CARE HOME ADULTS 18-65
The Firs And Hewlitt Woodside Road Abbots Langley Watford Hertfordshire WD5 0HT Lead Inspector
Ms Louise Bushell Unannounced Inspection 10:00 26th August & 2 September 2005
nd The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Firs And Hewlitt Address Woodside Road Abbots Langley Watford Hertfordshire WD5 0HT 01923 681157 01923 681157/8 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Life Opportunities Trust Mrs Rebecca Burrows Care Home 15 Category(ies) of Learning disability (15), Learning disability over registration, with number 65 years of age (15), Physical disability (15), of places Physical disability over 65 years of age (15) The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th December 2004 Brief Description of the Service: The Firs and Hewlitt is a care home providing personal care and accommodation for fifteen adults with learning disabilities, some of whom also have a physical disability. The home is owned by Life Opportunities Trust (LOT), which is a voluntary organisation. The home is located on the outskirts of Abbots Langley, a short walk from a shopping precinct that includes a surgery, pharmacist, convenience store and a restaurant. A little further away is the village of Abbots Langley, which has shops, pubs and a library. There is a local bus service to the towns of Watford, St Albans and Hemel Hempstead. The home was opened in 1993 and consists of two purpose built detached buildings that are accessed via a private drive. The Firs is a bungalow comprising a lounge, dinning room, kitchen, laundry room, seven bedrooms and two bathrooms, one with a shower and hoist and one small toilet. Hewlitt is a chalet style house, with a similar layout to the Firs, except that it has six bedrooms on the ground floor and two on the first floor, accessed by a stair lift. All the home’s bedrooms are single; none of the bedrooms have en-suite facilities. The home has a large, well maintained garden area. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home first inspection of the inspection year and was conducted over a period of two days. The inspection focused on meeting and talking to the service users, staff and the management of the home. What the service does well: What has improved since the last inspection?
Following the last inspection improvements have been made to the decoration of the home, although on this occasion these standards were not fully inspected. The home has also had a new specialist Arjo Malibu bath installed for the needs of the service users. The manager stated that the home is also currently awaiting the laminating flooring for the dining room area.
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 6 Following the positive work with service users, one service user has been supported in moving on to more suitable accommodation. Although the home still remains under staffed some recruitment has occurred which further supports the home and the provision of consistent care for the service users. What they could do better:
There are a number of areas within the home that require monitoring and reviewing to ensure that they are consistently meeting the national minimum standards. The Statement of Purpose and the Service Users Guide requires further amendments to ensure it contacts current up to date information regarding the service, work is also reviewed to ensure that the format adopted by the home meets the individual service users needs. Risk assessments within the home are required to be reviewed ensuing that changing needs are monitored and appropriate actions taken, this includes the implementation of risk assessments supporting specialist needs such as diabetes and manual handling assessments. Contracts for the service users must be signed ensuring that their individual rights are maintained and protected. Staffing levels within the home are currently insufficient with regards to permanent staff. Currently the home is supporting the service users with the use of agency staff. There is a need for the home to ensure that its recruitment drive continues to ensure that systems within the home are managed and maintained and that the needs of the service users are being met consistently. Specialist abuse training is to be provided within the home to further develop the training that the staff have received. This training would further ensure that safety and the protection of the service users. It is recommended that the home implements a training matrix of the staff and the training that they have received, this will then identify and focus on refresher dates and completion dates for core training. Medication systems in the home are in need of further close monitoring and management to ensure that the level of training and conformity to the policy is maintained by all staff. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 7 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. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 & 5 The Service Users Guide and Statement of Purpose are comprehensive and informative documents for service users to determine and make positives choices within the their lives about where to live. They require minor amendments to ensure that information provided is factual and current. EVIDENCE: The Statement of Purpose and Service User’s Guide requires reviewing with minor amendments to be made, ensuring that all information provided is current and up to date. The manager of the home stated that works are soon to commence on the Statement of Purpose and Service Users Guide in making this more accessible to service users in a pictorial format. A full assessment is always completed prior to admission. Copies of these were available for inspection. These contained detailed information regarding the needs of the service users and supported the home and the service users in the implementation of appropriate care plans. All service users are invited to come for a tea visit, an overnight stay and a longer short-term stay prior to any decision on admission. All admissions are subject to review after one week and again after three months. A contract is agreed with the service user at the review meeting convened three months after admission, which is attended by interested professionals and relatives as appropriate. This is written up and held on file in the home. The home should ensure that the rights of the service user are maintained at all times and that an opportunity has been provided for
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 10 the service user to sign their contract, or an appropriate representative/ relative. Service users confirmed that the referrals and admissions procedure was effective and that the process was smooth and sensitive to individual needs. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 9 & 10 Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, met and developed. In order for identified needs to be met the home must implement appropriate care plans for the management of specific need. EVIDENCE: Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, met and developed. Care planning systems within the home ensures that individual goals and aspiration are set, reviewed and planned. The home has an effective system in place that reflects the priority needs planning for the service user which enables specific goals and time scales to be set ensuring constant reviewing occurs. All service users have an individual care plan and an allocated key worker to support them in the home. Individual daily notes and guidelines for the service users were observed within the home. All service users are supported within the Care Management Framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. There is a need to ensure that where a specific need has been identified as part of the
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 12 assessment process that a care plan is drawn up with the involvement of the service user and other relevant professional to ensure sound management of the identified need. This will ensure that the methods of the planning are person centred, involve the service user at each stage and ensure that care plans are active working documents. The files specific to the service user must contain all relevant information in order for appropriate and specific care to be consistently provided. Those documents that are not current require archiving. The assessment process within the home is through and detailed. Completed assessments were seen on the service users files. Reviews occur within the home and records are well maintained. Whole live reviews occur annually with appropriate CPA meeting as required. Several referrals have been made to an advocacy service to support and further empower the service users in making and taking active choices in their lives. A number of risk assessments pertaining to the needs of individuals are held. There is a need to ensure that accurate and detailed risk assessments are present within the home for all service users that require support and manually handling. Risk assessments are in place for the management of choking for one particular service users however, this is in need of reviewing to ensure it is still current and active. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 the following standard(s): 15, 16 & 17 Service users are encouraged to engage and maintain social relationships, thus promoting independence. The rights of the service users are maintained providing them with appropriate support and assistance. EVIDENCE: Service users are supported to maintain family links and friendships inside and outside the home. Feedback from a service user determined that family; friends and visitors are welcomed into the home. The home supports and encourages the service users to develop and maintain personal relationships with people of their choice and information and specialist guidance is provided to help service users make appropriate choices. Services users confirmed that the daily routines within the house support and promote their independence. One service user discussed that she felt respected and dignified by the staff, stating that they were very kind and considerate. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 14 Staff and service users were observed to interact within each other well, providing mutual respect for one another. Service users were not restricted to access to the home and grounds. Service users commented that they were able to make positive choices in their lives concerning activities and holidays and day-to-day living choices. Services users are offered a healthy, wellbalanced nutritious diet, and feed back that the meals provided were “tasty”. Meal choices are provided within the home although there is a need for a system to be introduced to further empower service user choices. A pictorial system was discussed in detail. Menus were available and a four-week rolling seasonal menu is in place, which appeared well balanced. Records are maintained of food consumed and offered. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 20 All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. Service users physical and health needs are met, ensuring that their safety, wellbeing and health is promoted at all times. In order for identified needs to be meet the home must implement appropriate care plans for the management of specific need. EVIDENCE: All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Assessments and reviews are continuously completed, through the care management process, ensuring that the approach adopted by the home is person centred and holistic to each service users needs. Service users needs are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. Staff were observed supporting service users in a manner preferable to the service user. The home has a designated key worker system in place to support the provision of consistency within the
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 16 home, however due to the home being short staffed the level of consistency provided could increase, thus ensuring specific needs are being met. There is a need for the home to ensure that where a specific need has been identified as part of the assessment process that a care plan is drawn up with the involvement of the service user and other relevant professional to ensure sound management of the identified need. This will ensure that the methods of the planning are person centred, involve the service user at each stage and ensure that care plans are active working documents, meeting identified health care needs. With a secure structured staff team in place the management of this process would be more achievable. Medication systems within the home are well organised with a designated person coordinating the ordering and the returning of the medication on a monthly basis. The manager stated that currently the home is liaising with the pharmacist in providing some in house training for the staff. This will further develop and support the management of the task. The home has a procedure in place to monitor the temperature of the medication cupboard, however it appears that on numerous occasions this temperature had been exceeded. The home must ensure that if a management system is implemented that an effective protocol of actions is in place in such eventualities if the temperature is exceeded. Date of opening must be added to medication, ensuring that appropriate shelve life is not exceeded. Where a service users medication has been omitted for a particular reason, then appropriate coding systems must be applied to the Medication Administration Record. The home must ensure that old medication is returned the pharmacist on expiry. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 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 the following standard(s): Not Inspected on this occasion. EVIDENCE: Not inspected on this occasion. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not fully inspected on this occasion. EVIDENCE: Not fully inspected on this occasion. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 & 35 The home is currently not suitably staffed, thus management and monitoring of individual service users needs may be at risk. The permanent staff employed are well-trained individuals ensuring that service user needs can be met once a full compliment of staff are employed. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. Staff were seen to support the main aims and values of the home. All staff have received a copy of the General Social Care Council Code of Conduct. The home has clearly defined job descriptions and person specifications in place. Recruitment practices within the home appear well structured. Supervision and appraisal occurs within the home and staff felt that this was a valuable process. The home is currently short staffed, operating at 50 under numbers. The home is currently using agency staff to make up the deficiency within the team. The manager has been advocating a recruitment drive within the home to no avail. The manager of the home will be advertising shortly to hopefully recruit into the vacancies. In order for the staff and the management to provide an efficient, consistent service it is imperative that the current
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 20 vacancies are filled, thus ensuring that the needs changing needs of the service users are being met. The staff that are currently employed are competent and trained. Records show that staff levels are of a satisfactory level and ratio to meet the service users needs. Regular staff meetings occur within the home and records were seen. All staff received regular training. The Registered Manager has completed her NVQ Registered Managers Award. Training records are maintained on site for all staff. It is recommended that the home implements a training matrix of the staff and the training that they have received, this will then identify and focus on refresher dates and completion dates for core training. The level of permanent staff within the home that holds the NVQ is commendable under the current staffing resources. Following the last inspection the home is still looking at the available resources for the provision of suitable adult protection training. Following discussions with the manager a contact was provided for the training. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 40, 41 & 42. The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is meeting its aims and objectives. Systems for effective health and safety management are in place, works are still required within the home to ensure the safety is maintained. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to commented that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users appeared to benefit from this well structured and well run home. Service users spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment.
The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 22 The staff team and the manager of the home are adequately trained and experienced to ensure that service users needs are being met. Periodic training occurs within the home to ensure staff development is maintained. A vast range of policies and procedural guidelines are in place. Staff are requested to read and sign risk assessments and polices. The home has a multitude of risk assessments in place. All records required by regulation were available and maintained. All records are secure within the home and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. There is a need to develop a number of risk assessments pertaining to meeting the specialist needs of service users at the home. The home files that contain all information pertaining to the needs of the service users require sorting, in order for all staff to have clear structured guidelines on the care that is to be provided to the service users. Information that is out of date should be archived. The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 2 3 3 3 2 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 3 Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X x LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Firs And Hewlitt Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 2 2 X DS0000019569.V249049.R01.S.doc Version 5.0 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 1 Regulation 4 (1) (c), Sch 1, 16 Requirement Timescale for action 15/11/05 2 9 & 19 13 (4) (b), 15 (1) The Statement of Purpose and Service users Guide must be amended to include details of the current staffing and fee’s. This requirement has been carried forward from the last two inspection reports. Regulatory action may be considered if this requirement is not complied within the timescale. Appropriate risk assessments 15/11/05 must be put in place for the needs of individual service users, with the involvement and agreement of the service user. Risk assessments specific to the care and management of diabetes and epilepsy must be implemented. 3 23 & 35 13 (6) 4 6 & 19 15 (1) Adequate training must be provided for all staff on the prevention of abuse, including the responsibilities for whistle blowing. Needs specific care plans must be implemented. Care plans for the management of diabetes
DS0000019569.V249049.R01.S.doc 15/12/05 01/11/05 The Firs And Hewlitt Version 5.0 Page 25 5 5 5 (c) 6 17 16 (2) (i) 7 20 13 (2) must be implemented ensuring staff have clear guidelines on protocols to follow. Service users, supporters, relatives and or representatives must be involved of the drawing of the contracts of tenancy. Signing with agreement to the conditions and terms. The development of a choice system for meals must occur to enable a flexible provision of suitable food which is varied. • Medication must be dated once opened. • Expired medication must be returned to the pharmacist. • Appropriate coding systems must be entered on to the MAR when medication is omitted. • A protocol must be implemented for the management of the temperature of the medication cupboard. The home must be suitable staffed with competent and qualified people in such numbers to meet the specialist needs of the service users. Service users records must be maintained and up to date providing key information for all staff and service users Specific risk assessments must be implemented within the home to support staff and service users in the management of risk surrounding manual handling and diabetes. 15/12/05 31/12/05 30/11/05 8 33 18 (1) (a) (b) 31/12/05 10 41 17 (3) (a) 15/12/05 11 42 13 (4) (b) 15/11/05 The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 26 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 1 Good Practice Recommendations It is recommended that the staff and the service users should explore imaginative ways to make the service users guide more accessible to the service users. This recommendation has been repeated from the two previous inspection reports Information in some of the service users files is confusing and misleading. Information that is out of date and not current should be archived. This recommendation has been repeated from the previous inspection reports It is recommended that specific medication training be provided within the home by the pharmacist. 2 40 3 20 The Firs And Hewlitt DS0000019569.V249049.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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