Inspection on 23/02/06 for Maple House

This inspection was carried out on 23rd February 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maple House 07/02/07

Maple House 24/10/05

Maple House 22/03/05

Maple House 03/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Maple House 78 Aldborough Road South Seven Kings Ilford Essex IG3 8EX Lead Inspector Mrs Denyse Lillington Unannounced Inspection 23rd February 2006 10:00 Maple House DS0000025909.V284333.R02.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 Maple House DS0000025909.V284333.R02.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. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Maple House Address 78 Aldborough Road South Seven Kings Ilford Essex IG3 8EX 020 8590 7082 020 8550 0666 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) Mr Alan Philp Mrs Pamela Philp Mr Brad Holloway Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Moderate to high level of disability. To include named people as they reach 65 years of age, subject to the home being able to demonstrate that they are still able to meet their needs. 24th October 2005 Date of last inspection Brief Description of the Service: Maple Lodge is a residential home for Adults with a Learning Disability. The home is situated in a residential road in Seven Kings in the London Borough of Redbridge, with easy access to the local park, shops, places of worship and transport. The nearest shopping facilities are Seven Kings High Road, Ilford Shopping Centre and Newbury Park. Each service user has a single bedroom, individually decorated to a high standard, with personal items that reflects their individual character and interests. The home is part of the Alpam Homes organisation, which operates two other similar residential care homes in the London Borough of Redbridge and also has its own day centre, which service users attend daily, as well as using the Chadwell Day Centre. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived unannounced in the morning. Upon arrival, the staff team were in a staff meeting. Service users were able to choose their activities for the day and 3 service users had gone out. Five service users were in the home and one service user offered the inspector a hot drink. The home was clean and tidy and homely but two fire doors had been left wedged open downstairs, posing a fire and security risk to service users and staff. The staff and service users were relaxed and friendly to the inspector and assisted with the inspection where necessary. The manager was available throughout inspection and was accommodating. There were 9 requirements made and 5 recommendations. This was the second statutory inspection in the inspection year 2005/06. Across both inspections, all core standards have been tested. There are a number of requirements which have been made in reports of previous inspections, and which have not been implemented. Unmet requirements impact on the safety and well-being of service users. Failure to meet the required action by the new timescale will result in the Commission for Social Care Inspection considering enforcement action to secure compliance. Following the receipt of the provider’s response to the draft report some amendments were made to this report – to reflect some of the comments made. What the service does well: The service user care plans were comprehensive and regularly reviewed. The service users do have choices about their chosen lifestyles and have the option to attend day centres if they wish. All service users have access to all health care services and are supported by the staff team with personal care and to take a pride in their appearance. The service users can challenge the service and risk assessments were available in the service user files with details of how to minimise risks to themselves, other service users and staff. The environment was well maintained and personalised. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 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. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 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 Maple House DS0000025909.V284333.R02.S.doc Version 5.1 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): 1,2,5 Prospective service users have most of the information about the home and the services provided contained within the statement of purpose and service user guide. However the fees charged could not be found in these documents or in the service user contracts. Therefore prospective service users and their representatives do not have all of the information needed to make an informed choice about moving into the home. All new admissions to the home would have their needs assessed and all service users have a contract of terms and conditions. EVIDENCE: At the last inspection the manager was not available and the home did not have a system whereby staff had access to the information needed by the Commission to ascertain whether or not the home were meeting the minimum standards. At this inspection, the manager and staff were having a staff meeting and therefore the inspector was able to check the paperwork, which had been unavailable previously. The service user guide and statement of purpose had been updated since the last inspection and it included the required information except for the fees charged. Old service user guides were found in service user files and it is recommended in this report that the updated version replaced the old service user guides to save any confusion. Service users had a contract in their files. The contracts did not include the fees charged, which is a requirement. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 9 The fees were not available for inspection on the day. The manager said that the owners had the information required, but it could not be found at the home. The service user files checked had been reviewed in January 2006. All service users had care plans and risk assessments which outlined the service users’ needs, aspirations, wishes and daily choices, such as attending day centres or other activities in the community. On the day of inspection, five of the service users were relaxing in the lounge in the morning watching television and three service users were out at their chosen venues for the day. Later on the day of inspection, after lunch, a mini bus arrived to take those service users who wanted to go, to a day centre for the afternoon. Maple House DS0000025909.V284333.R02.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): 6,7,9 Care plans reflected the assessed and changing needs of the service users. Staff members do assist service users to make decisions about their lives and take risks as part of an independent lifestyle. EVIDENCE: During the inspection Service Users files were looked at and the care plan covered the areas of: communications, activities in the home, safe environment, eating/taking food and interactions with other residents. Each of the service user care plans were different and individualised, being personalised to the needs of each service user. One of the care plans looked at covered the area of personal care. This documented that improvements had been made, but there was a need for continuing support and the review of the care plan advised staff to be ‘tactful’. It documented that the service user needed a bath each morning and encouragement was needed for the service user to take pride in their appearance and support was needed with washing their hair. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 11 Each care plan was signed by the service user and had regular and planned reviews. Care plans contained risk assessments for service users to enable them to live a fulfilling life, understanding the risks they take and the support they needed from staff to keep them from harm. Service users’ preferences and choices were detailed in their care plans and regular meetings were held with service users to discuss their views and decisions about their lives and lifestyle. The minutes of the service user meetings were checked by the inspector and they were relevant to service users and recorded service users’ participation and suggestions. There was no evidence to show whether or not the service user requests or suggestions were actioned appropriately. Evidence must be available to demonstrate the action taken by the registered persons to follow up requests and suggestions, and whether service users are satisfied with the response. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 12 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): 11,17 Service users take part in activities and are able to meet with their own age and peer group. There are leisure activities and being part of the local community is encouraged. The home encourages service users to have contact with family and friends and their rights and responsibilities are recognised. Service users do have a healthy and enjoyable diet and thoroughly enjoy their mealtimes. EVIDENCE: All the service users in the home do have a number of activities and leisure pursuits to access and enjoy. During the inspection a number of the service users came back from a day centre and some of the service users had remained at the home. The support worker said that they do have a choice and could stay at the home if they wished. One service user does go out independently. One service user at the home was making tea and coffee and offered the Inspector with a cup of coffee when the inspector arrived. Later the same service user was assisting the staff to put crockery away after the washing up had been done. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 13 Service users have contact with family and friends and care plans looked at had documented the regular contact with family. Service users from the home attend a day centre run by the service providers and another day centre where they meet friends they have known for a long time. Service users receive a healthy and varied diet. The fridges and freezers looked at during the inspection were well stocked. These standards had not changed since the last inspection. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 14 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): 18,19,20 Service Users receive personal support in a way they prefer and their physical and emotional needs are met. Service users do not administer their own medication, but are protected by the homes policies and procedures. EVIDENCE: The care plans laid out the way service users prefer their personal support to be given. One service user’s care plan documented that staff must respect the service user’s dignity and privacy at all times and assist the service user to be suitably dressed. The service users’ files documented that their ongoing health and emotional needs were being met. One service user had an ongoing health problem that was contributing to their incontinence. On the service users file was a Redbridge PCT booklet in picture format, which documented their medical information. The home’s medication policy and procedure was in place. Medication Administration Records (MAR sheets) were checked at random against the medication in the blister packs and in individual packets and medicine bottles. These records were fully and accurately completed. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 15 No service user in the home was self-medicating. The inspector did find a discrepancy with the medication records, which was discussed with a member of staff and the manager at the time of inspection. One service user was prescribed ‘chewable senna’ daily, but the medication record sheets had a line crossed every other day by the staff in the home and the staff were giving the service user one chewable senna every other day. When the inspector questioned this, the staff and manager said that the GP had suggested that the service user only had one senna every other day. Nothing was written down by the home or the GP about this discrepancy. The manager must clarify this in writing and a requirement is made in the report to ensure that action is taken to address this issue. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 16 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): 22,23 Service users’ views and concerns are listened to but it is not clear if they are acted on. The home has an adult protection policy to protect service users from abuse, neglect and self-harm. However, as not all staff however were adequately trained in adult protection and the home did not have all the placing authorities adult protection procedures available, the inspector could not be confident that service users are adequately protected from abuse, neglect and self-harm. EVIDENCE: Service users’ files that were checked during inspection had a section on ‘concerns and complaints’ and this policy was in pictorial form, which included the contact details of the Commission for Social Care Inspection, as required. Residents’ meetings were seen as an area where concerns could be bought up and one agenda item was headed “Likes and Dislikes”. There were no dislikes recorded, which is somewhat surprising, as it is not easy to please all of the people, all of the time. The complaints records were checked and although complaints had been recorded there were no records of outcomes or whether or not the complainant had been informed of the investigation or outcomes. There was no evidence that the complainant was happy with the result of the outcomes of the complaint investigation. The inspector could therefore not be fully satisfied that service users feel that their views and concerns are appropriately acted on. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 17 Minutes of staff meetings were also checked and this was another area where the staff considered that concerns might be highlighted. One meeting had documented concerns from the staff about a service user shouting. The staff-training folder was looked at. There was a policy on whistle blowing, complaints and the grievance policy. The inspector checked serious incidents against the accident records and incident records and found that not all serious incidence had been recorded, for example a service user had bitten a member of staff and although this was recorded in the service user file it was not followed up in the incidences and occurrences book or the accident records. Staff members must be adequately trained to deal with incidences such as these and challenging behaviour. Not all placing authorities adult protection procedures were available at the home. The registered person must ensure that there is a clear audit trail from a concern, complaint or allegation being identified, through to the outcome of any intervention or investigation. Maple House DS0000025909.V284333.R02.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): 24,30 The service users live in a homely environment that is clean and hygienic, but fire doors were wedged open which places service users and other occupants of the home at risk from fire or from intruders. EVIDENCE: The service users live in a homely environment that is clean and hygienic, but fire doors were wedged open which places service users and other occupants of the home at risk from fire or from intruders.. During the inspection a tour of the building was undertaken and the home was clean and hygienic. Each of the service user’s bedrooms were comfortable and the lounge was nicely decorated and furnished. It was noted though that the kitchen fire door and the dining room fire door were both wedged open. The staff working in the kitchen needed to be able to have contact with the service users, however appropriate door equipment needs to be in place to ensure fire safety and the security of the building. This had not changed since the last inspection. The registered persons should therefore review the deployment of staff to ensure that the needs of service users are not compromised by staff undertaking domestic chores. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 19 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 Service users are supported by competent and trained staff, they are protected by the home’s recruitment of staff policy and procedures. Staff are training for NVQ to be able to adequately meet service users’ individual and joint needs. Some staff need further specific training. EVIDENCE: Some staff did not have up to date training for food hygiene. The support staff must have this training as they prepare food for service users. The manager explained that all staff will be NVQ trained and the home had put the staff forward for this training. Staff records were checked at random and all the required information and proof of identity was found to be in order. All staff had a relevant CRB check. One staff member had a reference on file that had been written but not signed. The manager was advised to get this reference signed. Staff were observed to treat service users with respect and when asked about service users the staff spoken to understood the service users needs. On the day of inspection the staff team were in attendance for a team meeting. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 20 With reference to the comments made in relation to the section on the environmental standards, concerning fire doors being wedged open to enable support staff to supervise residents, whilst undertaking domestic chores. The registered persons should review the deployment of staff to ensure that the needs of service users are not compromised by staff undertaking domestic chores. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 21 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): 37,39,42 The service users are benefiting from accountable management, as the business plan was eventually made available to the Commission. Quality assurance and monitoring needs development to ensure that service users are receiving good quality care, in accordance with the aims and objectives of the service, as set out in the home’s Statement of Purpose. The health safety and welfare of the service users was being protected by the manager and staff. EVIDENCE: The business plan was not available for this inspection. However the registered manager informed that this document was sent to the lead inspector for the service. Following the registered providers response to the draft report, it was confirmed that the Commission was in receipt of the document and was satisfied that the organisation had provisions in place to maintain the financial viability of the service. The inspector found quality assurance questionnaires in the service users’ files that were 2 years old, so service user views and views of friends and family of Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 22 the home need to be sought as part of the quality assurance monitoring. A quality assurance monitoring system is in place annually and the registered persons provide monthly provider reports to the Commission as required by regulation. These reports could provide more detail and this has been communicated to the registered persons in a meeting with them – most recently. The home had a lockable COSHH cupboard, food storage cupboard and laundry located in the garden. At the last inspection the inspector could not access records that needed to be checked because they were locked away in a cupboard that only the manager had a key to. This issue had been resolved in that when the manager was not on the premises, a manager from another home locally would be able to access the cupboard if needed. The home was adequately insured and the insurance was in date. The certificates for electrical safety, gas safety, fire equipment and infection control were all available and within date. The registration certificate had not been updated since a variation was applied for by the proprietors. One service user was over the age of 65 but the certificate of registration did not reflect this. This matter requires attention, as the Certificate of Registration must accurately reflect the situation in the home. When staff and service users go out for trips or on holiday, no specific risk assessments are written for the safety of everyone, so a requirement has been made in this report. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 23 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 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 x Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES 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 YA1 Regulation 5 Requirement Timescale for action 24/06/06 2. YA24 3. YA20 4. YA22 5. YA23 The Service Users’ Guide must include fees charged in the contracts. This is repeated from previous inspections. 23(4),12,13 The Registered Person must ensure the safety of service users and staff with regard to fire safety; fire doors must not be wedged open. This is repeated from previous inspections. 13 Staff must provide service users with the medication prescribed and must not alter the medication records unless the GP has given written permission. 22 All complaints made to the home must be followed up by the manager and investigated where necessary. The outcome of the investigation must be recorded and the complainant’s views of the outcome recorded. 18 All staff must have specific training to meet the needs of service users, this includes adult protection, challenging behaviour, food hygiene. DS0000025909.V284333.R02.S.doc 24/02/06 24/03/06 24/04/06 24/06/06 Maple House Version 5.1 Page 25 6 YA23 13,18 7 8 YA23 YA34 37 17,18,19 9 YA42 12,13 The registered persons must have copies of the all the placing authorities adult protection procedures available. Staff must report all serious incidences of violence. References received for staff recruitment must be signed by the person writing the reference. The home must provide risk assessments specifically for outings, trips and holidays. 24/05/06 24/02/06 24/03/06 24/06/06 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 2 3 4 5 Refer to Standard 1 9 20 22 YA33 Good Practice Recommendations It is recommended that old copies of the service user guides are replaced with the updated guides to save any confusion. Requests made by service users in meetings should be followed up by staff to show evidence that action has been taken to address these requests or suggestions. Staff should not rely on verbal instructions to change medication by the GP but insist on written instructions before altering medication records. When complaints are made by service users, written evidence that these complaints or concerns have been appropriately actioned should be recorded. The registered persons should review the deployment of staff to ensure that service users needs are not compromised by staff undertaking domestic chores. Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Maple House DS0000025909.V284333.R02.S.doc Version 5.1 Page 27 - 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. 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