CARE HOMES FOR OLDER PEOPLE
Hollybush 45 Glamis Road Newquay Cornwall TR7 2RY Lead Inspector
Lynda Kirtland Announced 10 August 2005 09.15 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. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Hollybush Address 45 Glamis Road Newquay Cornwall TR7 2RY 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) 01637 874148 01637 874148 Mr Neil Edward Brazier & Mrs Nicola Carla Brazier Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Dementia, over 65 years (4) Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Service users to include up to 14 adults of old age (OP) Service users to include up to 4 adults with Dementia (DE(E)) Total number of service users not to exceed a maximum of 14 Date of last inspection 8 March 2005 Brief Description of the Service: Hollybush is registered with the CSCI to provide care for up to fourteen service users who have care needs by reason of old age, four of whom may experience dementia. Mr and Mrs Brazier, the registered providers also own a registered care home in Redruth. The majority of service users accommodation and use of communal areas is on the ground floor level. Five bedrooms are on the first floor and are accesible by a chair lift or use of the stairs. Each service user has a private bedroom with en-suite facilities. Communal areas and service users rooms are decorated to a good standard with good quality furnishings. Corridors are wide to suit those service users who require mobility equipment. Service users need a degree of mobility to be able to access all parts of the home satisfactorily. There is one assisted bathroom and access to a shower room. The house is set within well laid out gardens to the front and rear with parking spaces to the side of the property. Hollybush is located in a quiet road of Newquay, local shops, beaches and access to local amenities is nearby. Staff are employed in sufficient numbers over the 24-hour day to address the needs of service users. The registered providers stated that day care is not provided by the home. If Hollybush has a vacancy they will consider a respite stay but this is dependent on room availability. The registered providers stated that they aim to provide a ‘home from home atmosphere at Hollybush’. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Hollybush Residential Home on the 10 August 2005 and spent over seven hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 8 March 2005. In addition the inspector focused on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and some management areas. Since the last inspection Hollybush have increased their capacity to provide care and accommodation from nine to fourteen service users due to the upstairs of Hollybush being converted from a private area to five bedrooms and a small communal area. The previous report detailed that the providers breached the conditions of registration by accommodating more people than they were registered for. This issue has now been resolved by issuing a formal caution to the registered providers. On the day of inspection fourteen service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, staff and the registered providers to gain their views on the services that Hollybush offer. The registered provider partially completed the pre inspection questionnaire, which is similar to a survey asking for information on what services/facilities the home provide. Completed comment cards from six residents and one relative in gaining their views on the home were received and assisted in the inspection process. Hollybush records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
Residents and a representative stated that Hollybush provides ‘good’ or ‘excellent’ care and accommodation. They made various comments about staff such as; they are ‘kind’ and ‘caring’. All residents commented that they felt that they were consulted about their care needs which staff met. Residents commented that they felt that all their health needs are met. Records showed that Hollybush has good relationships with local health colleagues. Residents commented that there is ‘enough to do’ at Hollybush and felt that they could choose how to spend their day. There are activities provided by the
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 6 home but residents are also encouraged to join in local community activities if they wish. All the residents said that their visitors are welcomed to the home. Residents, and staff all commented that they felt there were sufficient staffs on duty. The registered providers are encouraging staff to attend training to update their knowledge in older persons care. Hollybush have a satisfactory complaints policy. Residents commented that they felt able to raise concerns and that the registered providers would listen, investigate into their concerns and appropriate action to remedy concerns would be taken. The home was clean and tidy throughout with no odours. It has also been furnished and decorated to a good standard. Residents have been able to personalise their own rooms. What has improved since the last inspection? What they could do better: Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 7 From the previous inspection, five requirements have been re notified to the home. These are mainly in relation to developing policies and procedures in the home to promote safe working practices for resident’s care and staff accountability. It is of concern that these have needed to be re notified as no progress has been made on them. From this inspection twelve requirements and four recommendations have been identified. These are in relation to improving the service users guide so that residents have up to date and relevant information about provision of care and local services. Policies in respect of moving and handling, medication, adult protection, restraint, and the management of resident’s monies must be implemented to ensure safe working practices throughout the home. In addition residents risk assessments, particularly in regards to falls, and what preventive measures and action the home will take in case of a fall must be developed. The major concerns from this inspection were that the home has employed two members of staff without a Protection Of Vulnerable Adults first or Criminal Records Bureau check. These staff can not commence employment until at least the Protection Of Vulnerable Adults first clearance has been approved, and then they must be supervised at all times until the CRB check has been approved. Additionally the registered provider has removed the fire door closure devices form resident’s rooms, as he commented that the doors are too heavy for them to open. The registered provider knows the possible consequences of this and has agreed to review this urgently and take appropriate action. It is acknowledged that with the increase in staff the senior carer commented, that 50 of staff would achieve NVQ level 2 in the near future. The registered providers are considering employing a registered manager and are liaising with CSCI regarding this. As the registered providers own two homes with some geographical distance involved this would benefit the service to have a registered manager in day-to-day control of the home. 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. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 8 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 Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 9 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) 1,2,3,5 Hollybush has some information, which informs service users and their representatives about some of the services that Hollybush provides. Prior to admission, service users and their representatives participate in a pre admission assessment with members from the management team to identify individual care needs. A trail period of stay within the home is offered. EVIDENCE: The home has a statement of purpose, which describes the services and facilities that Hollybush provide. The service users guide did provide some contradictory information to the homes statement of purpose and this must be addressed i.e. staffing levels. It is required that the service users guide be expanded so that residents are aware of the homes guidelines, what to expect from the placement i.e. leisure, visitors, complaints process, incorporate information on facilities in the community and some residents views on Hollybush. It is also recommended that the registered provider consider how these documents are presented so that they can reach a wider audience. Financial expectations and accountability are clearly stated in the residents contract with the home, which has been signed, by the resident or their representatives and the home, or referring local authority.
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 10 The previous inspection required that pre admission assessments occur with residents and representative’s participation to ensure that Hollybush are able to meet individual’s needs. Since the last inspection this was seen to have occurred and was confirmed in discussion with residents. The pre admission assessment now addresses all individual care and social needs. A months trail period is offered to all new residents after which a review is held with all parties present to consider if the placement is appropriate and if so a long-term placement will be provided. Residents commented that the ‘moving in period’ was carried out sensitively by staff and could not see how this process could be improved. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10,11 Residents are consulted in the implementation and subsequent reviews of their individual care plans. Care plans ensure that physical, emotional, social, educational and leisure pursuits are assessed and action to address the care needs are detailed for all staff to meet in a consistent manner. Service users are treated with dignity and privacy at all times. EVIDENCE: Since the previous inspection the registered provider has developed care plans. They now address all personal, social, and health care needs, which was confirmed in discussions with residents, staff and inspection of documentation. The care plans identify service users skills and where assistance is needed. From this the care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. It was further evidenced that residents participate in their reviews of the care plans and their views are recorded. Residents commented that health needs are met by the staff at the home and by external professionals to a good standard. Detailed records of all health professional visits to individual service users further evidenced this. The registered provider stated in response to a previous requirement in gaining nutritional assessments, that she would request advice from a nutritionist if a
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 12 care need is identified. As there are no current difficulties with this area of care in Hollybush, compliance with this is met at this time. A previous requirement to review equipment in the home to assist in mobility has been met. There is now a hoist on baths, moving belts, slides sheets, raised toilet seats, grab rails and specialist mattresses as required. The previous requirement to review the homes moving and handling policy was not inspected on this occasion, and no update provided. Therefore this requirement remains. The inspector noted from inspection of documentation that risk assessments in respect of falls must be developed further. Additionally the accident book must adhere to the Data protection Act. Three of the four previous requirements in respect of medication have been met: permission is now sought form residents to store and administer their medication, newly admitted residents have a review of their medication, and the medicine cabinet is attached to the wall. However the senior carer said that the medication policy has not been reviewed and therefore this has been renotified. In addition it was observed that self-administered medication, which is in the ‘store drawer’, must be locked at all times. All residents spoken with stated that staff displays a high standard of respect in their daily interactions. Residents stated that staff ensures that their privacy and dignity is maintained and could not see how this area of care could be improved. In addition the inspector observed staff communicating with service users in a professional manner at all times, alongside a sense of humour when appropriate. From inspection of pre admission information residents views and wishes in respect of their health deteriorating, or in the event of their death are gained and included on the individuals care plan. Family are encouraged to be as involved as they wish with their relatives care. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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 standard(s) 12,13,14,15 The home provides suitable activities and aims to offer a lifestyle that meets individual residents needs. Links with family, friends and the community are good and allow residents the opportunity to socialise. The provisions of meals has been reviewed, to ensure a high standard of dietary provisions are maintained. EVIDENCE: Residents confirmed that there is flexibility in their daily routines. From discussion with residents, staff and observations it was evident that there is a number of activities that residents can participate in if they wish i.e. monthly church services at the home, or attending church in the community, entertainers, coffee mornings, mobile library, knitting, personal art work and reading. Residents commented that they felt ‘no improvements’ to this area of care could be made. Contact sheets also confirmed the level of activities residents participated in. Residents confirmed that visitors felt welcomed to the home and that they can visit them in private or in communal areas. The home has an open and flexible policy to visitors and there are no visiting restrictions. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 14 In respect of food, the majority of residents stated that the quality, quantity and presentation of food are to a ‘good’ standard. Residents confirmed that since the last inspection their views have been sought in the formation of the menus, and documentation supported this. However residents commented that they did not know what was for dinner each day but trusted the staff to ensure that the meal provided was what they liked. If they did not then they felt that staff would change the main meal for them. The registered provider agreed to look at how residents are informed each day of the menu. On the day of inspection the registered provider was cooking breakfast and preparing lunch. The cook has left and a replacement will be advertised soon. The previous recommendation for a member of staff to undertake the intermediate food hygiene certificate has been re- notified. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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 standard(s) 16,17,18 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Hollybush adult protection policy and procedure needs expanding to ensure that all residents are protected form all forms of abuse with staff having knowledge through training of Adult Protection issues. EVIDENCE: Hollybush has a satisfactory complaints policy and procedure. Hollybush and CSCI have not received any complaints about the home. From discussions with residents all stated that they had ‘no grumbles or worries’ and that if they had they felt able to approach the management team for these to be addressed. From discussion with some service users they confirmed that they had a postal vote to use in the forthcoming general Election. They also confirmed that there is access to local advocacy groups, solicitors or that family members will act on their behalf. The home has an adult protection policy; it was required at the previous inspection that this needs to be expanded to include the POVA process. The senior carer stated that this had not occurred and has been re notified to the home. Hollybush staff have applied to attend an adult protection-training course. The home has no policy or procedure for managing challenging behaviour or restraint these must be introduced and implemented. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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 standard(s) 19, 26 Hollybush is clean and tidy. The registered providers have taken action that places residents, staff and visitors at risk of fire by removing fire door systems and not installing infection control mechanisms. EVIDENCE: Installation of flooring in the laundry area, and new equipment has been purchased. In respect of installing paper towels in the staff toilet to minimise the risk of cross infection, this has not occurred and therefore this is re notified. The inspector also observed that a corridor light had no covering and the registered provider agreed to replace this immediately. Also observed was that fire doors had they door closure system unscrewed so that it no longer closed automatically. The registered provider stated he knew that this was against fire inspection standards and commented that he was aware of the consequences of this breach. He commented that due to the heaviness of the doors this is why he has removed them. The inspector commented that he consider alternatives if this is not practical such as having the doors wired into a fire alarm closure system. He is required to resolve this immediately.
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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) 27,28,29,30 Hollybush ensure that suitable trained staffs are employed in sufficient numbers at all times. Staff must be employed ensuring all relevant checks have been undertaken to ensure protection for residents in the home. EVIDENCE: On the day of inspection two carers, senior carer plus registered providers were on duty. Staffing ratio during waking hours is aimed to be around 1:7. At night there is one waking night staff plus a manager on call. The registered provider stated that there is currently no care staffing vacancies in the home. The inspector would comment on the day of inspection there were sufficient staffs on duty and observed staff to be communicating with service users in a caring, friendly and relaxed manner. Residents spoke positively about staff. Forty percent of staff holds the NVQ Level 2 certificate with other care staff in the process of or commencing this training. A recommendation was identified to ensure that 50 of care staff obtains NVQ level 2 status. From inspection of staff files in the main this showed that recruitment process had been followed appropriately. However two recent employers had commenced work without a POVA first clearance or CRB check. Staff are not to be employed without these checks being undertaken and advise was provided to the senior carer. This is re-notified. The senior carer commented that training for staff is under review and via appraisals and supervision training needs are identified. Individual training plans are in the process of being developed.
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 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) 35,36,37 Accountability in the management of resident’s money must be reviewed to ensure protection of their possessions. Staff has regular supervision to review their care practice. EVIDENCE: A previous requirement to implement a policy and procedure on the management of resident’s money has been attempted. The policy needs expanding further as currently the home has a statement of its intention but no process in how it will account for monies or belongings that it holds on behalf of residents. Supervision sessions have increased in number but the records need to be expanded to highlight how topics were discussed and what outcomes were made. Hollybush has a comprehensive induction pack. Appraisals occur yearly. The detail recorded in contact sheets have improved. Some of the homes records are in line with legislation but a few need to be updated i.e. staff files, accident book. Regarding fire issues please refer to environmental standards.
Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 19 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 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x 2 2 2 1 Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 20 yes 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 1 Regulation 5 Requirement The service users guide must be expanaded and available to all service users and their representatives at all times. (this requirmetn has been amended) The homes moving and handling policy must be reviewed. Annual staff training in this are must be provided. This is re notified to you (2nd time) risk assessments in the management of and action to be taken in respect of falls must be reviewed and developed. The medication policy must be expanded to cover all elements of the storage, receipt, administration and disposal of medication. This policy must be available to staff at all times. This has been re-notified to you (2nd time) All medication must be stored safely and locked away. The adult protection policy must be available to staff at all times. In addition the policy needs to be expanded to include the process of POVA. This is re notified to you (2nd time) A restraint and challenging Timescale for action 30/12/05 2. 8 13 30/11/05 3. 8 12 30/11/05 4. 9 13,12 30/10/05 5. 6. 9 18 13,12 12 30/10/05 30/11/05 7. 18 12 30/12/05
Page 21 Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 8. 9. 19,38 26 23,13 13 10. 29 18 11. 35 20,17 12. 37 17 behaviour policy must be implemented and appropriate training provided to staff Fire doors must be working as per fire inspection requirmetns at all times. Paper towels must be supplied in all communal toilets to minimise the risk of cross infection in the home. This is re notified to you.(2nd time) All staffs employed must have an up to date CRB/POVA clearance before they can commence unsupervised care with service users. This is re notified to you (2nd time) The registered provider must write a policy in the administration, management and auditing of service users monies. This policy must be implemented. This is re notified to you (2nd time) All records must be kept in line relevant legislation. 15/09/05 30/11/05 15/09/05 30/12/05 30/12/05 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. Refer to Standard 9 15 28 36 Good Practice Recommendations The storage of creams/liquid medication should be monitored in a room at the correct storage temperature. One member of staff should undertake the Intermediate Food Hygiene certificate. 50 of staff should hold a NVQ level 2 certificate. Staff supervision records should be more detailed. Hollybush D52-D04 S8930 Hollybush V233084 100805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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