Inspection on 12/11/07 for The Knole

This inspection was carried out on 12th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knole 19/11/08

The Knole 24/10/06

The Knole 09/01/06

The Knole 26/09/05

The Knole 10/03/05

The Knole 06/09/04

The Knole 25/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

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

CARE HOME ADULTS 18-65 The Knole 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE Lead Inspector Mr Adam Parker Key Unannounced Inspection 12th November & 19th November 2007 09:45 The Knole DS0000016612.V348709.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 Knole DS0000016612.V348709.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 Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knole Address 23 Griffiths Avenue St Mark`s Cheltenham Glos GL51 7BE 01242 526978 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) knole@langleyhousetrust.org www.langleyhousetrust.org The Langley House Trust Mr Malcolm James Gardiner Care Home 9 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (9), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (7) The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be over 30 years of age. All Persons accommodated will be male. Date of last inspection 24th October 2006 Brief Description of the Service: The Knole is a care home operating within Christian principals that provides registered accommodation for up to nine males who have mental health needs. Four places are registered for learning disabilities and up to seven for service users over 65 years of age. The home is a detached Victorian listed building situated in extensive grounds approximately one mile from the centre of Cheltenham. It has recently undergone major renovation. Current fees range from £402.13 to £2230.15 per week paid by placing authorities. Chiropody and personal toiletries are charged extra. The home makes information about the service, including CSCI reports available to people using the service through a service user guide and statement of purpose available in the home. The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The visit to the service included a tour of the premises, examination of documentation and medication systems and discussions with a person using the service, staff and management. As well as a visit to the service over two days, comment cards were received from six people who use the service. What the service does well: What has improved since the last inspection? What they could do better: The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 6 The recording of medication administration still needs to be improved especially as some of the shortfalls were around the recording of the administration of medication to control epilepsy for one person which if not administered could have serious implications for their health and safety. The home should include in its policy and procedure for the prevention of abuse reference to making contact with the Commission and the local Adult Protection Unit. The environment although generally well maintained needs some work doing where a toilet wall has been damaged by damp and odours need controlling in two toilets. Following the renovation of the home, window restrictors have been fitted, however these can easily be removed and consideration has apparently not been given as to how these could be secured if a risk assessment indicated the need for their use. The home must ensure that it makes notifications to the Commission about incidents in the home as specified in the Care Homes Regulations 2001. 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 Knole DS0000016612.V348709.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 Knole DS0000016612.V348709.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): 2 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service receive comprehensive assessments prior to admission involving a number of agencies to ensure that their needs can be met before they are admitted to the home. EVIDENCE: There had been no admissions to the home since the previous inspection. Where pre-admission documentation for the person most recently admitted to the home was examined. Full information about the person was obtained and this included a comprehensive assessment completed prior to admission into the home in conjunction with other agencies and relevant professionals. This is in line with the type of service offered by the home and relevant documentation had been obtained. In addition to this the home had completed an assessment of the needs of the service user. Any restrictions on freedom based on risk were fully documented in the assessment and had been discussed with the service user. The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 9 When they arrive in the home service users undergo an induction that is documented on a checklist. Needs assessments are kept under review. The Knole DS0000016612.V348709.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): 6,7,8 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are regularly and actively consulted about their care plans to ensure that their needs and personal goals are met. EVIDENCE: The care plan documentation for three people using the service was looked at. This gave evidence of key working meetings that were taking place where the person could discuss with their key worker how they were making progress in meeting goals set in the care plans. With the documentation looked at for one person meetings had taken place generally on a monthly basis although it was reported that the home was aiming to carry out key working meetings on a weekly basis. The key working meetings provide an opportunity for service users to make decisions about their lives with assistance and within any limits set by the nature of the service. A full review of the care plan takes place every six months with another every three months. There was evidence with one person receiving input from mental The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 11 health services with Care Programme Approach documentation on file. Monthly residents’ meetings are held where people have the opportunity to make decisions about issues that affect them collectively such as trips out of the home and discuss issues arising from living in a group. Any limitations on choice are made in line with the nature of the service and the home’s duties and responsibilities. A comprehensive risk assessment is undertaken prior to admission and in conjunction with other agencies. The home has policies and procedures and where necessary individual plans to respond to the unexplained absence of service users. Specific risk assessment s were seen for such issues as going out of the home and use of garden equipment by a person using the service. The Knole DS0000016612.V348709.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): 12,13,14,15,16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in appropriate activities outside of the home, have some links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. EVIDENCE: Two people using the service have been attending courses at a local college with another undergoing training at a café, this person spoke about the work he does there. The possibility of voluntary work had been explored for a number of people although for various reasons this had not taken place. People using the service have some contacts with the local community through links with a local church where some of them attend services. In addition use The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 13 is made of local facilities such as shops, cinemas, a gymnasium and swimming baths. Evidence was seen of people pursuing hobbies and interests with keeping cage-birds being popular. In addition several people work in the home’s garden during making use of green houses. People using the service have a weekly art session making use of the well equipped art room, this was seen on the first day of the inspection visit with a large back drop being painted for a nativity play at a local church which has links with the home. One person using the service was pleased with the work that had been done. Another described how he enjoyed attending the art group. The home organises trips out of the home and this was evident in the minutes of a recent residents meeting. One person had recently had a visit from friends outside of the home and another meets a friend in the local town from time to time. There are suitable locks for peoples’ rooms although these could be entered by staff using a master key in the event of an emergency. Mail is logged by staff but delivered to them unopened. People have responsibilities for some house keeping tasks such as washing up and there is a rota for them to do their own laundry. The home makes clear statements regarding the rules on smoking, alcohol and drugs. Lunch was observed being served in the dining room on the second day of the inspection visit. A choice of main dish is provided each day with the cooked lunch. At teatime a cooked snack is provided. Issues around meal choices had been discussed at a residents’ meeting where it was confirmed that a change had been made to the menu. Methods of cooking and healthy eating were also discussed. The home provides people using the service with bags of fresh fruit twice a week. People cook their own meals on a one-day a week basis and this has been a success. The Knole DS0000016612.V348709.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): 18,19 & 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have their health and personal care needs met although systems in place for the administration of their medication are not always followed consistently by staff and potentially put people at risk. EVIDENCE: The home provides support to service users in terms of guidance with such matters as personal hygiene where this is needed although it does not provide personal care. Service users are allocated to a member of staff who acts as a key worker to provide consistency of support. There was evidence with one person receiving input from mental health services with Care Programme Approach documentation on file. This included a crisis and contingency plan with information on signs of deterioration in the person’s mental health and who should be contacted. Monthly visits by the Community Psychiatric Nurse had been recorded. The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 15 The home provides secure storage for medication and keeps a record of every time the medication cupboard is unlocked. Some people using the service administer their own inhalers. At the time of the inspection visit the home had no liquid medication and no controlled drugs. A refrigerator was in use for one item and an electronic thermometer was in use to monitor storage temperatures. However no record had been made of checks on temperatures and the storage temperature in the cupboard had not been measured. The medication administration records were examined and as at the previous inspection there were some omissions from the recording of administration. This again included occasions when medication prescribed for the control of epilepsy had not been recorded as being administered to the service user. The deputy manager confirmed that in some cases the record kept of unlocking the medication cupboard showed that the medication had been given although in other cases there was no record of the cupboard being opened. On the second day of the inspection an audit of medication given showed that the amount of tablets given did tally with the administration record. Some handwritten directions in the administration charts had been signed and dated by the staff member making the entry. However changes to dates on one person’s chart had not been signed or dated and it was not clear why changes had been made. In addition where a course of medication had finished this had been handwritten on the chart but not signed or dated by the person making the entry. A designated member of staff undertakes a monthly audit of the medication administration records. All staff who administer medication have completed training in the home with others completing further training from an outside trainer. The supplying pharmacist also carries out regular audits. The Knole DS0000016612.V348709.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): 22 & 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place that safeguard people from possible harm or abuse and allow for complaints and concerns to be raised on their behalf. EVIDENCE: The home has a complaints procedure that is included in the service users guide, given to all people using the service. The home has a log for recording complaints; one complaint had been documented involving a complaint by one person using the service against another. It had been recorded that the complaint had been dealt with and resolved at the time. Six completed survey forms were received from people using the service with four indicating that they knew how to make a complaint and two indicating that they did not. Since the previous inspection care staff in the home have attended the alerter’s training in adult protection and two members of management have attended the enhanced training provided by the local authority. The home has a copy of the Langley House Trust’s policy for the prevention of abuse dated September 2005. However the policy gives no guidance on contacting the Commission in the case of registered services or contacting any local adult protection agencies. This situation remains despite a recommendation at the previous inspection. The Knole DS0000016612.V348709.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): 24,25 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although generally well-maintained and clean, people using the service would benefit from some improvements to certain areas in the environment particularly toilets. EVIDENCE: The home has undergone a major refurbishment in the recent past. Communal areas on the ground floor consist of a dining room, a smoking lounge, and a non-smoking lounge. In the basement there is an art room and a snooker room. As well as the main kitchen there is also a kitchen for people who use the service to use to develop cooking skills. All bedrooms in the home are now single occupancy and have been personalised by their occupants. The home was clean with handwashing facilities available in toilets. However during the inspection visit, one toilet on the ground floor was out of order due The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 18 to damp problems in the wall, this toilet was also odorous. On the first floor there was another toilet out of order that was extremely odorous. Concerns about both toilets had been raised at a recent residents’ meeting. In the laundry there was a small area of the wall where the paint was starting to flake, it was recommended that this be should be attended to at the previous inspection and this has not taken place. The Knole DS0000016612.V348709.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): 32,34 & 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures are robust ensuring that people using the service are safeguarded. Staff have access to a training programme that will equip them to meet the specific needs of people using the service. EVIDENCE: Staff undergo a basic staff course after starting work in the home. As well as preventing abuse this course includes communication skills, risk assessment, first aid and other subjects and provides underpinning knowledge for NVQ. In addition further training has been undertaken by staff in mental health, medication and dealing with violence. The level of staff trained to NVQ in the home is over 80 . A selection of documentation for recently recruited members of staff was examined and found to be in good order with all the required information about the staff member being obtained. The majority of the information relating to recruitment is held at the head office of the Langley House Trust and is provided to the home on an approved format. This was sufficient to determine if the correct procedures had been followed. The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 20 New staff receive induction training and it was confirmed that the most recent member of staff employed had completed this. The Knole DS0000016612.V348709.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): 37,39 & 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The systems for consulting people who use the service are good with a variety of evidence that indicates that their views are sought and acted upon. However, although training in safe working practices should ensure that the health and safety of service users is promoted and protected attention still needs to be given to the issue of window restrictors and the reporting of incidents to the Commission. EVIDENCE: The registered manager has a background in social work and has completed the registered managers award at NVQ level 4 and is an NVQ assessor. Since The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 22 the previous inspection he has recently completed training in moving and handling and conflict resolution. The home has a quality assurance system that where monthly managers’ reports are produced culminating in a monthly performance report. An example of this was seen relating to keyworking and support plans. In addition there is an annual service user survey with the results collated for an action plan. There is also a regional residents’ forum that representatives from the home attend and have input into planning and reviewing services. The minutes of the most recent forum held in October 2007 were seen. The home also holds monthly residents’ meetings, the minutes for the most recent meeting showed that people using the service had been discussing, menus, trips out and the situation with the toilets where an up date on remedial work was given to residents. Monthly inspections are made of the home by a manager from the Langley House Trust and reported to the Commission. Reports of these inspections showed that people who use the service are consulted by the visitor and a review is undertaken of a number of areas such as complaints and the state of the home environment. The registered manager reported that since the previous inspection there has been a move to further improve the involvement of people in the running of the service and an example given was that a representative was now attending the weekly staff meetings to provide an update on issues regarding people who use the service. The Langley House Trust West area has recently been awarded the Investors in People Award. Staff have received training in safe working practices in first aid, food hygiene, manual handling and fire safety. The home has ensured the servicing and maintenance of electrical and central heating systems and appliances. Following the renovation of the home, windows have been fitted with restrictors. However these can be easily removed. Despite a requirement at the previous inspection consideration has not been given as to how window restrictors could be secured if a risk assessment of a service user indicated the need for this. This issue of window restrictors has been reported in inspection reports prior to the renovation of the home. At the previous inspection a requirement was issued relating to the home not informing the Commission of a reportable incident. Examination of the incident/accident reports at this inspection showed that there were another two incidents that the Commission had not been informed of one involving an injury to a person and one where police where called to the home due to a possible intruder in the grounds. The Knole DS0000016612.V348709.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 2 25 3 26 X 27 X 28 X 29 N/A 30 2 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 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 N/A 3 X 3 X X 1 X The Knole DS0000016612.V348709.R01.S.doc Version 5.2 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 YA20 Regulation 13 (2) Timescale for action The registered person shall make 31/01/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home (This relates to the instances of lack of recording of the administration of medication to control epilepsy for one service user). This requirement has been repeated from the previous inspection. Take measures to control 31/01/08 residual odours in toilets so as to provide a more pleasant environment for people using the service. Ensure that remedial work is 29/02/08 undertaken to the damage to the wall in the first floor toilet so that this toilet can be brought back into use for people using the service. The registered person must give 31/12/07 notice to the Commission without delay of the occurrence of any event in the care home specified under regulation 37. This requirement has been DS0000016612.V348709.R01.S.doc Version 5.2 Page 25 Requirement 2 YA24 16 (2) (k) 3 YA24 23 (2) (b) 4 YA42 37 The Knole 5 YA42 13 (4) (c) repeated from the previous inspection. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (This relates to the window restrictors and how these could be secured if a risk assessment indicated the need for this). This requirement has been repeated from the previous inspection. 31/03/08 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 Refer to Standard YA23 YA20 YA20 YA20 Good Practice Recommendations The prevention of abuse policy and procedure should be updated to include reference to making contact with the Commission and the local Adult Protection Unit. The temperature in the medication storage cupboard should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. A record should be kept of the medication storage temperatures in the refrigerator. The practice of signing and dating handwritten directions on the medication administration charts should also be used when any medication is stopped and the chart is marked accordingly or when any changes are made to the chart. Any handwritten changes to medication charts should be checked and signed by another member of staff to ensure their accuracy. The flaking paint in the laundry should be attended to. 5 6 YA20 YA30 The Knole DS0000016612.V348709.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Knole DS0000016612.V348709.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!