Inspection on 28/07/05 for Spring Lake

This inspection was carried out on 28th July 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

Spring Lake 20/10/07

Spring Lake 23/11/06

Spring Lake 15/02/06

Spring Lake 17/02/05

Spring Lake 22/06/04

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 Spring Lake 17 Forty Lane Wembley Park Middlesex HA9 9EU Lead Inspector Bernard Burrell Unannounced 28 July 2005, 10:00am 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. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Spring Lake Address 17 Forty Lane Wembley Park Middlesex HA9 9EU 020 8908 5233 020 8908 5233 i.jones1@btconnect.com Mr Ian Jones 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) Perpetua Mary Caesar CRH PC Care Home only 11 Category(ies) of LD Learning Disability registration, with number of places Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 February 2005 Brief Description of the Service: Spring Lake is part of a group comprising two residential care homes and five supported living units. It was first registered in 1997 and transferred its registration to the former NCSC in 2002 and to the CSCI in 2004 under the Care Standards Act 2000. The home is registered to provide accommodation and care service to 11 male and female young adults with learning disability, autistic spectrum disorder and behaviour challenges. At the time of this inspection, the home had no vacancy. All admissions are planned and the home does not accept emergency admissions. The home is located in Wembley close to a variety of shopping, transport, leisure, recreational and social facilities and services. The property is a large detached house with two detached outer buildings used as learning centres for residents and staff. The bedrooms are all single occupancy and one with ensuite facilities. The home has a registered managed and deputy manager plus a full compliment of care staff. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place in one day. The inspection process was assisted with contributions from the manager and staff, review and examination of residents case files, records, administrative, policy and procedure documents. The inspector noted a range of physical and environmental renovation and developments have taken place since the last inspection visit. The home continues to be managed well with an adequate mix of staff with relevant experiences, training and competencies. Review notes and reports carried out by placing social workers/care managers, advocates and other stakeholders indicated the needs of the service users are been met adequately. What the service does well: The carers appeared dedicated, focused and have sound insight into the personal care needs, personalities and individual preferences of each resident. The inspector noted that the key worker system enables appropriate relationships to develop between individual keyworkers and residents. This appears to allow each resident to develop a sense of belonging and awareness of the key people in their lives. Good effort is being made by staff at the home to help ensure that the lifestyles experienced by residents are reflective of their individual care needs and preferences. The residents are supported to develop awareness of their individual and communal space and independence in key areas of their daily lives. The home provides appropriate learning and stimulating activities that help to enhance the knowledge and skills of each resident. The home provides a range of training and professional development opportunities for staff, including good system of support and supervision. The home is maintained in an orderly, clean and satisfactory manner with appropriate maintenance and development programme in place. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: An upstairs bath/shower room is still in need of renovation and upgrading. The exterior of the building will need regular maintenance and decoration as needed. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 7 The home will need to develop appropriate community activities, leisure and social activities for the residents during the winter months for example. The manager will need to ensure medication profile for all residents is kept under regular reviews and updating. Regular review must also be carried out on medication to prevent overstocking. 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. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 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 Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 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) 1,2. The home’s admission procedure is clear and straightforward for prospective residents. Adequate and appropriate assessments are carried out before residents move in. Residents are supported by advocates and relatives to decide how and if their needs will be met at the home. EVIDENCE: The assessment process and stages for each prospective new resident is very thorough and involve contributions from the residents, their relatives, social workers, the manager at the home and other stakeholders. The service users’ guide has been reviewed and updated to reflect changes at the home. It gives clear information about the services and support prospective residents can expect when they move in. It is written in a style and format that meets the communication needs and abilities of the residents. Residents are fully supported by advocates, social workers/care managers and their relatives to make choices and decisions about moving to the home. The care plans are now been structured in person centered way with clear explanation and signs of reference about how individual care will provided. A new resident moved to the home a few weeks before this inspection. The manager reported the resident was invited to visit the home with relatives, spend time with other residents and test the facilities. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 10 Each resident is supported at the home by a keyworker who has responsibility for ensuring individual residents’ care needs are appropriately met in line with the identified needs in their care plans. The keyworker and other staff make every effort to help each new resident to settle when they move into the home. The process involved assessment and observation of each residents’ capabilities, preferences and immediate care needs. Individual bedrooms are decorated to reflect the personalities and preferences of each resident. Information about their favourite colour schemes and home comforts are recorded in their care plans. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 11 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, 9. The home is able to meet the assessed needs of each resident. There are appropriate monitoring systems and procedures in place to help ensure changing needs are recognised and appropriate action plans developed to meet those needs. EVIDENCE: A thorough and comprehensive multi-disciplinary assessment is carried out for each resident before they move to the home. When new resident arrives at the home, staff carry out capability assessment to help identify each resident’s capability to help ensure a smooth and trouble free transition. This procedure has helped to recognise and develop the individuality and personal preferences of each resident. The case files for several residents were examined and contained up to date reviews involving contributions from people involved directly or indirectly in the lives of each resident. These included, relatives, advocates and social workers/care managers. There were good examples of daily recordings and updates maintained for each resident. The recordings verified that staff do make efforts to communicate with the residents, recognised changes in their moods and Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 12 feelings and coordinate daily activities. The inspector was satisfied that staff ensure the individual resident’s choices and preferences in meals for example, are recorded in their weekly care plans, including one resident who is diabetic. The keyworkers work closely with each resident to help ensure their needs are addressed and development of their independence and living skills were possible. For example, ensuring they develop the practice of eating at the dining table with each other and helping to clear up after meals. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 13 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) 12,13,14,17. The residents are actively supported by staff to develop their varied interests in activities inside and out of the home. The home provides good opportunities for the residents to learn new skills in the home and local community. The residents benefit from the provision of nutritious, varied and balanced diet. EVIDENCE: The manager and staff updated the inspector about the range of activities the residents are involved in. Each resident has his/her daily leisure and social activities documented in their care plans. There evidence of considerable planning in place to provide appropriate daily activities for each resident that is both stimulating and challenging. The inspection findings noted that the home is now working towards a 24 hour community and personal activity programme for each resident as part of the guidelines of the National Autistic Society Assessment (NASS). The individual care plans for each resident has detail information about the range of activity programmes, how they are to be achieved, the roles of care workers, the expectations of resident’s participation and outcomes expected. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 14 The outer buildings in the garden are used to provide learning opportunities and programmes for the residents. They are supported to learn new skills such baking, how the different products are used, measurements, colours, textures and taste. The residents are also supported to learn how different objects and colours work, including doing creative art work. The keyworkers indicated that efforts are made to discover each residents’ interests and what motivates them. The individual achievements are encouraged and improved on where necessary by keyworkers. There was evidence to show that appropriate measures are taken into account to maximise the potential of each resident, including adjustments created to reflect individual residents’ level of participation. The deputy manager reported plans are now been developed to encourage more service users to go on grocery shopping trips. The other activities on offer to residents include: helping them to develop levels of concentration, coordination of hand dexterity, development of the use of touch for shape identification, plus regular relaxation and massage therapy. The residents also receive assistance by staff and other professionals to help them learn how to identify objects of reference by using specially adopted equipment and learning tools. The inspector read reports of the positive progress made by some residents who attend day care services and activities outside the home. There were photographic examples of one resident being assisted to make fruit puree. The progress report indicated the resident has developed a keen interest and enjoyment in this activity. A consultant from a supportive agency, SENSE offers advice to the staff at the home on how best to manage the challenging behaviour of some residents. For example, staff are encouraged to let residents take the lead in actions so that they can understand better what they are doing and why. When something is done well, each resident should be rewarded appropriately. The menu planning is carried out in line with the dietary needs of residents, including the special nutritional needs of some residents. The kitchen has been completely renovated and the chef reported her satisfaction with the new equipment and facilities. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 15 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. The health care needs of each resident is adequately assessed and carefully monitored. There were appropriate systems and procedures in place to help ensure regular health checks are carried out. Good progress has been made in the administration of medication at the home, but continued monitoring is needed to prevent overstocking. EVIDENCE: The care plans for each resident have detailed assessments about their individual health care needs and wellbeing. There were separate medical case files for each resident with details of hospital and other medical appointments. There were clear guidelines for the administration of medication, notification sent to the CSCI and other agencies about illness of individual resident plus regular body weight measurement and monitoring. Each resident is registered with a local doctor and the recorded case notes showed evidence of regular access and appointments to the following services: dentist, chiropodist, optician, continence management, speech and behaviour assessments and management, plus psychological assessments and reports. In addition, each resident has a comprehensive medical examination at least every six months. The medical profile for one resident was last updated in May 2002. The inspector advised the manager that this needed to be reviewed and ensure Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 16 consistency is maintained with all medical reviews and updates for each resident. There was information to verify that permission was sought from the parent/next of kin of one resident before an invasive medical examination and tests were carried out. There were guidelines for the management of seizures, procedures on how to monitor seizures plus evidence of staff training and competency in managing such events when they occur. The management of medication has improved since the last inspection and the inspector advised the manager to continue ensuring that overstock of medication do not build up unnecessarily through the repeat prescription process. There was evidence of staff with responsibility for medication administration receiving the necessary training in this area. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 17 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) 23. The home has up to date policy and procedure guidelines on how complaints and concerns should be managed. There were appropriate guidelines and information about protection of vulnerable residents. Staff were able to demonstrate their awareness, understanding and knowledge in these areas. EVIDENCE: The inspector reviewed the individual risks assessments carried out for each resident. They contained relevant information to help staff become aware of each resident’s vulnerability and how they are expected to promote the safety and wellbeing of residents. The complaints guidelines for each resident have been updated with pictorial references to help them understand the process and the information. The CSCI has received no complaints or vulnerable adults concerns or notification of investigation relating to the residents at the time of this inspection. The staff who spoke to the inspector confirmed they have received training and updates in vulnerable adults protection issues. The home has also received satisfactory CRB checks and reports for each staff working at the home. There were relevant certificates verifying that gas, electric and other appliance testings have been carried out successfully. The inspector observed staff interacting with residents and was satisfied they demonstrated respect and caring approach plus observance of for privacy when entering residents’ rooms. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 18 Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 19 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, 25, 27 30. Substantial renovation, decoration and environmental improvements have been carried out at the home since the last inspection in February 2005. The home is well maintained with adequate equipment and facilities to promote residents’ independence and ensure a safe environment. EVIDENCE: The home is a large detached house located on a main road near Wembley Stadium and within easy access to local leisure, social and shopping facilities plus public transportation. The provider has carried out major renovation work since the last inspection. The work included repainting of the house, new double glazing windows, renovation of the kitchen with new units and facilities, improvements to one bathroom/shower, a new additional outer building and improvements to the pavement area leading to the garden. The sensory room has also been upgraded and several resident’s bedrooms. The manager stated that an upstairs bathroom/shower will be upgraded and gave details of the plans been considered for this room. The problem of dampness to a wall that adjoins the property next to the house remains Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 20 outstanding. The manager explained the dampness has been investigated and originates from the adjoining building. Several measures have been taken to help minimise and reduce the problem. There is reportedly ongoing communication between the two property owners to have this matter resolved permanently. Each resident’s bedroom is adequately furnished with their personal belongings, including photographs of themselves and their families, colour schemes that reflected their individual preferences and likes. The bedrooms each had adequate space, ventilation, natural light and heating. The garden area was well maintained. The staff had adequate space to work and also store their personal belongings. The relevant environmental health and safety tests and monitoring have been carried out, including testing of the gas, electric and appliance equipment. There was appropriate storage of food, drink, equipment, household and clinical waste. The home has adequate space in the main driveway for off street parking. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 21 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, 36. The agency had a compliment of staff with appropriate experience, skills and training. The procedures for staff recruitment are through and offer adequate safety and protection to residents. Staff are able to meet the needs of the residents and receive regular supervision and support from the managers. EVIDENCE: The evidence reviewed by the inspector showed that about 5 staff have either or almost completed the NVQ levels 2 training. Staff receive supervision support once each month in addition to annual appraisal from both the manager and deputy manager. The home conducts appropriate staff recruitment that are based on equal opportunity and procedures that work to the benefit of the residents. For example, there was evidence of appropriate employment references, CRB checks and health Two new bank staff were receiving induction on the day of this inspection. The manager informed the inspector that the total staff team is currently 20 care workers, 8 of whom are bank staff. There are normally 5 care workers on the day shift, 4 in the afternoon shift including an extra staff who offers one to one care support to a resident. There are also 2 staff on waking night duty. In addition, there is a driver, cook and Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 22 cleaner. Additional staffing is provided by the manager and deputy manager plus professional support and advice from external professionals and advocates. All existing staff have received training in various health and social care issues, including statutory mandatory training in adult protection and health and safety. The staff who spoke with the inspector reported morale was satisfactory among the workers and good support is offered where necessary. Regular staff meetings, case reviews and updates take place on a daily or weekly basis as necessary. Staff also reported they have good communication and support from the managers. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 23 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) 38,39, 40,42. The home is managed satisfactorily and in the best interest of residents with good support from the registered provider. The registered manager has been making serious efforts to complete her registered manager award training. EVIDENCE: The home is managed satisfactorily and there was evidence of the registered provider carrying out regular monthly visits and assessment of the home, its operation and the welfare of the residents. The manager has been working cooperatively with the CSCI and other partner agencies to promote, protect and enhanced the welfare and safety of residents. She demonstrated sound understanding and awareness of the individual care needs of each resident, their welfare, behaviour, and daily routine. There were examples at the home verifying that appropriate monitoring and risks assessments are carried out and kept under regular reviews. In addition, Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 24 there were sound procedures in place to monitor and provide necessary health care and support to the residents. The procedures for staff recruitment and supervision help to ensure the safety and welfare of residents are protected, including an organised system of record keeping and communication with partner agencies and relatives of residents. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 4 3 x 4 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 3 2 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 4 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Spring Lake Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 3 3 G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 26 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 27 Regulation 16,23 Requirement The registered provider must ensure that the bathroom/shower in the upstairs section of the home is upgraded with necessary bathaid and equipment. The registered provider must ensure there is a programme of regular maintenance for the home, including external painting and upkeep. The manager must ensure a comprehensive review and update is carried out of the medication profile for each resident. The manager must ensure that continued monitoring and review is carried out to help prevent overstocking of medication through the repeat prescription process. Timescale for action 30 October 2005 2. 20 13 30 October 2005 Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 27 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. Refer to Standard 43 Good Practice Recommendations The registered manager should continued to seek available resources where she is able to complete her Registered Managers Award (RMA) training. Spring Lake G62-G11 17450 Spring Lake V242887 270705 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH 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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