Inspection on 30/03/06 for Litslade Farm

This inspection was carried out on 30th March 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 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

Litslade Farm 23/08/06

Litslade Farm 29/06/05

Litslade Farm 22/03/05

Litslade Farm 24/05/04

Litslade Farm 20/11/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Litslade Farm 2 Bletchley Road Newton Longville Bucks MK17 0AD Lead Inspector Sue Smith Unannounced Inspection 30th March 2006 12:55 DS0000023077.V287885.R01.S.doc Version 5.1 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 DS0000023077.V287885.R01.S.doc Version 5.1 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. DS0000023077.V287885.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Litslade Farm Address 2 Bletchley Road Newton Longville Bucks MK17 0AD 01908 648143 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) Hightown Praetorian & Churches Housing Association Mrs Olive Bateman Care Home 5 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000023077.V287885.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 people, learning disabilities, physical disabilities Date of last inspection 29th June 2005 Brief Description of the Service: Litslade Farm is a small community home providing care and support to 5 Service Users with learning disabilities. The home is situated in the small village of Newton Longville, within driving distance to the Bletchley local amenities and Milton Keynes City Centre. The home is a bungalow that has been adapted to meet the long-term needs of the Service Users, situated in a pleasant and well-maintained garden. The Manager is suitably qualified and experienced to undertake her role, providing a high quality service to vulnerable Service Users. DS0000023077.V287885.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 30/03/06 at 12.55pm to 3pm. The Manager was available during the last hour of inspection. The inspector spent time assessing Careplans, Risk Assessments, Menus, Recruitment files, Supervision files and Induction Packs. Unfortunately due to the limited communication skills of the Service Users it is hard to gain their views, therefore the Inspector sat with them in the dining area observing practice and the activities they were involved with. All Service Users were relaxed and happy in the environment, there was pleasant music playing and some were involved in tabletop activities. Staff were interactive throughout ensuring the needs of the Service Users were met and supporting them to undertake the activities. 18 of the Standards were assessed with outcomes of 17 standards fully met, and one partially met. As a result of this inspection 1 requirement and 1 recommendation have been made. The inspector would like to thank the staff and Service Users at Litslade Farm for the warm welcome and assistance in completing the inspection process. What the service does well: Provides up-to-date plans of care which outline the needs of Service Users Ensures Service Users are able to participate in meaningful and enjoyable activities. Supports Service Users to attend a local college. Provides Service Users with a balanced, nutritious and tasty diet, which takes into consideration the likes and dislikes of Service Users as well as their ongoing health needs. Robust medication procedures are in place offering protection and support to the Service Users. The home is a pleasant bungalow set in pretty and well-maintained gardens. The home is well maintained, providing equipment and adaptations necessary to support Service Users. DS0000023077.V287885.R01.S.doc Version 5.1 Page 6 The Organisation ensures all recruitment of staff includes thorough security checks, which includes 2 written references, a CRB Disclosure and a POVA List check. Staff are supported by the Manager, undertaking regular 1:1 supervision sessions to discuss practice issues and changes in the needs to Service Users. All new Staff complete a 6-month induction pack to support them in their role. Staff are competent in their role, possessing a clear understanding of the needs of the Service Users and how to communicate with them. The Manager operates a hands on, open door policy, which ensures staff are able to approach her with any issues of concern. The Manager is suitably qualified in her role, recently completing her Registered Managers Award to support her practice. What has improved since the last inspection? What they could do better: A plan of decoration is urgently needed to address the present poor quality of the bathroom. A requirement has been made to this effect. The home needs to ensure a risk assessment is put in place for the use of medication cupboards in Service Users bedrooms. A recommendation is made to this effect. The home needs to ensure all areas of the Careplan are reviewed in line with the review dates. DS0000023077.V287885.R01.S.doc Version 5.1 Page 7 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. DS0000023077.V287885.R01.S.doc Version 5.1 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 DS0000023077.V287885.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed during this inspection however standards 2 and 5 were assessed as met during the June 2005 unannounced inspection. DS0000023077.V287885.R01.S.doc Version 5.1 Page 10 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. Plans of care, which support the service users, are in place, thus ensuring their identified care needs are met. Service Users are supported to make decisions about their lives, ensuring they are supported to express their personal preferences. Risk assessments are in place, which ensure the Service Users are able to maintain their independence in a safe manner. EVIDENCE: Careplans for Service Users were assessed during this inspection. Careplans were generally well maintained providing up-to-date information on the identified needs and personal goals of the individual. Careplans contain a pen picture of the wants and needs of a Service User, which outlines how the Service User prefers care to be implemented. Link Worker plans which provide the Link worker with a list of important dates and events significant to the Service User are provided, these ensure such things as birthdays, anniversaries and appointments are listed which enables DS0000023077.V287885.R01.S.doc Version 5.1 Page 11 staff to support Service Users to maintain relationships and attend necessary appointments. A daily and night time diary is provided which contains clear notes of the care implemented, activities undertaken, general mood of the Service User and any other useful information which staff can read to up-date themselves on the Service Users day. These were well written and informative. Lifestyle Plans, which provide a description of activities planned, daytime appointments and leisure and household tasks to be undertaken on any given day are in place. These are colour coded to ensure staff are able to clearly identify what support is required on any given day. A record of family and friend contacts is maintained; this describes the type of visit, the amount of privacy that was offered and how successful the visit was. Support Plans are in place, which identify the goals Service Users are working toward. These are supported by Staff Plans to Prepare for Support, Deciding on Support notes and Support Plan Reviews, these were generally well maintained with the inspector identifying one Deciding on Support document requiring to be up-dated to reflect current identified plans for the Service User. The Inspector discussed this with the Manager and will leave it in her capable hands to ensure it is completed as soon as is possible. In addition to the general support plans Service Users have documented evidence of monthly weight monitoring, epilepsy monitoring and continence records. Within the Careplan individual Risk Assessments are in place, which are developed in a manner that ensures the Service Users, are able to maintain their levels of independence in a safe manner. Measures implemented to reduce the risks to Service Users are reflected in the risk assessments with a date of review and a review document included. In most instances the risk assessments were found to be up-to-date and reflective of reviews, some of the assessments have been identified for review on the 23rd March 2006 which the Manager needs to ensure is carried out as soon as is possible to avoid confusion and future requirements on the Service. One Service Users Risk Assessments has a reflected review date, which needs to be changed immediately due to a mistake in the year recorded. A recent Monitoring Audit carried out by the Organisation has also highlighted this. The Manager has assured the Inspector this will be carried out during her afternoon shift on the day of inspection. The staff work hard to ensure Service Users participate in the decision making that affects their daily lives, this is no easy task when taking into consideration the limited communication skills of the Service User group. The staff team are DS0000023077.V287885.R01.S.doc Version 5.1 Page 12 to be commended for their achievements and the manner in which it is recorded, providing future staff with clear guidance on preferred methods of communication. Throughout the inspection staff were observed talking with Service Users in a friendly and inclusive manner, it is evident the home is Service User focused, ensuring all activities and day to day routines are discussed with the Service Users. Service Users appeared happy and content, they were well dressed, clean and tidy, giving further evidence of appropriate support to Service Users. DS0000023077.V287885.R01.S.doc Version 5.1 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 & 17. All Service Users at Litslade Farm take part in meaningful and enjoyable activities, ensuring they are able to access and become part of the local community. Service Users are supported to access local educational facilities and improve on their independent living skills, thus ensuring they are able to reach their full potential. Menus are planned with the Service Users taking into consideration their likes and dislikes, ensuring the home provides a balanced and nutritious diet to its Service Users. EVIDENCE: The Service Users at Litslade Farm continue to expand their list of Activities, with some excellent examples of staff observations as to the likes and dislikes of Service Users aiding them to implement a meaningful and enjoyable programme. DS0000023077.V287885.R01.S.doc Version 5.1 Page 14 As well as the fun aspects of activities the home has worked hard to ensure the Service Users of Litslade Farm have been able to access educational courses at the local College. Four Service Users now attend the college for learning sessions with one service user attending without staff support. This is a great achievement for the Service Users and one that has taken three years to develop to ensure successful outcomes for the service Users. Annual holidays are planned with the Service Users; these are planned in a manner that provides the Service Users with an enjoyable and relaxing experience. One Service User has a holiday independent to his peers, as this is the best possible manner in which to ensure he has an enjoyable outcome. One holiday has already been planned for this summer with other Service Users still deciding on where they would like to go; once this has been achieved bookings will be made. The home provides tasty and nutritious meals, which ensure the ongoing health of Service Users. Menus are planned with the Service Users each Sunday using picture cards, which have, colour pictures of meals and individual food products. The home have also engaged the services of a dietician due to the support needed for one Service User, this has been a positive initiative which has supported the home to provide him with balanced meals, cutting down on the number of cakes and treats offered to ensure positive outcomes for this Service User. On the day of inspection the Service Users were awaiting the planned birthday party for one Service User with a buffet of finger foods prepared and a sumptuous birthday cake. The staff are to be commended for their commitment to ensuring birthdays and other relevant anniversaries are catered for which includes fun and enjoyable activities. DS0000023077.V287885.R01.S.doc Version 5.1 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): 20. Robust medication procedures are in place, which ensure Service Users are protected. EVIDENCE: The home follows the Organisations Medication Policy ensuring all staff that administer medication receive suitable training. MAR (medication administration records) sheets were found to be up-to-date with no gaps evident. All medication is stored appropriately in a metal lockable facility. Opening dates are reflected on all bottles and boxes to ensure there is no out of date medication held in the home. A system for countersigning the medication is in place, with the senior member of staff coming on duty checking all medication stocks and comparing with the administration records to ensure any issues of concern can be raised as soon as possible. The Senior then documents this monitoring has been undertaken on the handover recording sheet. The home have explored whether or not to place lockable medication cupboards in the Service Users own bedrooms rather than one central facility DS0000023077.V287885.R01.S.doc Version 5.1 Page 16 in the office. It has been decided the risks it would pose to Service Users outweighs this as a suitable initiative for change in the home. It is recommended that a written risk assessment be formulated to reflect these findings. DS0000023077.V287885.R01.S.doc Version 5.1 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. Complaints are fully investigated and documented in line with the Organisations policies and procedures, ensuring all complaints are resolved in the best interest of the Service Users. EVIDENCE: The home has received no complaints in the past 12 months. Should a complaint be made the home ensures all investigations take place within the recommended timescales for action. All documentation relevant to complaints is held in a secure file. DS0000023077.V287885.R01.S.doc Version 5.1 Page 18 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, 29 & 30. Litslade Farm is a homely and well-maintained environment, which ensures the Service Users live in safe and pleasant surroundings. Single occupancy bedrooms are provided for all Service Users, which are decorated taking into consideration the personal preferences of Service Users. Sufficient numbers of toilets and bathrooms with suitable adaptations are available to Service Users, ensuring the needs of Service Users can be met. Large and homely communal space is provided to Service Users ensuring they are provided with equipment, which enables them to live in a comfortable and homely environment. All adaptations and equipment necessary to maintain the independence of a Service User are provided. The home is cleaned to a high standard ensuring infection control measures and current legislation is adhered to, thus ensuring the safety and ongoing wellbeing of Service Users. DS0000023077.V287885.R01.S.doc Version 5.1 Page 19 EVIDENCE: Litslade Farm provides its Service Users a homely and relaxed environment to live in. The home is well maintained with suitable adaptations and equipment to support them. Communal areas are large with comfy furnishings. Pictures of the Service Users and ornaments are displayed throughout, providing a homely and relaxing area for Service Users to enjoy. HI FI equipment, a large television and other equipment are available for Service User use. An open plan kitchen and dining room are available to Service Users, which is greatly utilised with Service Users observed during the inspection sitting around the dining table pursuing individual activities. Suitable numbers of toilets and bathrooms are provided with adaptations in place to support the Service Users. The main bathroom still requires decoration as this area is starting to look very shabby with peeling paint and damage to grouting evident. The inspector has previously mentioned this as the weakest point in the facilities provided and will require the Organisation to provide a decoration plan that addresses this issue as an urgent area for repair. Individual bedrooms are reflective of the needs and personal likes and dislikes of Service Users. These are pleasantly decorated; colour coordinated and provides each Service User with a private and pleasant space. Furnishings and fittings are of a high standard and reflective of the needs of the Service User. The home was found to be cleaned to a high standard on the day of inspection with no offensive odours present. Suitable laundry facilities are provided with no outstanding laundry present during the inspection. Secure facilities are provided throughout the home to store items classified as C.O.S.H.H. with all cupboards found to be locked on the day of inspection. There were no items of C.O.S.H.H. found around the home. There is sufficient heating and ventilation provided throughout the home with adequate amounts of hot water available to bathrooms and personal hand basins. These were all running within the recommended 43°c - 45°c ratio therefore protecting the Service Users from harm. Relevant records for the testing of temperatures were open to inspection. DS0000023077.V287885.R01.S.doc Version 5.1 Page 20 The home is set in a well maintained and pretty garden, Service Users participate in the up-keep of the garden, growing flowers from seedlings, planting and weeding. DS0000023077.V287885.R01.S.doc Version 5.1 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): 34 & 36. The Organisation has robust recruitment procedures, which ensures staff undertaken relevant security checks, which deems them, appropriate for the role. Support and supervision are offered to staff throughout their employment to ensure the home is run in the best interest of Service Users and protects them from harm. EVIDENCE: Records of two staff members employed since the last inspection were inspected. These records were found to contain evidence of successful security checks, which included two written references, a CRB disclosure reflecting a clear POVA check. In addition relevant information validating the identity of staff is held on file, which includes a form of picture I.D. Supervision records were open to inspection with all staff receiving supervision at least 4-6 weekly. Evidence of an annual appraisal taking place was on file. All new staff undertake a full induction programme which the Manager aims to complete within 6 months of employment, this seldom runs over the six months, however this system is dependent on the availability of appropriate mandatory training courses. DS0000023077.V287885.R01.S.doc Version 5.1 Page 22 The home is presently well staffed with only 1 full time vacancy and 1 32hr vacancy. These hours are being covered by regular staff (up to 2 shifts per week) and two bank workers. The home is not using Agency staff at this time. DS0000023077.V287885.R01.S.doc Version 5.1 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): 38. The Manager is suitably qualified and experienced to execute her duties, ensuring the service is run in the best interest of the Service Users. EVIDENCE: The Manager has recently completed her Registered Managers Award and has now received her certificate validating this qualification. In addition to this she is a Registered Nurse with many years experience working with this Service User group both in the community and in their previous hospital setting. The Manager is hands on in her approach, undertaking shifts to ensure she is available to both the Service Users and Staff. The Manager operates an open door policy which was evident throughout the inspection with Service Users visiting her in her office and staff asking to speak with her concerning changes to Rotas. Her management style is appreciated by her staff who have always reported finding her approachable. Presently the Manger is overseeing another of the Organisations projects as well as her own, CSCI received notification of this and has agreed it is a DS0000023077.V287885.R01.S.doc Version 5.1 Page 24 suitable short-term solution whilst the Organisation recruits a replacement Manager. The Manager has ensured she keeps the Commission up-to-date as to the progress of the recruitment. At this time the Manager is dividing her hours of work between the two projects spending 3 days per week at Litslade Farm undertaking administration duties and 2 days administration duties at the other project. The inspector does not have any issues of concern with this arrangement as it presently has had no adverse effect on the Service Users at Litslade Farm, however the inspector advises liaising with the Link Inspector for the other project to ensure the arrangement is a mutual success. DS0000023077.V287885.R01.S.doc Version 5.1 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X X 3 X X X X X DS0000023077.V287885.R01.S.doc Version 5.1 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 27 Regulation 23 (2) Requirement A decoration plan to repair and improve the existing bathroom facilities needs to be submitted to the Commission within 2 months of this report. Timescale for action 30/05/06 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 20 Good Practice Recommendations A risk assessment is formulated for the fitting of lockable medication cupboards in the Service Users own bedrooms. 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