Inspection on 26/04/05 for Rosedene

This inspection was carried out on 26th April 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Rosedene 22/01/08

Rosedene 21/06/07

Rosedene 02/06/06

Rosedene 13/09/05

Rosedene 07/12/04

Rosedene 03/06/04

Rosedene 18/12/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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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 HOMES FOR OLDER PEOPLE Rosedene 141-147 Trinity Road Wandsworth London SW17 7HJ Lead Inspector Sharon Newman Unannounced 26 April 2005 10:00 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 Older People. 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. Rosedene Version 1.10 Page 3 SERVICE INFORMATION Name of service Rosedene Address 141-147 Trinity Road, Wandsworth Common, London SW17 7HJ 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 8672 7969 020 8672 3005 Mr T Lewis Mrs Partricia Barber Care Home (CRH) 67 Category(ies) of Mental Disorder - excluding learning disability registration, with number or dementia (MD), Mental Disorder - excluding of places learning disability or dementia - over 65 years of age (MDE), Learning disability (LD), Dementia (DE), Dementia over 65 years of age (DE(E)) Rosedene Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 Learning Disability: the home may provide accomodation and care for one named service user with a learning disability only. the category LD is to be removed once this service user is no longer accomodated at the Home. Date of last inspection 7th December 2004 Brief Description of the Service: Rosedene is a Registered care home, presently registered for 67 nursing beds for service users over the age of 38 with needs including dementia and mental health.The property is located in Wandsworth Common, close to shops, pubs, the post office, bus routes, underground and over ground rail links. The home is on a busy main road, with parking to the front. The property comprises four large three storey terraced houses that have been joined together to form one care home. There are two passenger lifts between all floors. There is a garden to the rear, to the side of which there is a building where activities are provided. Rosedene Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th April 2005. The Registered Manager was present throughout the inspection. Additionally the activities coordinator, a senior carer and the catering and domestic manager were also spoken to. The inspector also had the opportunity to speak to the relatives of three service users. Three service users were spoken to during the course of the inspection. Records examined included care planning documentation, health and safety information and staff files. A tour was also taken of the premises. The Pharmacy inspector has undertaken a separate inspection regarding medication matters. The conclusions of his visit are included in the main body of this report. Four Immediate Requirements were made at the time of the inspection in relation to medication concerns. The relatives of three service users spoken to at this inspection were highly complimentary about the home and the care given to their relatives. Three service users spoken to were very positive about the care at the home. The Registered Manager and the home staff were open and welcoming. They were observed to have a very good rapport with the service users. Improvements in care planning documentation were found to have taken place since the last inspection visit. Ten Requirements and two Recommendations have been made following this inspection visit. What the service does well: The home staff were observed to have a good rapport with service users and relatives. There is a designated activities co-ordinator at this home who has a good knowledge of the service users. Service users and relatives were very complimentary about the food at this home and the catering manager was found to have a good knowledge of service users likes and dislikes. Rosedene Version 1.10 Page 6 The home was observed to be well maintained and clean at the time of inspection. It has a comfortable and homely atmosphere. The Registered Manager was found to demonstrate good management skills and is respected by service users and relatives. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rosedene Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rosedene Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4. Service user assessments are thorough and allow for a detailed care planning process to develop from this documentation. Good information is provided about the home in the Statement of Purpose and this allows service users to make decisions about their care. EVIDENCE: Detailed and thorough assessments were in place for the three service users whose files were examined. Immediate admission information obtained by the home includes personal details such as next of kin and details of doctors and social workers. All three files contained a photograph of the service user, the Service Users Guide and a copy of the home’s terms and conditions. The Service Users Guide contains information about health and social links and activities available for service users. A Statement of Purpose is available and includes information about service users civil rights, choice, personal and health care, complaints, staffing and social activities. This document was found to be regularly reviewed and was last updated in February 2005. Rosedene Version 1.10 Page 9 The Registered Manager stated that assessments of need are carried out for planned admissions prior to the service user being admitted. Service users are admitted for respite and there is a relevant policy in place. The Registered Manager stated that prospective service users and their relatives can visit prior to making a decision about staying at the home. Contracts were available for three service users whose files were seen at this inspection. One service user spoken to at the time of inspection stated ‘I like it here it is lovely’. Standard 6 is not applicable – the home does not provide intermediate care. Rosedene Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The health needs of service users are adequately met and there is evidence of multi-disciplinary working with healthcare professionals. The home has arrangements for the ordering, storage, recording and auditing of medication and has access to a pharmacist for advice. Serious errors in recording and administration of medication were found that have an effect on the health and welfare of service uses. EVIDENCE: Three care plans were examined at this inspection and found to be detailed, thorough and well organised. They all contained photographs, personal details and risk assessments for areas such as falls, pressure areas and moving and handling. Individual risk assessments were also in evidence and these related to health and behavioural issues. Personal profiles were seen and service users likes and dislikes were well-documented. A keyworker system was noted to be in place and they are responsible for ensuring the updating of the care plans relating to specific service users. There is evidence of multidisciplinary input from health and social care professionals including: Community psychiatric nurses, chiropodists, GP’s and Rosedene Version 1.10 Page 11 dieticians. The Registered Manager stated that occupational therapists and wound care specialist nurses visit as requested. The written policies and procedures relating to medication were found to be adequate on the last inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. Two staff were interviewed and medication for ten service users was counted and compared to the records of receipt and administration. From these observations and discussions differences were found between the amount in stock and the amount that should be in stock for nine service users indicating that medication had not been administered correctly. Four service users did not have the receipt of current medication recorded, three had missing entries on the administration record indicating administration/non-administration of medication. Three service users had no record of administration for one medication, as the medication was not written on the administration record making it difficult to assess whether the service users had received the correct medication. Also, large amounts of medication had been returned with no indication as to why. Changes to medication were clearly identified and medication was stored safely. All service users have access to a lockable cupboard in their rooms. The Service Users Guide states that the home recognises the values of privacy, dignity and independence. Interactions between staff members and service users on the day of inspection were observed to be appropriate. A policy on death and dying is available in the home. Rosedene Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Dietary needs are well catered for and food is well prepared nutritious and tasty. The employment of a designated activities co-ordinator has helped to improve the quality of life for service users in this home by providing a range of activities. Service users are encouraged to retain their independence through the care planning and risk assessment process. EVIDENCE: The home employs an activities co-coordinator who was spoken to at this inspection visit. She stated that service user choice is respected and they have the right to take part in whatever activities they choose. Music and dancing is provided. Other activities include: bingo, painting, drawing, watching videos, participating in sing-a-long sessions and gentle stretching exercises. There is a designated activities room situated in the rear garden of the home. The activities co-ordinator said that she accompanies some of the service users to church weekly, they can then have refreshments in the church hall if they wish. She stated she helps the service users to choose appropriate clothing when they leave the home to participate in local community activities. She demonstrated a good knowledge of the service users likes and dislikes. Service users artwork was seen to be displayed in the activities room. Rosedene Version 1.10 Page 13 Two relatives of one service user stated that there are ‘good activities’ and commented that the summer party held last year and the Christmas party were particularly good. One family member stated that their relatives spiritual needs ‘were met’. A pastor was seen to be visiting a service user at the time of inspection. One service user stated ‘I go to church to pray’. The menus seen demonstrated that service users have a choice of two hot meals and two dessert choices at lunchtime. The catering manager displayed a very good knowledge of individual service users dietary needs, likes and dislikes. She stated that the menus change according to the seasonal choice available. On the day of inspection a water main had burst in the locality affecting the home for a short period of time. The catering manager demonstrated the home could adapt quickly to a change of circumstances and she changed the menu at short notice to take account of these outside unforeseen factors. Thus ensuring the service users were not affected in a detrimental manner. A choice of water, juices, tea, coffee, milkshakes, yoghurt drinks and hot chocolate are all available to service users throughout the day. The catering manager said that tea, coffee and juice drinks are served with all meals and a choice of fresh fruit is available daily. Two relatives of one service user stated that the home provides ‘good food’ and that the service user was ‘eating well’. They also commented that they can visit the home freely and participate in the care of their relative if they so wish. Another relative spoken to at the time of inspection stated that they were ‘very happy’ with the ‘good care’ given at this home. Service users who choose to smoke were seen to be doing so in the conservatory area of the home. Regular fully minuted service user meetings were found to be taking place. Subjects observed to be discussed included service users asking for their clock to be fixed and asking to go shopping. Rosedene Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Whilst it is recognised that that there are systems in place for the protection of service users there are concerns that if adequate recruitment checks are not in place then service users could be at risk of abuse. A lack of specific risk assessments relating to cot side equipment and serious errors in the recording and administration of medication reflect shortcomings at the home. However, relatives spoken to state any issues raised are dealt with immediately. EVIDENCE: The Local Authority Protection of Vulnerable Adults Policy was available in the home. An organisational abuse and Whistle blowing policy were also found to be in place. Two staff members spoken to demonstrated a clear understanding of the Whistle blowing policy. A complaints policy is in place in the home and relatives spoken to at this inspection said they are aware of how to complain about any issues. All the relatives spoken to stated that any issues they have raised with the Registered Manager have immediately been rectified and they have no complaints about the home at present. The complaints policy has now been amended to include up-to-date details about the Commission for Social Care Inspection. There is a complaint log available in the home and there is one complaint logged in this since the last inspection. A further complaint was seen to be Rosedene Version 1.10 Page 15 logged separately - this concerned a Protection of Vulnerable Adults investigation that was investigated by the Crown Prosecution Service this year. The Registered Manager stated that this complaint was not proceeded with due to a lack of evidence. However, there was no evidence in the home at the time of inspection to support this. One staff file did not have two references in place. (See Standards 27 - 30). Twelve accidents were noted to have been recorded in the accident book since the last inspection and four incidents in the incident book. Copies of Regulation 37 incident forms which are sent to the CSCI were seen to be kept in a separate folder within the office. Three service users spoken to at this inspection visit stated they were very happy at the home and would feel satisfied that any issues they may raise would be dealt with satisfactorily. They said they have no cause for complaint at present. A cotside risk assessment was found not to be in place for one service user, this must be put in place. Rosedene Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25 and 26. The standard of the environment within this home is good providing service users with an attractive and homely place to live. The standard of maintenance of the premises is also good. EVIDENCE: This home was originally four separate houses that have been made in to one large home. It consists of three storeys and has two passenger lifts which serve the floors. No maintenance issues were identified at this inspection visit and the home was seen to be well maintained and decorated to a high standard. Additionally the home was found to be clean and hygienic on the day of inspection and it presented as being comfortable and homely. Three cleaning staff are employed and one works on each floor. Cleaning was seen to be taking place on each floor during this inspection visit. A full-time maintenance person is employed by the home and full records were seen to be kept with regard to repairs. Rosedene Version 1.10 Page 17 Bathrooms and toilets were found to be clean and hygienic at this inspection. Three service users spoken to stated they liked their bedrooms and they liked living at this home. One service user said this home was better than the previous home they had been in. Bedrooms were seen to be personalised to each service users individual taste. One family member spoken to said that their relative’s bedroom was ‘lovely and clean’. Two relatives of one service user said the cleaning is a ‘good standard’ at the home. There is a spacious dining room on the ground floor with tables at which the service users sit to have their meals. Service users may smoke in the conservatory that adjoins the ground floor lounge and were seen to be doing so. There are communal lounges on each floor and all presented as being comfortable and clean. A garden and patio area can be found to the rear of the property. The home has a pet cat and service users were seen to be interacting with her. Rosedene Version 1.10 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Staff showed they had a very good knowledge of service users needs and displayed a conscientious attitude to their work. Improvements can be made in of staff training to ensure all staff have up-to-date knowledge in areas such as manual handling, first aid and food hygiene. There are concerns relating to adequate recruitment checks - all required checks must be in place. EVIDENCE: Some of the staff at the home have been here for a number of years and display a strong loyalty to the home and demonstrated a conscientious approach to the care of the service users. One relative stated ‘the staff are superb’ and the ‘care is excellent’. They stated that a member of staff had stayed with their family member when they had been taken to the A & E department to ensure the service user had a familiar face with them who knew about their condition. Two family members of one service user stated their relative has ‘improved’ since coming to this home and staff are ‘one big happy family’. They stated that staff include them in the care of their relative. Four staff files were examined and three were found to contain all necessary recruitment documentation, however one file was found to have only one reference. The Registered Provider must ensure that all recruitment checks are in place. Rosedene Version 1.10 Page 19 There is an induction programme in place for new members of staff and staff have to complete an induction workbook. A staff member spoken to stated they had ‘good induction’ period of three months and were supported by a named nurse. They said they had been sent on a report writing course the previous week. This staff member demonstrated a good knowledge about the importance of service user choice, confidentiality and privacy. The Registered Manager informed the inspector that the Deputy Manager has left the home suddenly, this has caused slight disruption in relation to staff training as this member of staff had been responsible for this. She stated a new member of staff has been interviewed. She said there are sufficient staff at the home to meet the needs of the current service users. Staff training was seen to require updating particularly in the areas of: first aid, food hygiene and manual handling. However, there has been an overall improvement in the staff training programme at this home. Evidence was seen to show that a Health and Hygiene consultant has been engaged by the home to provide training in this area. Rosedene Version 1.10 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38 The Registered Manager provides clear direction and leadership within this home. There have been improvements in record keeping – specifically relating to care planning since the last inspection. The systems for service user consultation have not yet been fully implemented. EVIDENCE: The Registered Manager is currently completing the NVQ Level 4. Feedback about the Manager was very positive. One service user said ‘I like Matron’. A relative commented that the ‘manager knows all the patients.’ Another relative stated that the Registered Manager is ‘honest and approachable’. Two further relatives stated that the Registered Manager is ‘lovely’ and ‘very helpful’. A staff member spoken to also stated that ‘the manager is very approachable’. The management structure in the home is very clear with the Registered Manager retaining overall responsibility and a Catering and Domestic manager Rosedene Version 1.10 Page 21 is place to oversee all aspects of catering and cleaning. There is a named nurse system in operation and each named nurse supervises three key workers. Regular management meetings are held and minuted, issues discussed included: staff training, policies, inspection reports and decoration of the home. Evidence was seen to demonstrate that regular fire drills are carried out. Records regarding Portable Appliance Testing, fire safety and gas safety were all found to be in order and first aid boxes were seen to be checked monthly. Records relating to the maintenance of the two passenger lifts and the hoist equipment at the home were up-to-date. Fridge and freezer temperatures were observed to be checked daily. Hot water temperatures are checked weekly and full records kept. The Legionella risk assessment was found to have been updated in February 2005. Regulation 26 visits by the provider have not been supplied to the CSCI and will be required to be sent in monthly. Rosedene Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 2 x x 2 x 3 Rosedene Version 1.10 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 OP18 Regulation 12, 13 (4) Requirement The Registered Persons must ensure that individual risk assessments for cot side equipment are put in place. The Registered Persons must ensure that all staff files contain two references. The Registered Persons should ensure that staff training is upto-date. Refresher training must be provided for staff as required with regard to Manual Handling, First Aid and Food Hygiene. The Registered Persons must ensure that a formal system for reviewing the quality of care in the home is fully implemented. (Previous timescale of 01/03/05 not met) The Registered Person must ensure that the monthly visits by the provider as required by Regulation 26 are in place. Copies of the report must be kept in the home and a copy forwarded to the CSCI. The Registered Persons must ensure that all care staff receive one to one supervision six times a year (pro-rata for part-time Version 1.10 Timescale for action 1st June 2005 30th June 2005 1st August 2005 2. 3. OP29 OP30 19 (1) Schedule 2 18 (1) 4. OP33 24 (1) (2) (3) 1st August 2005 5. OP33 26 1st June 2005 6. OP36 18 (2) 30th June 2005 Rosedene Page 24 7. OP9 13 (2) staff). All staff responsible for facilitating such sessions must receive suitable training. (Timescale of 01/04/05 not met). The registered person must ensure that the receipt of all medication is recorded accurately. The registered person must ensure that the administration/nonadministration of all medication is recorded accurately. The registered person must ensure that all medication is counted and the correct amount recorded on the administration record. The registered person must ensure that all medication is administered as directed. Where medication is not given the reason must be clearly recorded. 5th May 2005. 8. OP9 13 (2) 5th May 2005. 9. OP9 13 (2) 6pm 4th May 2005. 10. OP9 13 (2) 6pm 4th May 2005. 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 OP9 OP21 Good Practice Recommendations It is recommended that the reason for disposal be recorded when large amounts of medication are returned It is recommended that consideration be given to additional adapted bath equipment at the home. Rosedene Version 1.10 Page 25 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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 Rosedene Version 1.10 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!