Inspection on 25/02/09 for Magnolia Lodge

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Magnolia Lodge 09/12/09

Magnolia Lodge 28/04/08

Magnolia Lodge 25/04/07

Magnolia Lodge 05/10/06

Magnolia Lodge 30/11/05

Magnolia Lodge 15/12/04

Magnolia Lodge 16/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Magnolia Lodge Herbert Road Chelston Torquay Devon TQ2 6RP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stella Lindsay     Date: 0 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Magnolia Lodge Herbert Road Chelston Torquay Devon TQ2 6RP 01803605348 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : magnolia@hotmail.co.uk Rotel Ltd care home 11 Number of places (if applicable): Under 65 Over 65 11 learning disability Additional conditions: Date of last inspection Brief description of the care home 11 The last key inspection took place on 28th April and 7th May 2008. Magnolia Lodge is a care home for up to eleven adults with Learning Disabilities. This large detached house is in a residential area of Torquay, close to the railway station, bus routes, and the Riviera Centre. There is car parking space at the front of the house, and gardens to the back. There is level access to the house, through a sun lounge. The lounge, dining room, kitchen office and laundry are on the ground floor, as well as six bedrooms, each with an en suite toilet and shower or bath. One of these is currently used by staff on sleeping in duty. Stairs lead down to a flat on the lower ground floor, occupied by one resident. There is another staff bedroom on a mezzanine floor, and six further residents bedrooms and a bathroom on the first floor. Current fees range from 425 to 998 pounds per week, and transport is provided in the homes minibus at 40 pence per mile, divided by the number of passengers. Taxis are paid for by the resident if the minibus is not available for essential appointments. Information about the service is available in the lounge. The previous inspection report may be obtained from the office on request. Care Homes for Adults (18-65 years) Page 4 of 30 Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on 25th February and 3rd March 2009. The Pharmacy Inspector came on the first morning to inspect the medication system in the home. During our visit we spoke to five people who were living at Magnolia Lodge, one of the Directors, the manager, and five other staff members who were on duty. We case tracked two people who use the service. Case tracking means we looked in detail at the care these people receive. We spoke to staff about their care, looked at records that related to them, met with them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records and policies and procedures. Care Homes for Adults (18-65 years) Page 6 of 30 We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. The Manager had sent some information about how the service is run. All this information helps us to develop a picture of what it is like to live at Magnolia Lodge. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information that was available for prospective Service Users was incomplete, and needed better presentation to help people understand it. Shortfalls in management decisions had lead to residents needs not being met, but action was being taken to prevent any recurrence. Evidence: A statement of Purpose was available in the office. It needed to be made specific to Magnolia Lodge, with information about current staff and their qualifications. There was also a brochure and Service Users guide. The Manager told us that she planned to improve these with additional pictures and symbols, to help people understand. There had been one admission since the last inspection. It had been arranged as an emergency, which meant that the person did not get a chance to visit, and the current residents did not have the opportunity to meet the person before they moved in. The health and social service staff provided full information about the persons history, care needs and what staff should watch out for as alerts to potential problems. It was not Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: clear that this home could meet these needs. Staff told us they would have found it useful to meet as a group to discuss potential hazards and ways of dealing with issues, as people ask different questions, and they do not always think of all the possibilities when reading care plans and risk assessments. It was not obvious how this home might succeed with the complex issues involved which were outside their regular service provision. Additional training for staff was not agreed at the time of admission. During this inspection, another prospective resident was visiting. An arrangement was made for them to return for tea later in the week, to meet other people living in the home. The Manager was giving careful consideration to the professional assessment of the persons needs. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were being developed in consultation with residents. Changes had been made in the service which showed that residents were listened to. Risk assessments had not prepared staff to deal with a partially predictable event. Evidence: We saw that care plans were written in a clear form, with the issues listed on the left of the page, and How can you help me written on the right. These covered personal care in useful detail, as well as communication, eating and drinking, medication, relationships, and handling money. We saw that aims and goals still needed to be worked out for some residents who could not communicate these easily. We saw that Person centred planning was being introduced, as a shell was available but needed to be completed by the resident and keyworker together. We saw that staff involved residents in discussion about activities of daily life, such as meals and colour schemes. Changes had been made, such as an additional staff member at weekends to enable outings. This was in response to residents requests. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We looked at the money that is held on behalf of residents, and saw that they had not been expected to pay for items that the home normally provides. Some had paid considerable sums for taxi journeys. The Manager said this was a last resort, as the minibus was made available when possible. All staff had attended training in the implementation of the Mental Capacity Act, and understood the potential need for assessments for residents. Risk assessments had been written, to tell staff how risky activities or behaviours could be made safer. Some staff who spoke to us were very well aware of these, but not all. In one case, the risks were documented, and staff were aware of the triggers that had in the past alerted carers to a the emergence of disturbed behaviour. They did not have advice on how to act in the event of a disturbance, and they had not discussed the team approach. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has improved arrangements to give residents choice in activities, including at weekends. Good meals are provided. Resident involvement in cooking and meal preparation could be further developed. Evidence: Residents were participating in a variety of activities. Two residents were at home during the day. One of these considered themself to have retired from their day placement, and the other was unwell. Rotel provide day care in a facility called Focus 2000 which has recently moved closer to Magnolia Lodge. During this inspection three Magnolia Lodge residents were attending this provision, with one of the Support staff from Magnolia. People going to Focus 2000 from Magnolia take packed lunches with them. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: One enjoyed horticulture and also worked regularly on a training farm. They said they would like staff to work with them to devlop the garden at home. At the previous inspection, residents had asked for more staff to be available at weekends to give them opportunities for more activities. This was being arranged, and a new worker, able to drive the minibus, had been appointed and was due to start work at weekends. The Manager told us that another staff member had been given the role of Activity Organiser, and had started to compile a record of the outings that had been enjoyed. These included an ice show, and a visit to Living Coasts to see the penguins. There are enough staff to enable people to choose whether to go or stay. Holidays were being arranged. Discussions were still going on, with the intention of making arrangements to suit each resident. Parties had been enjoyed, including Christmas and Valentines, and residents were encouraged to invite family and friends. Relationships with families were seen to be supported. One had visited a family member during this inspection, while another was excited about plans to move closer to their family. Support staff cook the main meal for around 5.30pm, when people come home from their day activities. Photo menus were on display in the hall. The support worker who was cooking during this inspection said that when people come in, she tells them what is for supper, and if they do not want it she will offer them a choice of alternatives including ommelettes and jacket potatoes. During this inspection we saw that she gave residents a free choice in what they had for lunch. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff had a good understanding of residents support needs. The handling of medicines at the home does not put people at risk although there are some areas where improvement can be made. Evidence: We examined the care plan of one of the more dependent residents and found that details of personal care were clearly recorded, so that staff would know how the person liked to be supported. The care plan included advice to staff on the persons communication needs, and how to help when their behaviour was disturbed. The Aims and Goals still needed to be clarified. The plan had been checked monthly, but no changes or developments recorded. We found that medicines are stored in secure cabinets and that the keys to these cabinets are looked after safely. However one of the cabinets was not fitted in accordance with the current regulations. We found that staff had good information about how to support people to take their medicines although some detail for staff to make decisions about administration was missing. The recording was not good enough to show why some residents had, or had Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: not, been given medication, or who had made that decision. It was not possible to know whether the correct amounts of medication were in stock, due to gaps and inaccuracies. The Manager introduced improved systems of recording promptly to deal with these issues, and agreed to audit the records monthly. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management decisions had resulted in residents and staff not being protected from harm. However, management were working energetically to improve training and procedures, to ensure protection from harm in the future. Evidence: There is a complaints procedure, and residents who returned our surveys said they knew who to speak to if they had worries. Residents meet regularly for 1;1 discussions with their keyworker in the home. No formal complaint had been received by the home since the previous inspection. Residents also had the opportunity to share concerns at the house meetings, the latest of which had taken place on 03/02/09. They said at this meeting that they would not want anyone admitted to Magnolia Lodge who brought alcohol into the home. This anxiety was a result of a recent incident in the home. Staff and residents had been at risk and staff on duty had been powerless to prevent serious harm. The aggression involved could not be predicted by the staff, as there was no clear diagnosis, or understanding of how the person might progress. The unpredictability and violence of the incident made it impossible for staff to assure the safety of vulnerable adults in their care. There was no advice on the care plan of what to do in the event of an assault, and staff told us they had not discussed such an eventuality as a staff group. Staff also said they needed more training to deal with other dangerous situations, for example, if a resident is seriously self harming. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Since this event, staff training in dealing with aggression has been arranged, and attention has been given to maintaining and improving security in the house. The home had a full and comprehensive policy on dealing with allegations of abuse. The Manager undertook to find the contact number for the local safeguarding team. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the environment, in line with residents wishes. Evidence: The Directors had arranged for interior redecoration and new carpets, and the house was looking bright and comfortable. New sofas had been provided in the lounge, some with chair raisers so that residents could all get up independently. New wooden dining tables had been provided. We were advised that more new furniture would be arriving shortly after this inspection. A door bell and lock had been fitted to the front door, for improved security. No current resident smokes, but management had plans for an attractive garden shelter for any future smokers. One resident who previously had difficulty getting into a bath or shower was about to move into a room which had an en suite shower with enough space for easier access. One resident was proud to show us their private room which had recently been refurbished. They said they had chosen the colour scheme, and were pleased with new light fittings as well as a wide screen television. Liquid soap and paper towels were available in bathrooms. The laundry was in good order, as was the kitchen. A dishwasher had been provided, which is good for hygienic cleaning of dishes and cutlery. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The bath in the upstairs bathroom had damaged enamel, which is potentially hazardous, and twleve shampoo bottles were on the side of the bath, which also pose a potential risk to residents. We found that although upstairs bedrooms were fitted with restrictors to protect residents, the upstairs bathroom window opened wide. This was dealt with immediately. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were committed and well motivated. Training was being provided. Additional staff had been appointed to enable more social activities at weekends. Evidence: We met with five staff who work at Magnolia Lodge, and we received five surveys. We found that they were at ease with the residents, good listeners, and the residents felt they could trust them. All had achieved National Vocational Qualification in care or were working towards it. We looked at the files of two staff who had recently been recruited and found that all the checks required to protect residents from potential harm had been obtained or applied for. Additional staff have been appointed in response to residents requests for more opportunities for outings at weekends. A cleaner had just been appointed, for two mornings per week. As the environment has been improved, there is an initiative to keep it bright and clean. There has been an awake Night Carer three nights per week for a year, to provide emotional support for a resident. On other nights, one of the day staff stayed up till 12 midnight for this purpose. Residents had met the new staff in the process of their recruitment. One was particularly pleased that a new Support Worker will be able to drive at weekends. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: There were a minimum of two staff on duty at any time. Some staff work very long shifts, the longest being from 8am on a Friday morning to 9am on the following Monday morning. This is good in that it provides continuity for residents, but management must be vigilant to ensure that fatigue does not impede staffs performance, and that staff attention is directed towards residents while they are on duty despite long absences from their home. Residents said that staff sometimes had long conversations on their mobile phones. A Skills for Care Induction programme was available. It had not yet been used but the Manager said it was in place for the new staff. Staff told us they were delighted with the training that was being provided now. Training had been provided in Moving and Handling, Infection Control, safe handling of medication, and risk assessment. Training for all was being arranged in Conflict resolution, and in breakaway techniques. The Manager showed us the arrangements she had introduced for providing individual supervision sessions for the staff. All but one of the staff who returned surveys said they were happy with the support they had from management. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If the current management input is sustained, a safe and reponsive service will develop. Evidence: Iona Fusco is the Responsible Individual for Rotel. She and a brother who is also a Director of the company give management support to Magnolia Lodge. Staff said how pleased they are that the Directors have increased their presence at the home recently, giving prompt attention to practical requirements and resources for staffing, training and other requirements. Iona also provides management support to the Manager, who was appointed in September, having moved from another Rotel establishment. She has not yet applied to register with the CSCI, or completed her NVQ training in care and management. These three people provide out of hours support and advice to the shift workers. There was no particular arrangement to tell staff who they should call upon. The Manager had reviewed all policies and procedures in the home. We saw that record keeping in the home was to a good level, and where deficiencies Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: were found, in recording of medication, this was promptly improved. Records showed that the electrical system and the fire alarm system had been checked and serviced. Fire training had been held in July 2008, and a new trainer was being sought for an up-date. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The Manager must as far as possible assure herself and the staff team that they can meet a persons needs before accepting responsibility, or consider what additional resources are needed to ensure a positive outcome to ensure that they offer their service appropriately and safely 05/04/2009 2 20 13 Arrangements must be made to fix the Controlled Drugs cupboard in accordance with the current regulations This is to ensure that these medicines are not diverted from their prescribed use. 30/04/2009 3 23 13 Scrutiny of risk assessment and care planning followed by staff training as needed must be maintained by management 05/09/2009 Care Homes for Adults (18-65 years) Page 28 of 30 to protect the rights and best interests of residents and the safety of all. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 4 9 Residents should be consulted before a new admission and during their trial placement. Risk assessments should be reconsidered by the staff team, to ensure that all know how best to react in any worst case scenario, and to enable staff and management to consider what additional training or other resources might help. It is recommended that guidance around the use of specific medicines be reviewed with the person receiving the medicines, so that they will receive them consistently from all members of staff administering medicines. The medication system and records should be audited monthly. Good standards of safety and hygiene should be maintained in the upstairs bathroom. The Manager should submit her application to register with the Commission for Social Care Inspection. The Manager should complete her Registered Managers Award and NVQ level 4 in Care and Management. The Manager and Directors should arrange a rota to let staff know which of them is available and on-call in the event of an emergency. 3 20 4 5 6 20 27 37 7 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - 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!