Inspection on 18/10/06 for Ledgers Bungalow

This inspection was carried out on 18th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ledgers Bungalow 06/12/05

Ledgers Bungalow 21/06/05

Ledgers Bungalow 02/02/05

Ledgers Bungalow 08/07/04

Ledgers Bungalow 24/09/03

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

CARE HOME ADULTS 18-65 Ledgers Bungalow Queen Street Paddock Wood Tonbridge Kent TN12 6NP Lead Inspector Debbie Sullivan Key Unannounced Inspection 18th October 2006 09:30 Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ledgers Bungalow Address Queen Street Paddock Wood Tonbridge Kent TN12 6NP 01622 769114 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ledgers@MCCH.org.uk MCCH Society Limited Mrs Jennifer Mary Parrott Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Some Service Users may also have a Physical Disability. Date of last inspection 6th December 2005 Brief Description of the Service: Ledgers Bungalow is one of a number of registered care homes managed by MCCH Society Ltd in the south east of England. The home offers 24-hour care to 5 service users with learning disabilities, who may also have a physical disability. Ledgers Bungalow is registered for 6 people; there are currently 5 residents, with the 6th registered room being used as the staff office. All residents have single rooms. The home comprises of an assisted bathroom and shower room, kitchen dining room and separate lounge. The home has a small separate laundry facility. There is a large car park offering parking for up to approximately 5 cars, and the home’s minibus transport. Ramps are fitted to external doors to allow access to the garden for wheelchair users. The bungalow is situated in a small hamlet of Queen Street, approximately 2 miles from Paddock Wood. Paddock Wood has a main line railway station and bus services. Paddock Wood is a small town offering all local shops and amenities i.e. library, supermarket, various shops, hairdressers, opticians, dentists, GP and banking services etc. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report of the Key inspection of Ledgers Bungalow has been written using information gained on a site visit that lasted six and a half hours, the pre inspection questionnaire completed by the registered manager, and survey and comment cards completed by relatives and health and social care professionals. Information gained from discussion the Registered manager and other members of staff at the home is included, as well as that gained from reading records and documentation and from general observation during the day. Due to the nature of the service it is difficult to reliably incorporate the views of the residents in this report so some judgements regarding choices and quality of life have been made using information gained from discussion, records and observation of residents physical responses where possible. The cost of the service is £1,682 per week. Comments made on comment cards by relatives included, “ The care and concern has been excellent and much appreciated” “They are always well looked after by very kind staff” Comments made by health and social care professionals on comment cards included, “Staff appear very helpful and caring, very keen to continue the -----programme on the patient I am visiting” “The staff I’ve encountered are very friendly and do the best for their residents” Comments made by staff during the inspection included, “It’s a happy home” “ Training opportunities are good” What the service does well: Care plans are thorough and contain comprehensive information that has been revised and reviewed as needs change. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 6 Residents are offered opportunities to access a range of activities provided by the home and within the community. Each individual’s personal preferences are respected and activities provided are realistic as regards their needs, abilities and aspirations. Contact with relatives is promoted and supported. Contact with a range of health and social care professionals takes place on a very regular basis. The home provides a comfortable, homely environment with a friendly atmosphere. Staff are well trained and supported. What has improved since the last inspection? The statement of purpose is now available to residents in a clear pictorial format. Out of date information has been removed from care plans, they have been tidied up, and risk assessments and information on behaviours have been reviewed and revised where necessary. Daily diaries contain more comprehensive information and give a good picture of each resident’s daily activities. The manager has introduced a tracking system in respect of accidents or injuries so that any pattern can be identified. A second vehicle is available so opportunities to go out have been expanded. The kitchen has been fully refurbished and refitted. Repairs have been undertaken to the large assisted bathroom and a shower chair is in place. Medication procedures and recording have been improved upon. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 7 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. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 1,2,3,4 and 5 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. Potential residents and their families are able to access information about the home to enable them to make an informed choice. The needs of residents are fully assessed. EVIDENCE: The home has a statement of purpose and service user’s guide; the information has been revised since the last inspection and now includes pictorial information to make it more accessible for residents, photographs of the service and places that are accessed in the community are included. All the current residents are well established at the home, one resident had been for respite and then moved in. Should any change in the group be considered and a potential new resident be introduced, organisational policies and procedures are in place for this. The person centred planning approach is being introduced and was being applied in reassessing needs where required. Each resident has a care plan that includes a large amount of information including a full assessment of health, personal care and social needs. Information is revised if needs change. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 10 Contracts are in place between the home, service user and sponsoring authority. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 6,7,8,9 and 10 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. Care plans are comprehensive and contain information that reflects the needs of residents and any changes; work needs to continue to make the information more accessible to residents. Residents are supported in making decisions about their lives. EVIDENCE: Care plans for three of the residents were read, due to the complex needs of the residents a large amount of information needs to be available so each resident has a health needs file, and a file that includes assessments, risk assessments, reviews and information on personal care needs and preferences and social activities and interests. A financial file is also kept for each resident as well as a daily diary. All the documents are kept securely in one location in the home, and care plans have been cleared of out of date information and generally tidied up since the last inspection. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 12 During 2006 some residents have experienced health difficulties, there was recording in place of reassessment of needs and much liaison with health professionals in some cases. Risk assessments had been revised following injuries sustained by residents and where risk assessments had been reviewed, but no change to them was required this was recorded. Work continues to be underway to make care plans more accessible to service users. Residents are supported in making choices about their daily lives, one resident said that they enjoyed helping with the daily routines of the home such as meal planning. Other residents mainly need to rely more on staff or relatives to help with making choices, staff are able to understand the non-verbal communication of residents and their preferences. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 11,12,13,14,15,16 and 17. The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. Residents have opportunities to attend a range of social, recreational and therapeutic activities provided by the home and in the community. Contact with relatives is promoted. Meals are healthy and nutritious. EVIDENCE: Residents are able to attend a variety of activities in the community with the support of staff. During the inspection three residents went out to organised day activities settings, one for half a day and the others all day. One day centre was local, and the other in Tunbridge Wells. Another resident went shopping for items for their forthcoming birthday party. The home is in a rural setting and reliant upon it’s own transport, it part fund raised for a second vehicle that had arrived very recently, allowing for residents to have more choice over going out. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 14 One resident spoke of enjoying attending day activities, going out with staff, visiting relatives, and was looking forward to a holiday later in the year. Efforts are made to include the youngest resident in activities with peers. Other trips out include those that are purely recreational or social, such as to events with other MCCH houses, meals out, church, events at the local hop farm and going out for drives. Some residents also attend therapeutic activities such as hydrotherapy. Within the house residents can choose to listen to music, watch TV or videos and chat with staff, a music therapy session is held fortnightly and a hairdresser and an aromatherapist visits regularly. Contact with relatives is promoted and the manager spoke of regular visits to and from relatives, some of whom live locally. The kitchen had recently been fully refurbished and provides a comfortable, attractive and functional space for meal preparation, eating and socialising. During the inspection representatives from MCCH and Kelsey housing visited to check over the new fittings. Meals are healthy and varied, residents are included as far as possible in meal planning and good quality and fresh ingredients are used, healthy eating is promoted. There were a small number of gaps in the recording of meals taken, these mainly related to meals taken at day centres. One resident is currently partially PEG fed; the gradual inclusion of more solids is being overseen by the speech therapist and dietitician. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 18,19 and 20 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. The personal and healthcare needs of residents are well met and the home maintains contact with a range of health professionals. Staff are aware of individual needs and preferences and treat residents with respect and dignity. EVIDENCE: Residents at the home require a substantial amount of support with their personal care needs, support required is well documented and provided in a manner that respects privacy and dignity. A resident spoken with was happy with the way in which their care was provided. Where there are complex health care needs contact with a range of health care specialists takes place. During 2006 the home has experienced changes in the healthcare needs of the majority of the residents, and an increase in the need for specialist interventions. Some residents have needed to spend time in hospital, during these periods the service provided staff to be with them for much of the time to ensure that needs were fully met. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 16 The health problems that have been, and are being experienced by service users this year are varied, some are resolved and others under further investigation. For example records showed that contact is maintained with GP’s, dieticians, speech therapists, District Nurses, physiotherapists, behavioural specialists and chiropodists, as well as other professionals. During the inspection a district nurse and physiotherapist visited. Recommendations in respect of medication procedures made at the last inspection have been acted upon; medication is securely stored although storage space is not sufficient. The need for an extension to the medication cupboard was raised with the MCCH representative who was visiting and options discussed. All care staff receive medication training and the list of staff administering medication has been updated. The breakfast time medication round was partially observed and staff were following correct procedures. Additional recommendations are made in this report regarding medication documentation. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 22 and 23 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. Systems are in place to enable residents, staff and visitors to raise concerns or complaints. Most residents require support to raise concerns. The home has adult protection policies and procedures in place and safe working practices have been improved upon following an adult protection investigation. EVIDENCE: The home has a complaints procedure that is available at the home; no complaints had been received since the last inspection. The majority of residents rely upon relatives or other advocates to raise concerns or complaints on their behalf. Staff spoken with were aware of the procedure. Adult protection procedures and protocols are in place; again staff spoken with were aware of the procedure and had been on adult protection training. There had been one adult protection alert since the last inspection that had been fully investigated, an injury to a resident was found to be accidental, although avoidable by more adherence to, and knowledge of safe working practices in terms of moving and handling. Measures have been put into place to ensure that staff are aware of safe working procedures at all times and related risk assessments have been revised, especially in relation to use of wheelchairs. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 18 Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 24,25,26,27,28 and 29 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. The home provides a comfortable and well-maintained environment for residents to live in. Bedrooms are personalised and equipment is available to meet individual and collective needs. Improvement can be made to the assisted bathroom environment to enhance the health and safety of residents and staff. EVIDENCE: The home is well decorated, clean, well furnished and comfortable. The standard of hygiene is good throughout. Substantial improvements have been made to the kitchen and assisted bathroom. The bathroom still has no means of natural light or ventilation, and can be very uncomfortable for residents and staff especially in hot weather, to the extent where it is a health and safety hazard. The home is fully wheelchair accessible and there are ramps into the attractive and well-kept garden. Throughout the home equipment to meet individual or Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 20 communal needs is available and bedrooms contained each residents’ personal equipment, one resident was keen to explain each item and state it was their own. A senior member of the care staff undertakes regular walking routes and other safety checks and any repairs necessary are passed to the maintenance department for action. All bedrooms are single and are personalised. One bedroom contains some sensory equipment for the occupant who has hearing and sight difficulties. Communal areas comprise of the lounge and the kitchen/diner, the kitchen especially was being well used as a place to congregate and socialise. The lounge carpet needs replacing as it has become stained. A small laundry room is separate from any area used for meals or food preparation or storage. Each resident’s laundry is separately washed. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 21 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 36 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. Residents are supported by a staff team that are competent, and in the main well established. Staff are well supported and provided with good training opportunities. EVIDENCE: The Performance Relationship Manager for the organisation audits staff records centrally at least once a year; therefore standard 34 was not fully inspected. The audit carried out in July 2006 found that recruitment documentation and staff vetting was in place, recommendations included improvement to application forms and the interview process. Senior support workers, support workers, a housekeeper and the Registered manager staff the home. Three to four support staff are normally on duty during the mornings, three in the afternoons and there is one waking and one sleeping member of staff at night. The number of staff on duty can fluctuate dependent upon the activities that residents are attending each day, and if a trip out requires additional staff they are provided. Existing staff or MCCH bank staff cover any gaps in the rota. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 22 The staff team comprises of well establish staff members and those who have joined the home more recently, a number of staff have worked at the home for several years. Staff observed during the inspection were competent, had a good understanding of individual needs and good rapport with residents. A key working system is in place and over 50 of care staff have gained an NVQ qualification in care. Staff spoken with stated that they did not commence work until their CRB disclosures were through and that they received induction training. Staff said that training opportunities are good and the organisation and other training providers provide both mandatory and additional training. Recent training undertaken included, medication and food hygiene. A senior support worker is responsible for tracking training requirements. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 23 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41 and 42 The outcome in this quality area is good. This judgement has been made using available evidence including a visit to the service. The home is well run by an experienced manager and the atmosphere is friendly and welcoming. Improvements in some recording and procedures have enhanced the ability of the service to ensure the best interests of residents and staff. EVIDENCE: The Registered manager has worked at the home for a number of years and is experienced in working with people who have a learning disability. The manager has improved and expanded upon some recording methods and other documentation since the last inspection in order to further ensure the best interests of residents and their health and safety. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 24 The atmosphere in the home is open and friendly; one resident said that it was like living with relatives. As far as is possible the views of residents are sought regarding the running of the home. Health and safety, and equipment checks are regularly carried out; a senior staff member is responsible for a number of areas relating to health and safety. Fire equipment is serviced at correct intervals and evidence was seen of a full fire practice that took place in September 2006,fire practices are held at regular intervals. Records are kept safely and securely and staff have access to the homes’ policies and procedures which are organisational or specific to the service. Regulation 26 reports have not been received by the Commission on a regular basis this year, the manager was aware that this needs to be reinstated and the Commission needs to be provided a summary of the annual quality assurance survey undertaken by the home. Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 3 X Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 12(1)(a) 23(2)(p) Requirement “ The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users” and “the registered person shall ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home used by service users” In that the assisted bathroom must be fitted with a window to allow for adequate natural lighting and ventilation to ensure the health and safety of service users and staff. 2. YA39 26(2)(a)(c) “Where the registered provider (3) is an organisation the care home shall be visited by the responsible individual or an employee of the organisation not directly concerned with the conduct of the care home, visits shall take place at least once a month and be unannounced” In that reports of Regulation 26 Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 27 Timescale for action 31/12/06 30/11/06 of monthly visits must be must be submitted to the Commission and available for inspection. 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. YA20 Refer to Standard YA6 Good Practice Recommendations It is recommended that work continue to make care plans more available to residents. This recommendation is repeated from the last inspection. It is recommended that all meals taken by residents be recorded and the temperature of cooked food be consistently recorded. It is recommended that where a change in medication is recorded on a MAR sheet a statement is included regarding who prescribed the change and on what date. It is recommended that the space to store medication be enlarged. It is recommended that the lounge carpet be replaced, as it is very stained. It is recommended that the summary of the results of the most recent quality assurance survey and any related action be forwarded to the Commission. YA17 4. YA28 5. YA39 Ledgers Bungalow DS0000024043.V309819.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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