Inspection on 31/07/05 for Lammasmead

This inspection was carried out on 31st July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lammasmead 05/07/06

Lammasmead 31/01/06

Lammasmead 25/01/05

Lammasmead 05/07/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Lammasmead 61 Lammasmead Cheshunt Hertfordshire EN10 6PF Lead Inspector Claire Farrier Unannounced 31 July 2005 8:40 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lammasmead Address 61 Lammasmead Cheshunt Hertfordshire EN10 6PF 01992 421020 0208 882 0010 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) Residential Community Care Services Ltd Care Home 3 Category(ies) of LD Learning Disability - 3 registration, with number MD Mental Disorder - 3 of places Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home may accommodate 3 people with mental disorder (only when associated with a learning disability) Date of last inspection 25 January 2005 Brief Description of the Service: Lammasmead is a care home providing personal care and accommodation for three young adults with learning disability and associated mental disorder. The home is owned by Residential Community Care Services, which is a private organisation. It was opened in June 2002 and consists of a detached three bedroomed house, indistinguishable in appearance from the neighbouring houses. The home is situated in a residential area of Wormley, close to local shops, recreational and educational facilities and public transport. All the home’s bedrooms are single, without en-suite facilities. The home has a small, secluded rear garden, surrounded by tall hedges. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one Sunday, starting at 8.40am. The majority of time was spent observing and talking to residents and staff, some time was also spent looking at care plans, records, complaints and staff training. All three residents and three members of staff, including the manager, were spoken to during the inspection. This was generally a positive inspection, and the majority of the standards were met or partially met. New requirements were made on the provision of appropriate training to meet the needs of the residents, and staff records. Requirements have been repeated from the previous inspection report on medication and reports of the proprietor’s monthly monitoring visits. Enforcement action may be considered if these requirements are not met. What the service does well: What has improved since the last inspection? Lammasmead continues to provide a good quality of care for the residents. All three residents took part in the inspection, and it was noticeable that two were more communicative than on previous occasions. One held a conversation with the inspector and answered questions, whereas previously she has only asked repetitive questions. Another took more interest in the process of the inspection, and the improvement in communication and talking has been recorded in her care plan. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 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. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: There have been no new admissions to the home since the last inspection, but during a previous inspection comprehensive and detailed assessments were seen to be carried out prior to admission, including a social services assessment and CPA (Care Programme Approach) meeting minutes and care plan that addressed the service user’s mental health needs. The care plans contain full details of all the residents’ needs, which show that their needs are assessed and understood (See Standard 6). Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 The good quality of information in the residents’ files has been maintained. The residents’ care plans contain detailed information on all their personal care and health care needs, and comprehensive risk assessments related to each individual, which enable the staff to provide a good quality of care. The staff were observed to treat the residents with respect and to assist them to make choices about their lives. EVIDENCE: Detailed case tracking was carried out through the files of two residents, which showed what care is provided for the residents and how it is recorded. The care plans for all the residents clearly define their needs and how these needs are to be met. There are comprehensive guidelines available to staff in respect of dealing with situations where service users are likely to be aggressive. These ensure that a consistent approach is taken by the staff team (but see Standard 19). Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 10 Each resident has a key worker, who ensures that they understand their care plans, and the care plans are made available to those residents who are able to read them. Reviews are fully recorded with evidence of the service user’s involvement. The care plans were seen to be not only a record of information, but also an effective tool to assist the staff in providing a good standard of care to the service users. Although there has been no change in the good quality of information provided in the care plans, they could be further improved by incorporating the principles and practice of person centred planning (PCP), which should focus on the person being totally at the centre of all planning. The care plans provide a good framework for providing appropriate information on each resident’s needs and for monitoring their progress, and the format could provide a basis for a PCP approach. The views of residents and their families are taken into account when writing care plans, and the care plans contain good details of all the residents’ care needs, but not in a PCP format. It was suggested that the key workers could assist and enable residents to write and monitor their own objectives, and that care plans should more closely reflect the voice of the resident. The high quality of risk assessments for individual residents has been maintained. The policy and procedure for risk assessment includes an explanation of risk assessment and risk management. All the residents at Lammasmead have individual behaviour management difficulties and appropriate risk assessments were seen to be in place for each of them. There is a detailed management plan for each assessed risk that includes the details of the assessed risk, the score, the benefits of undertaking the assessed activity and the safety strategies that have been put in place. Staff spoken to are fully aware of each risk assessment and strategy. The risk assessments were seen to be an integral part of the care plans. The risk assessments are reviewed regularly and updated and revised as required. Residents are involved in decisions about their lives in the home, and it is evident from talking with the residents and staff that Lammasmead is the home of the residents, and the staff have the role of assisting them to live as independently as possible. Each resident was asked what they wanted for breakfast, and their plans for the day were discussed with them. It was noticeable that residents who have previously taken little active part in discussion during inspections were more able to make their views known. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 and 17 The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. This ensures good relationships with their families and with the local community, and that individual rights and responsibilities are recognised and supported. EVIDENCE: Two residents attend college during the week, and the staff encourage and enable the third to take part in community activities such as shopping and going for walks or drives in the car. The residents spoken to said that they take part in activities such as swimming, shopping, the cinema and the Gateway Club. The care plans include goals for community access and for integrating into the community. The staff encourage the residents to take part in activities in the home appropriate to their abilities, and these are recorded in their care plans. One resident was seen to vacuum the living room carpet with minimal prompting by the staff, and the others hang washing in the garden and take the laundry to the washing machine. All the residents are encouraged to tidy their own rooms. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 12 Two of the residents visit their families every week, and both went out with their families during the inspection. The third resident has no close family, but he is encouraged to maintain contact with a brother, and to talk about his family. Friendships are encouraged, and the residents go another RoCCS home for social evenings with their friends there. A choice of well-balanced and wholesome meals are provided and residents are able to choose what they want to eat. One resident is encouraged to follow healthy eating plan, and she has lost weight and maintained the weight loss. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. All personal and health care support is well maintained within the home ensuring that individual needs, choices and preferences are met at all times, but there is a need for appropriate training in the management of challenging behaviour. Medication administration procedures must be improved to ensure service users are kept safe at all times. EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6), and a good relationship was observed between the staff and the residents. Behaviour guidelines are in place for each resident. One member of staff explained the behaviour guidelines for one resident. She had good understanding of the principles of behaviour management, and she explained that it is based on positive reinforcement. Sanctions of loss of privileges, such as going to the Gateway Club, are also used, but the resident understands the sanctions, and has said that she knows that when she does not go to the Gateway Club it is because of her behaviour. However the sanctions recorded in the care plans in some cases seem more like a punishment than a positive reinforcement. The manager is aware of this, and it was reported that discussions are taking place with the other RoCCS managers on implementing more rewards than sanctions. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 14 One of the proprietors, who is a consultant psychiatrist, provides information for the staff on behaviour management, but there is no formal training available. The staff would benefit from a recognised training course in the management of challenging behaviour. Medication is supplied in nomad monitored dosage boxes for each resident, and PRN (when required) medication is kept in its original packaging. One resident has haloperidol and lorazepam as PRN medications, and bottles of these are kept in the medication cabinet. It is not clear whether these medications should be treated as controlled drugs and stored and recorded separately, and the manager should consult the pharmacist for guidance. One resident has PRN paracetamol. When it is used, the reason for administering it is not recorded, and it is possible that not all paracetamol administered is recorded, as there was a discrepancy of at least seven tablets when a spot check was carried out. One tablet from the dossett box was not administered, but there was no recorded reason for this omission. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Appropriate policies and procedures are in place for the protection of the residents. There is a simplified complaints policy in widget format for the residents, and appropriate policies and procedures concerning adult protection that follow the guidelines given in the Hertfordshire County Council adult protection procedures. EVIDENCE: A comprehensive procedures for complaints is in place, and the Service Users’ Guide contains a simplified complaints policy in widget format. No complaints have been recorded since the last inspection. The procedures on prevention of abuse contain information on the different forms of abuse, and follow the guidelines given in the Hertfordshire County Council adult protection procedures. There is a clearly written whistle blowing policy. The staff spoken to were aware of the procedures, but there is no formal training for staff in prevention of abuse. A clearly written policy on the use of physical restraint is in place. The need for restraint in particular situations is clearly detailed in each service user’s care plan. Full details of all restraints, with the methods used and the outcomes are recorded on incident reports stored in each service user’s file. Comprehensive protocols are in place for the use of restraint for each service user, including full details of the methods to use for specific situations. A restraint book has been implemented, and details of restraints used are recorded in it by hand. This seems to be an unnecessary duplication of recording, and it would be acceptable for a copy of the report of each restraint to be placed in the restraint book instead of writing the details out again. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: No changes have been made to the fabric of the home since the last inspection. The building is a detached house in a residential road and has the same appearance as the neighbouring properties. It is in keeping with the surroundings and the accommodation meets the standards for younger adults. There is a homely atmosphere, and the atmosphere is that it is the home of the residents. The garden is paved, with gravel beds containing shrubs. There was some broken furniture in the garden, and the beds needed weeding. The garden would benefit from some attention to bring it to the same standard as the interior of the home. The home appeared to be clean and well maintained. Staff spoken to confirmed that they follow the policies and procedures for maintenance of hygiene and control of infection. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 The home is staffed by support workers who are experienced and competent to care for younger adults with learning disabilities and associated mental health problems. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work, but there is a lack of training in some areas. EVIDENCE: The staffing rotas show that there are two support workers on duty throughout the day from 9am to 9pm, and one during the night. When the inspection started at 8.40am one member of staff was assisting two residents to get up. The third resident did not get up until 10.00am. The staff spoken to feel that the staffing levels are sufficient for the needs of the residents. It was reported that the early morning staffing levels will be reviewed in September, when all the residents will be attending college and will need to get up before 9am. The manager is currently recruiting for two new full time staff. A thorough recruitment procedures is in place that include full details of former employment and references, and checks including a CRB (Criminal Record Bureau) disclosure. The file for one new member of staff was inspected. It contained all the required information, but no evidence of a CRB check. The manager confirmed that he has seen the CRB disclosure, but it is not kept in the home. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 18 The individual staff files record the training completed and needed for each member of staff, but there is not a training and development plan to meet the identified training needs. A new member of staff started work in March. She has had training in food hygiene and moving and handling, but there is no evidence of the other training required for the induction of new staff. There is no formal training in prevention of abuse (see Standard 23), and there has been no fire training this year. The proprietor provides information for the staff on the residents’ behaviour management programmes, but there is no formal training in managing challenging behaviour (see Standard 19). Three of the six members of staff have NVQ2 qualifications. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is meeting its aims and objectives. The quality assurance system ensures that views of the residents and their families underpin all self-monitoring, review and development of the home. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. EVIDENCE: A new manager has been appointed to the home. He has transferred to Lammasmead from another RoCCS home, where he was the registered manager. The ethos of the home is that the residents are living in their own home, supported by the staff, and the manager is involved and approachable. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 20 RoCCS has a system of internal audits, and the manager and another manager carried out an audit of the home shortly before this inspection. There is informal consultation with residents and their families. Regulation 26 requires the proprietor to make a monthly monitoring visit to the home and provide a report to the CSCI. The proprietors carry out monthly monitoring visits, but only two reports of these visits have been sent to CSCI since the last inspection. Appropriate procedures are in place for monitoring health and safety, including regular fire drills. The environmental health officer carried out a food hygiene inspection in February, with two follow up visits. Requirements were made on the use of food probes, cleaning and food hygiene training for all staff. During this inspection it was noticed that the record of fridge temperatures showed regular measurements of up to 8ºC, which is above the limits of 0ºC to 5ºC that are recommended for the maintenance of food hygiene. This may be due to the time of day when the temperatures are recorded, and it was recommended that the night staff should record the temperatures when the fridge has been closed all night. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lammasmead Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x x x I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 22 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 19, 35 Regulation 18(1)(C) Requirement All the residents have challenging behaviour, but there is no formal training available. Appropriate training must be provided for the staff to ensure that they have the skills to implement behaviour management pogrammes effectively. Some errors were found in medication records, and it was not clear whther some medication should be classed as controlled drugs. All medication must be stored, administered and recorded in accordance with the Royal Pharmaceutical Society guidelines. (Previous timescale of 28.2.05 not met) There is no formal training in the prevention of abuse. Training must be provided for all the staff in the procedures for prevention of abuse and protection of vulnerable adults. There was no evidence of a satisfactory CRB check in one staff file. All the required information on Timescale for action 31 December 2005 2. 20 13(2) 30 September 2005 3. 23 13(6) 31 December 2005 4. 34 17(2) 19(1)(b), Schedule 2, 30 September 2005 Page 23 Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Schedule 4.6 5. 35, 42 23(4)(d) 6. 35 18(1)(c) 7. 39 26 staff must be kept in the home, including evidence of a satisfactory CRB disclosure. The staff have had no training in fire prevention this year. All staff must undertake fire training as part of their induction and annually thereafter. A new member of staff has not had a full induction training. The home must provide a structured induction programme for all staff that covers all mandatory training. The proprietors must ensure that monthly unannounced monitoring visits take place and are recorded. Reports on the conduct of the home must be sent to the CSCI each month. (Previous timescale of 31.3.05 not met) 31 December 2005 31 December 2005 30 September 2005 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 6 Good Practice Recommendations The care plans contain good details of all the residents care needs, but not in a PCP format. Consideration should be given to incorporating the principles and practice of PCP into the homes care plans and reviews. The garden kooked untidy, and the flower beds were full of weeds. The garden should be maintained to the same standard as the interior of the house. The home should have a training and development programme to ensure that the training needs of all staff are met. The record of fridge temperatures showed regular measurements of up to 8ºC, which is above the limits of 0ºC to 5ºC that are recommended for the maintenance of food hygiene. I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 24 2. 24 3. 4. 35 42 Lammasmead It is recommended that the night staff should record the temperatures when the fridge has been closed all night. Lammasmead I52 s29111 lammasmead v236838 310705 stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ 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. 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