Inspection on 23/01/07 for The Garden House

This inspection was carried out on 23rd January 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Garden House 01/12/08

The Garden House 21/11/05

The Garden House 02/06/05

The Garden House 17/11/04

The Garden House 28/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Garden House Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU Lead Inspector Alan Pitts Key Unannounced Inspection 23rd January 2007 09:30 The Garden House DS0000038198.V326023.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 Garden House DS0000038198.V326023.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 Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Garden House Address Bowden Derra Park Polyphant Launceston Cornwall PL15 7PU 01566 86230 01566 86230 carynjory@btinternet.com 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) Bowden Derra Park Limited Mrs Caryn Anne Jory Care Home 12 Category(ies) of Learning disability (12) registration, with number of places The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 Brief Description of the Service: The Garden House is an independently registered home within the Bowden Derra Park complex, which is owned by Bowden Derra Park Limited. It provides care and accommodation in single rooms for adults with learning difficulties, some of who may have associated nursing needs. Service users are essentially a younger age group. The home is situated within large grounds on the edge of a small village approximately seven miles from Launceston. Although it was built before the national minimum standards came into force the home has been designed to provide space for wheelchairs users to be able to move around with relative ease. Service users are encouraged to have an active life style. Full support from carers is provided, plus transport where necessary, to enable this to happen. The Garden House fees range from £890 - £3000 per week. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 23rd January 2007 over a period of approximately 6 hours. The inspector met with the registered manager, staff, residents, and a visiting relative. The inspector toured the premises and examined relevant documentation. The Garden House staff treat everyone as an individual and avoid taking people out in large groups, unless this is the residents’ choice. They prefer to go on a 1:1 basis, or with another friend who may or may not be a resident. The premises provide a home to a young group of adults and the entertainments, décor, and lifestyle try to reflect this. The overall outcome for residents is very good, and the requirement and recommendations should not be seen to detract from the hard work and commitment of the registered manager and the staff team. What the service does well: What has improved since the last inspection? The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 6 This was the inspector’s first inspection at The Garden House, and as such it is not possible really to say what has improved since the last inspection. The outcomes for residents continue to be very good. 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 summary of this inspection report can be made available in other formats on request. The Garden House DS0000038198.V326023.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 Garden House DS0000038198.V326023.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. National Minimum Standard 2 was inspected. This judgement has been made using available evidence including a visit to this service. Prospective residents are fully assessed prior to admission to ensure that the home can meet their care needs and aspirations. EVIDENCE: The registered manager is well aware of the importance of having a congenial mix of residents in the home and assesses any potential resident carefully in advance to decide whether the home can offer the support the person needs and whether the resident will benefit from the client group. The most recent admission to the home has lived there for approximately 18 months now, so there is an established group of residents who’s care needs and aspirations are well known and documented. There is a plan of care for each resident, resulting from the initial assessment and ongoing review. Potential risks or limitations on choice are recognised and documented, and a openly discussed with the resident and their representative. Where it is not possible to ascertain the residents’ interests or preference, the representative’s agreement is sought. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 9 A visiting relative confirmed the good communication links that existed, and that they felt they were included in the care provision. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 6, 7, and 9 were inspected. This judgement has been made using available evidence including a visit to this service. Needs and choice are assessed on an individual basis and full care plans implemented to address these. Staff implement thorough risk management procedures to safeguard residents and involve them in decision making as much as they (the residents) are able. Choice and individuality is at the heart of the care provided for service users. They are actively encouraged to participate in as many aspects of the home as they wish or are able. EVIDENCE: Each resident has an individual plan that sets out his or her needs in detail and the care needed to meet these. The resident, and/or family, or other relevant people are included in preparing plans. Some are produced in alternative formats if this is easier for the resident to understand. Each person has a key worker. Although care plans are clearly reviewed regularly and frequently more could be done to show residents/representatives involvement in care plan reviews. The registered manager should make arrangements to ensure that The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 11 residents and/or their representatives are included in the care plan review process. There is a regular house meeting which all are encouraged to attend where residents’ views are recorded and actioned. Topics covered at the last meeting included: 1. Menu 2. Choice of holiday 3. How to spend New Years Day All risks are thoroughly assessed and well documented, both on individual activities on a daily basis and as an overall view of a residents’ needs. There is recognition that a level of risk is sometimes necessary in order to fulfil residents’ capabilities. Where there are limitations on choice or facilities, it is in the person’s best interest. Any limitations are fully documented and reviewed on a regular basis to ensure their ongoing relevance. The staff ensure that resident’s functional needs and abilities are fully included as well as their developmental and social goals, as this can form an important reference point subsequently when progress is being assessed. Options are currently being explored for new work/educational experiences for some residents. The care records are informative, and show how and why choices have been made, including when others have made decisions. The home has recently acquired relevant information relating to relationships and sexuality for one resident in order to further improve the life experiences available. Residents’ finances are currently ‘pooled’ in a central residents’ account, which is managed by the parent care home Bowden Derra. This is unacceptable as residents may be disadvantaged. The registered manager said that this was already under review with a view to setting up individual accounts, and that this process would now be hastened. The registered provider must make arrangements for each resident to have their own bank accounts. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. National Minimum Standards 12, 13, 15, 16, and 17 were inspected. This judgement has been made using available evidence including a visit to this service. A flexible lifestyle that provides residents with opportunities is at the heart of the care provided. Residents are provided with as many options as possible to encourage independence, further education and interesting leisure opportunities. They are fully supported to enable them to get the maximum benefit from these, whilst being encouraged to be responsible and responsive in their daily lives. Care is taken to ensure that meals and mealtimes are enjoyable. EVIDENCE: Personal development is strongly encouraged with opportunities sought to advance this. Communication is one of the main areas needing help as a number of the residents in The Garden House have poor communication skills. The registered manager is actively exploring further educational/work experiences for one resident. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 13 Residents are helped to integrate with the surrounding community and all have active programmes that involve participation in community activities and use of community facilities. All residents are encouraged to become as independent as they are able. Severe limitations due to residents’ functional abilities, remain, but for the majority a 1:1 carer, who has developed a sound knowledge of a person’s preferences and needs, enables the resident to be part of the community and become involved in some very imaginative leisure and activity plans. The staff are aware of the need to arrange activities that are age appropriate, but attainable and to this end residents attend college, drama groups, hydrotherapy, and a local gym, as well as practising independent living skills training at the day centre in the local town. Residents’ records show family involvement with the home and the care of their relative. Interaction with the staff is encouraged. Residents have opportunities to meet and mix with people of their own age by attending clubs and outside activities. A visiting relative confirmed the good communications that exist with the registered manager and the staff. Staff appeared to be well aware of people’s individual preferences and were all seen to knock & wait before entering a person’s room. Residents were seen to be able to spend time alone if they wished. Families are welcomed to visit and residents can go home for weekends and breaks if they wish. Everyone is offered a holiday of their choosing. Residents now have the choice of dining area and with whom they might wish to sit, and those who need a quiet area away from distractions are catered for. There is a four-week menu in operation, which offers 3 choices at lunch and evening meals. The registered manager advised the inspector that the chef is trained in nutritional needs, and a dietician is involved on an individual basis as needs arise. Meals are prepared in the central kitchens and delivered to The Garden House in a hot trolley for serving. The Garden House does have the capacity to prepare meals, and simple snacks and drinks. Diets or special nutritional needs are met. Soft diets have their component parts prepared individually and moulds are used to enhance the presentation of the meal. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 18, 19, and 20 were inspected. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their health needs will be pursued actively, with their involvement and include specialist input as necessary. Medicines are administered safely. The care needs of the residents are handled with respect. EVIDENCE: Personal care was observed to be provided quietly and effectively for residents. The majority of residents have 1:1 carers so the staff have got to know the person for whom they care well and know how the resident likes to be assisted. The time for getting up/going to bed, and other activities is flexible, though as discussed the registered manager should encourage staff to record the times of the ‘waking day’ in the care notes. Residents are dressed in their own clothes, and their lifestyle reflects their personality. There is a wide range of aids available to assist with the meeting of care needs, and residents receive additional specialist support as necessary. The nature of the resident group is such that they are predominantly unable to manage their own health care, though staff monitor residents’ capabilities. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 15 There is a comprehensive medicines procedure. Medicines are stored securely. Medicine Administration Records were seen to be in order, though the registered manager should ensure that were these are produced by the home the prescription entered is checked as correct and two initials recorded. Records are kept of medicines received and returned. Staff training undertaken includes the safe handling of medicines. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 22, and 23 were inspected. This judgement has been made using available evidence including a visit to this service. No complaints have been received since the last inspection. Complaints are taken seriously and addressed quickly. Protecting residents from abuse or neglect forms part of the regular training that all staff have to undertake. EVIDENCE: The complaints procedure is produced in a variety of formats to aid understanding. The complaints procedure is on display at the home. The registered manager should ensure that the complaints procedure is reviewed as the current version is dated 2003. A visiting relative said that they had confidence in the management and staff to deal with any concerns, and that they would feel able to express any concerns. The registered manager undertook to record the more ‘ad hoc’, informal comments sometimes made, along with any action taken as a result. The adult protection procedures in use are dated 2003. The registered manager and deputy manager demonstrated a good understanding of the issues involved with adult protection. The registered manager should ensure that the home’s adult protection procedure is reviewed and amended to provide clear instruction as to the steps to take in the event of an allegation of abuse, including the relevant contact details for the local Adult Social Care office. The Garden House DS0000038198.V326023.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 24, and 30 were inspected. This judgement has been made using available evidence including a visit to this service. The home is well maintained and its décor reflects the age and tastes of the residents. Sufficient and suitable equipment is provided to assist both residents and staff. Residents can choose where they prefer to spend their time when at home and this is respected by the staff. EVIDENCE: The home was seen to be in good order with regular redecoration on going. The home is decorated in a bright and cheerful style that suits the age group of the people living there, with a choice of communal areas. Some of the residents are independently mobile so there is frequent damage in doorways and on corridor walls from wheelchairs, but this is constantly being repaired & redecorated. A selection of seating is provided in various areas. Storage has been a problem as a number of residents have additional equipment to aid physiotherapy exercises. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 18 All residents have their own individual rooms. They have been decorated and personalised to each person’s taste. They contain pictures of families, pop stars/sports men & women, and ornaments, etc. Many have their own music systems, videos & televisions, or computers, as well as coloured lights with the result that people choose to spend time there as well as in the communal parts of the home. Staff are aware of who prefers their privacy and respect this. The home has two fully adapted bath/shower rooms with overhead hoists available, plus additional toilets and bathroom. Hoists are fitted in bedrooms as well where indicated. Scales to weigh people who rely on wheelchairs are provided. The home has CCTV, which may be used within strict agreed guidelines. The registered manager keeps this under review. Laundry is taken to the central laundry and returned ready to be put away. The home was seen to be clean throughout at the time of the inspection. The Garden House DS0000038198.V326023.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 32, 34, and 35 were inspected. This judgement has been made using available evidence including a visit to this service. Residents benefit from well supported and trained carers. Staff and residents were seen to interact well with one another. EVIDENCE: Staff levels are high as the majority of residents have 1:1 carers with them throughout the day. The staff team are organised so that whilst residents have a key worker to whom they can refer, other carers are familiar with peoples’ needs so that there is flexibility within the working day. Staffing ratios are usually as follows: • 8am-8pm: registered manager nurse 8-10 carers • 8pm-10pm: nurse 6-7 carers (dependent on activities) • 10pm-8am: nurse 2 carers Of the 45 staff employed at the home, 8 are registered nurses. Of the 37 care staff: • 9 have achieved NVQ 2 or above • 3 have achieved the LDAF qualification • 7 are undertaking NVQ 2 or above The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 20 • 7 are undertaking LDAF training Approximately 45 have therefore achieved NVQ 2, equivalent, or higher qualification. New staff undertake a National Training Organisation compliant induction training programme, as well as an in-house induction. The registered manager advised the inspector that all care staff have been provided with the General Social Care Council handbook. Approximately 80 of the staff have worked at the home for more than 1 year so the residents benefit from a stable staff team. A sample of three staff personnel files were inspected. Staff details are recorded in individual files that include essential personal information and copies of each person’s training profile. Applicants are invited to the home for an introductory visit to all the areas on the campus and then invited to apply if they wish. New staff are taken on after satisfactory references and Criminal Records Bureau clearance. New staff are given the opportunity to work indifferent areas of the Bowden Derra complex initially so they can decide where they feel most suited. A full training programme is arranged and staff are expected to participate with promotion and a financial reward prospect. Training covers basic subjects such as first aid, food hygiene, health & safety, etc. Courses are arranged in house and externally. The registered manager confirmed that staff training is a high priority. The Garden House DS0000038198.V326023.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. National Minimum Standards 37, 39, and 42 were inspected. This judgement has been made using available evidence including a visit to this service. The residents benefit from clear leadership, and good management in the home. The registered manager and staff are committed to the rights and input of the residents. The health and welfare of residents is protected. EVIDENCE: The registered manager of The Garden House is part of a team with two other managers. Whilst they all have their individual responsibilities they work together to plan and formulate new ideas for the management of the homes and the well being of the service users. The registered manager is experienced in the field of care for younger people and has brought a number of ideas and good practices to the home. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 22 With the exception of any specifically mentioned, records within the home are up to date and meet the statutory requirements. Safe working practices are maintained. There is clear definition of responsibility and accountability within the home. The registered manager conducts and annual environment and meals audit. There is a visual format questionnaire for residents, and the success or otherwise of activities, such as holidays, is always ascertained. As discussed at the time of the inspection, the registered manager should expand quality assurance to include residents’ representatives and health care professionals, publishing a summary of the findings (possibly in the Statement of Purpose). The fire warden is responsible for the staff (approximately 120) on the whole complex, not just The Garden House, and is also a full-time maintenance person. The records of fire training are confusing and it is not clear that all staff are receiving training at the frequency recommended. The fire brigade recommend a fire training frequency of 3-monthly for night staff and 6monthly for day staff. Whilst the inspector does not have any concerns about the safety of residents, there does not seem to be a system for monitoring fire training to ensure that individual staff do not ‘fall through the net’ of sufficient and appropriate training. The registered provider should review the fire training system to ensure its effectiveness. Maintenance records were inspected and seen to be in order. The Garden House DS0000038198.V326023.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 4 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 2 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 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 YA7 Regulation 20 Requirement The registered provider must make arrangements for each resident to have their own bank accounts. Timescale for action 01/03/07 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 YA6 YA18 Good Practice Recommendations The registered manager should make arrangements to ensure that residents and/or their representatives are included in the care plan review process. The time for getting up/going to bed, and other activities is flexible, though as discussed the registered manager should encourage staff to record the times of the ‘waking day’ in the care notes. The registered manager should ensure that were Medicine Administration Records are produced by the home the prescription entered is checked as correct and two initials recorded. The registered manager should ensure that the home’s adult protection procedure is reviewed and amended to provide clear instruction as to the steps to take in the event of an allegation of abuse, including the relevant DS0000038198.V326023.R01.S.doc Version 5.2 Page 25 3. YA20 4. YA23 The Garden House 5. YA39 6. YA42 contact details for the local Adult Social Care office. The registered manager should expand quality assurance to include residents’ representatives and health care professionals, publishing a summary of the findings (possibly in the Statement of Purpose). The registered provider should review the fire training system to ensure its effectiveness. The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Garden House DS0000038198.V326023.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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