Inspection on 06/04/05 for The Shrubbery

This inspection was carried out on 6th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

The Shrubbery 15/09/09

The Shrubbery 22/09/08

The Shrubbery 25/07/07

The Shrubbery 25/04/06

The Shrubbery 23/06/05

The Shrubbery 06/01/05

The Shrubbery 21/04/04

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

CARE HOMES FOR OLDER PEOPLE The Shrubbery 33 Woodgreen Road Wednesbury West Midlands WS10 9QS Lead Inspector Jon Potts Unannounced 6 & 11 April 2005 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 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 Older People. 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 Shrubbery Version 1.10 Page 3 SERVICE INFORMATION Name of service The Shrubbery Address 33 Woodgreen Road Wednesbury West Midlands. WS10 9QS 0121 556 8899 0121 556 8899 Telephone number Fax number Email 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. A. S. Sandhu Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Shrubbery Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: the home is registered for 15 older people Date of last inspection last statutory inspection on 21.12.04 with numerous monitoring visits since. Brief Description of the Service: The home is situated on a main route between Wednesbury and the M6 and is easy to access by public transport and car. The facilities offered by Wednesbury town centre are also in easy reach. The house itself is a mature detached residence set in its own grounds and well screened from the road. There is ample off road car parking at the front of the house. The house has three floors, all accessible by lift. There are many pleasing period feaures that have been retained that add character and ambience to the home. The ground floor consists of two lounges, a dining room, one bedroom, bathroom,toilets and service areas (kitchen, laundry etc). The other two floors contain bedrooms, toilets and bath/shower rooms. The home has a range of adaptations that include bath hoists, grab rails, raised toilet seats, call system, although the home is not seen as suitable for a person who is a permanent wheelchair user. The home is staffed by care assistants, a cook, cleaner and handyman under the supervision of a manager. The Shrubbery Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced on the first day, although the second visit was announced (this so that the inspector was able to meet with the responsible individual). Evidence was drawn from discussion with residents, relatives and staff, case tracking, reviewing case files, staff files, some policies/procedures, minutes of meetings, records of monies in safe keeping (against valuables kept) and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: There are many areas identified where the home needs to improve, the most noticeable related to the consistent management of the home, this impacting on staff management, monitoring of the quality of services provided and responding to issues/requirements in a pro-active, rather than reactive manner. The lack of consistent management arrangements has impacted on the guidance available to staff and practices within the home. The home’s The Shrubbery Version 1.10 Page 6 practices in respect of how service users are protected from abuse, in particular in regard to their finances needs continued improvement. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Shrubbery Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Shrubbery Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 The home is only currently meeting some of the standards set by the provider in its statement of purpose. The home was not at the time of the inspection meeting all the needs of the residents living there. EVIDENCE: Due to the current suspension on placements by Sandwell M.B.C the home has had no admissions this year, this meaning any comments in respect of pre admission assessments would be based on dated information. There was evidence that the last acting manager of the home did take forward concerns expressed by the CSCI in respect of the reassessment of one resident, where there were doubts about the home meeting their needs. This person has now received some reassessment, this based on the report seen confirming that the home cannot currently meet the needs of this person. This is partly related to the skills and knowledge of the staff team in working with a service user whose needs are more complex than those the home is able to fully meet. This is underlined by the fact that only two of the staff team have had any training in dementia care. It should be noted that this statement is not The Shrubbery Version 1.10 Page 9 intended to devalue the skills, experience and abilities of the staff team, but highlight where there are shortcomings due to accepting residents that are outside of the home’s agreed categories of registration. Discussion with the provider, since the inspection, has indicated that a decision to resolve this issue, in the best interests of the service users, has been taken. The home’s last statement of purpose dated December 2004 was given to the inspector and examination of this did indicate that there is a need for review of the information contained in it as some information is inaccurate (for example – the number of registered places available). In addition, the home is only currently meeting some of the standards it sets itself within this document’s aims and objectives (appropriate examples include activities and philosophy). On the positive side though the statement of purpose is concise, easy to read and not over long. The Shrubbery Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, & 9 Whilst care plans have improved, these are still not sufficiently robust to provide a satisfactory framework for the provision of appropriate care to residents that has been agreed with them. Residents are enabled access to primary health care services with the assistance of staff with the exception of regular dental checks. Generally the home manages resident’s medication appropriately although there is concern that medication is given covertly with no recognition of this within care documentation and policy. EVIDENCE: Whilst there was noted to have been some improvement in the quality of the homes care plans since the time of the last statutory inspection, there is still areas where further improvement is necessary, particularly in respect of: - Evidencing the involvement of the resident or representative in the formulation of the plan (none of the plans were seen to be signed by the resident) The Shrubbery Version 1.10 Page 11 - The full range of risk presented to the individual resident (there was no documentation detailing some of the risks presented to some residents such as going out alone, choking, etc) - The accuracy of the detail in the plan. Examples include detail on the plan not reflecting the actual practice in respect of bathing, administration of medication in food and the way food needs to be presented to assist a resident to eat independently. Tracking of the involvement of residents with primary health care services, and discussion with residents indicated that the staff contacted these services appropriately in most cases although there was a lack of evidence to show that there was the opportunity for regular dental checks made available. There are however formats now available for the home to show the risk to residents in respect of tissue viability (skin condition), falls and nutrition. There was however no evidence of assessment in respect of continence (where this was appropriate). A recent visit by the contracted pharmacist on the 5.4.05 did not highlight any major concerns in respect of how the home handles the resident’s medication. The home has a revised medication procedure available, this an improvement of the previous ones seen although there was no policy on the administration of covert medication, this stated to be the practice for one resident by a staff member. There was no reference to this practice in the care plan, or an agreement with the representatives of the resident for this to happen. Observation of a senior administering medication did not give rise to any concerns, with practice seen to be in accordance with the homes policy. It was pleasing to see that there was interaction between the staff member and the resident at the time medication was given and taken. The Shrubbery Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The home is not providing for the recreational interests of the residents. The quality of the food provided does not always meet with the satisfaction of the service user and the serving of, and the way it is presented for less able residents needs improvement. Visitors are welcomed into the home and hospitality offered readily by staff. EVIDENCE: There was a residents meeting on the 18/2/05, this documented, and showing that the residents attending had expressed clear choices as to the activities (including day trips) and food they wanted. Views were also expressed as to the quality of the food available with comment to the bread (as ‘dry horrible and thick’). Discussion with a number of residents indicated that there was still some dissatisfaction with the quality of the bread although overall views as to the quality of the food varied from ‘marvellous’ to ‘terrible’. Time spent looking at the foods available in the pantry did indication that the comments of the residents at the meeting had been considered, with some of the foods requested available. Sight of the main meal of the day on the second day of the inspection evidenced that there was a choice of two meals available, with the size of The Shrubbery Version 1.10 Page 13 portion and presentation appearing acceptable. There was concern though that the staff once having served the meals did leave the dining room, and the inspector noted that one resident was seen to be having trouble picking up her meat with her fork as it had not been cut up. There was also comment from residents to the inspector at the time that they had to wait for the meal to be served after sitting in the dining room; pudding was served too quickly after the main meal. All the residents spoken to stated that they would like to see more activities organised, this clearly not an issue that had been followed up from the residents meeting. One comment was that ‘there is a lot of sitting between meal times’ and ‘staff are always busy’. Discussion with two visitors to the home evidenced that the staff provided them with a drink and had offered meals in the past, with there being no known restriction on reasonable visiting time, this confirming the homes policy. The Shrubbery Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home’s complaints procedure is accessible to all residents and visitors to the home. Residents are not safeguarded from abuse due to the home’s lack of guidance on adult protection. The safety of residents’ monies when handled by the home is potentially not safe due to instances of poor or lack of recording. EVIDENCE: The home’s complaints procedure was seen to be on clear display in the foyer of the home, this copy in large print. The policy gives an assurance that complaints will be responded to within 28 days and carries contact details for CSCI. There have been no complaints received by the home or the CSCI over the last 12 months. When requested by the inspector it was stated that the home currently has no policy on the protection of vulnerable adults, this to be drawn up in the near future. There was seen to be a copy of Sandwell Social Services Protection of Vulnerable Adult’s procedure available however. There was evidence of the majority of the staff having received training in the dealing with abuse since the last inspection. The Shrubbery Version 1.10 Page 15 The home’s policy on the safekeeping of residents valuables was limited and in need of expansion and there were a number of issues identified in respect of the way in which the home recorded monies this including a lack of clear records of some monies received and then expended. There was also a lack of records relating to the fees and contributions paid by residents towards their accommodation at the home. It was of note however that some of the residents spoken to were quite clear that they felt safe at the home. The Shrubbery Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,25 The home is clean and comfortable but is in need of some maintenance. EVIDENCE: From a tour of the premises the home was seen to be comfortable and generally well presented although there were areas that would benefit from attention such as some furniture that requires replacement (some stained bed bases, broken drawers, chipped mirrors etc). There was no programme for the planned redecoration and refurbishment of the home over the next twelve months, although the management informed the inspector that an audit was to be carried out in the near future, with a plan to be drawn up following costings. Those residents spoken to were generally happy with their bedrooms although one mentioned that the room ‘takes a while to warm up’. There are known to be difficulties in another room in respect of the heating, although this can be managed through regular attention to the radiator (this evidenced by a specialist central heating engineer commissioned by CSCI prior to the inspection). The temperature in one room in question is also compromised by one window not shutting fully into its rebate and therefore letting in a draught. The Shrubbery Version 1.10 Page 17 There have been repeated difficulties with the supply of hot water to some bedrooms over the past few years, this now finally resolved. This was only rectified after CSCI issued an enforcement notice. The Shrubbery Version 1.10 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The home’s recruitment and staff induction procedures are not sufficiently robust enough to fully protect service users. There are sufficient staff employed although the support of these staff in pursuit of their duties has been hampered by inconsistent supervision. EVIDENCE: Following enforcement action by the CSCI there are now three care staff available during daytime hours in addition to ancillary staff, which consists of one cook, one cleaner and a part time handyman. There is a current vacancy for a second cook. There are two waking night staff available through the night. Three of the care staff have a current NVQ level 2 qualification, this out of a complement of 16 (care staff). It was stated by the responsible individual that six care staff are about to commence their NVQ training, this to be seen as a positive move to improve staff skill and knowledge. There has been some training input since the last inspection in moving and handling, understanding abuse and first aid, although there are still some staff that require input in areas of mandatory competence. The majority of staff require training in infection control. The home does not currently have a training plan although there was seen to be an improvement in the records of the training staff have received. The inspector checked four staff files thoroughly, some of these recent employees, and found that whilst there was an improvement in the recruitment The Shrubbery Version 1.10 Page 19 checks carried out of late there were still some serious shortcomings, these including the lack of checks against the Protection of Vulnerable Adults list, obtaining a full working history and ensuring that two appropriate references are obtained prior to employment. All the available enhanced disclosures for staff were checked, this showing that out of 18 staff 10 had no current disclosure, this of serious concern. There was evidence that four of these staff have applied for a disclosure recently. The inspector spoke to a recently employed staff member who confirmed that they had been given a workbook that on description matched that expected although it was stated that only three days off the rota were allowed before the new staff member was counted as part of the full complement of staff. The ability of the new staff member to work, as part of the staff team should be reviewed dependent on their competence (with factors such as previous experience, training and aptitude). The Shrubbery Version 1.10 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34 35 & 38 The running and management of the home has suffered due to the constant turnover of, or lack of management at the home over the last few years. The policies and practice of the home in respect of service users financial interests have led to mismanagement of service users monies. EVIDENCE: The home has had numerous acting managers since April 2002, none of these achieving registration with the CSCI. There have been periods with the home running without a manager following one leaving and prior to recruitment of another. This has lead to concern amongst the staff team and residents, with this confirmed by comments to the inspector. A new acting manager commenced at the home on the 13.4.05. An application for registration has been submitted to the CSCI. This turnover of managers has lead to a lack of leadership for staff with such as supervision as piecemeal. The Shrubbery Version 1.10 Page 21 Records of residents monies in safekeeping was seen and found to be appropriately recorded although there was some difficulty matching receipts to transactions, these needing to be better referenced. All these monies balanced with recorded amounts, as did the resident’s fund, although records of the residents fund from December 2004 show an amount of approximately £133 unaccounted for. Following a recent Adult Protection investigation the provider was found to have been keeping a residents money in the homes bank account, not one in their own name as should be the case. This money has now been refunded to the resident in question. At the time of the inspection there were still no records available to allow tracking of the amounts paid by privately funded residents for accommodation beyond receipts for cheques given to staff at the home. There were also piecemeal records in respect of monies accepted by staff at the home off a resident for specific payments. There was seen to be a brief policy on safekeeping of residents money that was very brief and needed expansion to fully cover how the homes practices would protect any resident for any from of financial abuse. The responsible individual and the acting manager at the time of the inspection were considering ways in which they could reduce the handling of any resident’s monies through use of such as direct debits, third parties etc. The provider has recently agreed to his son taking over a controlling role in the running of the home on a day-to-day basis and initially discussions and responses from this new responsible individual indicate a wish to resolve the difficulties the home has had of late. The inspector had received a response from the responsible individual to the verbal feedback given at the time of the inspection prior to the writing of this report, the proposals within this indicating an understanding of the areas that need to be addressed. The Shrubbery Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 x x x x x 2 x STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 1 1 2 2 1 1 1 2 The Shrubbery Version 1.10 Page 23 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 3 Regulation 14 Requirement Timescale for action was 19.2.05 now 1.6.05 2. 5 3. 7 4. 7 A pre admission assessment form that includes all areas detailed with the National Minimum Standards must be developed. This is a repeated requirement from the previous inspection. 4(1) c Sch A policy on emergency admission 1 must be developed. This is a repeated requirement from the previous inspection. 15 & 17 Development of care records must be continued so that there is documentation detailing all needs of the residents within care plans. These are to contain clear detail of the full range of a residents needs, what action is to be taken, who is to take the action and the timescales for completion (as appropraite), the latter updated where there is change. Every care plan must detail the outcome of the choices of the individual resident in respect of all their lifestyle. 15 All care plans must be signed by the resident, or where this is not possible the representative. To assist understanding the care plan must be presented in an Version 1.10 was 19.3.05 now 1.6.05. 1.6.05. 1.6.05 The Shrubbery Page 24 appropraite format. 5. 6. 7. 7 8 8 18(1)c 13(1)b 13(2)c Staff training in completing care plans must be continued All residents must be offered the opportunity to regular check ups by a dentist. Reviews of residents medication as carried out by the G.P. or their agent must be clearly documented Staff training in the administration of medication (this to be accredited) is to continue. Where residents are given medication covertly this must only take place follwing the full agreement of the resident or their representative. A suitable policy in repect of the same, this to include details of safeguards for the resident must also be developed. Residents must be provided with activities that are in keeping with their expressed preferences and social needs. Residents food must be presented to them in a way that is suitable to allow them to eat independently as far as this is possible. The residents satisfaction with the food provided by the home must be monitored and recorded. Policies must be developed and made available to all staff in respect of Adult Protection, this to include a policy on the safeguarding of residents finances and valuables The registered provider must produce a documented programme of routine maintanence and renewal of the home and its contents that Version 1.10 on going 1.6.05 on going 8. 9 13(2) 1.7.05. 9. 9 12 & 13 (2) 10.5.05 10. 12 16(2) m & n 16(2)i 1.6.05. 11. 15 immediate 12. 15 12(3) on going 13. 18 13(6) 10.5.05. 14. 19 16 & 23 10.5.05 The Shrubbery Page 25 15. 19 23(2) 16. 19 23(2) 17. 29 13 & 19 18. 29 19 19. 30 18(1)c 20. 33 26 21. 33 26 22. 34 25 shows forward planning within financial forecasts. An audit of tiles in all bathrooms and toilets must be carried out and any that are cracked replaced/repaired. This is a repeated requirement from the previous inspection. Curtains or blinds must be provided at the window of the landing between the ground and first floor (this to ensure privacy from the public house next door) The registered provider must ensure that staff, new and existing and any persons that offer a service at the home (i.e the hairdresser) apply for an enhanced disclosure. No new staff can be employed at the home without appropriate recruitment checks carried out first as detailed in the Care Home Regulations (2001) and Department of helath guidance A staff training and development programme must be developed that identifies how the home is to meet is aims and objectives. This programme should meet National training Organisation standards and identify those areas of training discussed at the inspection. The registered provider must continue to develop the homes quality monitoring system as discussed at the time of the inspection. Copies of reports by the registered provider (or his representative) following monthly unannounced monitoring visits of the home must be forwarded to the CSCI. This is a repeated requirement. The registered provider must produce a business and financial Version 1.10 was 19.2.05 now 10.5.05 19.5.05. with immediate effect with immediate effect 1.6.05 19.5.05 on-going was 19.3.05 Page 26 The Shrubbery 23. 35 17(2) Sch 4 24. 36 18 25. 37 17 & 24 26. 38 23 27. plan. This is a repeated requirement. There must be a clear record of any transactions involving residents monies this to include; any monies paid for or towards their accomodation with invoice/receipt numbers, amount paid and balance; clear referencing in all records to any supporting documentation such as receipts; documentation of all valuables kept by the home; Any monies the staff handling with the express reason of carrying out financial transactions on behalf of the resident. The acting manager must recommence and maintain staff one - to -one supervisions at least six times per annum. All policies and procedures must be reviewed on a regular basis (at least annually) and signed and dated by the management. There must be regular checks of the premises to ensure that they are safe, with no obvious risks to residents, this to include such as checks of water temperatures, safety of furniture, rooms etc. Void now 1.7.05. 10.5.05 ongoing ongoing immediate and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 27 Good Practice Recommendations There should be a schedule of service users meetings identifying dates for the same over the forthcoming year. The registered provider should obtain the appropriate staffing guidance from the residential forum. The Shrubbery Version 1.10 Page 27 Commission for Social Care Inspection Mucklow Office Park Mucklow Hill Halesowen West Midlands. B62 8DA National Enquiry Line: 0845 015 0120 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 Shrubbery Version 1.10 Page 28 - 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!