Inspection on 06/07/06 for Linwood House Care Home

This inspection was carried out on 6th July 2006.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linwood House Care Home 01/10/08

Linwood House Care Home 12/12/05

Linwood House Care Home 13/09/05

Linwood House Care Home 02/02/05

Linwood House Care Home 27/07/04

Linwood House Care Home 18/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Linwood House Care Home 1 Mount Hooton Road Radford Nottingham NG7 4AY Lead Inspector Joanna Carrington Key Unannounced Inspection 6th July 2006 09:30 Linwood House Care Home DS0000002297.V301263.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 Linwood House Care Home DS0000002297.V301263.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. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linwood House Care Home Address 1 Mount Hooton Road Radford Nottingham NG7 4AY 0115 978 6736 0115 9786736 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) info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited Miss Claire Anne Turner Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users shall be within category LD The registered manager shall complete the registered managers award by December 2005 and NVQ4 in care within the following 12 month period by december 12th December 2005 Date of last inspection Brief Description of the Service: Linwood House is a detached older property adjacent to the Forest Recreation Ground and on the tram route to Nottingham City Centre. Accommodation is provided on three floors. There is a private garden and ample space for car parking. Linwood House is registered to provide personal care for up to thirteen adults with learning disabilities. The fees range from £326 to £743.11 per week. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over six and a half hours on 6th July 2006. This was the home’s key inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which meant selecting three service users and tracking the care and support they receive through checking their records, observation of care practice and discussion with them and with staff. Staff records were looked at and a partial tour of the premises also took place in order to assess environmental standards. Altogether three service users and two staff members were spoken with. The manager was not available on the day of the inspection. The senior was available for discussion and feedback throughout. Overall the inspection found there to be very positive outcomes for residents. What the service does well: Prospective service users do not move to the home until their needs have been assessed and there has been opportunities for them to be introduced and ‘test drive’ the home. All service users have a contract when they move to the home stating the terms and conditions of their place. Care plans and risk assessments are thorough and provide detailed information on how service users’ needs are to be met. Step-by-step guidance is provided on how to support service users with their personal care and individuals’ preferences are included, which is good practice. It is evident that staff are committed to promoting choices and enabling communication with service users. Specialist health and social care professionals are accessed when necessary to help in meeting the needs of service users. Service users have good opportunities to participate in meaningful and fun activities both in the home and in the community. Service users are supported to maintain contact and relationships with family and other significant people. Staff treat service users with respect and promote their rights and responsibilities. There is an appropriate complaints procedure in place, to ensure that residents and their representatives’ views are listened to and acted on. To assure that residents are safeguarded from abuse the Nottinghamshire Policy and Procedures are adhered to. Training and support for staff is good, which ultimately the residents’ benefit from. Recruitment practices ensure the protection of residents. The environment is maintained generally to a satisfactory standard. It is homely and comfortable with adequate communal space for everyone. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 4 and 5 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users have the information they need to make an informed choice about where to live and have their needs assessed prior to moving into the home. All service users have a contract, which details the terms and conditions of their placement. EVIDENCE: For all three service users case tracked each had a copy of the placing authority’s community care assessment on their file. This information is necessary for deciding whether the home would be suitable in meeting that individual’s needs. The service user that was most recently admitted to the home had a series of introductory visits before they moved to the home. The Statement of Purpose meets the standard however the recommendation to include information about respite provision is now outstanding from two previous inspections. Prospective service users may wish to know that if there is a vacancy then the home provides short breaks so this should be included. All service users have a contract when they move to the home, which is kept on their file, of which the content complies fully with the regulations. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 and 9 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans cover all areas of need but any changes or increases in need must be reflected in relevant care plans. Service users are supported to make decisions in their lives and to be independent and take acceptable risks. EVIDENCE: All service users case tracked had clear care plans in place on how to meet their individual needs. There was evidence that care plans are reviewed and that service users are involved in the development of care plans, when they choose to be however when there are significant changes as well as being documented under the evaluation section the actual care plan must also be updated. The care plan for general health for one particular service user must be updated to reflect their current situation. Service users spoken with know who their keyworkers are and it is apparent from discussion with service users and from looking at care plans that residents are supported to make decisions in their everyday lives. For example, choosing to go on holiday, how to decorate their bedrooms and what Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 10 activities they would like do. Service users are consulted in their regular house meetings. There are care plans identifying the communication needs of service users, which are important for enabling individuals’ to exercise choices and to be listened to. There are risk management plans in place that cover activities pertinent to individual service users’ and their chosen lifestyle such as smoking, food handling and expressing negative feelings. It is recommended that in accompaniment to the Missing Person procedure a risk management plan be devised for the named service user that the Commission received a notification about prior to the inspection. This plan is to provide more specific guidance to staff on how to support this service user and what to do if he chooses to leave. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 and 17 Quality for this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. There is a commitment from the staff team in promoting residents’ rights and enabling residents to experience a fulfilling quality lifestyle. EVIDENCE: There are various opportunities for service users to participate in activities and to access the community. There are group trips provided every month, which have included an owl sanctuary, a museum and day out in Matlock. A service user spoken with said they like going to the pub with their keyworker and another service users said they are looking forward to going swimming. Some service users attend a day centre on a part time basis while other service users are on work placements and go to a training centre. There are no service users that currently have spiritual needs to fulfil. Staff spoken with gave good examples of how they assist service users in maintaining contact and relationships with family and friends. Family and friends are invited along to their birthday parties and daily records show that keyworkers help service users maintain contact by assisting them to write letters and to make phone calls. A service user has stated in the Commission’s Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 12 service user survey that they can use the phone when they want to make calls to friends. Staff were observed interacting with service users in a respectful manner and knocking on bedroom doors before entering. Service users can have keys to their bedrooms so that they can keep their own space private and secure. Service users are encouraged to help out with domestic duties such as cooking and cleaning their bedrooms, which helps promote their independence. There are no prepared menus. Service users are consulted on what they want that day. The menu records show that there are usually at least two options available and that generally meals are healthy and varied. It is recommended that more detail be added on what vegetables have been provided to demonstrate variation and also state who has had what meal, in case of an outbreak of food poisoning. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 18, 19 and 20 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users receive personal support in the way they prefer and require and health care needs are generally well met. Medicine management must improve to ensure the safety of service users. EVIDENCE: Daily records show that there is flexibility with when service users choose to go to bed and get up, which was confirmed by those service users spoken with. Support with personal hygiene and tasks such as dressing and washing are identified in relevant care plans. Specialist health and social care professionals such as psychiatrist, dietician and continence nurses are involved in residents care when appropriate. Appointment records show that service users have annual health checks and access to primary healthcare services when needed. The staff team have supported a service user to attend outpatient appointments. It is recommended that NHS best practice guidance be sought for this service user, who has a serious illness, to ensure they receive the appropriate and necessary care and services. More advice must also be obtained from relevant professionals regarding their eating and drinking and the relevant care plan updated to include guidance on what action is taken when the service user refuses to eat. There are ethical issues involved, which Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 14 the home should not have to deal with alone. The service user concerned is losing weight therefore the weight chart is an essential tool for monitoring and promoting their health. Any serious illness of a service user at a care home where nursing is not provided should be notified to the Commission in accordance with Regulation 37 of the Care Home Regulations 2001. In respect of the controlled drug, as part of the inspection, all was found to be in order. The controlled drug is stored correctly and there is a controlled drugs register, which is correctly filled in. Errors were found however with two out of the three other medicines audited. For one medicine the instructions for administration on the Medication Administration Record (MAR) had been altered, but there was no date stated when the change was made and by which doctor. It was explained that the instructions had changed the previous month but the label on the box supplied this month still had the old instructions on. It is recommended that a copy of the repeat prescription be attached to MAR records in order to check that instructions on the MAR tally with prescriptions and GP instructions. For the same medicine the MAR stated that there were one hundred and sixty eight tablets and thirty-five tablets had been signed for on the MAR. This means there should be one hundred and thirty-three tablets remaining but one hundred and thirty six tablets were counted. This means that three tablets have not been administered but have been signed as. The same problem was found with the second medicine. Eighty-four tablets were counted in, including the tablets in the monitored dosage system and the tablets in bottles for the day centre (this is correct). Fifty-three had been signed for which means only thirty-one should be remaining. Thirty-six were counted. It was explained that sometimes the tablets from the day centre are returned because they have not been administered. If this is the case then this must be recorded as so on the MAR to account for the quantity of medication in the home. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is an appropriate complaints procedure in place, to ensure that residents and their representatives’ views are listened to and acted on. The Local Adult Protection Procedures are appropriately followed, which helps to assure that residents are safeguarded from abuse. EVIDENCE: There is a comments, complaints and concerns policy displayed in the home and service users spoken with confirmed that they know how to make a complaint should they wish to. There are no recorded complaints since the previous inspection. Staff spoken with confirmed that they have had training in adult abuse and demonstrated an understanding of their role and responsibilities in terms of whistle blowing and in accordance with the local adult protection procedures. Since the last inspection the Nottinghamshire Adult Protection Procedures have been appropriately followed in response to a disclosure by a service user that they are being financially abused by a member of the public. The police and Social Services are currently involved. The Commission will be informed of the outcomes once the investigation and action has been completed. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 the following standard(s): 24, 26 and 30 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a homely and comfortable environment but with no progress made on consulting with the environmental health authority this does not ensure the environment is adequately safe and hygienic. EVIDENCE: The home is pleasantly furnished and is domestic in style. The décor was satisfactory although some areas of paintwork are worn. Bedroom doors are currently being repainted and each one will be fitted with a number and brass doorknocker. The main kitchen is fitted with modern units and appeared clean and hygienic. The communal hallway was clean however the edges have collected a lot of dirt where rope has been used to finish the laminate flooring. The environmental health authority should be consulted over this along with other outstanding issues as recommended in previous report; there is a sluice in the laundry room, which is also used for hand washing. Given that there are service users with continence needs the environmental health authority must be consulted over the current facilities to ensure they are adequate. The environmental health authority has not yet been consulted over the safe use of Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 17 the boiler. The boiler does look worse for wear and it states on the CORGIregistered annual service report that it is “old and needs replacing very soon”. The vent fan in the laundry room has been cleaned out and appears to have resolved the damp and condensation problem. The maintenance book was looked at and showed that required jobs are done in a timely fashion. There is a maintenance man that visits weekly. Bedrooms seen are nicely personalised with individuals’ own pictures and belongings. A service user has recently had their bedroom re-wallpapered. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 18 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): 32, 34, 35 and 36 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Training and support for staff is well managed, which service users ultimately benefit from. Recruitment practices protect service users. EVIDENCE: The home is well on its way to achieving 50 of the staff team being qualified to at least a National Vocational Qualification (NVQ) level 2 with staff members currently in the process of doing the course. There was evidence seen on the three randomly selected staff files that new staff members receive an induction and attend the Learning Disability Award Framework foundation training, which goes towards NVQ 2. A training matrix shows that mandatory health and safety training is kept up to date and there was evidence that other courses relevant to the needs of service users have been accessed for example, diabetes and aggression management. It is recommended that some form of training in mental health be sourced because there are a number of service users needing support with their associated mental health difficulties. Staff said they feel supported by the manager and there was documentary evidence on files indicating that staff are regularly supervised. There was also evidence of two written references and a Criminal Record Bureau disclosure on the three staff files looked at. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 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, 39 and 42 Quality for this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well run but an integral part of quality monitoring must be seeking the views of service users to ensure the home is run in their best interests. The health, safety and welfare of service users is promoted and protected. EVIDENCE: Staff spoken with reported that the manager is always supportive and approachable in her style. The results of this inspection indicates the home is well run, with positive outcomes for service users, despite only twelve hours being allocated for management duties per week. Nevertheless, it is recommended that the number of allocated hours be reviewed to ensure they are adequate for the effective management and running of the home. There are systems in place for monitoring quality and conduct at the home. Monthly monitoring visits are carried out in accordance with Regulation 26 of the Care Home Regulations and information that is gathered each month forms the basis of a report identifying any outstanding quality issues. It was reported that thorough six-monthly audits are going to be implemented. The Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 20 last time service user surveys were distributed was way over eighteen months ago. Obtaining their views as part of quality monitoring is now well overdue. This was made a recommendation in the last report. This is now a requirement. The fire log shows that all necessary fire safety testing and drills have been carried out. The servicing of equipment and electrical and gas systems are all up to date and there are measures in place for the prevention of Legionella. It was recommended in the last two inspection reports that an accident book in line with data protection legislation is obtained. The accident book currently in use records a number of incidents and accidents on the same page, as opposed to accidents involving different service users being recorded separately. The recommendation therefore remains in this report. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 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 2 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 X 2 X X 3 X Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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 YA6 Regulation 15 Requirement Ensure care plans are updated where any changes or increases in need are identified. This refers specifically to the named service user whose general healthcare plan must reflect current situation. Update care plan for eating and drinking for the named service user, to include advice given by dietician and necessary action if service user continually refuses to eat (following consultation with relevant professionals involved). Ensure all notifications are made to the Commission, as specified under Regulation 37. This refers to the diagnosis of a serious illness of a service user. Timescale for action 30/08/06 2. YA19 15 31/07/06 3. YA19 37 06/07/06 Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 23 4. YA20 13 5. YA24 16, 23 Ensure that there are adequate 31/07/06 arrangements for the recording, handling, safekeeping and safe administration and disposal of medicines received into the care home. This refers to: 1. Only signing for tablets that are administered. 2. Identify very clearly on the Medication Administration Record (MAR) when tablets sent to the day centre have been returned to the home not administered. 3. Ensuring instructions on the MAR correlate with instructions on the box and original prescription (recommend keeping a photocopy of the prescription) otherwise any amendments to instructions are recorded clearly with a record of when the doctor requested the change. Consult with the Environmental 30/09/06 Health Authority over the following issues: 1. Safety of the boiler 2. The rope finish in the communal hall. 3. The hand washing and sluice facility in the laundry room. Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 24 6. YA39 24 Ensure that the system for 07/10/06 reviewing the quality of care at appropriate intervals provides for consultation with service users and their representatives. 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 YA1 Good Practice Recommendations Add information regarding respite care provision to the Statement of Purpose and Service Users Guide. This recommendation is now outstanding from two previous inspections. Devise risk management plans for named service users that may choose to leave. Add more detail on menu records for example what vegetables have been provided, to demonstrate variation and also state who has had what meal, in case of an outbreak of food poisoning. Source mental health training for staff. Review the allocated hours for management duties to ensure that they are adequate for the effective management and running of the home. Obtain a new style accident book, which is designed for data protection. This is repeated from two previous inspections. 2. 3. YA9 YA17 4. 5. 6. YA35 YA37 YA41 Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Linwood House Care Home DS0000002297.V301263.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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