Inspection on 23/01/06 for May Morning

This inspection was carried out on 23rd January 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 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

May Morning 01/12/06

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

CARE HOME ADULTS 18-65 May Morning Barrow Hill Sellindge Ashford Kent TN25 6JG Lead Inspector Lois Tozer Announced Inspection 23rd January 2006 09:45 May Morning DS0000065338.V280380.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 May Morning DS0000065338.V280380.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. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service May Morning Address Barrow Hill Sellindge Ashford Kent TN25 6JG 01303 813166 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) CareTech Community Services (No.2) Ltd Miss Amanda Clare Ena Waghorne Care Home 8 Category(ies) of Learning disability (8) registration, with number of places May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: May Morning is a large property which offers care for a maximum of 8 service users who have learning disabilities; current Residents predominately having Autistic Spectrum conditions or Aspergers syndrome. It is situated in Sellinge, with access to a local shop and pub 10 minutes walk away. The towns of Ashford, Hythe and Folkestone are accessible by the public bus service and by using the home’s dedicated vehicle. The home is owned and operated by Caretech Community Services (No 2) Ltd. Day to day management is conducted by Registred Manger, Miss Amanda Waghorne.. The home is set in approximately 2 acres of ground, and shares some outdoor space with another Care Tech property. The home offers 5 communal rooms, two lounges, one dining room, a snozelan room, and an art and activities room, which can be accessed for private use if required. All bedroms are registered for single occupancy. May Morning has a restricted access policy in place, which is a requirement to manage specific service user behaviour and to ensure no unaccompanied service users come into contact with the busy road nearby. The Home has reviewed safer access to the garden and now is able to offer a greater level of freedom for the residents. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 23rd January 2006 between 09:45 and 16:45. The manager, Miss Amanda Waghorne, was available throughout the inspection and offered assistance wherever required. The home is registered to accommodate 8 people, and is fully accommodated. All service users met up with the inspector, and all gave some feedback, be it verbal, observed or signed. Three service user comment cards were returned, and these helped gain an impression of life in the home, which was generally positive. One indicated that sometimes staff didn’t listen, and this issue, when explored, is being addressed by the manager. Other service user comments from verbal and comment card feedback included (paraphrased) - ‘I like the staff’. ‘I like everything about the home’ ‘Parents cant always come here, but I am supported to get to their house, and I use the phone each week to keep in contact’. ‘I get privacy’. ‘Its good here because when I ask for a trip, it is arranged’. ‘I like my friends, going out, nice bedroom, shopping and going on holiday. I like wearing my suit, and I trust X with my problems, and know I should speak up if I am unhappy’. ‘I am happy, I like this room (smile)’. ‘I like the people I live with, things I do here, like swimming and bowling’. As well as speaking to a service user and staff, records of activities, health and safety logs and documentation, medication, physical intervention plans, quality assurance, and training were inspected. A tour of premises and communal areas, 6 bedrooms were seen. What the service does well: After a prolonged period of considerable instability, the home now has a registered manager who has lots of experience with the needs of the service user group. The people living at the home benefit from being supported by staff who treat them as individuals and include each person in decision making. Key working systems have been reviewed, and staff seek individuals views, and document them, on a weekly basis. Care, support, development plans, and risk assessments are well written and explain what support should be given in known scenarios. Staff have received a wide range of training that help them meet service user needs, such as Makaton, managing challenging behaviour and avoiding conflict and the manager has a wide knowledge on Autistic Spectrum Disorders and Aspergers syndrome. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: This home has shown marked improvement over the last 6 months. The manager knows the areas where improvement is still needed and has realistic goals that will sustain the service users continuity of support. Its recommended that a fully ‘person centred’ approach to care and goal planning is used, that can be better understood by the service users. Requirements made at this inspection can be easily met, and two are focused on improving the environment and include sorting out the heating in the rear ‘quiet’ lounge, as it is very cold, and the radiator, linked to the main system, is only barely working. The ceiling lighting in the upstairs corridors has experienced continued problems with bulbs blowing, and has resulted in dark corners – the problem needs solving properly. Medication is generally well managed, however a few shortfalls were seen, including liquid medication that was in use did not have a prescription label on it; the medication cupboard was overstocked, and needed a clean and a record of the medication fridge temperature needed to be kept. May Morning DS0000065338.V280380.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. May Morning DS0000065338.V280380.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 May Morning DS0000065338.V280380.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): 1, 2 Information is available in a variety of ways that informs perspective service users about the home. Needs assessments are conducted to ensure individuals will have the right support when living in the home. EVIDENCE: The standard statement of purpose and service user guide (SUG) is written in plain English. The SUG is aided with pictures, and, as part of the preadmission assessment process; individual photographic introductions to the home have been created making it more meaningful to the person. Individual assessments are carried out by experienced managers and staff, and take place in the persons current home, covering the full range of necessary topics. Funding is discussed prior to placement being offered, ensuring any special support requirements or hobbies are adequately supported. May Morning DS0000065338.V280380.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, 10 The service user plan is reviewed regularly to reflect personal developments, changing support needs and aspirations. Staff facilitate meaningful decisionmaking and ensure that all service users are involved and participate in aspects of running the home. Risks are well thought out and are documented with action to increase participation but reduce harm. All documentation is stored safely. EVIDENCE: Big improvements have taken place within this group of standards. The individual plans are meaningful, and support the person to get the most out of their life. Staff contact with service users has increased, and the whole concept of decision-making and participation in day-to-day activities, such as cooking, cleaning, snack and drink making has been reviewed. People who were previously limited or excluded from such activities are now regularly participating, and the calm atmosphere, and visible reduction of stress-related behaviour seen during the inspection was a credit to the staff and management team. Where participation is unlikely to be accepted, it is nevertheless offered. A minor point for improvement would be to record that events have been offered to people who seldom participate, so what or how a task that is being offered can be reviewed. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 11 Risk assessments are in place for known events and activities that are common to all. Individual and specific risk assessments are incorporated within the individual support plan where necessary, thus making the reader more aware of the importance of consistency. All documentation is stored securely and is available on a need to know basis. May Morning DS0000065338.V280380.R01.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, 12, 13, 14, 15, 16 Support given to increase service users chances of personal development has improved. Activities are those chosen by service users, and staff ensure that they are reviewed regularly with the changing and developing needs of the individual. Many activities take place in the local and wider community, including leisure and work experience. Friendship opportunities have been highlighted as needing greater support, so the home has plans to increase individual access to social networks. Service users feel respected, and observations indicate that staff are aware of their roles to provide personal support in a sensitive manner. EVIDENCE: Having taken consultation and assessment from a behavioural advisor, personal development has really been targeted as a necessary improvement over the last 6 months. The staff team have now started to notice the difference promoting individuals in a developmental way can make to them, and to the workplace. Staff have really supported people to move from a solitary life, to one where a better quality lifestyle is beginning to be reestablished. Staff spend time with an individual several times per shift, to build up tolerance of others and increase communication, and this seems to be May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 13 working well. Its recommended that this time spent is recorded in minutes, so increases in tolerance are easily identified and staff can better reflect that their efforts have been tangibly rewarded. No service users are currently using formal educational facilities (planned to be rectified in the next academic intake), but 7 residents maintain a paid job share. Art and craft, computer skills, Internet access, and other life skills are taught at the organisations own ‘Opportunities and Choices’ resource centre. Improvements in community links have taken place, and individuals are more involved in shopping for groceries and their own personal toiletries. Shopping trips take place a few times per week, so a variety of people can experience supermarkets without having to be in them too long! Leisure opportunities out in the community are frequent, and recently, lots of indoor games and activities have been introduced, that has enabled people who would not normally participate, to be in some way actively involved. The garden is much more accessible, having been fenced off from the car park, and as such, in warm weather, people can come and go into the garden much more freely. Residents have meetings, mainly on a 1:1 basis, and have raised the issue of needing wider opportunities to make and maintain friends. The home have plans to create a social group that can meet regularly, and access any community clubs that individuals are interested in. Family contact between siblings is set to improve, with firm plans already in place. Daily routines are now more structured, which suits all the service users. Staff support service users to deal with their mail, and to book appointments. Staff were busy chatting to service users, and including them in day to day goings on in a natural manner; Makaton signing was being used fluently. May Morning DS0000065338.V280380.R01.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 support needs and preferences are clearly documented in the individual plan. Healthcare support, both physical and emotional, has improved significantly. Medication management is generally safe, but some shortfalls indicate this is an area that could improve. EVIDENCE: Each individual has clearly documented personal support requirements, highlighting how much support is needed, and how this should be conducted. Where needed, very specific instructions to enable a routine to be reestablished are in place. Staff have been briefed on the rationale behind their use, and have had positive outcomes. One individual has had a built in wardrobe fitted, and now accepts that their clothes live in their room, and has benefited from being able to access, with staff support, a wider choice. Mental and physical health support has improved, and action suggested or required for the service users benefit is carried out. As stated above, it is recommended that contact duration be recorded for an individual, to enable better assessment of progress. Medication management is, on the whole sound, but some areas need improvement. Full feedback was given, but these include all prescription medication must have a pharmacy label attached to it; medication cold storage must be monitored to ensure it remains at the correct temperature; all medication storage must be cleaned regularly. Some good practice May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 15 recommendations included having service user photo, medication over-view (what the meds are for, side effects, contra-indications; - as required and homely remedies) as front sheets for each MAR sheet, storage of liquid and external medication and overstock (from over-zealous previous ordering) be improved. May Morning DS0000065338.V280380.R01.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 have access to the pictorial complaints process, but rely on staff to listen and act on their behalf, which is well supported. Adult protection awareness is reasonable amongst the team, and adult protection procedures are always adhered to. EVIDENCE: The organisation has a service user complaints procedure that is in simple, plain English. This is not really accessible to the majority of service users, so it was pleasing to hear that the organisation were seeking good practice from individual homes, and possibly a Makaton signed video would be produced. Staff are the service users main key to having their views heard, and this has proved successful. Staff, in the main, are fully aware of their role to ensure people living in the home are protected from abuse in all its forms. Whistle blowing has enabled managers to take action and rectify problems. Ongoing training and coaching has heightened awareness. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 17 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 Generally, the home is very comfortable and homely, but some areas need attention. Bedrooms suit individuals lifestyles and although several are not to new NMS size, do meet individual needs. Shared space is well maintained and extensive. Specialist equipment, where needed, is supplied. The standard of hygiene has improved. Access to the garden has improved, but staff must be aware of leaving garden furniture in areas that increase risk of climbing fences. EVIDENCE: Maintenance and repairs have improved the overall environment, and several service users have chosen to have their bedrooms re-decorated in a colour scheme of their choosing. Other service users are benefiting from having a friendly decorator help them complete changing their rooms in the near future. The communal areas were bright and cheerful, the relaxation room is now in daily use, and is enjoyed very much by a particular person. Bathrooms and toilets have improved considerably, and the standard of hygiene is much better. Toilet paper is available, in robustly mounted dispensers, to everyone, which is a real achievement – well done!! Two areas of improvement that require attention are the temperature of the quiet lounge that ongoing reports to maintenance have not resolved. The room is very cold; it really could not be comfortably used during winter. Secondly, the landing areas have dark corners, and the ceiling lighting is continually out of action, and when replaced, May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 18 the bulbs are said to blow very quickly. The wiring check certificate was not available to view; this problem needs resolving. Recommendations discussed included redecoration of the small WC and descaling the non-slip flooring; the kitchen is totally functional and EHO approved, but looks shabby and dark, the cupboard doors having been repainted in dark red – that this is considered for a refurbishment in the long term. The laundry is in clean and tidy order, but the tumble dryer fluff has settled on the boilers near electrical switches, so regular vacuum cleaning is strongly recommended. Externally, flat fencing has been fitted to prevent climbing, but benches were left right next to the fence, which then becomes a step, and should be avoided! May Morning DS0000065338.V280380.R01.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): 31, 35 Staff are clear in their roles and responsibilities and conduct their duty in a professional but friendly manner. Staff training files indicate extensive courses have been attended, but a better overview to gauge and monitor the team skills has been requested. EVIDENCE: Throughout the day of the visit, and seeking feedback from the service users (through observation, question asking and records), it was apparent that the staff have clarity in their roles and responsibilities. The staff shift planner is being completed to include service users in day to day chores, and allocates a given staff member to a service user to offer support throughout the day. Service users appeared much more settled, and staff much more organised. Staff said they felt more motivated and had a clear understanding of the aims of the home. The training file was being audited, but had not been completed. Records available indicated that the team have received a wide range of essential training, but as former staff records were also included, it was difficult to ascertain the true picture. It is recommended that the team training be put onto a matrix as a management tool to see, at a glance the skills of the team as a whole. A request that this is sent to CSCI was made. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 20 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, 38, 39, 42 The home manager ensures that service users benefit from the correct support, delivered by a well-organised staff team. Feedback indicates that the ethos of the home is fully focused on the improvement of life for service users. Quality assurance processes are in place that informs the ongoing development of the service in a way that benefits the people living at the home. Health and safety systems are in place that protect service users and staff, and environmental risk assessments are currently under review, but some shortfalls need addressing. EVIDENCE: The new registered manager has assessed, and in priority order, addressed the shortfalls of the service. Service users have benefited from skilled management refocusing staff on the statement of purpose, to empower and support people in their own home. The environment has become more of a shared home than a workplace, and clearly the ethos expected by the organisation is being supported. Staff have given positive feedback on how they feel valued as employees, and that they are gaining much more satisfaction supporting people to really achieve the small but meaningful steps May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 21 in their lives. Quality assurance systems are in place, and in the main, these really tackle the outcomes sought by the NMS, however more could be developed, in the future, to involve seeking what really matters to service users. Feedback left highlighted the benefits of helping service users life-plan using a ‘person centred’ planning approach, in pictorial form. This is quite complex, and the manager was given feedback to consider obtaining training in this area (through BILD or via a local University provider). Health and safety environmental checks are routinely completed and meet the standard, but on this occasion, the electrical wiring certificate could not be located (the manager is seeking). Some files, such as the fire log, would benefit from a tidy up, and staff register of drills be amended to reflect the current team only. The fire risk assessment is in place, and will need reviewing in light of the change of room usage, which is in hand. The service users may benefit from the kitchen door being held open with an appropriate closure; the manager said they would seek advice. May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 22 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 3 2 3 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 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 23 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 YA20 Regulation 13 Requirement All prescription items must be labelled. Shortfalls to be reported to the dispensing pharmacy. Keep temperature record of cold storage. Make the ‘quite’ lounge a comfortable temperature. Seek expert advice and improve the lighting in the landing areas. Locate the internal wiring certificate. Timescale for action 01/02/06 2 YA24 13 23 13 20/02/06 3 YA42 20/02/06 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 Refer to Standard YA8 YA20 Good Practice Recommendations Record time spent with named service user. Review the recording system to better reflect the work being conducted. Each individual have a meds over view sheet with his photo displayed. Regular cleaning of medication storage. Keep internal and external medication separately & make DS0000065338.V280380.R01.S.doc Version 5.1 Page 24 May Morning provision for sticky liquid medication. Obtain and keep an up to date B.N.F. reference book. Limit stock held in the ‘current’ medication storage to the bare minimum. 3 YA24 Regular cleaning of tumble-dryer fluff from boiler cupboard (possible fire risk). Assess positioning of garden furniture. Redecoration and de-scaling of small upstairs WC. Long term plan to improve kitchen. Prepare and maintain a team training matrix, copy to CSCI with Pre-Inspection Questionnaire. Seek Person-Centred planning training and information and incorporate in quality assurance systems. Review Fire Risk assessment and incorporate environmental changes and assess kitchen door access. 4 5 6 YA35 YA6 YA37YA39 YA42 May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 May Morning DS0000065338.V280380.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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