t know where to move too”. This was in case they sat in another resident’s chair. Staff on hearing the resident took immediate action to ensure the resident was made comfortable, including the offer to move to another area of the lounge. Before the inspection, a relative raised concerns over the ‘lack of tables to put hot drinks on’. Two residents were seen to balance their hot drinks on a small table placed between their armchairs. The table was found to ‘rock’ and be unsafe. This was fed back to the manager, who sent a member of staff to purchase 9 new tables, which were put together and in use by the end of the inspection. Residents and staff said the areas of the home redecorated, made the home look fresh and bright. A resident said they “liked their new bedroom carpet” which had come as a nice “surprise”. Relatives and staff raised concerns over the ‘lack of funds’. A relative felt that the company seemed ‘to drag their feet when it comes to spending out money’, and were ‘not concerned for the welfare of the residents’. The home’s five-year maintenance plan for 2005 showed lounges to be painted and areas in the home to have new carpets. Staff confirmed that radiator covers would be painted within the next two months. Residents, who had noticed the improvements being undertaken, looked forward to further work being carried out. Five of the upstairs dining room chairs were found to have some of the strapping to support the seat pad, missing or broken. Three residents were complaining that the dining room was “hot and stuffy”. Staff said only one window could be opened, but this was close to where other residents were sitting and they did not like the draft. No mobile fans were seen in the dining room. Residents said the situation got worse in the summer. The home has recently had problems with the hot water supply and heating, which resulted in new equipment being purchased and installed. A relative raised concerns that the home had been too hot when they visited and that some bedrooms still had no hot water. The manager confirmed that heating could be controlled using the individual controls on the radiators. Sample of hot water temperatures were checked in each of the four areas, which are I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 16 served by different boilers. Temperatures ranged from 32°C to 50°C. The home was asked to take immediate action to reduce the temperature in one bedroom, which was too hot. One resident said the hot water had been cold, which was now warm to the hand at 38°C. Another resident said the water was “plenty hot enough” for their needs. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 30. The home’s training programme ensures that staff is provided with the skills and knowledge to undertake their role. EVIDENCE: Residents felt that they were well looked after. One resident described the staff as “nice as you can get”. Residents discussing the inspection at the lunch table, said they “had no complaints at all”. One resident said they had “no fault to find” and that the staff were “good and helpful”. They said that sometimes the staff got called away to answer a call bell, but always returned. Staff had all ticked ‘yes’ to having sufficient training to undertake their role. Seven of the nineteen staff had completed their NVQ 2 training, with a further four currently undertaken training. A training plan on the notice board gave information on what training staff had undertaken. This included Health & Safety, Customer Care, and Dementia Awareness. The manager and staff in charge of shifts had attended training to support them in their role. This included Care Assessing & Planning, Supervision, Medication Administration and Risk Assessment. Staff said “training was much better” at the home, and gave information on courses they had been on. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34 and 38 People using this service can expect an approachable manager, who is experienced and keen to resolve any concerns. The home has comprehensive policies and procedures in place to ensure the health and safety of people living and working there. However the quality of furniture supplied, is not always safe for people to use. EVIDENCE: A resident described the manager as being very “supportive”, especially when helping them keep in contact with their family. The Statement of Purpose gave information on the manager’s qualifications (NVQ4 - Diploma in Care Management Services) and experience. The manager attends training days, organised by the company, to update their knowledge. Staff described the manager as very supportive, but felt at times they were restricted by budget restraints. Six staff comments cards were returned to the CSCI. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 19 Three staff had ‘ticked’ to say that they felt the home was well run. Although three had said that they felt the home was not well run, comments made, referred to the owners management of the home. One had written ‘managed okay, but company reluctant to spend money for residents comfort and quality of life’. Another commented on the ‘lack of funds’. A relative wrote that ‘The manager and staff do all they can in the circumstances, and are very helpful’. Since the last inspection money has been spent on the home as part of the company’s five-year refurbishment plan. The five-year plan, with estimated costs has been given to the CSCI. Residents were pleased that money was being spent on the home. Money has also been invested in staff training, and ensuring the home is safe for residents, by covering hot radiators, and regulators put on hot water supplies. Safety information was available in the office for staff to read and follow. Staff spoken with confirmed that they had been on First Aid, Fire Safety and Food Hygiene training. Records viewed showed fire equipment had been regularly checked and staff had attended fire training. The manager confirmed that they monitored who attended, to ensure all staff receive training “over a period of time”. A letter sent to the CSCI by a relative, described their concerns over the ‘health and safety issues concerning the patio area’, and lack of action by the owners to start the work. Residents said they felt safe in the home, but would not go outside alone, although they would be able to when the patio is finished. Some dining room chairs and hot drinks tables were found to be unsafe to use. Although the hot water supplied to residents bedrooms are regularly checked, one hot water tap tested was found to be too hot for the resident to safely use. I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x x 3 x 2 3 STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x 3 x x x 2 I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 21 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 9 Regulation 13 (2) (4) Requirement Controlled medication must be stored securely. Staff must follow safe procedures for checking medication. Staff must dispense medication as directed on the Pharmacy’s dispensing label and MAR sheet. Dining room chairs must be safe to use. Chairs with broken webbing must be repaired or replaced. To reduce the risk of scolding, action must be taken to regulate the temperature of the hot water supply to Bedroom 4, to within safe limits (41°C to 43°C). Action must be taken to ensure that the ventilation in the upstairs dining room, meets resident’s needs, and offers a comfortable environment. Timescale for action Immediate 2. 9 13 (2) (4) Immediate 3. 19, 25 13 (4) (b) 16 (2) (c) Immediate 4. 25 13 (4) (b) (c) Immediate 5. 25 23 14/07/05 I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 22 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. Refer to Standard Good Practice Recommendations I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 5th Floor St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ 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 I54-I04 S24418 Hillside V219822 050512 Stage 4.doc Version 1.30 Page 24 - 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!