Inspection on 21/06/05 for Ledgers Bungalow

This inspection was carried out on 21st June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ledgers Bungalow 18/10/06

Ledgers Bungalow 06/12/05

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 Lynnette Gajjar Announced 21 June 2005 09:30 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. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MCCH Society Ltd Mrs Jennifer Mary Parrott CRH Care Home 6 Category(ies) of LD Learning Disability registration, with number of places Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Some Service Users may also have a Physical Disability Date of last inspection 2 February 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 a learning disabilities, who may also have a phyisical disability. Ledgers Bungalow 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 homes 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 H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09.30am until 16.50pm with two regulatory inspectors on 21st June 2005. The home has 5 people in residence who have lived together for a number of years. The visit was spent talking directly with all five residents at the home privately and collectively, with staff interpretation through their individual communication methods; four care workers, the senior carer, the manager and four relatives who visited during the day. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service user in the report. Some judgements about quality of life and choices were taken from direct conversation and physical responses with people living in the home as well as direct observation followed by discussion with staff and relatives, evidencing records and care plans held at the home. Additional evidence was gained from the returned pre inspection questionnaire and comment cards received from relatives and professional visitors to the home. A tour of the house and garden was undertaken. What the service does well: What has improved since the last inspection? Staff and their direct families have given their own free time to landscape and tend to the large gardens to make them more accessible and comfortable for those with limited mobility or wheelchair dependant. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 6 Residents are now benefiting from a core stable staff team for the past 8 months. Redecoration of the hallway and lounge has brightened up the home and offers a more comfortable environment for residents to relax. Resident’s personal care has been enhanced with the additional equipment assessed for individuals and ensures safety for both residents and staff. 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 H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 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 Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 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) 1,2,3,4, Residents and representatives looking at Ledgers Bungalow are given all the information that they need to be able to make an informed decision to live there. EVIDENCE: The homes statement of purpose and service users guide are currently being reviewed to use more pictorial / photographic / object referencing. This will enable residents easier access and clear understanding of what services the home provides who have limited reading skills. The key working and person centre planning process is developing slowly to offer clear promotion and support in identifying personal aspirations and meeting individual care needs. The current residents living in the home have lived here for many years. The home has not had any new admissions, although the organisation has full procedures and assessments to follow in the event of a vacancy occurring. Relatives reflected their initial contact with the home, trial visits and discussion with staff and other professionals prior to deciding to move into Ledgers Bungalow. Relatives felt they were given all the support necessary about the home and services provided. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 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) 6,7,8,9,10 Care plans continue to develop to contain clear information and guidelines to ensure that residents receive consistent and individual care. EVIDENCE: Care plan records seen were sufficiently up to date, detailed and contained clear information instructing staff to how meet the needs of the individuals. Relatives spoken with had varying understanding of their care plans, some had discussed care at reviews but had not looked through the full written assessments/care plan and signed as representatives to their agreement of the content on behalf of their relatives. Residents and relatives were observed to talk directly to care staff sharing information to help to develop their care and personal needs. Records confirmed regular contact with the GP, chiropodists, opticians and consultant appointments, sometimes with relatives taking them or staff from the home. Records are stored securely. Interaction between residents and staff is good showing genuine respect and appropriate familiarity with each other. One resident has a good understanding of their care plan, documentation held within it and records maintained. This resident currently is the only one who has the ability to fully understand the care planning process and expresses any interest in it. Others are heavily reliant of their relatives advocates support and understanding to sign on their behalf. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 10 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) 12,13,14,15,16,17 Residents are given encouragement and support to make choices about aspects of their daily lives, including a range of local social and recreational interests. Menus provide wholesome and nutritious food. EVIDENCE: Continued support from staff enables individuals to access Paddock Wood amenities and the local area including shopping, walks in the park, trips to the coast, garden centres, meals out, concerts, local authority and charitable day centres. Due to the remote location of the home all amenities have to be accessed by transport. Resident’s families are in regular contact, with an open door visiting policy. Those spoken with today are happy with the service provided and on the whole the care provided by staff. All felt staff are approachable and welcoming. There is high regard from families towards the staff team and care provided. Residents are supported to visit or meet relatives outside the home with regular social meetings booked as part of their weekly planners. The kitchen was observed to be clean, well – equipped (although still awaiting refurbishment to make it more resident accessible) and had been awarded the bronze award from the local council. The kitchen was stocked with fresh produce and meals were served with ample portions. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 11 Special diets are catered for. Relatives felt food was of a good standard and suited to the individual’s choice and preferences. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 12 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) 18,19,20,21 The health, social and personal care needs of residents are well supported with regular contact with specialists and external professionals. Residents are treated with genuine respect and dignity by care staff. EVIDENCE: Through discussion with a relatives and records viewed, it is clear that residents are given full support and encouragement to maintain personal contact with practices nurses, GP, community learning disability staff, challenging behaviour specialist, mobility advisors and consultants, as well as chiropodist and dentists, to maintain good standards of health and well being. Staff spoken with today evidenced they were aware, of the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Written feedback was received from professionals working with the home, specific praise was given by the challenging behaviour therapist who felt the staff had taken on board their advice and supported a service user to have positive outcome and remain at the home, (included within the summary section). Other feedback received felt the home could improve their working with residents, to include more specialist advice in the care plan, but this required constant monitoring to ensure there are not any lapses and staff maintain consistency of care. A care manager felt “ The manager is dealing very sensitively with an issue at present – she is thinking and working along person centred planning.” Safe and secure Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 13 systems are in place with regards the storage and administration of medicines. Only staff who are trained administer medication. The home has experienced difficulty with dispensing Pharmacist due to constant changes in their staff. Staff when identified, addressed an error on printed MAR sheet immediately. Medication was being administered as direct by GP. Personal wishes in the event of illness and death, although a difficult subject, are discussed sensitively with residents and families to ensure appropriate levels of support are respected and personal dignity maintained at such times. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 14 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) 22,23 Systems are in place to enable those living and those visiting the home to raise concerns or complaints with staff. Protection from abuse is promoted through staff training and understanding of actions they may need to take. EVIDENCE: Copies of the complaint procedure are available in the home. Due to the nature of the service and those resident living here, using this system is very limited. It was evident a resident was clear about whom they would talk to if they were unhappy about something and had done this in the past. Others would require relative/ advocate to identify concerns and raise them on their behalf. Relatives spoken with, felt they had responsibility to raise any concerns and felt in their experienced these have been taken to the staff /manager and resolved to their satisfaction. All felt the manager was approachable and listened to the concerns raised. Advocacy for residents has been transferred to referral list for emergencies through West Kent Advocacy Scheme. Staff who were spoken with showed a good understanding of how to protect and prevent abuse, including reporting under local procedures. There are no current adult protection alerts relating to this home. An adult protection was raised by the home since the last inspection. This has been fully investigated and staff dismissed and referred to POVA. Issues of restraint have been address particularly for the use of bedsides and wheelchair lap-straps. Behaviour guidelines are set through multi-disciplinary meetings and are proactive in positive responses and intervention for the individuals. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 15 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) 24,25,26,27,28,29,30 Residents live in a comfortable, nicely decorated and clean home. Safety will be enhanced further following completion of the kitchen and dining area. Bathrooms will offer safer facilities on receipt of the assessed shower chair, and the completion of subsidence work. EVIDENCE: The home continues to be presented to good standard of hygiene and cleanliness. No further action has occurred within the homes action plan to upgrade and refurbish the kitchen / dining area to be make easier , safe access and use by residents to make their own drinks and snacks where possible. The subsidence is being reassessed at present by the housing dept but again no further action has occurred. It was noted that large cracking in the bathroom floor had been sealed by hazard tape. This was worn and not promoting effective infection control but also of concern for tripping and catching of wheelchairs and hoists. This bathroom does not have any natural light or ventilation. Further cracking has occurred since the redecoration in the hallway. All rooms are single, individually decorated, furnished. All have specialist equipment to meet their personal care needs. One resident is currently awaiting the delivery of a new specialist bed purchased by the organisation. Relatives discussed supporting residents to purchase items of Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 16 their choice, relaxation and entertainments for their rooms. Laundry is undertaken on site in a small confined area. There is no dry ironing area by the machines as part this and ironing is done in the home communal areas. Staff had been out to purchase fans for each room due to the heat wave currently being experienced and offer a cooler home. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 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) 34,35,36 Residents have benefited from the recent stabilizing of the staff. Residents would benefit further when the full staff complement is achieved. EVIDENCE: The manager continues to try to reduce the use of agency staff through the use of regular casual staff employed by MCCH and recruitment to vacant posts. The same staff are booked to try to maintain familiarity for residents. Staff continue to attend in house one-day training courses relevant to this resident group. Three staff holds NVQ 2 in care or above and two staff are awaiting verification by the external assessors. Staff on duty today evidenced a good understanding of residents care needs through the positive relationships formed between them and residents. Rosters are covered by all staff on 24hour basis including waking night. Options of employing permanent waking night staff are currently being explored. Staff stated they receive regular formal supervision. Records tracked today did not fully evidence that all staff will achieve 6 supervisions in 12 months. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 18 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) 37,38,41,42,43 Service users personal preferences support and care needs are encouraged through the registered managers open approach to managing the home and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this people with a learning disability for many years and is currently working through the Registered Managers Award NVQ 4, hoping for completion October 2005. The manager has become more confident and has a better understanding of when to challenge practice and following the organisation staff performance and development protocols through the adult protection process experienced earlier this year. Residents, relatives and staff expressed a high regard for their management approach to the home. Relatives felt the registered manager was approachable and staff said they felt well supported. A formal quality review of services provided would be of benefit to the manager to assess what the home does well and what could be improved, with residents who are able or their relatives or other professionals involved in their care. The registered manager demonstrated through discussion, a good understanding of the needs of current residents Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 19 and current issues. Monitoring health and safety in the home is to a good standard, with weekly health and safety walking routes taking place, and equipment serviced as required to maintain a safe home and facilities. Risk assessments continue to develop for individuals and staff activities in the home and care duties. Six staff are trained to first aide. Core health and safety training is undertaken by all staff. Staff evidenced a clear understanding of accident/incident recording and reporting under regulation 37 to the commission. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 4 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ledgers Bungalow Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x x 2 3 x H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 24,27 Regulation 23(2) (b)(o) Timescale for action Full written The registered person shall having regard to the number and response to be needs of service users submitted ensure:That the premises to be to the used as a care home are of commissio sound construction and kept in n by 30th good state of repair externally July 2005 and internally.In that the with subsidence is assessed and completion remedial work undertaken, dates. particularly in relation the large assisted bathroom where the flooring is raising and cracking causing concern of tripping and infection control hazards.External grounds, which are suitable for and safe use by, service users, are provided and appropriately maintained.Staff have been working hard in their own time to maintain the garden and make it more accessible for those in wheelchairs and with limited mobility. This remains an ongoing requirement from the previous tow inspections. Proposals to move of site fell through mid last year and no alternatives are currently being explored. Work must be competed to maintain a safe Version 1.30 Page 22 Requirement Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc living and working environment. 2. 27 23(2) (n) The registered person shall having regard to the number and needs of service users ensure:Suitable adaptations are made and such support, equipment as may be required is provided for service users who are old, inform or physically disabled.Shower chair is currently on order and waiting delivery via the OT dept. The registered person shall ensure that:All parts of the home to which service users have access to so as far as reasonably practicable are free from hazards to their safety.In that all requirements identified from previous inspection are addressed and implemented.Particularly in relation to:·The environment maintenance (subsidence and decoration)· Shower chair replaced.This links to requirements identified in the previous inspections dated 30th April 2003 and 24th September 2003 and 8th July 2005 listed above 30th August 2005 3. 27,42 13(4) Full written response to be submitted to the commissio n by 30th July 2005 with completion dates. 4. 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 1 Good Practice Recommendations It is recommended that additional good information seen in this large file should be referred to in the Statement of Purpose and stored to view at their leisure. The statement of purpose and residents guide should be written or presented in a format that is easily accessible and H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 23 Ledgers Bungalow 2. 5 3. 6 4. 5. 17 20 6. 27 7. 29 8. 9. 36 39 10. 41 understood by the residents. It is recommended that service users be supported by relatives/ representative/advocates when drawing up the contract/ statement of terms and conditions. Particularly where they are appointees and responsible for the payment or partial payment of fees It is recommended that the plan be drawn up with the involvement of the service user together with family, friends and or advocate, and relevant agencies.It is recommended that the plan is made available in a language and format the service user can understand (visual, graphic, simple printed English, etc) and is held by the service users unless there is a clear (and recorded reason not to do so.Ongoing work was in evidence today. It is recommended that food records detail actual food consumed rather that ‘Packed Lunch’ It is recommended that the home ensure that MAR sheet direction labels correlate to those on the dispensed medicine containers as part of the checking in process.It is recommended that medication times are correct and correlate to residents activities (times for getting up / going to bed, actual mealtimes) where prescribed times are within reasonable times sale to the activity i.e. ½ before food. . It is recommended that bathroom window be explored in the main bathroom to aid ventilation and lightingFrom the last two inspections it was stated that Kelsey Housing have done a sight visit and due to the home proposed move, the cost of the window being inserted would not be approved.This plan has been put on hold and due to this facility being in constant use by the residents, this require reassessment and action plan submitted to CSCI of proposals to address with clear deadline and completion dates. It is recommended that consent for the use of bedsides is reviewed and included in care plans as part of the next multi disciplinary review meeting. This remains ongoing through the review process. It is recommended that staff receive at least 6 formal and received supervisions over a year. It is recommended that Mrs Parrott continues to develop written auditing/self monitoring tools in relation to daily records and practises with in the home. Ongoing work was in evidence today It is recommended that internal yearly reviews are undertaken to seek formal feedback from residents who are able, relatives, and other professional involved with the home to review how the home is performing and H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 24 Ledgers Bungalow identify areas for improving the service. Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent 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. Extracts may not be used or reproduced without the express permission of CSCI Ledgers Bungalow H56-H06 S24043 Ledgers Bungalow V223579 210605 Stage 4.doc Version 1.30 Page 26 - 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!