Inspection on 26/10/06 for The Limes Blackheath

This inspection was carried out on 26th October 2006.

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 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Limes Blackheath 17/04/09

The Limes Blackheath 14/10/08

The Limes Blackheath 31/01/06

The Limes Blackheath 24/08/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The Limes Blackheath 37 Avenue Road Blackheath West Midlands B65 OLP Lead Inspector Jayne Fisher Unannounced Inspection 26th October 2006 09:30 The Limes Blackheath DS0000063539.V316485.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 Limes Blackheath DS0000063539.V316485.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 Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Blackheath Address 37 Avenue Road Blackheath West Midlands B65 OLP 0121 559 3935 0121 561 1333 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) Mr Mohammed Iftikhar Ali Debbie Bennett-Hopper Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 31 January 2006 Brief Description of the Service: The Limes is registered to make provision for a maximum of eight people learning disability. The home is situated within easy travelling distance of Blackheath town centre and close to public transport systems. The home has its own transport. This is used for holidays, group outings and to take service users to appointment, where applicable. Service user accommodation is provided over two floors. There are eight single bedrooms, four of which have en-suite facilities. The communal facilities on the ground floor consist of a lounge/dining area, conservatory and kitchen. Toilets and bathing facilities are available on both floors. There is a garden to the rear of the building. The main entrance is at the front of the building and limited car parking facilities are available at the side of the property. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was requested by the Commission for Social Care Inspection (CSCI) however the manager was unable to provide this information which was said to be held only by the Registered Provider. There are additional charges for toiletries, hairdressing and transport. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first key inspection for this inspection period 2006 – 2007. As it was a key inspection this means that all keys National Minimum Standards were assessed. This inspection was unannounced meaning that no one associated with the home received prior notification and were therefore not able to prepare. The Inspector arrived at 9.30 a.m. and left at 7.45 p.m. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with the registered manager and three support staff. Although all eight residents had completed questionnaires, unfortunately these had not been received by the inspector. However all residents were at home during the inspection and actively participated in interviews and showing the inspector around their home. Two relatives completed comment cards. Four residents’ care was case tracked by reading and assessing care documents, observing interactions and by talking to staff and chatting to residents. Three meal times were observed and a tour of the premises was undertaken to assess the standard of the environment. Staff personnel files were accessed and a sample of maintenance and service records were examined. Other information was gathered prior to the inspection visit, from reports of visits undertaken by the organisations representative and pre inspection questionnaire submitted by the manager together with a review of other relevant documentation. What the service does well: Staff continue to give maximum encouragement to residents to maintain and develop social, emotional and independent living skills. For example, some residents travel independently, they help with food shopping and food preparation, they access the kitchen and make drinks for themselves and visitors whenever they wish. They are supported to manage their own finances and self administer their own medication. Residents have unrestricted access to all parts of the home and through out the day they were seen to be either in the kitchen, sitting in the lounge area or relaxing in their own bedrooms. Some residents chose to go out shopping and one resident went out to fetch his daily newspaper. Residents are supported to access a range of educational and training opportunities as well as stimulating leisure activities within the local community. The atmosphere was relaxed and friendly through out the day, residents looked at ease in their surroundings, laughing and joking with staff. There was positive responses from all relatives regarding the support given by staff. Residents’ health is fully promoted with access to various health care professionals. The manager also promotes health and wellbeing by ensuring that residents enjoy a healthy and varied diet with attractively presented meals. Residents are able to make their concerns known through a complaints The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 6 procedure if they wish and staff are aware of how to support them. There are also procedures in place to protect residents from abuse. The home was warm and comfortably furnished. Residents are able to personalise their own bedrooms and can choose to hold their own bedroom keys if they wish. Residents are supported by a small, qualified and well trained staff team who demonstrated during interviews and observations that they clearly know residents’ likes, dislikes and preferred routines. Staff were very complimentary about the manager and her style of management which is open, inclusive and supportive. What has improved since the last inspection? What they could do better: Some recording systems need improvement in order to allow for accurate planning, monitoring and evaluation of residents’ needs for example with regard to activities, daily routines and how behaviour is managed. There are a number of improvements still outstanding with regard to the premises involving redecoration and refurbishment. Progress is slow in this area. The bathrooms in particular need prioritising due to walls and ceilings which are damaged by damp and stained grouting. As a result they are not inviting or attractive areas in which residents can enjoy bathing. A recent Food Safety inspection has also been undertaken which identified a number of areas for improvement, which again have been outstanding for some time and have been highlighted in previous CSCI inspection reports. These include the replacement of worn kitchen units and work surfaces which have deteriorated in condition so that they cannot be effectively cleaned. A letter has been sent to the Registered Provider by CSCI to request proposals for carrying out the works identified by the Food Safety Officer. At present there is a small staff team and the manager despite attempts, is struggling to recruit staff of the right calibre for the two existing vacancies. Agency staff are used and the manager is herself covering some support worker duties, as well as providing continual emergency on call support to staff. The majority of residents are male and at present there are no male support workers. These staffing difficulties can from time to time impact upon The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 7 the range of activities and outings available for some residents. Registered Provider must make continuing efforts to address this issue. The 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 Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with information regarding the services available, however further amendments are necessary in order them to be able to make informed choices and have up to date information. Assessment tools need further expansion in order for existing residents’ needs to undergo periodic reassessment to assist with the evaluation of existing care plans. EVIDENCE: As identified at previous inspections there has been a long standing requirement to add further details to the statement of purpose and service user guide in order to fully comply with the Care Homes Regulations and National Minimum Standards. The changes in ownership and management also need to be reflected in these documents. The home remains fully occupied. There has been no vacancies at the home since 2003. The manager has developed a detailed assessment tool to assist in measuring existing residents’ independent living skills in order that effective care plans may be generated. However, as discussed with the manager, this tool must be expanded to cover all aspects of personal, social and health care The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 10 needs, all subjects included in the National Minimum Standards 2.3 should be covered in this document. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a range of care plans and risk assessments in place, however some of these are more detailed than others and as a result, require review and expansion in order to ensure all aspects of residents’ support and needs are included. EVIDENCE: A sample of care plans were examined and interviews were held with staff, service users and the manager. The manager is continuing to overhaul the care planning system and progress has been made in a number of areas, although the new systems have yet to be fully implemented for all service users. As a result, two out of the three care plans examined contained very detailed goals and objectives covering aspects of social, personal and health care needs. The third care plan folder contained excellent background details regarding the resident in the form of a service user profile and ‘thumbnail’ sketch however care plans had yet to be generated. Two residents’ care plans contained very detailed management behavioural guidelines for staff whilst the The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 12 third care plan did mention some details of patterns of behaviour in the service user profile, as yet no detailed guidelines had been devised as to what strategies staff needed to employ with regard to diffusion and de-escalation techniques. The manager stated that she had spoken to psychologists to obtain their approval with regard to one resident’s behavioural management guidelines which had been devised. During interviews that manager stated that she had prioritized the development of care plans according to the dependency levels of residents which is a good initiative. According to the manager staff had declined to be actively involved in the drawing up of care plans although it was pleasing to see that during interviews they were aware of the goals and objectives in place for example with regard to the increased nutritional needs of one resident. The majority of care plans examined did not contain any evidence that the reviews had been undertaken with significant professionals such as social workers. The manager stated that only two residents had social workers who had participated in the reviews of their needs and care plans despite invitations to attend other service users’ reviews. As discussed with the manager this must be pursued in order to demonstrate that the home continues to meet residents’ needs. Record keeping in general needs improvement. For example daily reports do not reflect goals and objectives contained within care plans. One resident had recently exhibited some challenging behaviour however staff had not explicitly followed the management behavioural guidelines. The manager suggested why this may not have been possible but these details should have been included in the incident report including how the resident was checked following the episode and the debriefing and reassurance given to the resident by staff. Care plans must also reflect residents’ changing needs. For example, one resident’s care plan stated that they attend college once a week, yet according to staff the resident has not been able to attend this resource for some time. All residents’ case files contained communication packages providing staff with details as to how residents are supported to communicate and make decisions as is good practice. As yet not all service users have care plans in place with regard to how they are supported to manage their finances. Those which are in place require slightly more detail for example with regard to what benefits residents receive. As with care plans, risk assessments vary in quality and the manager is continuing to update these documents. One resident had a detailed risk assessment in place with regard to a range of topics including use of a wheelchair, smoking, falls, use of equipment and the environment. The risk assessment review date however was overdue. As discussed with the manager, all residents must have detailed risk assessments in place with regard to management of challenging behaviour that identify the level of risk The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 13 and strategies employed by staff (including training). For example, one resident can damage property although other than instructing staff to remove damaged property, there was no risk assessment in place identifying control measures to minimize risk and diffuse behaviours. There were however detailed risk assessments in place with regard to residents’ independent living skills. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 14 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support service users to achieve fulfilling lifestyles through a variety of independent living skills, activities and community outings. Staff support residents and their families to maintain their important relationships. The meals provided to residents are well balanced offering both choice and variety. EVIDENCE: During interviews residents chatted about their favourite leisure pursuits and hobbies. One resident stated “we go out more now, especially in the summer, we went to Clent”. One resident discussed how he liked astrology and to undertake scientific research. The manager had arranged for him to take an NVQ in computer training and a computer had been purchased. The resident talked about how much he liked sport and enjoyed visiting his ‘drop-in’ centre. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 15 All residents with once exception attend a variety of college courses and during the day they spoke about how they enjoyed attending college. During interviews the manager explained that one service user had been refused attendance at college and she had been trying to identify another suitable resource but as yet had not been successful. Only one resident made a negative comment about the variety of activities available. A few years ago the previous proprietor had employed a person once a week to undertake activities with residents. The resident said how he missed going rock climbing, archery and running. This was discussed with the manager and staff. Staff stated that they felt he possibly missed the male carer (see further comment in standard 33). It was pleasing to see that a rock climbing activity had already been planned as a forth-coming activity. Minutes from residents’ meetings demonstrate that activities are also raised as a subject and discussed at this forum. Residents had recently been on their annual holiday to Blackpool. The majority talked about how much they had enjoyed this trip, showing programmes of shows they had watched and photographs they had taken. As previously identified activity programmes need to be reviewed and expanded following consultation with individual service users about their preferences. On examination activity programmes are still not fully completed, one service user’s file contained no programme, others contained partially completed programmes. The manager admitted during interview that she had not had sufficient time to carry out this task. Daily reports completed by staff gave some detail as to what activities are undertaken and in addition there are activity monitoring sheets. Some of these contained evidence of a variety of trips and outings. For example, during September 2006, one resident had been on four shopping trips, a visit to a Safari park, archery and going out for lunch. There was only one activity recorded in October 2006 which was swimming. Interviews with the resident confirmed that he had been on more activities which staff had failed to record. Another resident’s activity monitoring sheet contained no activity for October 2006 and the daily reports during this period listed only one shopping trip and a hair cut at the local town. The manager stated that staff need to improve record keeping. There is a small staff group and at present there are a couple of vacancies this can impinge upon activities (see further comment in standard 33). Staff fully support residents to maintain important links with their family. During interviews residents talked about how they visited their families and kept in contact. One resident said “I’m going to my mom’s tonight and will stay overnight”. Another resident confirmed that he visited his family when he wished. Daily reports contained evidence of family contact and visits. Two relatives completed comment cards. They both stated that they were made welcome by staff when they visited and could see their family member in private if they wished. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 16 Daily routines were observed to be flexible and promote independence. For example, the manager has recently introduced a new skills tasks whereby residents are being supported to do their own laundry which is an excellent initiative. Through out the day residents were seen engaging in a range of independent living tasks, such as making drinks for each other and for visitors without prompting, assisting with preparing lunch, washing up and cleaning the kitchen. During interviews they stated that they enjoyed doing these tasks. Residents stated that they could hold keys to the front door and to their bedrooms if they wished (some choose to do so and showed the inspector their keys). Residents can go to the shops on their own if they wish (and are assessed as being competent to do so without staff). One resident still fetches his newspaper every morning. On inspection of food records there is a well balanced and varied menu. Although there is a menu plan this is used as a guide only and residents are asked on a daily basis what they would like to eat. All residents who were interviewed stated that they liked the food and could have alternative options if they wished. One resident said “yes we can have anything we want and we like to cook”. Examination of minutes from residents’ meetings confirm that food is discussed amongst the service user group. At lunch residents had chosen either egg salad, scrambled egg on toast or cheese and crackers. For the evening meal residents were seen enjoying roast chicken, potatoes and vegetables. During interviews staff stated that the manager had encouraged more healthy eating and as a result the meals they were preparing were much more appealing. Commendably the manager had arranged for some staff to undertake training in nutrition which was said to have been excellent. Meals prepared at both lunch and dinner were well presented and smelt appetizing. Good strategies were seen to be in place with regard to one resident who needs increased nutritional support such as energy and protein rich foods and supplements. Nutritional screening has been undertaken. However, as this was carried out in September 2005 these now require review. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care and health needs of service users are well met and careful monitoring helps identify any potential complications at an early stage ensuring service users’ receive the treatment they require. There are safe systems for the residents in the control and administration of medication, only some minor improvements are required. EVIDENCE: Observations through out the day confirmed that residents’ preferences regarding how they are supported are respected. For example on arrival at 9.30 a.m. two residents were eating their breakfast, other residents were either in the lounge area or in their own bedrooms and one resident had gone to fetch his daily newspaper. Details of residents’ preferred sleeping patterns are contained within their case files. Some residents’ care plans contained detailed goals and objectives with regard to personal support and hygiene. Residents were seen to be dressed in modern clothing and groomed in styles which reflected their own personal tastes and personalities. All residents are mobile although one resident does require the use of a wheelchair to negotiate long distances. The manager has ensured that he has received assessments from an Occupational Therapist (O.T.) and recommendations had recently been The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 18 made with regard to bathing aids which the manager stated would be purchased in the near future. Both relatives who completed comment cards stated that they were happy with the overall care provided and that they are kept informed of important matters affecting their family member. One person stated “the care that my relative gets at The Limes is exceptionally good. If there is a need, I am contacted and any problems are discussed and sorted immediately. We have no worries”. There was ample evidence to confirm that residents’ health is monitored and they are supported to access appropriate health care facilities. For example, on examination, case files confirmed very good details of residents’ appointments with health care professionals and their treatments. According to his case file, one resident had been to see his doctor on five occasions since 20 June 2006 for health issues. Staff act promptly on identifying any problems. For instance one resident was noted to have a potential problem on 30 September 2006 and was taken to see his doctor on 4 October 2006. All residents were seen to attend annual well person clinics and had up to date checks for ophthalmology, chiropody and dentistry. There are procedures in place to monitor potential complications from breast, cervical and testicular cancer. In the past residents had been shown videos and had discussions with staff to raise their awareness. Residents are supported to access psychiatrists and psychologists on a routine basis and as and when any problems are identified. One resident becomes distressed when having to attend health care appointments; staff have arranged for him to receive visits at the home to minimize his anxiety. During interviews the manager and staff demonstrated a proactive attitude towards promoting residents’ rights to access health care facilities. One resident requires extra nutritional support and it was reassuring to see that he is weighed on a more regular basis (fortnightly) to monitor his weight. Since the last inspection one resident’s care plan regarding his diabetic management has been expanded as required. Examination of records, interviews with the manager and staff plus inspection of the drugs cupboards and monitored dosage systems confirms that efforts have been made to improve arrangements for the safe handling of medication. For example, all medication received is now fully checked and recorded, the medication administration record (MAR) sheets were more accurately completed by staff, the drugs cupboards have been moved from the kitchen to a more suitable area so that the air temperature does not exceed the recommended limit, the manager has clarified the dosage of Senna, as required on behalf of one resident, and risk assessments with regard to self administration of medication have been updated. All staff have now received accredited training in the safe handling of medication with one exception (the latest member of staff to have been recruited, during interviews she confirmed that she is not responsible for administering medication). Other evidence of good practice includes the safe handling of keys to the drugs cupboard which on examination was seen to be clean and tidy with external The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 19 and internal drugs stored separately. Drugs requiring lower storage temperatures such as Dakacort were seen to be kept in the fridge (temperatures are checked and recorded). Although it is recommended that a separate lockable container is purchased. The pharmacist does not routinely visit the home to carry out audits and it is recommended that this continues to be pursued by the manager as well as requesting that the pharmacist does not use dispensing labels on the MAR sheets. There are some items identified at previous inspections which still require further attention and are detailed within the requirements section of this report. For example, to ensure all “as directed” dosages are clarified with the prescriber and/or pharmacist and two staff signatures must always be obtained to confirm that any handwritten instructions on the MAR sheets are accurate. The only new requirement is to ensure that where there are variable doses (for example with regard to Cocodamol), that staff record whether or not they have administered one or two tablets. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 20 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive complaints system which ensures that users’ views are listened to and acted upon. There are procedures in place to safeguard service users from abuse. EVIDENCE: No complaints have been received by CSCI regarding The Limes. Neither has the manager received any complaints about the service provided. Both relatives who completed feedback forms said that they had not had to make a complaint. There is a complaints procedure which has been explained to service users (this is confirmed on examination of personal files). During interviews staff gave good examples of how they would deal with any concerns in a prompt manner. Interviews with residents confirmed that they are able to express any concerns to staff. Four out of the six support staff currently employed have received training in vulnerable adult abuse awareness. During interviews a staff member demonstrated good understanding of the principles of safe guarding residents from abuse and was aware of the differing forms of abuse that residents can be subjected to. Five staff have received training in understanding challenging behaviour. There is a copy of the Local Authority vulnerable adult abuse procedures held on the premises for staff to reference. The manager stated that a couple of policies still require updating as identified at previous inspections with regard to Whistle Blowing and the home’s own vulnerable adult abuse procedures. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 21 Service users have a range of money recognition and management skills and it is pleasing to see that they are encouraged to maintain as much responsibility for their own finances as possible. Interviews with management and staff confirm that residents all have their own bank accounts and that staff do not have any access to their Personal Identification Numbers (P.I.N.). The manager nor staff do not act as appointee for any residents. Some residents require more support to manage their finances and there are details of all monies held on their behalf and of financial transactions undertaken with two staff signatures. Two residents’ monies and records were checked. One balanced accurately, the other demonstrated a slight discrepancy (£0.02p) which was rectified upon further examination of records which had been calculated inaccurately. The manager audits records and monies on a monthly basis. Receipts are obtained for purchases made on behalf of residents. Monies and receipts are held in individual boxes although these were found to be both loose and the receipts were not numbered or held in any particular order. This may benefit from a more organised system in order to make auditing and balancing an easier procedure. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of décor and furnishings with in the home is variable. Although there are some positive changes to the décor and furnishings, the overall impression is tired and lacking attention in certain areas. The premises are clean and hygienic although improvements are needed to the kitchen and communal bathrooms to promote good infection control. EVIDENCE: The Limes is a detached Victorian property located within walking distance of the small town of Blackheath. There is level access to the front building. Accommodation is provided on two floors. There is an attractive garden to the rear of the building with a small car park to the side. On inspection The Limes is a warm, comfortable and clean premises. Since the last inspection carpets have been cleaned or replaced although the stair carpet will need replacing at some point in the near future due to wear. There is evidence of on-going maintenance of residents’ bedrooms with the handyperson and the manager involved in redecoration. A sample of residents’ bedrooms were accessed The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 23 (with their consent). It was pleasing to see that residents continue to be encouraged to individualize their own bedrooms with personal possessions, hifi and television equipment, pictures, photographs and ornaments. The results demonstrate that bedrooms are homely and residents looked comfortable in their surroundings. During interviews one resident confirmed that he had chosen his own bedroom colour schemes saying “I like these, they are my favourite colours”. He stated that he would like his worn armchair replaced but later the manager explained that he has in the past expressed a preference (as have other residents) that they would like to keep some of their worn bedroom furniture. As identified at previous inspections, worn bedroom furniture should be replaced however, if residents wish to keep this furniture it must be discussed and recorded in their care plan. There are still some outstanding repairs and redecoration which have been identified at previous inspections for example repairing cracked plasterwork in bedrooms and replacing a worn window frame in one resident’s bedroom. A couple of items such as replacement of worn flooring in the first floor shower room has not received attention as the manager wants to address behavioural problems of one particular service user with regard to flooding this area before redecoration. The manager states that she does not hold a budget for maintenance and redecoration as this is held by the Registered Provider. It is therefore required that a written programme of refurbishment and redecoration is established together with timescales for completion so progress can be monitored by CSCI, and which will also assist the manager and provider in prioritising works. The home received a Food Safety inspection by Environmental Services on 21 October 2006. The report arrived on the day of the inspection visit. This report highlighted some items which have already been identified at inspection visits undertaken by CSCI and have remained outstanding since 2005 including worn kitchen units and work surfaces (these were also identified by the Food Safety inspector at their own previous inspections). The condition of the sink base unit and storage cupboards have continued to deteriorate so that they can no longer be effectively cleaned according to the Food Safety inspector. New deadlines have been set for compliance. In addition the standard of cleanliness in the kitchen was questioned particularly the ventilation canopy over the cooker. The manager explained that she takes responsibility for the cleaning of this equipment and had been on leave (see further comment in standard 42). On inspection the grouting around the showers and bath on the first floor and ground floor remains stained. The manager stated that this had been replaced on the first floor but had once again become stained. Ceilings and walls in both the ground floor and first floor bathrooms were mouldy with damp. The grouting around the toilet pedestal in the ground floor bathroom also requires replacing. Not only are there implications for infection control but the overall The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 24 appearance of the bathrooms encouraging residents to bathe. are not inviting or pleasant areas for Other elements of infection control however were seen to be good. The laundry was clean and tidy. There was a supply of paper towels and liquid soap. Appropriate containers with lids are used for transporting dirty laundry around the premises. Staff were see to be wear personal protective clothing when carrying out domestic and catering tasks. One member of staff has completed infection control training. The manager stated that she is currently applying for staff to undertake this as a long distance training course with a local college (see standard 42). The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 25 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, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a small qualified staff team who are fully aware of residents’ needs and preferences. Staffing shortages however can impact upon some aspects of residents’ lives. Recruitment and selection procedures are robust and offer safeguard to residents although the use of agency staff needs more careful monitoring with regard to pre-employment checks. EVIDENCE: According to information supplied on the pre-inspection questionnaire the home continues to exceed standards with regard to the number of staff who are qualified to NVQ II or above. Since the last inspection staff have received specialist training in diabetes awareness (this was covered in nutritional training which the manager feels is adequate to meet the needs of the service user group), challenging behaviour and autism awareness. The manager states that she has so far been unable to access training for epilepsy awareness. Since the last inspection 3 staff have left employment. A new member of staff was recruited in May 2006. There remains two full time vacancies. The The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 26 manager explained that she has been actively trying to recruit but has incurred difficulties with finding staff with the required skills. Agency staff are used to cover shortfalls and where possible only the same agency staff are employed to provide consistency of care to residents which was confirmed on examination of the duty rota. However, this means at present there is a relatively small staff team of only six support staff which can impinge upon the flexibility of services offered to residents. For example, one resident stated that he cannot always go out on day trips with his drop-in centre as there are no staff from the home to escort him. This was confirmed during discussions with the manager. Also both the manager and staff stated that the same resident did not particularly enjoy his annual holiday to Blackpool and would have preferred to go elsewhere but there were insufficient staff to facilitate this. Some staff felt that leisure activities could be varied, and although as already stated in this report, there are opportunities for residents to enjoy a wide range of activities, the manager acknowledges that constraints can arise because of staff shift patterns. On examination of the duty rota there is normally two staff on duty per shift. This includes the manager who is also solely responsible for the emergency oncall system. The manager stated during interview that although there are no dedicated supernumerary hours on a daily basis, she does identify time to allocate to management tasks. As discussed, this needs formalizing at least on a weekly basis and needs to be identified on the duty rota. Proposals must be forwarded to CSCI regarding the on-call arrangements and manager’s supernumerary hours. There are no male support staff and the home has 7 male residents. The manager said that she is hoping that the handyperson may be able to take on some support work. Whilst the difficulties in recruitment are recognised, the manager and provider must continue to pursue this in order that sufficient staff are employed to meet all of the needs of the resident group. Examination of a recently recruited new member of staff confirms that robust procedures were followed. There are only a couple of minor improvements needed. For instance with regard to ensuring that staff complete a statement with regard to their health prior to their appointment, as this information must help form the judgement regarding suitability (as in compliance with the Care Homes Regulations 2001). In addition any staff who have been commenced employment without a satisfactory criminal record bureau (CRB) disclosure check, (on a Protection of Vulnerable Adult (POVA) check, a written risk assessment must be completed which identifies the control measures in place (as discussed with the manager). The appointment must be discussed and a copy of the risk assessment forwarded to CSCI. There was one serious concern identified with regard to the use of agency staff which was rectified by the manager prior to the completion of the inspection. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 27 The manager had failed to obtain evidence from the agency that one of the two agency staff currently used had received a CRB and POVA check within the last twelve months. The agency faxed through confirmation of these checks upon request. Good improvements have taken place with regard to training and development of staff. For example, during interviews, the new member of staff confirmed that she had undertaken an accredited learning disability awards framework (LDAF) induction. Staff had up to date individual training and development assessments in place. Good progress is being made towards ensuring that all staff receive a minimum of six supervision sessions per year. One member of staff had received two supervision sessions this year; the manager stated that a third session had yet to be written up. Any other items discussed during inspection of these standards are included in the Requirements section of this report. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 28 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership through out the home with staff demonstrating an awareness of their roles thereby ensuring that residents benefit from a well run home. Overall there is good health and safety practice although some elements need improvement in order to offer residents more safeguards. EVIDENCE: Ms. Bennett-Hopper has been in post as manager for nearly over eighteen months and has recently enrolled on an NVQ IV in care (or the equivalent of), and has already obtained the required management qualification. The findings of this inspection confirms that Ms. Bennett-Hopper continues to be a dedicated and hard working manager who is committed to raising standards of care and support for residents. There was a very good rapport observed The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 29 between the manager and residents. As already stated Ms. Bennett-Hopper works as a support worker to cover shortfalls in the rota and in order to support staff. Continuing improvements have been seen for example in the standard of food and nutrition, health care and access to college courses and education. One relative commented that the manager “is extremely professional”. Staff were also positive in their feedback with comments including “she will always sort out any problems that residents may have, her door is always open for clients and for us”. As identified at previous inspections, holistic quality assurance systems need to be introduced and the implementation of an annual development plan based upon feedback from users. A number of maintenance and service records were sampled to evaluate health and safety practice as well as interviews with management and staff and observations during the visit. This demonstrated that good practice is maintained. For example, since the last inspection, the water system has been chlorinated and tested for Legionella as required. The fire and emergency alarm system plus fire extinguishers have received an annual inspection. There are regular fire evacuation drills and staff have received annual fire safety training. Five out of six support staff have received training in food hygiene and health and safety training. All support staff have been trained in first aid. There is on-going plans for staff training in moving and handling and infection control. There were a couple of new health and safety items identified such as staff are not always consistently checking and recording weekly fire alarm safety checks. Water temperatures had not been tested and recorded since May 2006. Upon request these were tested on the day of the inspection and found to be within safe limits. The manager thinks that contractors have in the past stated that regular testing is not necessary because of the type of water system in place. This must be clarified and until such a time, continuing tests must be undertaken. As already stated, a report from the Food Safety Officer arrived on the day of the inspection (see standard 24). The standard of cleanliness was reported to be not as high as would be expected in some areas of the kitchen and as recommended, a kitchen cleaning schedule is required. A number of other recommendations were made with regard to food hygiene practice including the safer storage of raw meat and slightly high temperature of the fridge. These were both seen acceptable on the day of this inspection. There was regular testing of fridge, freezer and cooked food temperatures. High risk products were also stored correctly and labelled with the date of opening. There was a separate wash hand basis with a supply of paper towels and liquid soap available. Any other items discussed during this inspection and which are either outstanding or new, are included in the Requirements section of this report. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 30 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 2 2 2 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 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 1 X X 2 x The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 31 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 YA1 Regulation 5 Requirement Timescale for action 01/03/07 2. YA2 14(2) To amend Statement of Purpose and Service User Guide to ensure it accurately reflects service provision and complies with current Standards and Regulations (to forward to the Commission for Social Care Inspection). (Previous timescale of 1/1/04 is not met). To expand the current 01/03/07 assessment tool to ensure it meets the requirements of standard 2.3 of the National Minimum Standards for Younger Adults - in order to assist in the assessment of new service users, and to assist in the periodic reassessment of existing service users. 3. YA6 15 To apply for a minor variation in Registration in order to provide care for one person who is now over the age of 65 years by 1 January 2007. A written plan, which details how 01/03/07 all their care needs are to be met by the home, must be produced for each service user. To include DS0000063539.V316485.R01.S.doc Version 5.2 Page 32 The Limes Blackheath all aspects of care and with clearly stated goals and objectives with timescales for monitoring. (Previous timescale of 1/1/04 is partly met). To carry out a review of all service users individual behavioural management programmes. To ensure that there are explicit guidelines for staff to follow based on professional best practice. (Previous timescale of 1/6/05 is partly met). To introduce a person centred planning process to assist service users with developing their care plans. (Previous timescale of 1/12/05 is partly met). To continue to pursue plans to ensure that service users’ needs assessments and care plans are reviewed on a six monthly basis as part of a multi-agency approach involving other significant professionals. 4. YA7 17(2) Where any restrictions are made on a service users right to make their own decisions, this must be discussed with all relevant people, agreed, recorded and regularly reviewed. For example with regard to financial decision making. (Care plans must be established with regard to how service users are supported in this area). (Previous timescale of 1/1/04 is partly met). Individual risk-taking assessments must be undertaken on all service users DS0000063539.V316485.R01.S.doc 01/03/07 5. YA9 13(4)(c) 01/03/07 The Limes Blackheath Version 5.2 Page 33 6. YA12 16(2)(n) 7. YA20 13(2) and regularly reviewed, i.e. with regard to challenging behaviour, wheelchair users etc. (Previous timescale of 1/1/04 is partly met). To undertake a review of 01/03/07 individual activity programmes in consultation with service users with a view to increasing the number of leisure and social activities (in-house and community based). (Previous timescale of 1/6/05 is partly met). To improve the control and 01/03/07 administration of medication: 1) Medication policy/procedures must be reviewed and include details of all aspects of the safe handling of medication. (Previous timescale of 1/11/03 is partly met). 2) To ensure that two staff initials are obtained to confirm any changes made to computerized instructions on Medication Administration Record (MAR) sheets. (Previous timescale of 1/11/05 is not met). 3) To ensure that care plans contain guidelines with regard to the administration of ‘as and when’ required (PRN) medication including pain relief. (Previous timescale of 1/5/06 is not fully met). 4) To ensure that any ‘as directed’ instructions are clarified on MAR sheets. (Previous timescale of 1/5/06 is not met). 5) To ensure that The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 34 creams/ointments are labelled with the date of opening. (Previous timescale of 1/5/05 is not met). 6) To ensure where there are variable doses, that staff record the amount of tablets which have been administered. The home must review its Adult 01/03/07 Protection policy/procedure to ensure compliance with the Department of Health Guidance and associated legislation (this must include procedures regarding the new Protection of Vulnerable Adults (POVA) scheme. (Previous timescale of 1/1/04 is partly met). To review and expand the Whistle Blowing policy to include contact names and numbers for senior management and to cover false allegations and misuse of the policy. (Previous timescale of 1/11/05 is not met). To undertake the following improvements to the environment: 1) To repair cracked plasterwork in individual service users bedrooms. (Previous timescale of 1/12/05 is not met). 2) To progress plans to replace worn flooring in the first floor shower room. (Previous timescale of 1/12/05 is not met). 3) To investigate and repair creaking floorboards in service users bedroom (adjacent to first floor bathroom). (Previous The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 35 8. YA23 13(6) 9. YA24 23(2)(b) 01/03/07 timescale of 1/12/05 is not met). 4) To repair worn flooring in service users ensuite toilet. (Previous timescale of 1/12/05 is not met). 5) To repair worn window frame in service users bedroom. (Previous timescale of 1/12/05 is not met). 6) To ensure all wardrobes are securely fixed to bedroom walls. (Previous timescale of 1/12/05 is partly met). 7) To replace all worn bedroom furniture. (If residents wish to retain personal items of furniture which are worn, this must be recorded in their care plan file with confirmation of their preferences). (Previous timescale of 1/12/05 is partly met). 8) To carry out a written risk assessment with regard to the use of multiple electrical adaptors. (Previous timescale of 1/12/05 is not met). 9) To replace worn kitchen units. (Previous timescale of 1/12/05 is not met). 10) To replace stained grouting around showers and bath. (Previous timescale of 1/12/05 is partly met). 11) To treat ceilings which have been damaged by damp in the first and ground floor bathrooms and carry out redecoration. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 36 12) To comply with all of the requirements made by the Food and Health & Safety Officer on 21 October 2006 within timescales identified which include: repair or renewal of sink base unit, deteriorated storage cupboards and worktops, replacement of mastic sealant around worktops and broken ceramic wall tiles, removal of flaked and cracked paint and redecoration of kitchen walls. (Letter sent to Registered Provider on 6 November 2006 regarding proposals to ensure compliance with this requirement to be received by 17 November 2006). 13) To establish a written programme of maintenance and renewal for the fabric and decoration of the premises (which include all of the aforementioned items in this report) together with timescales for completion, and to forward to CSCI by 1 January 2007. To provide specialist training for all staff in: 1) Epilepsy awareness. (Previous timescale of 1/4/04 is not met). 11. YA33 18(1)(a) To ensure that all staff meetings which take place are fully recorded (minimum six per year). (Previous timescale of 1/5/06 is not met). The Registered Provider must ensure that the Manager is allocated specific supernumerary hours and must review the current emergency on-call arrangements. To forward The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 37 10. YA32 18(1)(c) 01/03/07 01/03/07 written proposals to the Commission for Social Care Inspection. The duty rota must identify which hours are dedicated to supernumarery responsbilites and which are dedicated to assisting with care. To continue to pursue recruitment of extra staff in order to ensure that sufficient staff are employed to meet all of the needs of the service user group. To ensure all agency staff who 01/01/07 are employed have received a CRB and POVA check within the last 12 months with written confirmation obtain from the agency and held on the premises. To ensure that fully completed health declarations are received prior to appointment of potential new staff (as this must help form judgements as to whether the candidate is physically and mentally fit for the purpose of work that he is to perform). To ensure that risks are fully explored with regard to starting new staff whilst awaiting the completion of a satisfactory CRB check (and to forward a copy to CSCI). To provide staff with training in 01/03/07 equal opportunities and disability equality. (Previous timescale of 1/4/04 is not met). To ensure that all staff receive a minimum of six recorded supervision meetings per year. (Previous timescale of 1/6/06 is partly met). 01/03/07 12. YA34 19 13(6) 13. YA35 18(1)(c) 14. YA36 18(2)(a) The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 38 15. YA39 24 To introduce an annual appraisal system for staff. (Previous timescale of 1/6/06 is not met). Effective quality assurance systems must be developed by the home. (Previous timescale of 1/12/05 is not met). An annual development plan must be devised based on a systematic cycle of planningaction-review, reflecting aims and outcomes for service users. To provide training for all staff commensurate with their duties which include: 1) Moving and handling. (Previous timescale of 1/1/04 is partly met). 2) Infection control. (Previous timescale of 1/1/04 is not met). 01/03/07 16. YA42 18(1)(c) 01/03/07 17. YA42 13(4)(c) To improve health and safety practice: To carry out written risk assessment for all Control of Substances Hazardous to Health (COSHH) products which are used. (Previous timescale of 1/11/04 is partly met). To ensure that there is more consistent weekly testing and recording of the fire alarm system. To ensure that there is more regular testing and recording of water temperatures (i.e. monthly). 01/01/07 The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 39 18. YA42 13(4)(c) To make the following improvements to food hygiene practice: 1) To defrost and repair broken drawers on small freezer located in the kitchen. (Previous timescale of 1/11/05 is partly met). 2) To establish a written kitchen cleaning schedule identifying tasks to be carried out by staff, cleaning materials and frequency. 01/01/07 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. Refer to Standard YA6 Good Practice Recommendations To consider strategies for improving record keeping by staff to ensure that: 1) daily reports reflect goals and objectives identified in care plans. 2) descriptions of how challenging behaviour is diffused correlates with behavioural management guidelines or explanations are given as to why this is deviated from. 3) there is more accurate correlation between service users’ activity plans, practice, and records of activities and outings. To ensure that nutritional screening tools and assessments are reviewed at least on an annual basis (or sooner if high risk is identified). To obtain a lockable tin to enable more secure storage of medication in the refrigerator. To continue to pursue regular audits from pharmacist in line with contractual arrangements. The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 40 2. 3. YA17 YA20 4. 5. YA33 YA37 To request that the pharmacist does not use dispensing labels on MAR sheets. To continue to pursue the recruitment of male staff. The Registered Provider should continue to support the manager to ensure that she obtains an NVQ IV in care by September 2007. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance The Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Limes Blackheath DS0000063539.V316485.R01.S.doc Version 5.2 Page 42 - 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!