Inspection on 24/08/06 for The Gables

This inspection was carried out on 24th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 26/02/09

The Gables 02/07/07

The Gables 30/03/07

The Gables 13/02/06

The Gables 03/03/05

The Gables 03/09/04

The Gables 03/02/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB Lead Inspector Chris Schwarz Unannounced Inspection 24 & 25 August 2006 2:40 th th The Gables DS0000023055.V301831.R01.S.doc Version 5.2 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 Gables DS0000023055.V301831.R01.S.doc Version 5.2 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 Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Moreland Drive Gerrards Cross Bucks SL9 8BB 01753 890399 01753 890399 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) admin@fremantletrust.org The Fremantle Trust Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2006 Brief Description of the Service: The Gables is a home for seven adults with learning disabilities and high care needs. The home is situated within close proximity of Gerrards Cross town centre. There is a main bus route from the town centre to nearby towns. The house is sited on a large cul-de-sac, next to a school. The accommodation is over two floors, however the majority of service users have bedrooms on the ground floor. There are two bedrooms upstairs for the more mobile service users. All bedrooms are individually decorated to personal taste. The home has a large communal lounge, dining room and a separate sensory room. There is a large garden at the back of the home and some parking spaces at the front. The property is not identifiable from the outside as a care home. Fees for the service: £997.22 per week. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of two days and covered all of the key standards for younger adults. Prior to the visit, a questionnaire was sent to the manager alongside comment cards for distribution to service users, relatives and visiting professionals. Any replies received from the comment cards have been taken into consideration and have helped form judgements about quality of care. The inspection consisted of discussion with the manager and individual meetings with some of the staff team. There were opportunities to observe care practice and to meet with service users to gain their views. A tour of the premises and examination of some of the required records was also undertaken. At the end of the inspection, feedback was given to the manager. Staff and service users are thanked for their co-operation and hospitality during these visits. What the service does well: Care plans are in place for each service user, outlining their needs in order that these can be met. Service users are enabled to make decisions in everyday life, with support from staff, affording choice and opportunity. Risk taking is enabled, promoting independence. Needs arising from equality and diversity are met. Service users are part of the community and have a range of activities, providing them with community presence and stimulation. Service users are enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities are respected, ensuring that service users have appropriate recognition. Menu planning is appropriately managed, ensuring that nutritional needs are met. Health and personal care needs are reflected in care plans, to ensure that service users received the support they require. The Gables provides a comfortable, clean and well maintained environment for service users, giving them appropriate surroundings in which to live. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 6 Recruitment processes are robust enough to protect service users from the risk of harm. There is effective monitoring by the provider to ensure that quality of care is sufficient to meet care needs. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not applicable – see below. EVIDENCE: There have not been any new admissions to the service since the last inspection, therefore standards in this section were not covered on this occasion. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans are in place for each service user, outlining their needs in order that these can be met. Service users are enabled to make decisions in everyday life, with support from staff, affording choice and opportunity. Risk taking is enabled, promoting independence. EVIDENCE: Each service user has a care plan, identifying their needs, with various assessment tools such as nutritional assessments, Waterlow assessments and dependency level assessments. There was evidence of care plans being reviewed but some of the accompanying risk assessments were not dated or signed. Service users’ money is managed using the Fremantle Trust’s residents’ savings scheme, with receipts kept of purchases and individual records to The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 10 explain expenditure. An independent auditor visited the home on the first day of this inspection to look at the financial systems in the home. A missing person procedure is in place and this notes that the Commission is to be informed of anyone who goes missing from the service. All respondents to comment cards indicated that they are satisfied with care at the home. A care manager added that “All the residents appear to be happy and well cared for and the staff are very helpful and look after their visitors as well.” The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are part of the community and have a range of activities, providing them with community presence and stimulation. Service users are enabled to have appropriate relationships, maintaining important social contacts. Rights and responsibilities are respected, ensuring that service users’ have appropriate recognition. Menu planning is appropriately managed, ensuring that nutritional needs are met. Some attention is needed to meal times to ensure that these are always well managed. EVIDENCE: Most of the service users attend day services during the week, using transport provided by the centres. There was evidence of a service user attending The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 12 college as part of day service attendance and undertaking a group as part of a move towards independence. Within the home, service users have a sensory room which is nicely arranged and soothing, and there are television, music and video facilities as well as some service users having their own in their rooms. A holiday had been planned for a little later in the year. Service users have contact with family and friends and some regularly stay with family at weekends. There were no restrictions on visiting. Evening meals on both days of the inspection looked appetising. Service users were given assistance to eat their meal and enjoyed the food and staff interacted with them throughout. The meal could have been better managed had the television been switched off, to prevent the intrusion of loud noise, and if food debris had been wiped away from service users’ faces before leaving the table. Recommendations are made to attend to both matters. Routines within the home were flexible. When service users came back from day services they were made to feel welcome and offered drinks and their bags unpacked. One service user helped herself to a cup of coffee and those who are mobile were free to walk around the premises. Service users who wished to watch television or listen to music in their rooms were enabled to do so. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Health and personal care needs are reflected in care plans, to ensure that service users received the support they require. A range of medical appointments are attended, although routine checks with dentists and opticians need attention in some cases. Medication practice needs attention to ensure that best practice is followed and that service users receive the medicines they require. EVIDENCE: Care plans contained information on health care needs and provided evidence of involvement with a range of health care professionals such as physiotherapists, occupational therapists, community nurses and the consultant in learning disability. Protocols on the use of “as required” medicines and epilepsy care plans were awaiting verification by service users’ doctors. Grab rails and adaptations were in place around the building to assist service users with daily living tasks. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 14 Medical appointments were largely recorded in service users’ files although gaps were noticed to dental and optical check ups in some instances. It is important that these routine checks take place and a record kept of the outcome; a requirement is made to attend to this. Notification had been made shortly before this visit whereby some service users were not given their medicines on one shift. The person who had forgotten these service users had received training, according to records at the home, of safe medication practice and minutes of staff meetings provided evidence of instruction to staff on correct medication procedures. Staff on duty on the first day of the inspection were not able to explain why there was a tablet in a pot covered with cling film, which transpired to be for disposal. Examination of the cabinets and medicines’ fridge showed overall proper storage aside from evidence of decanting rectal diazepam tubes from one pack to another, contrary to safe practice. Medication administration records appeared accurate and reflected that medicines had not been given to some service users on the day of the notified incident. A requirement made at the last inspection regarding medication practice is repeated on this occasion and must be fully complied with. A district nurse commented that “There is always good communication between the home and district nursing staff. Any requests made by district nurses always carried out promptly”. An observed moving and handling manoeuvre was correctly undertaken. Service users were appropriately dressed for weather conditions and staff were seen lowering the outside awning when sunlight started to become a problem for service users. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Complaints procedures are in place to ensure that views are listened to. Adult protection practice needs improving to ensure that staff respond appropriately to any allegation, suspicion or incident of abuse, to reduce the risk of harm to service users. EVIDENCE: There is a central complaints procedure for service users’ representatives to use and a pictorial version which is more service user-friendly. All those responding to comment cards indicated that they are aware of how to make complaints. The Commission has not received any complaints about the service and the pre-inspection questionnaire indicated that none have been received at the home. There are adult protection and whistle blowing policies in place. Training on Protection of Vulnerable Adults for staff had been touched upon in staff meetings; this needs to be supplemented by staff attending a more detailed course, in light of a recent incident. A member of staff had not appropriately handled an allegation made by a service user and other members of the staff team had colluded with this. There could have been serious implications for how the matter was handled, especially as a written record of events showed that leading questions had been asked of the service user. The home needs to have a copy of the local authority inter-agency adult protection guidelines to supplement the training as well as making sure that each person working at the home is given a copy of the General Social Care Council code of practice The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 16 (order line details given at time of inspection). Advice was given to make use of the free adult protection training offered by Buckinghamshire Social Services. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The Gables provides a comfortable, clean and well maintained environment for service users, giving them appropriate surroundings in which to live. EVIDENCE: The Gables is a large detached house located to the south of the village centre, set in a residential street next to a school. Accommodation is on two floors, with most of the single bedrooms on ground floor level, each arranged and decorated to different taste and reflecting particular interests such as Arsenal Football Club. The downstairs bathroom has been refurbished, as required. The kitchen and laundry were in good order although it was noticed that the draining board in the kitchen slopes towards the wall, resulting in water collecting on the work surface. It was also evident under the lowered work surface that the wooden panelling is beginning to rot and this needs looking into. Upstairs there are two further bedrooms, the office, a bathroom, shower room and storage cupboards. It was noticed that the upstairs bathroom does not The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 18 have a shower hose for hair washing, with staff reliant upon a plastic jug. A recommendation is made to address this. There is a large enclosed garden at the rear with seating areas. The front of the property is well maintained with a few parking spaces and ramped access. All parts of the home were clean, well furnished and in a good state of décor. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 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): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Induction and responsibilities of staff need some thought, to ensure that staff understand their roles and carry these out in line with the service’s policies, procedures and good practice. Recruitment process are robust enough to protect service users from the risk of harm. Some work is needed on training to ensure that accurate records are maintained, missing certificates are obtained and learning is translated into practice, to ensure that staff have the skills to meet needs. EVIDENCE: The home was adequately staffed on both occasions and individuals were seen engaging with service users and taking an interest in them. There is some concern that, on occasion, responsibilities are not fully understood, resulting in areas such as medication practice and protection from abuse being poorly handled, despite training in these areas of care. National Vocational Qualifications have been completed by three staff. Training records were difficult to follow and could easily lead to the need for The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 20 update/refresher courses being missed because of the layout of the folder. Deficits in one person’s mandatory training were attributed to the record keeping rather than not attending the courses and this needs to be verified. A recommendation is made to rationalise the folder and a requirement for records to accurately reflect which training has been undertaken. Use of agency staff had reduced since new staff had started. The assistant manager position was vacant at the time of the inspection and this will be a key post for the home. Recruitment records of the two newest staff were in good order with all required checks in place. Both members of staff were working supernumerary to the rota whilst being inducted. There was no induction checklist to work through and sign off upon completion. The manager was advised, in the absence of a corporate format, to download the induction format produced by Skills for Care to show evidence of a thorough induction for staff. Staff meetings had taken place on four occasions so far this year, according to minutes. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 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, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a new manager who needs to complete appropriate training and registration to ensure that the home is in good hands. There is effective monitoring by the provider to ensure that quality of care is sufficient to meet care needs. Health and safety practice needs to be supplemented to ensure that service users, staff and visitors are adequately protected against the risk of accidental injury. EVIDENCE: The home has a new manager who has been promoted from within the service and is thus familiar with the organisation, service users, staff and relatives. She is yet to apply for registration with the Commission for Social Care Inspection and will need to undertake National Vocational Qualification level The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 22 4/Registered Manager’s Award. Until this has been achieved, the standard cannot be scored as fully met. One relative commented that communication had improved at the home since the new manager has been in place. Reports of monthly monitoring visits by the provider are sent to the Commission on a regular basis and demonstrate effective evaluation of care at the home by different senior staff with the Fremantle Trust. An audit of care practices by the provider was booked to take place in October this year. Various health and safety checks are undertaken at The Gables. There was a current gas safety certificate and portable electrical appliances had been safety checked in February this year. Thermostatic valves were tested by an external company in May and hoists had been serviced a few days prior to this visit. Generic risk assessment of the premises had been updated for this year and the accident book was being used to record any injures. First aid boxes were in place; a checklist is needed for each box to ensure that supplies are maintained. Any opened packs of dressings are to be discarded if unused rather than put back in the box for future use. Recommendations are made to attend to these matters. Window restrictors were in place and working effectively. Hot water was tested in bedrooms and one bathroom and found to be at safe temperatures. Soap and hand towels were in place at all bathroom/toilets and in the kitchen. The fire log showed that there is a fire based risk assessment of the premises and the most recent visit by the fire officer took place in July this year with all matters being satisfactory. Weekly testing of the alarm system and servicing were in good order and the means of escape were being checked frequently. There had been an eight month gap between the last two recorded fire drills; these should take place at least every six months. A requirement is made to address this. Emergency lighting was not being checked by staff at the home due to technical difficulties in being able to do this and the manager said that she was waiting to hear back from the landlords about this. A regular check of the lighting system needs to be undertaken, to ensure that lights work when needed, and a requirement is made to address this. The Gables DS0000023055.V301831.R01.S.doc Version 5.2 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 Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 2 3 The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 2 Standard YA19 YA20 Regulation 13(1) 18(1) Requirement Service users are to be given opportunity for regular dental and optical check ups. The correct protocols and procedures are to be adhered to in relation to administering and recording of medication. Previous timescale of 01.04.06 not met. The manager must ensure that all staff are trained in Protection of Vulnerable Adults. Previous timescales of 15.09.05 and 31.03.06 not fully met. This is to include notifying the Commission within 24 hours of any allegation, suspicion or incident of abuse. Accurate records are to maintained of training undertaken by staff. A written induction format is to be used for any new staff, such as the Skills for Care checklist. Fire drills are to be conducted at least every six months. Emergency lighting is to be tested monthly. Timescale for action 01/12/06 01/10/06 3 YA23 13(6) 31/01/07 4 5 6 7 YA35 YA36 YA42 YA42 10(1) 18(1) 23(4) 23(4) 01/10/06 15/09/06 15/09/06 15/09/06 The Gables DS0000023055.V301831.R01.S.doc Version 5.2 Page 25 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 3 4 5 6 7 8 9 10 11 Refer to Standard YA6 YA17 YA17 YA23 YA23 YA24 YA24 YA24 YA35 YA42 YA42 Good Practice Recommendations Care plan documentation is to be dated and signed. The television should be switched off when service users are eating. Spilt food should be wiped from service users before they leave the table. An up-to-date copy of the local authority inter-agency adult protection guidelines is to be available in the home at all times and followed by staff. All staff are to have a copy of the General Social Care Council code of practice, which can be obtained free from the General Social Care Council. The draining board in the kitchen needs attention to rectify the drainage of water toward the wall. The wooden panel on the wall under the lowered work surface needs attention where signs of rotting are evident. A shower hose is needed to replace the plastic jug in the upstairs bathroom. The training folder is to be better organised in order that records are easier to use. A checklist of contents is be added to each first aid box and stock replenished as necessary. Opened packs of dressings are to be disposed of rather than placed back in first aid boxes. 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