CARE HOME ADULTS 18-65 NOBLE LODGE 143 Bounds Green Road London N11 2ED
Lead Inspector Susan Shamash Unannounced 3rd May 2005 @ 13:00 pm 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 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 Stationary 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. NOBLE LODGE Version 1.10 Page 3 SERVICE INFORMATION
Name of service Noble Lodge Address 143 Bounds Green Road, London, N11 2ED Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8245 7560 020 8245 7560 shaukatally@yahoo.co.uk Mr Shaukatally Hossenally Ms Ellen McTaggart Care Home 6 Category(ies) of MD registration, with number of places NOBLE LODGE Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: One named service user over the age of 65 may remain in the home, for ar long as the home is able to meet their needs. Date of last inspection 9th September 2005 Brief Description of the Service: Noble Lodge is a care home providing personal care for 6 adults who have mental health needs. It is a private care home owned by Mr Shaukatally Hossenally. The home, which opened in 1990, is in Bounds Green close to the underground station and local shops and services. There are six single bedrooms on the ground, first and second floor. There is a dining room and lounge as well as a garden to the rear. The home is not accessible for wheel chair users.The stated aims of the home are to provide a quality service for people who have mental health needs and to promote their independence. Noble lodge aims to achieve this by providing support to help service users to maximise their potential physically, intellectually, emotionally and socially all within a homely atmosphere. One of the current service users is over the age of sixty-five. The home therefore has a condition on the registration certificate for one named person over sixty-five. NOBLE LODGE Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the routine schedule of inspections for the home, and lasted approximately eight hours. The registered manager was available throughout the inspection, and the registered provider was available for a short time during the day. Five residents were living at the home at the time of the inspection, and the inspector had the opportunity to speak with four of them. One was staying with family, and two were out during the day but returned towards the end of the inspection. The inspector also had the opportunity to speak with one staff member and one volunteer during the inspection. The inspection also included a tour of the building and inspection of records maintained at the home. What the service does well:
All feedback received, from both staff and residents, was positive about the way the home is run and regarding conditions provided within the home. One resident told the inspector ‘they’re nice people here,’ and went on to describe the support provided by staff enthusiastically. The overall impression is that the quality of service provided to residents is inclusive and flexible, and that residents find staff supportive and generally enjoy living at the home. The home is commended for the support provided to a previous resident who has moved out of the home since the previous inspection due to deteriorating health needs. The support that staff at the home provided to this resident, and has provided to other residents in the past as their health deteriorated, was highly in keeping with the home’s objective of providing a home for life, so long as this can be safely achieved. Residents are very satisfied with the food provided and are comfortable using all the areas available to them in the home. The home is particularly good at providing flexible support to semi-independent residents who have contacts and interests outside of the home. NOBLE LODGE Version 1.10 Page 6 What has improved since the last inspection? What they could do better:
Requirements outstanding from the last inspection regarding the need for a report of the quality assurance audit to be made available, photos of all residents to be kept on file and first aid training for all staff, must be met. This is in order to promote the highest possible quality service for residents and to protect their safety at all times. Greater detail is needed in residents’ care plans and risk assessments to ensure accurate continuity of care and there is a need for a significant increase in the number of supported activities provided to residents outside of the home. Residents would benefit from a holiday and the possibility of this being arranged must be researched. Of particular concern to the inspector, were inaccuracies found in medicines dispensed by staff at the home. It is vital that the registered persons ensure that only appropriately trained staff carry out this task and double check to ensure that there are no errors. There is also a need for a risk assessment and agreement form to be completed for the resident who intends to self medicate, and the time at which homely remedies are administered to residents must be recorded. The garden furniture in the home needs to be cleaned/replaced and soap and towels must be provided in the laundry area at all times to protect the hygiene of staff and residents in the home. An accurate record of the hours actually worked by the manager and provider team must be recorded (these hours are frequently in excess of those anticipated on the rotas) to evidence that there is adequate staff cover within the home. Appropriate CRB (Criminal Record Bureau) disclosures must be obtained for the cleaner and any new staff prior to their working unaccompanied in the home.
NOBLE LODGE Version 1.10 Page 7 The homes procedures must be updated at least annually to ensure that they remain in line with best practice and remain relevant to the actual situations found at the home and more detailed, accurate records of resident’s finances handled by the home must be maintained to protect both staff and residents. Finally risk assessments for the home’s building must be undertaken and a current gas safety certificate is required for the home to ensure the safety of residents. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. NOBLE LODGE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection NOBLE LODGE Version 1.10 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 standard(s) 2 and 3. Prospective service users can be assured that their needs and goals will be assessed prior to admission and that they will only be admitted if the home is able to meet their needs effectively. EVIDENCE: One service user had been admitted to the home since the previous inspection, and appropriate assessments were available for him. The inspector had the opportunity to speak to the new service user, who indicated that the admission procedure for the home had been followed as appropriate. Assessment information found in each service user’s files was detailed and of satisfactory quality. Records found within the four service user plans inspected indicated that the admissions policy had been followed in each case, using a comprehensive assessment of need. Service users spoken to confirmed that their needs were being met effectively and spoke very positively about the support provided by staff. NOBLE LODGE Version 1.10 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 standard(s) 6, 7 and 9. Service users can be assured that their needs and goals are monitored and are consulted regarding the support to be provided to them. They are supported to make their own decisions about their lives and take informed risks according to their wishes. However insufficient detail included within care plans and risk assessments places service users at risk of not receiving all the support that they require should they require support from a worker who is unfamiliar with their care. EVIDENCE: The four service user plans inspected were generally detailed and demonstrated service user involvement in the care planning process, with signatures included. Service users spoken to confirmed that they were encouraged to develop independent living skills with support from staff at the home. There was evidence that reviews of service users’ needs take place at least every three months. As required risk assessments were being reviewed at least six-monthly. NOBLE LODGE Version 1.10 Page 11 Whilst photographs of each service user were available in some files, it remains required that these be available within every service user file. Discussion with the manager, staff and service users indicated to the inspector that the service user plans (care plans and risk assessments) were not as detailed as they might be in describing how service users needs were being met. It is therefore required that care plans and risk assessments be updated to include a greater level of detail about the ways in which service users needs are met e.g. the exact nature of support needed by a service user when having a bath. NOBLE LODGE Version 1.10 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 standard(s) 12, 13, 14, 15, 16 and 17. Service users are encouraged to attend various day activities, be involved in the daily running of the home and maintain contacts with friends and family in accordance with their own wishes, so that they can lead lifestyles of their choice. However insufficient support is currently available to enable service users to participate in leisure activities. Dietary needs of service users are catered for with a balanced and varied selection of food available that meets their nutritional needs. EVIDENCE: Service users are widely mixed in age range and all are relatively independent at choosing their own activities and preferred lifestyles. There is evidence that staff have generally been able to provide individual opportunities relevant to service users’ needs and aspirations on a daily basis and service users join in with some housework tasks according to their wishes. NOBLE LODGE Version 1.10 Page 13 Some service users attend day centres during the week, one spends regular time away visiting family and another has a partner that she visits on a regular basis. Two service users were in the home on the day of the inspection, whilst others attending day services returned towards the end of the visit. One service user spoken to advised that they were sometimes bored at the home, others appeared to be more independent at finding activities in which to engage. Staff and service users spoken to confirmed that service users are encouraged to maintain contact with family and friends. Records indicated and service users confirmed that the home does not currently provide many supported leisure activities on a regular basis e.g. trips to the pub, cinema, cafes, bowling, day trips etc. The manager explained that due to the deteriorating condition of one service user (including increased confusion and dependency) who has since moved out of the home, greatly increased staff support had been needed at the home, and this had had the knock on effect of decreasing the amount of emphasis put on organising leisure activities. A requirement is made that service users be supported to undertake a range of leisure activities on a regular basis, and that the possibility of arranging a holiday for service users be researched. All service users spoken to were satisfied with the selection of food provided to them within the home, and the home was well stocked with provisions. Menus indicated that a varied and nutritious diet is provided to service users. As one service user noted “we get smashing food here.” NOBLE LODGE Version 1.10 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 standard(s) 18, 19, 20 and 21. Service users receive appropriate physical and emotional support and their wishes in the event of death or illness have been obtained so that they may be treated in accordance with their wishes as far as possible. Service users are not adequately protected by systems in place for administering medicines thus placing them at risk. EVIDENCE: All service users have detailed healthcare records and service users have access to local health centre facilities as and when required. Attendance of health care appointments are recorded appropriately for each service user so that these can be tracked easily. As required at the previous inspection, service users’ wishes in the event of death or dying had been recorded. NOBLE LODGE Version 1.10 Page 15 The home is commended for the support and care provided to a service user whose needs had deteriorated significantly since the previous inspection. Staff support within the home was increased so that the service user was enabled to remain within the home for as long as possible. However unfortunately the service user had to move to alternative accommodation when his needs could no longer be met by the home. Records are maintained of all medicines brought into the home or disposed of, and the manager had introduced a format for recording medicines given to service users for overnight stays. However the inspector was concerned to note that although two staff members were dispensing medicines into dossette boxes and signing to show that these had been checked, three mistakes were noted in the medicines dispensed. It is usually strongly recommended that only a qualified pharmacist be responsible for the dispensing of medicines. Whilst this remains recommended, the manager advised that previous attempts to engage a pharmacist for this task had involved numerous difficulties, and resulted in errors that staff at the home had had to correct, when doctors had made changes to medicines at short notice. The manager advised that the medicines had been dispensed by staff members who did not usually undertake this task. All mistakes were rectified immediately during the inspection, and the manager advised that she would oversee the dispensing of medicines in future to ensure that no further mistakes occurred. Other requirements are made regarding the need for a risk assessment and agreement for the service user who is to self medicate and the need for the time to be recorded when homely remedies are administered. NOBLE LODGE Version 1.10 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 standard(s) 22 and 23. The home’s complaints procedure is satisfactory to ensure that the concerns of service users are listened to and acted upon effectively. Procedures are in place to ensure that service users are protected from abuse. EVIDENCE: There have been no complaints since the previous inspection. The home has developed an adult protection policy including a clear procedure for all staff to follow, and as required a copy of the local authority adult protection procedure is available within the home. It is recommended that the adult protection procedures for Newnham and Islington also be obtained for the home as they are the placing authority for service users at the home. NOBLE LODGE Version 1.10 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 standard(s) 24, 27, 28 and 30. Service users live in an environment that is homely and comfortable, with adequate private and communal space. The standard of decoration has been improved since the previous inspection, but service users’ comfort could be further enhanced by an improvement in the provision of garden furniture. The safety and hygiene of the home for service users is compromised by the lack of hand washing and drying facilities in the laundry. EVIDENCE: A pleasant, reasonably well-maintained environment is provided for service users. The lounge had been painted since the previous inspection and the stairways in the home had been painted (requiring one more coat of paint). Service users have personalised their own rooms, and one service user’s room had been refurbished since the previous inspection (belonging to the service user who had left the home). NOBLE LODGE Version 1.10 Page 18 Requirements made at the previous inspection regarding monitoring and rectifying the functioning of fire doors and redecorating the first floor toilet had been met as required. The manager advised that all fire doors are checked at least weekly during the fire alarm tests for the home. It is required that the garden furniture be cleaned/replaced and that hand towels and soap be provided within the laundry. NOBLE LODGE Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 and 36. Staff are adequately trained and supervised to meet the needs of service users safely and effectively. This is with the exception of clearly specified management cover at all times and sufficient training in first aid to ensure that service users’ safety is adequately protected at all times. Service users are not adequately protected by the current recruitment practice of the home. EVIDENCE: The registered manager has worked in the home for a number of years and is supported by the registered person who is at the home on most days and works in the home at weekends. However on examining the staffing rota for the home, the inspector noted that it was not always clear who was providing staffing backup in the home between shifts. It is required that the management/provider team ensure that the actual hours that they work within the home are recorded, to evidence that there is adequate staffing cover in the home at all times. NOBLE LODGE Version 1.10 Page 20 Examination of staff files, and discussion with staff members indicated that training opportunities and regular supervision are provided for the staff. The manager advised that a sufficient number of staff were taking/had achieved a relevant NVQ qualification to meet the national minimum standard of fifty percent by the end of 2005. However a requirement is restated for the second time regarding the need for current first aid certification to be available for the remaining two identified staff members. It is also required that a satisfactory CRB disclosure including a POVA check be obtained for the domestic worker and any other new employees employed at the home prior to them working unsupervised at the home. The home continues to employ a volunteer (ex-staff member) at the home, and the inspector had the opportunity to speak to her. She spoke positively about the support provided to her and general working practices at the home. NOBLE LODGE Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41 and 42. Although there has been some improvement in the quality assurance procedures at the home, the absence of an annual summary report compromises the rights of service users to receive the highest quality of service at the home. Whilst the majority of procedures and safety checks are appropriate to the home, insufficient administrative procedures may place service users at risk to their physical health and of errors regarding their finances. EVIDENCE: At the previous inspection quality assurance initiatives had been developed in the home but had not yet been utilised to conduct an audit. At this inspection, the registered provider advised that he had conducted an audit, and that an updated summary of the audit would be available by the end of May 2005. He advised that as recommended the volunteer working in the home had assisted service users in completing questionnaires about their experiences of living at the home.
NOBLE LODGE Version 1.10 Page 22 Although a comprehensive selection of policies were available for the home it is required that these must be updated at least annually. Records of service users finances dealt with by the home were seen by the inspector. The provider and manager described the difficulties that they were experiencing due to the local authorities funding two service users not having paid the fees for approximately three months. Evidence was available that the manager was invoicing the health authority for a service user who is entitled to £4 weekly for incontinence aids. Records were not adequately maintained of how this money was paid to the service user, although receipts were available of money spent on incontinence aids. To fully protect the service user and the home a clear audit trail must be recorded regarding all monies paid to service users at the home. There are regular maintenance checks of the home’s equipment and installations including fire safety equipment, and as required at the previous inspection a current electrical installation testing certificate was available for the home. Manual handling training was provided for all staff during the week of the inspection, and all perishable foods stored in the kitchen were labelled appropriately. A current portable appliances testing certificate was available, however it is required that a current gas safety certificate be obtained for the home (as the previous certificate expired on 6th April 2005). It is also required that risk assessments with regard to the building must be undertaken for the home, and reviewed at least annually. NOBLE LODGE Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 1 3 Standard No 37 38 39 40 41 42 43 Score x x 2 2 2 2 x NOBLE LODGE Version 1.10 Page 24 YES 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 6 Regulation 17(1)(a) Sched 3(2) Requirement The registered persons must ensure that current photographs are maintained on file for each service user in the home. (Timescale of 22/10/04 not met). This requirement is restated. The registered persons must ensure that care plans and risk assessments are updated to include a greater level of detail regarding the exact nature of support needed by service users. The registered persons must ensure that service users are supported to undertake a range of leisure activities on a regular basis, and must look into the possibility of arranging a holiday for service users. The registered persons must ensure that the following requirements regarding service users medication are met: - medications must only be dispensed and checked by staff members who are adequately trained and familiar with the medicines taken by each service
NOBLE LODGE Version 1.10 Page 25 Timescale for action 8th July 2005 2. 6, 9 14(1) 15(2) 8th July 2005 3. 14 16(2)(m) (n) 8th July 2005 4. 20 13(2) user. Two such staff members must check each dossette box once medicines are dispensed and only sign the record when certain that there are no errors. - A risk assessment must be undertaken for the identified service user who is to self medicate including an agreement to be signed by all parties. - The homely remedies record must be updated to include the time at which medicines are administered. The registered persons must ensure that the garden furniture is cleaned/replaced. The registered persons must ensure that handwashing facilities (including soap) and hand drying facilities are available in the laundry. The registered persons must ensure that the actual hours worked by the management/provider team at the home are recorded, to evidence that there is adequate staffing cover in the home at all times. The registered persons must ensure that a satisfactory CRB disclosure including a POVA check is obtained for the domestic worker and any other new employees employed at the home prior to their working unsupervised at the home. The registered persons must ensure that evidence of current first aid training is obtained for the identified staff members. (Timescale of 26/11/04 not met). This requirement is restated for
NOBLE LODGE Version 1.10 27th May 2005 5. 6. 24 30 23(2)(d) 16(2)(j) 24th June 2005 3rd June 2005 7. 32 17(2) Sched 4(7) 3rd June 2005 8. 34 19 Sched 2(7) 27th May 2005 9. 35 19 Schedule (2)(5) 22nd July 2005 Page 26 the second time. 10. 39 24 The registered persons must ensure that a quality monitoring audit is conducted at least annually, and the findings are used to inform the business and development plans for the home. A copy of the audit summary must be sent to the local CSCI area office. (Timescale of 05/11/04 partially met). This requirement is restated and amended. The registered persons must ensure that the homes policies and procedures are reviewed and updated at least annually. The registered persons must ensure that a clear audit trail is available regarding all monies paid to service users at the home. The registered persons must ensure that a current gas safety certificate is obtained for the home. The registered persons must ensure that risk assessments are recorded regarding the homes building, and that these are reviewed at least annually. 10th June 2005 11. 40 18(1)(c) 8th July 2005 27th May 2005 12. 41 17(2) Sched 4 (9) 13(4)(a) 13. 42 10th June 2005 8th July 2005 14. 42 13(4)(a) 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 20 23 Good Practice Recommendations It is recommended that only a qualified pharmacist should dispense medicines into dossetted boxes for service users at the home. It is recommended that the adult protection procedures for Newnham and Islington be obtained for the home.
Version 1.10 Page 27 NOBLE LODGE Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road, London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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