CARE HOMES FOR OLDER PEOPLE
The Swallows Helions Bumpstead Road Haverhill Suffolk CB9 7AA Lead Inspector
Anna Rogers Announced 5 September 2005 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. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Swallows Address Helions Bumpstead Road Haverhill Suffolk CB9 7AA 01440 714745 01440 714745 none Burrows Care Homes 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) Mrs Megeita Barrett Care Home 16 Category(ies) of OP Old Age (16) registration, with number of places The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 5th January 2005 Brief Description of the Service: The Swallows residential home offers care and accommodation for up to sixteen older people, in single storey accommodation situated on the outskirts of the town of Haverhill in a rural position. The home was first registered in 1995 and the building adapted to provide appropriate accommodation for seven residents. In February 2000 an extension was completed, providing good quality and pleasant additional communal and bedroom accommodation and increasing the registration of the home to fifteen. In November 2000 a previous office was converted into an additional resident bedroom and the total again increased to sixteen residents. All resident bedrooms are for single occupancy with one room having an ensuite toilet facility. The home came under new ownership and management in June 2005 and the new owners have already made changes to improve and upgrade the environment and action a number of requirments and recommendations that have been outstanding from the previous inspection. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first announced inspection since the home changed ownership in June 2005. The inspection took place on Monday 5th September at 10.00am and was completed at 4.30pm. Evidence for the inspection was gathered from a variety of sources. The preinspection questionnaire provided information regarding residents and staff. Seven comment cards were received from residents and eight from relatives/visitors. Six residents were spoken to individually and two were spoken with informally during the day. Three visitors to the home were also spoken with. The cook, a visiting hairdresser, a decorator, the registered manager and two care staff were spoken to during the course of the inspection. The inspector undertook a tour of the home and saw a number of resident’s bedrooms. What the service does well:
The staff team are very good at caring for residents. It was clear from discussion with residents that they feel well cared for. One resident said “they work so hard”, another said “nothing is too much trouble for them” “ they are always so willing and cheerful”. Residents all looked well cared for and happy. Staff were observed to carry out their tasks in a calm and relaxed way and were reassuring residents who are mentally frail. Residents spoken with said that staff responded quickly at night when they rang their call bell and would also provide them with a hot drink if they needed it. Residents were very happy that they are now provided with serviettes at meals but also said it was “wonderful that we have serviette rings as well”. It is clear that the staff want to be able to meet resident’s needs. The manager has identified two residents that need to have their needs reassessed to ensure they receive the appropriate care. A new resident was admitted on the day of this inspection and it was evident that staff wanted to ensure the resident received a warm welcome and reassured them that they could stay with another relative already living at the home. Relatives who either completed The Commission for Social Care Inspection (CSCI)) questionnaire or met the inspector on the day of inspection expressed satisfaction with the care provided and several made positive comments about the work of the new owners. Visitors felt they were kept informed about their relatives. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 6 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 Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 8 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 The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 9 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) 1,3. (Standard 6 does not apply to this service). Residents can expect to be provided with a copy of the homes’ Statement of Purpose and Residents Guide but can not be assured that all residents admitted will be in accordance with the category of Registration. New residents can expect that their needs will be assessed. EVIDENCE: The new providers have updated the Statement of Purpose. It is a detailed document and includes the information set down in Schedule 1 of The Care Homes Regulations 2001. The Residents Guide also provides some good information including how the resident can make a complaint. There are now at the entrance of the home copies of the Statement of Purpose, The Service User Guide and the last Commission for Social Care Inspection (CSCI) inspection report. During discussion with the manager and inspection of a sample of care plans it was noted that one care plan had recorded that the resident has dementia, which is outside the category of registration for the home. The manager confirmed that a relative of the resident is seeking an alternative placement.
The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 10 The manager is also asking for a re-assessment of one other resident to ensure The Swallows remains an appropriate placement. The resident has dementia, which is outside the category of registration for the home. The organisation must apply for a variation of registration if the home feels they can continue to care for this person. On the day of this inspection a new resident was being admitted to the home. The manager had been to visit the person in hospital and also had an assessment completed on the 30th August by the resident’s social worker. The manager also completes an assessment of the resident’s needs. The new resident has a relative already at the home and they were clearly very pleased to be together. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 11 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 The residents can expect that the staff team will ensure that their healthcare needs are met and contact healthcare professionals when necessary. Residents can expect that their care plan will detail how their needs are to be met. However, the existing administration of medicines is not carried out in a manner that assures the safety and welfare of residents. EVIDENCE: Three resident’s care plans were seen, two of residents already in placement and the third of the resident admitted on the day of inspection. Two of the care plans provided details regarding the care they receive. The care plan for the new resident had not been fully completed. The manager confirmed that a new format for care plans were being introduced for new residents and eventually existing care plans would be reviewed to ensure they contain the same information. The new format covers the assessment criteria set down in Standard 3 of the National Minimum Standards The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 12 The care plans detail the health care needs of residents and the daily notes indicate how the needs are met. For example one resident is prone to pressure areas developing and there was evidence that the District Nurse has been involved in monitoring and dressing areas when necessary. All residents are registered with local GPs and there was evidence that staff will contact them when necessary. The new care plan formats will provide evidence of nutritional screening. The residents are routinely weighed monthly. There was also evidence in the new care plan format of assessments for continence. Risk assessments for moving and handling are in place. The new manager is a trained assessor for risk assessments and has arranged for one of the senior members of staff to attend a Risk Assessors course and they then will in conjunction with the manager undertake regular reviews for moving and handling. All residents seen were clean and tidy. Clothing looked well cared for. One of the carers said that the laundry arrangements had been changed and this made it easier to ensure residents clothing was returned to the right person. Following the last inspection a number of requirements were made relating to the system of medicine administration included the unsafe preparation of medicines into secondary containers, which was seen as unsafe practice. The new manager at the home has addressed these concerns in a positive way. The inspector was informed that a Monitored Dosage System (MDS) is to be introduced at the home on the 3rd October 2005. Training for staff to use the new system has been planned for the 13th and 30th September. There remains a need to monitor the administration of medication until the new system is introduced. A review of the medication policy and procedure was also required. An updated medicine policy and procedure has been produced but should be reviewed again with the providers of the MDS system to ensure it remains relevant. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 13 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) 13,14 The arrangements at the home encourage visits from resident’s family and friends. Residents can expect to be encouraged to decide how they would like to spend their days but opportunities for going out into the community are limited. EVIDENCE: Residents spoken with confirmed that their relatives and friends were able to visit at all reasonable times. The inspector spoke with three visitors. They confirmed that they are always made welcome by the staff team and offered a drink. Visitors also said they were kept informed of any incidents involving their relatives. Residents said they had a choice about what they did and were able to follow their own routines. One resident gave the example of where they liked to have their meals, which include a combination of their room and the dining room where they met up with other residents who shared the same table. Two residents said that the new owners had provided some attractive flower tubs and boxes at the front of the property and that they enjoyed the opportunity to sit outside on the seating available to enjoy the colourful plants. A sunshade has also been provided to ensure residents do not get too hot. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 14 Residents are provided with choices about their meals but the manager confirmed that they want to introduce residents meetings so that residents can have more say about things that are important to them. One of the residents has recently died and another resident has requested an opportunity to attend the funeral, which has been arranged by the manager. One resident commented in their feedback form to The Commission for Social Care Inspection (CSCI) that they would like opportunities for more activities. The manager explained that these were the sorts of issues they would like to see discussed. The involvement of choice by residents has been developed in a new policy and procedure titled Code of Practice. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 15 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) 16,18 There is an effective system in place for residents to express their concerns. Residents cannot be assured that the recruitment safeguards in relation to Criminal Record Bureau (CRB) checks have been followed to protect their safety. EVIDENCE: The statement of purpose and service users guide contains information on how residents/relatives can make complaints and contains the Commission’s details. All of the residents said they would either talk to their relatives or staff if they wanted to make a complaint but felt they had nothing to complain about. The manager said that they had received one complaint three days after taking over the home. This related to a residents clothing not being ironed. The manager responded within seven days to reassure the relative that arrangements were in place to ensure this did not occur. Details of the complaint and response were available on file but the manager was informed of the need to have a complaints log. The Commission for Social Care Inspection (CSCI) have received a complaint about the attitude of the Responsible individual (RI) towards members of staff which involved shouting at them in front of residents. CSCI have investigated this complaint and concluded that the complaint was upheld. The home has a policy and procedure on The Protection of Vulnerable Adults although this needs to be developed to ensure it meets with the expectations of the Suffolk Protection of Vulnerable Adults (POVA) inter agency policy, procedures and guidelines for staff.
The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 16 Members of staff spoken with were not able to explain the local procedures but were clear that they would report any suspicion or allegation of abuse to the manager. The Registered Manager has recently attended a Protection of Vulnerable Adults training course and a copy of the Suffolk Protection of Vulnerable Adults (POVA) inter agency policy, procedures and guidelines for staff is available in the office. The manager has also developed an in house training booklet titled “Vulnerable Adults – at risk of abuse.” The expectation is that staff will complete this and then use it for discussion in supervision with the manager. The recruitment process was not explored in detail during this inspection but it was clear from information provided that one member of staff’s CRB certificate related to another post and service, which is not transferable to their present post. There was also no evidence that a POVA 1st check has being undertaken. The manager confirmed that a new application for a CRB has been made in respect of the member of staff. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 17 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) 19,21,24,26 Residents can expect the home to provide them with a safe and secure environment, which is well maintained, comfortable, clean, and free of offensive odours. EVIDENCE: There was clear evidence that the new owners have begun to upgrade the environment. A resident’s bedroom was in the process of being decorated and other areas including a bathroom and toilet have already been decorated. Externally pots with seasonal plants provide a welcoming approach to the home and residents have commented that they enjoy sitting outside. A table, chairs and umbrella have been provided to ensure they sit in comfort. Residents have also commented that the garden at the rear of the property is being tidied up. There are three separate toilets available for use by residents in addition to toilets located within bathrooms. All were clean and fresh. The location makes it easy for residents to access from bedrooms and/or the lounge. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 18 Residents spoken with said they were happy with their bedrooms which they have been encouraged to personalise with memorabilia and items of sentimental value from their own homes. One resident said they enjoyed spending time in their room particularly after having their lunch. All spoken with said their beds were comfortable and that they had sufficient storage space. Call bells were located within easy reach of where residents were sitting in their rooms and they confirmed that staff made sure it was accessible at night. They also said staff responded positively if they used the call bell at night. The laundry room was well ordered and a member of staff commented that changes to the layout have improved the arrangements fro ensuring residents clothing is returned to the correct people. Cleaning materials are kept locked away. There are Control of Substances Hazardous to Health Regulations (COSHH) risk assessments in place for most of the cleaning products in use but it was noted that bleach is used as a toilet cleaner and a risk assessment was not in place. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 19 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) 27,28 Residents can expect to be cared for by a staff team who are committed to provide good quality care. The management of the home recognise the importance of providing training opportunities for staff EVIDENCE: The rotas show that there are a minimum of two staff on each of the three shifts i.e. early, late and night time shifts. Two of the permanent staff are on maternity leave, which together with vacancies means that approximately 78 hours are having to be covered over a two week period. The existing staff team is currently filling these vacant hours although the manager provided evidence that they are recruiting to these vacancies. The manager provided details of how they intend to increase the number of trained staff. Currently the Deputy and Assistant Managers hold a National Vocational Qualification (NVQ) III qualification. The manager explained that six members of staff are to begin their NVQ level II training in September at a local college. This was confirmed in discussion with one of the staff identified to attend the training. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 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) 31,33,36,37,38 Residents can expect to live in a well managed home. However lines of accountability need to be developed. Residents can expect to be cared for by staff who are well supported. EVIDENCE: The registered manager is qualified and very experienced of working with elderly people in residential settings. They are currently working one day a week and alternative weekends at the home although are scheduled to cover for holiday periods. There is evidence that there is an improvement to the environment, a number of policies and procedures have been reviewed and attention has been given to increasing the training undertaken by the staff team. However there is evidence to indicate that the role and responsibilities of the senior team needs to be agreed and shared with the staff team, as this is a change from the previous management arrangements at the home.
The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 21 There is also a need to develop communication system within the home and ensure the lines of accountability and contact when the manager is absent. The manager is aware of the need to develop a quality assurance system. There is also a need to identify an external person who can undertake the Regulation 33 visits monthly. A system has been developed whereby all staff will receive 1:1 supervision with the manager on a six weekly basis. The manager has developed a supervision agreement and a record of each session. The agreement highlights the equal responsibility of supervisee and supervisor to attend and identify agenda items for discussion. Staff spoken with confirmed they had had their first session and found it helpful. It was evident that the manager is in the throes of reviewing the recording practice within the home. A number of policies and procedures have been reviewed and/or developed. One recent development is the introduction of a bathing policy. This is practice focussed and highlights the need for the resident’s privacy and dignity to be respected. Other records have new formats for example care plans and these will be looked at in more detail at the next inspection when they have been put into use There was evidence from discussion with the manager and staff that a number of courses relating to safe working practice have been arranged. The manager provided evidence that fire training is planned for the 24th October, First Aid 25th October, moving and handling has recently been provided and all staff have up to date certificates. As noted in previous section Protection of Vulnerable Adults training has been planned. Training relating to food hygiene and health and safety are to be completed by a distance learning course and dates for these are to be arranged. The accident book was seen and the record found to be satisfactory. The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 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. 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 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x 3 x x 3 3 3 The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 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 1 Regulation 4 Requirement The Registered Persons must ensure that residents placed at the home are within the criteria set down in the Statement of Purpose and category of Registration. An application for a variation to the registration must be made in relation to residents who have a diagnoses of Dementia if the home can demonstrate thay can continue to meet their needs. A complaints log must be maintained and availabe for inspection by The Commission for Social Care Inspection (CSCI) The homes Protection of Vulnerable Adults Policy must reflect the guidelines set out in the Suffolk Interagency Procedures for the Protection Of Vulnerable Adults. The Registered Person must ensure that a current Criminal Record Bureau (CRB) check and POVA 1st check are obtained for all new staff in the home prior to them undertaking care duties. Timescale for action Immediate 2. 16 22 (8) Immediate 3. 18 13 (6) By September 30th 2005 4. 18 19 (5) By September 30th 2005 The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 24 5. 18 19 (5) 6. 26 13 (3) The staff records must show evidence of an up to date Criminal Record Bureau (CRB) and POVA 1st check. Risk assessments for all cleaning products available in the home must be in place. The registered manager must demonstrate in writing to The Commission for Social Care Inspection (CSCI) how they will ensure they have in depth day to day knowledge of the homes operation. Arrangements must be made for monthly visits to be undertaken as set down in Regulation 26 of The Care Homes Regulations 2001 and for copies to be sent to The Commission for Social Care Inspection (CSCI) The Responsible Individual and Registered Manager must maintain good personal and professional relationships with each other and with service users and staff. By September 30th 2005 Immediate 7. 31 12 (5) (a) By October 30th 2005 8. 33 26 Immediate 9. 12 5 Immediate 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 3 9 Good Practice Recommendations Needs assessments completed by the manager should include the criteria set down in 3.3 of Standard 3 of the National Minimum Standards. The medicine policy and procedure should be reviewed again with the providers of the MDS system to ensure it remains relevant. Te nutritional form should record the dexterity of the resident. All policies and procedures should be dated.
I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 25 3. 4. 7 37 The Swallows The Swallows I54 - I04 S63929 The Swallows V236055 050905 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 5th Floor St Vincent House Cutler Street Ipswich IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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