Inspection on 16/01/09 for Kingswalden Villa

This inspection was carried out on 16th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswalden Villa 30/01/08

Kingswalden Villa 16/02/07

Kingswalden Villa 06/02/06

Kingswalden Villa 22/08/05

Kingswalden Villa 13/01/05

Kingswalden Villa 07/06/04

Kingswalden Villa 12/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kingswalden Villa 40 The Baulk Biggleswade Bedfordshire SG18 0PX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Dalton     Date: 1 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Kingswalden Villa 40 The Baulk Biggleswade Bedfordshire SG18 0PX 01767318674 F/P01767318674 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Farm Trust Name of registered manager (if applicable) Mr Ian Chambers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Kings Walden Villas is one of five registered care homes within Bedfordshire that are managed by Home Farm Trust. HFT is a nationwide provider for people with learning disabilities. Kings Walden Villas is situated in a residential area of the market town of Biggleswade, and is a short distance from the local HFT headquarters and day care facility in Shefford. The home is within walking distance of the towns shops, public houses, cafes, and bus and rail links. A leisure facility with swimming pool is a short car journey away. The home does not have off road parking. The building was originally used as a private domestic dwelling. It has been sympathetically converted to retain its homely environment, and provides single accommodation to eight adults with learning disabilities organised on two levels. Communal space consists of toilet and bathing facilities, a lounge, dining room, and kitchen. In addition, at the rear of the property is an all weather conservatory that leads to a small-enclosed garden. Within the garden, is an outbuilding used for storage and laundry. The home is not Care Homes for Adults (18-65 years) Page 4 of 28 care home 7 Over 65 0 7 Brief description of the care home currently adapted to accommodate people with physical disabilities. Information regarding the homes range of fees and the managers figure provided in the preinspection questionnaire in January 2007 stated that the monthly fee ranged from 2098.40 pounds to 2609.78 pounds. Any additional fees not included were also specified and that they would incur an additional charge. The home had reduced from 8 beds to 7 beds and has asked the commission for an amended certificate of registration. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: One inspector conducted this unannounced site visit on 16th January 2009 between 10.35 am and 5.45pm. Two people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service, their relatives, members of the staff team and the manager. We received some surveys from people who use the service and their comments have been included in the report. We were present for lunch and observed interaction between staff and people who use the service. We toured the building and examined Care Homes for Adults (18-65 years) Page 6 of 28 documentation to check that what was happening in the service was being recorded. The services monthly fees are under review but currently range from 2098.40 pounds to 2609.78 pounds. This does not include toiletries and private chiropody and other personal expenses. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The necessary information is in place to enable people who use the service to make an informed choice about moving in. Evidence: Each person who uses the service had a service users guide in their care plan folder. This contained information about the home and local area and facilities and had photographs to illustrate the information. It also made it simple to understand for people who use the service who have difficulty reading. Some people who use the service had moved into the area and found the service users guide helpful in providing information about their new home and local facilities. There have been no new admissions since the previous inspection. The statement of purpose is equally as informative and this is reviewed each year to ensure that all the information is current and correct. A new computer system has been introduced and there are plans to review all documentation to ensure that it is as user friendly as it can be. A reassessment is completed each year so that the person using the service can be assured that their Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: needs are being met and any new developments are included in information given to staff. Each person who uses the service has a person centred plan which identifies hopes, dreams and aspirations and how staff can help them to be realised. The aim of the service is to enable individuals to develop their independence and move into supported living accommodation. This has successfully occurred with previous people who use the service. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service enables people who use the service to take control of their lives and make their own decisions and choices. Evidence: A new computer system introduced on 29/12/008 has been introduced: SPARS Support Planning Assessment & Recording System. This aims to streamline the recording of information. At the moment staff are duplicating their recording until they are familiar with the new system. All social care and health needs are reflected in the reassessment. This is updated annually and describes each person who uses the service, their needs, daily routine, likes and dislikes. The SPAR system is moving more towards identifying aims and describing how they are met. This may provide information in a more straight forward manner. There are plans to develop the system to ensure that the information that is produced is user friendly as this is not currently in place but the system is new. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: We looked at 2 care plans. Information is recorded regularly and if significant but not daily as people who use the service have lived there for between 3 and 10 years and staff have a good understanding of core needs. The reassessment is put together from information that has been recorded by staff and will be updated more regularly if needed. Risk assessments reflected how individuals were assisted in managing risks. They are also used in a positive way in helping people who use the service move towards their goals. One person who uses the service is planning to buy a bike and accessories to enable them to ride to work. We observed staff helping them to search the internet for information. Staff are supporting cycle proficiency training sessions which will result in increased levels of freedom and independence. Each person who uses the service has a person centred plan which identifies their wishes and aspirations: this enables staff to know the goals that they are working towards. Each person who uses the service has a monthly meeting with their keyworker to review how their goals are being met. People who use the service receive support from various health and social care professionals and this is reflected in the care plans. The Advocacy Alliance is available for people who use the service if they require independent support. Care plans reflected that useful information had been received from them e.g. a fact sheet about criminal bureau checks. Important family information was recorded such as birthdays and the help that was needed to by a card or small present. End of life plans are ready to be completed and are in each care plan. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and how they spend their leisure time. Evidence: The ethos of the service is to develop and maintain independence, enabling those who wish to move into supported living. This has occurred with former occupants and as stated previously, care plans facilitate this process. People who use the service attend college and work placements. They travel independently using public transport or walking. One person who uses the service requires support from staff to deal with the traffic around the service but they previously lived in a quieter setting. Their family told us that staffing levels sometimes prevented support from happening but it was only in times of staff sickness. We observed people who use the service communicate with staff by telephone during Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: the inspection. Each person who uses the service has a mobile phone to maintain contact should they have any concerns but most use it to inform staff they are on their way home. People who use the service use the community facilities frequently: they go to the pub, cinema and shopping as well as attending clubs each week which enables them to meet friends. Those who choose to attend church independently. Care plans reflect individual leisure activities and staff facilitate them. There was an advert for a future bowling trip displayed accompanied by a photograph which some people who used the service planned to attend. Choices are made in house meetings and people who use the service use their meetings to make decisions about the running of their home, their holidays and leisure activities. Each person who uses the service has an allocated day to complete their laundry and all participate in household chores and preparing meals. One person who uses the service told us We have a jobs rota and do different jobs on different days. I like helping with shopping and cooking. Menus are decided by each individual with one person choosing meals on various days. This system works well for everyone as they choose to eat what they like and alternatives are available. The staff team are working with the psychology team to overcome the difficulty of people who use the service taking bread and hiding it. Various approaches have been tried to remedy the situation and new methods are being explored. Until a solution is found bread is kept in the office with a supply of crackers, biscuits and fruit available throughout the night. We spoke to people who use the service and they knew why bread was kept in the office. They told us that they could come and get bread when they wanted to. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medication system does not safeguard people who use the service, however care plans reflect individual health and social care needs. Evidence: Care plans and reassessments reflected how people who use the service wish to be supported. Personal preferences are reflected and discussed in individual meetings with key workers. Each person who uses the service has an individual health plan and illustrates that each individual receives support form various health and social care professionals. Medication is stored at the correct temperature and records reflected this. Copies of prescriptions are kept to show receipt of medication. A medication cabinet is awaiting fixture to a wall but medication is currently correctly stored. No controlled drugs are currently used in the service. Medication records require some attention. The Medication Administration Record sheets (MAR) reflected that medication had been checked out as the service was closed over Christmas and people who use the service returned home to their families. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: However the amount of medication returned was not recorded so the amounts could not be checked to ensure that they were correct. Handwritten instructions were incomplete and did not advise of the route, start date or amount. 3 doses of paracetamol had not been give as there was no medication available as the service had run out. This could have been purchased over the counter. Staff stated that this was an as required (PRN) medication but the MAR sheet did not reflect this and the medication was administered regularly. Staff updated records during the inspection. The service has received training from the company who provide their medication. In response to this training staff have used the code M to reflect that medication has been made available. This does not reflect which staff administered and dispensed medication. Medication should be administered or self administered - made available does not clearly illustrate which route of administration is being followed: If self administered there must be an accompanying risk assessment demonstrating that the person who uses the service is competent to do so. This was only present for one person who self manages her diabetes and insulin injections. Staff had received training and worked in partnership with the individual to maintain their Independence. Nutritional guidelines were in place for staff to follow. We observed a telephone call from a person who uses the service to report they were experiencing low blood sugar and staff reinforced the action taken by the person who uses the service. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are enabled to express their concerns. Staff have a clear understanding of the safeguarding procedure. Evidence: The complaints policy reflected that people who use the service were able to make a complaint. A record of the complaint and the action taken are recorded which means if regular complaints are recorded an overall picture can be gained. This also monitors concerns that people who use the service may raise. Most issues are resolved at house meetings or one to one meetings. There is the facility for people who use the service to access independent support from the Advocacy Alliance if they wish. We observed staff support a person who uses the service as they had left college early as they were unhappy and efforts were made to resolve the issue. We received 5 completed surveys from people who use the service and all reflected that they knew who to speak to if they were unhappy. All staff have received training on safeguarding vulnerable people and the manager has prepared a power point presentation to deliver to staff as an update. We checked two financial records and found them to be in good order. The service uses a specialised system (Versapak) which has a separate number for a lockable tag. Each time finances are checked a new tag is issued with a corresponding number. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a clean and comfortable environment to live in, which encourages independence. Evidence: The service was clean and tidy. A new freezer was being delivered whilst we conducted our inspection. There is a homely and friendly atmosphere and the service is personalised by the people who live there. Bedrooms were personalised and locked when vacant. There are activities around the building which are utilised - there is a computer available for people who use the service to access. There are also computer games and DVDs. 2 people who use the service have their own computer and use it to download music etc. The service has a WiFi (wireless) for people who use th service to access with their laptops. The manager has updated the homes fire plan and accessed the countys fire service risk assessment to ensure it was comprehensive. A new wet room has been installed following recommendations made by an Occupational Therapist. The toilet seat is broken and a new one is on order. Doorguards are on order for 2 bedroom and the office to ensure that people who use the service can keep their doors open if they wish. A new maintenance company has just been employed and the manager plans to refer Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: the leaking conservatory and warm (not hot) water issues to them to be resolved. The manager reported that the conservatory has been repaired previously but the source of the leak could not be identified. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive support from competent and trained staff. Evidence: There have been no new staff employed since the previous inspection. Two recruitment files were inspected and found to be in good order. All required paperwork was in place to reflect that people who use the service are protected. There were records of ongoing training being completed. The manager is updating the training matrix to reflect the variety of training completed e.g. food hygiene, safeguarding vulnerable adults, Mental Capacity Act, medication training. All staff complete the Learning Disability Award Framework induction and foundation. This equips them with specialist induction training which enables them to progress to completing NVQ qualifications. 3 staff are working towards NVQ level 2 and 2 staff have achieved level 3. There is a stable core of staff: some of whom have worked in the service for over 10 years. One staff member stated the service has excellent training to the needs of people we support. Staffing levels were commented on in surveys received from people who use the service. It would be nice if we had more staff so that we could go out at the weekend. I would like to go out at weekends if we had more staff on. Staff commented in their surveys that they felt lone working at weekends compromised the people who used the Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: service not getting the support they needed. The manager stated that one person who uses the service usually went home at weekends and the use of the on call did not increase at this time. They stated that should the needs of people who use the service increase that they would be responded to. There was evidence to show that activities do take place at the weekend and the manager agreed to monitor the situation. The on call is available out of hours and is only half an hour response time away. People who use the service were positive about the support they received from staff: I think staff are all very good at supporting me with the things I want to do. Staff always try to help me. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an effective quality assurance system in place and the manager ensures that the focus is upon people who use the service. Evidence: The manager has worked at the home for several years and is supernumerary to the numbers of staff rostered on each shift. The manager is also responsible for managing a supported living service. Some staff also work in the service so when people who use the service transfer they are familiar with members of staff which eases the transition. The manager has a good rapport with people who use the service and they clearly feel comfortable accessing the office as this was evident during the inspection. The AQAA (Annual Quality Assurance Assessment) was completed prior to the inspection by the manager to demonstrate how the service had reviewed the care they delivered and identified any improvements required. We inspected fire records and found them to be in good order. As stated previously the manager has updated the fire plan following guidance provided by the local fire service. It also explains more clearly the action staff and people who use the service Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: should take during a fire.Health and safety records are maintained and reflected that necessary safety checks were being conducted e.g. hot water checks to ensure the safety of people who use the service. The service sends out a quality assurance questionnaire to families, people who use the service and to professionals. A report is published and sent out to all participants and reflects what action will be taken. The manager plans to incorporate the findings into the statement of purpose as this is reviewed annually. This will ensure that the statement of purpose illustrates how the service is responding to comments that are made by people who use the service and their relatives. We spoke to some relatives who were complimentary about the service: We can talk to anyone, not just the keyworker. Weve no great quibbles and any problems are dealt with sensibly. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Accurate medication records 28/02/2009 must be kept to ensure the safety of the person who uses the service. The amount of medication must be recorded to ensure it is available, the service must not run out of medication. If medication is given as required (PRN) the Medication Administration Record sheet (MAR) must reflect this. The code M for made available must not be used. A registered care home must only administer or oversee self administration of medication and this code is not appropriate. Handwritten instructions must detail the route, dose and amount of medication prescribed. Staff must sign the MAR sheet to reflect medication has been administered or record the reason why medication has not been given. Care Homes for Adults (18-65 years) Page 26 of 28 A safe medication system must be in place to protect people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!