Inspection on 09/05/06 for Richford Gate, 52

This inspection was carried out on 9th May 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 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Richford Gate, 52 28/04/08

Richford Gate, 52 23/07/07

Richford Gate, 52 03/11/05

Richford Gate, 52 01/04/05

Richford Gate, 52 20/01/05

Richford Gate, 52 07/07/04

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 Richford Gate, 52 52 Richford Gate Richford Street Hammersmith London W6 7HZ Lead Inspector Sheila Lycholit Unannounced Inspection 9th May 2006 10:30 Richford Gate, 52 DS0000019146.V291667.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 Richford Gate, 52 DS0000019146.V291667.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. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Richford Gate, 52 Address 52 Richford Gate Richford Street Hammersmith London W6 7HZ 020 8749 0307 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) info@yarrowhousing.org.uk Yarrow Housing Ms Judy Miller Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005. An additional visit took place on 24th November 2005 Brief Description of the Service: 52-53 Richford Gate is a registered care home providing support and accommodation for eight men and women with a learning disability. The service is provided by Yarrow Housing, a ‘not for profit’ organisation in a building owned by Kensington Housing Trust. The home, which is comprised of two separate flats, is well located, close to facilities in the local community and the shops and transport links of Shepherds Bush and Hammersmith. The home provides accommodation on two floors and is not accessible to people with mobility difficulties. Each service user has a single room. The accommodation does not have its own garden. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 9th May 2006 from 10.30AM until 3.30PM. There were 7 service users living at the accommodation, one of whom was on holiday in Madrid with 2 staff. There was 1 vacant place. One service user is moving to other accommodation in June. One service user was at home and another returned later. The remaining service users were attending day activities. The Manager came on duty at 11.30AM and left for a case conference at 1.30PM. She had recently completed a pre-inspection questionnaire. The Deputy Manager was on duty and made herself available throughout the visit. The Inspector made a tour of both flats, with 2 service users showing her their rooms. The vacant room was also seen. What the service does well: What has improved since the last inspection? What they could do better: Unacceptable delays continue to occur in carrying out repairs, redecoration and in the replacement of furnishings. Much of the work needing to be carried out following the last inspection has yet to start. Ways of improving storage need to be found, so that corridors and the laundry can be kept clear. Although staff have attended training in medication, errors are still being made. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 6 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. Richford Gate, 52 DS0000019146.V291667.R01.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 Richford Gate, 52 DS0000019146.V291667.R01.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, 3 and 5 The quality of the outcomes for these standards is good. Service users are provided with clear information about the home and about their individual terms and conditions in an accessible format. Sound multi-professional assessment procedures are in place. EVIDENCE: Three service users’ files were looked at. Each contained an up to date copy of the service user’s guide and a contract. The guide contained all required information about the service, including the house rules, a copy of the complaints procedure and a summary of the results of a recent customer satisfaction survey. Copies of contacts were also available on service users’ files. Both the guide and contract are in an accessible format, signed by the service user and are regularly reviewed. Service users files’ show that assessments took place before they moved to the home – though many of the service users have lived at Richford Gate for a number of years and no one has moved to the service in the past 12 months. The Deputy Manager was not aware of anyone being considered for the current vacant place. In assessing whether the service was suitable account would need to be taken of the current mix of service users, the lack of outdoor space and the difficulty of storing equipment. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 9 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 and 10 The quality of outcomes for these standards is good. Staff are developing ways of involving service users in all aspects of their PCPs and in the daily life of the home. The service shows a commitment to providing individualised care and support. EVIDENCE: Individual files and person centred plans show that service users needs are regularly reviewed. One service user whose has become increasingly frail has been re-assessed and she and her family have agreed that she will move to another home which is better able to meet her needs. Each service user has a key worker, who spends one to one time with them. The key worker develops the PCP with the service user and completes a monthly summary, noting significant events and commenting on progress made regarding objectives set in the PCP. The 3 PCPs seen contained information in an accessible format, including photos. Individual files show that staff work with colleagues in the Learning Disability Team to ensure that service users have access to services, such as Psychology and Speech Therapy and that a multi-professional approach to managing any challenging or difficult behaviour is developed. Each of the files seen contained up to date risk assessments. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 10 The home has a confidentiality policy and service users’ records, other than PCPs, are kept in a locked filing cabinet in the office. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 11 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, 14, 15, 16 and 17 The quality of outcomes for these standards is good. Staff provide individualised support to service users to develop social and communication skills and to take part in a range of social and leisure activities. Action has been taken to improve the variety of menus, though this area would benefit from further attention. EVIDENCE: Records and discussion with staff show that service users are supported to develop ways of communicating, both verbally and through the use of multi media. Some of the challenges presented by some service users appear to have been reduced or ameliorated through strategies for improving communication between service users and in supporting service users to express their wishes and feelings more appropriately. Each service user has a programme of activities throughout the week, including attendance at college, at Options and Macbeth Centres and at Yarrow’s own day service, The Gate. One to one time is allocated to support service users to enjoy a chosen activity, such as going to the theatre or on an outing. The Deputy Manager confirmed that all service users have a holiday. In some cases, where service users have found longer holidays too unsettling, day trips are arranged. At the time of the inspection visit one service user was spending Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 12 a week in Madrid with 2 staff, where he was planning to see Real Madrid play. The risk assessment for the holiday in Madrid was looked at. It showed that consideration had been given to possible eventualities and action taken to minimise risk. Holidays to Portugal and to Ghana were being planned. Photos of service users on holiday in the UK and abroad are displayed in PCPs and throughout the flats. Tenants meetings are held weekly in each flat and are recorded. The fridges in both flats were clean and tidy, and contained fresh produce. Packets of cooked meat did not show the date of opening. The Manager said that labels were available and that she would remind staff. Potatoes in the vegetable racks in both kitchens were green and sprouting. They must be stored away from the light and any green potatoes discarded. Menus are produced in a more attractive format, using colour and illustrations The Deputy Manager said that staff are trying to encourage service users to try a wider range of foodstuffs with some success, though pot noodles remain on the menu. The low weight of two service users is being monitored, one of whom is prescribed food supplements. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 13 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, and 20 The quality outcomes for these standards are adequate. Care/support plans are generally well written and reflect service users’ individual preferences. Health needs are given a high priority and staff work closely with health care colleagues. Staff training in the administration of medication is now up to date, though some errors continue to be made. EVIDENCE: Service users need differing degrees of support with personal care. Some are largely independent, while one service user needs considerable assistance. Support guidelines are well written but need to be more detailed for the service user who needs the most support. It is suggested that these guidelines are written in the first person with her involvement and are completed before she moves to another service. Records show that the health care needs of service users are given a high priority, with referrals to GPs, Dentists, Ophthalmologists and other health care professionals made. Health care needs are regularly checked at reviews. The District Nurse from the local Health Centre visits when requested. Staff training in the administration of medication is up to date and the Manager has written a new procedure for the service. Nevertheless errors continue to be made. The Manager said that the error where a service user was given her medication twice has been discussed with the member of staff concerned and Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 14 in the Team Meeting. The home uses a pre-measured dosage system. MAR sheets seen were up to date but the codes did not provide unambiguous information and an entry for that day was illegible, as it had been written over, rather than crossed out. Printed MAR charts would be clearer and less likely to lead to errors than the current charts where printed labels are stuck on. Two service users are assessed as being able to manage their own medication. Risk assessments have been undertaken. Service users who manage their own medication are expected to keep it in a locked place in their room. One service user showed the Inspector his medication, which was in an unlocked drawer. The Deputy Manager did not have access to all the training records and was unable to confirm that all staff have received training in the administration of Diazepam PR, which is held for one service user. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 15 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 and 23 The quality outcomes for these standards are good. There is an effective complaints procedure and policies and procedures are in place to protect service users from abuse. EVIDENCE: There is a well written complaints procedure in an accessible format. No complaints have been recorded since the last inspection. Adult protection policies and procedures are available and staff have receive training in the protection of vulnerable adults. There have been two adult protection investigations in the previous 12 months. Action has been taken to monitor and to take preventative action regarding the concerns raised in both cases. Records show that use is made of local advocacy services. Careful records are kept of financial transactions made on behalf of service users. A sample of service users’ finances are checked by senior Managers when carrying out monthly visits and by Yarrow Housing’s finance staff. The Inspector looked at one service user’s financial record. Receipts for purchases were available and the account regularly reconciled. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 16 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 and 30 The quality outcome for these standards is adequate. The accommodation is well integrated into the community and close to shops and services. The lack of outdoor space and limited communal space within the maisonettes place some limitations on the lifestyle of a quite active group of service users. Unacceptable delays in carrying repairs and redecoration have resulted in the accommodation having a somewhat neglected appearance. EVIDENCE: The accommodation is comprised of two maisonettes in a housing association block of similar homes, which are situated above a day nursery. Access to the maisonettes is via stairs or a lift. On the day of the inspection the main door to the block was open and the Inspector, receiving no reply to the buzzers at the entrance, was able to walk into the accommodation unchallenged as both doors to the maisonettes were open. Staff said that the security system at the main door had been out of action for some time. Steps to improve security must be taken. Redecoration to the communal areas noted at the previous inspection has not been carried out. The Manager explained that she had been late in confirming the colour scheme with service users and that this had delayed the start of the work. Curtains have been cleaned and re-hung and net curtains looked newly washed. On the day of the inspection, the temperature in the building was Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 17 acceptable. The Manager confirmed that a new ventilation system is to be installed, although she did not have a date for the work. The desk in the office, also noted at the last inspection, is broken and a bare light bulb hangs from the ceiling. The Manager confirmed that a new desk has been ordered. Each maisonette has a rather small dining/sitting room and no other communal rooms. Both of these rooms need some attention to make them more attractive, including new or cleaned carpets. Cushions, lamps and other accessories would improve the appearance of these areas. Two service users showed the Inspector their rooms. Each room was individualised, with a considerable number of personal possessions, showing each persons own interests. Both service users confirmed that they were happy with their rooms and the furniture and equipment provided. The Inspector also looked at the vacant room, which is light and bright, with builtin storage space but will need re-decorating before it is occupied. There are sufficient bathrooms and lavatories and there is shower room which is used by a service user who is unable to use the bathroom. At the time of the inspection the shower had a water-proof covering taped around the walls as the tiles had been removed following a leak to the floor below. Staff said that that the shower was usable and that the work would be completed shortly. The laundry is used for both maisonettes and contains 2 washing machines and 2 driers. One of the driers was out of order. The staff were trying to dry the floor and carpet as one of the service users had inadvertently left an item of clothing in the door when starting the machine causing it to flood. The laundry contains a bicycle belonging to one of the service users. Staff explained that there was nowhere else to store it. Two boxes of Christmas decorations were sitting on the landing of one maisonette. As the light bulb needed replacing and the area was in darkness this was particularly dangerous. It is suggested that the empty bedroom is used for storage until a solution is found. The building was clean, though there was an over powering smell of air freshener coming from one bedroom. The accommodation has no garden or outdoor area. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 18 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, 33, and 36 The quality outcome for these standards is good. Service users are supported by a consistent staff team. Sound supervision systems are in place to support staff. Staffing levels have been kept under review to ensure that service users changing needs are met. EVIDENCE: Staff undertake Yarrow’s induction programme, which has recently been updated. The Manager calculates that 45 of staff have achieved NVQ2 or above. Two staff have no qualifications. Staff have access to Yarrow Housing’s training programme which provides accredited training and additional workshops. Training records were not seen, as the Deputy Manager did not have access to the information. There are 1.5 FTE vacancies and 2 staff have left since the last inspection. Additional staff hours, which are kept under review, are provided for one service user, whose behaviour has presented challenges. Staffing at night currently consists of one waking night staff and one member of staff sleepingin. The use of waking night staff was implemented to meet the changing needs of service users and is not a permanent increase in the staff establishment. Rotas show that staffing levels are sufficient to allow service users to be supported in a range of activities and to receive one to one time. Staff meetings take place monthly and are recorded. Support staff receive supervision from the Deputy Managers monthly. Supervsion is noted on the staff rota. The Deputy Manager did not have access to the copies of supervision notes, which are kept locked but was able to show the Inspector Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 19 the supervision notes that she holds on the PC. These were detailed and well written showing that issues are carefully followed up, in particular action regarding service users. Richford Gate, 52 DS0000019146.V291667.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, 39, 41, 42 and 43 The quality of outcomes for these standards is good. There is an experienced senior staff team that ensures that record keeping is of a good standard. Steps are being taken to implement a more comprehensive quality assurance system for the home and the organisation. Health and safety systems are in place, though further vigilance is needed in some areas. Monthly visits on behalf are Yarrow Housing are taking place more regularly, with copies of reports sent to CSCI. EVIDENCE: The Manager is experienced in working with people with a learning disability. She is undertaking NVQ4/RMA, which she hopes to complete by the end of the year. One of the Deputy Managers has achieved this qualification. Service user surveys are being completed with the help of families and staff from other services. The Manager said that a report would be compiled based on the surveys. The results of an earlier survey were seen indicating a high level of satisfaction. Service users can attend a monthly tenants forum at The Gate. Yarrow Housing produces its annual report and development plans in accessible formats. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 21 Records are generally well kept and in good order. It is recommended that ways of involving service users in their daily logs be developed, for example using signs, symbols and photos. Staff receive regular training in health and safety. Accidents and incidents are carefully recorded. Ten incidents/accidents have occurred since January 1st 2006. A fire safety risk assessment was carried out on 20th March 2005. Fire drills and the testing of the alarm system take place regularly. Records show that the fire detection system and fire fighting equipment are regularly serviced. The hot water temperatures are checked at every outlet monthly. A monthly health and safety check of the building is undertaken, nevertheless a number of issues were noted at the inspection visit: the key was left in the lock on the hot water tank door, which was open; the light bulb on the stairs had not been replaced leaving the stairs very dark; the lamp shade on the stairs was scorched. The window in one service user’s room was pushed up fully, as there was no restrictor. No risk assessment had been carried out. The Deputy Manager undertook to look into this, as other service users could go into her room. Monthly visits on behalf of the provider are taking place more regularly, with reports available in the home and copies sent to CSCI. No report for February 2006 was available. Richford Gate, 52 DS0000019146.V291667.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 3 4 x 5 3 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 2 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 x 35 x 36 3 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 x 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x 3 2 3 Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 23 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 YA17 Regulation 16 Requirement Timescale for action 31/05/06 2 YA20 13 3 YA24 23 4 YA42 13 Staff must ensure that packets of food, such as cooked meat, have the date of opening marked on the packet. Steps must be taken to ensure that unusable foodstuffs, such as green potatoes, are not used. Steps to continue to improve the 31/05/06 standard of the administration of medication must be taken. The Manager must confirm that all staff have received training in the administration of Diazepam PR. The accommodation, furnishings 31/05/06 and furniture must be maintained to a higher standard. Access to the premises must be more secure. Ways of improving storage need to be found. Staff must ensure that hazards 31/05/06 in the home are identified and prompt action taken. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 24 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 YA18 YA40 Good Practice Recommendations More detailed support guidelines for the most frail service user should be developed before she transfers to another service. Ways of service users contributing to their daily logs should be considered. Richford Gate, 52 DS0000019146.V291667.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. 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