Inspection on 06/02/06 for The Thomas More Project

This inspection was carried out on 6th February 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Thomas More Project 06/03/07

The Thomas More Project 01/09/05

The Thomas More Project 29/03/05

The Thomas More Project 02/12/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Thomas More Project Thomas More House 33 Fallodon Way Henleaze Bristol BS9 4HX Lead Inspector Nicky Grayburn Unannounced Inspection 6 February 2006 09:30 th The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 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 Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 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 Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Thomas More Project Address Thomas More House 33 Fallodon Way Henleaze Bristol BS9 4HX 0117 9629899 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) Thomas More Project Mrs Janet Smith Care Home 11 Category(ies) of Learning disability (11), Physical disability (1) registration, with number of places The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate persons aged between 30 and 70 years. Date of last inspection 1st September 2005 Brief Description of the Service: Thomas More, 33 Fallodon Way, is registered with The Commission for Social Care Inspection as a care home for 11 clients aged 30 - 70 years with learning disabilities, including one client with physical disabilities. The house is purpose built, blends in well with its surroundings and situated in a quiet residential area. The house is a two-storey building with single bedrooms on both floors and several communal areas for the clients to access. The garden is well sized and easily accessible from the house. It is close to local facilities and amenities and has its own transport to support clients in accessing community facilities. Clients are encouraged to participate in their local community and remain in contact with their relatives and friends. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection for the year. It is advised that this report be read alongside the previous inspection report to gain a full picture of the home and its qualities. Evidence was gathered primarily through consultation with clients, staff and examination of records. A tour of the property was also undertaken. A phone call the next day was held with the manager to give feedback from the inspection. The manager requests that service users are referred to as clients. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 6 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 Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Prospective clients have clear information about the service provided by Thomas More and have opportunities to visit the home prior to moving in. Clients have individual contracts regarding their fees for living at the home. EVIDENCE: Thomas More have a very user-friendly service user guide, which following a requirement, has been updated with the most current inspection report. Further, records have been amended to present the correct phone number for the CSCI. There has been one new client living at Thomas More since the last visit who moved in just prior to Christmas. The admissions process was discussed with the manager. Thomas More have a very good procedure and was mostly followed. The previous care home provided the manager with some personal details of the client but with very limited information. The client is funded by Bristol Social Services and the manager received the latest review notes from October 2005. Due to some lack of information and the timescale imposed by the previous home, the manager is still carrying out a full assessment of the client’s needs. The manager has been proactive in sourcing information but due to confidentiality issues, it has proven to be a slower process than expected. The manager has made an appointment with the client’s psychiatrist to explore the amount medication that is prescribed. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 8 The manager is currently forming the care plan and essential lifestyle plan with the client. Information from various sources is seemingly contradictory to present behaviours from the client. The manager confirmed that the client visited the home and stayed for a weekend, then shortly moved in. The inspector met the new client and they said that they liked living there. Clients have licence agreements with the housing association that owns the property and also weekly fee agreements, which show the current expected fees. These were updated in January 2006. The newer client’s agreement needs to be completed along with the other documentations. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9, 10 Clients are involved in their individual plans ensuring that their needs and choices are reflected. Clients would benefit further from the key worker system if the reports where regular and presented more detail. Clients are supported to take risks in their lives but would benefit further if these were reviewed more regularly. Clients are assured that their confidentialities are kept. EVIDENCE: Standard 7 was inspected at the last visit and scored 3. Each client has an individual ‘essential lifestyle plan’ which is person centred and holds much detail regarding daily living support needs such as, routines; likes and dislikes; non-negotiables; preferences; and relationships. Clients are allocated a key worker who is responsible for writing the monthly reports. Aspects of the reports are good, but need to be in more detail and to reflect personal goals. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 10 Within the details of the client’s daily routines, the risks involved are stated with details as to how to minimise them. There is also a specific set of risk assessments, which cover certain tasks and activities. Some state that they will be reviewed if the incident reoccurs. However, some date from 2003 and need to be reviewed. Clients have forms in their files for ‘release of information’. A recommendation was to include the CSCI on this, which has been done. Client’s files are kept in a locked cabinet. There is also a confidentiality policy in place. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Clients enjoy the opportunities for their personal development and having appropriate relationships. Routines and lifestyles are respected and supported. Clients are offered a healthy diet. EVIDENCE: Clients are active in their daily living routines and attend local day centres and colleges. It had been previously told to the inspector that the home is close to their ‘sister’ home and often have joined activities. The home also has good relations with their neighbours. Maintaining family relationships tend to be noted under the ‘essentials’ part of the clients’ person centred plan. One of the clients had just spent the weekend with their family and this is also common for others. From the previous visit, it was explained by staff that families are often invited in the home. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 12 It was evident that some clients have keys to their doors. There are corresponding records stating whether the resident wanted a key or not. It was of concern that one clients’ records stated that their room be left open whilst the resident is in the home, however, it was locked when the client wanted to show the inspector their room. Further, a bedroom’s door was wide open despite a notice stating that it be locked when they are out. Staff must respect and abide by these wishes. This was discussed with the manager. Menus were on display in the kitchen and presented a varied and healthy choice of meals. There are also details of clients who need packed lunches for the following day. A member of staff explained how the home is striving to be healthier, i.e. by using natural sugars rather than refined, and tries different snacks for the packed lunches. A resident was helping to prepare the evening meal that was full of fresh vegetables. There are two tables in the dining area for clients to eat altogether if they wish. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 21 Clients’ health needs are met in a way they prefer and require. Clients can be assured that their wishes in the event of death will be respected. EVIDENCE: Each client has an individual essential lifestyle plan that details how they need support in their lives, specifically with their intimate care. As some clients use their own personalised language, it was evident that staff knew what ‘noises’ indicated certain needs. The new client has been registered with the local dentist as a check-up was evidently in need. The manager said, and was recorded in notes, that the home has a hygienist who visits the home on a regular basis to ensure that clients’ oral hygiene is maintained. This is good practice. Any refusals of attendance to appointments is duly recorded. A previously made requirement regarding gaining clients’ wishes in the event of death has been met. The manager confirmed that the task was not as hard as she thought and found that many clients had already thought in great detail about their wishes. This was further evidenced in clients’ care files. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Clients are listened to but would be better protected from any form of abuse once the staff team are fully trained and have the correct checks in place. EVIDENCE: Clients have regular in-house meetings to discuss the various issues of the home. It was observed that staff members have a good understanding of clients’ personalised communication methods. A previous requirement from the previous visit was to confirm that all staff have their Enhanced Criminal Records Bureau check in place. One member of staff’s CRB had taken 4 months to return and resulted in the disciplinary action. The staffing rota and a discussion with a member of staff confirmed that the home is understaffed at present and has taken on two new members of staff without the full CRB check. This conflicts with the home’s Adult Protection policy, which states that ‘all staff must have a recent CRB…before they start’. The manager confirmed that this policy is soon to be reviewed. Employing staff without the CRB must only happen in dire circumstances and those staff must not work unsupervised or take on roles such as being a Key Worker. Staff are in need of Protection of Vulnerable Adults training. The last recorded ‘session’ was in November 2004. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 15 This need became even more apparent whilst reading daily record notes concerning a clients’ behaviour. This information had not passed onto the manager, as she was unaware of the incident. The notes were sparse and did not explain the situation. The inspector spoke with the member of staff regarding the incident to establish what had occurred and why they had not reported this. The manager will be discussing this further with the member of staff. Formal training is being arranged. The manager confirmed that the subject of abuse is frequently discussed in the staff meetings. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 Clients live in a homely, clean and comfortable home. Bedrooms are situated to aid independence and shared spaces complement the number of clients. EVIDENCE: Thomas More home is a comfortable and homely environment. The building is purpose built and has 11 bedrooms. It is set in a residential area with local amenities nearby. There is no lift so mobility issues would have to be taken into consideration prior to placement. There is a pleasant front garden and a good-sized garden to the rear. The management are aware that the back fence is need of repair. During the warmer weather good solid garden furniture is brought out which was seen at the last inspection. There are bedrooms on both the ground and first floor of the property enhancing independence for those who use a wheelchair. Seven bedrooms were entered and were found to be clean and personalised. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 17 Toilets and bathrooms are accessible and appropriately located to clients’ bedrooms. One bathroom on the ground floor was out of use on the day of the visit as damp and mould had been found and is being decorated and dehumidified. It is due to be finished shortly. An upstairs toilet still presents an unpleasant odour. The manager confirmed that this has been fully investigated to no avail. The sanitary bin was rather full and pads were not correctly disposed of. This was discussed with the manager who said that staff remind clients of how to dispose of the pads. In some bathrooms there are pictorial sheets to prompt clients as to how to wash themselves and their hair properly. There are also signs on the toilet doors to improve independence. There are call bells in all the bathrooms and any exposed hot water pipes are covered with padded materials to avoid burns. There are chair hoists with space either side of the bath in the downstairs bathroom for those who need support when washing. There is a large lounge with sofas and chairs that the clients use often. The second lounge area appears to be more used than from the previous visit and it was observed how clients were using this room more than the main lounge. The home has also redecorated the smaller relaxation/storage room into a computer room for both clients and staff usage. There is also a large dining area. Clients with mobility difficulties have bedrooms on the ground floor. Some mobility aids are kept near the stairs and a back door. Staff must ensure that these are stored correctly and do not block the fire exit. Clients are encouraged to help with the cleaning of their bedrooms during their ‘Training Day’, but staff are responsible for the general cleaning. The home was found to be clean and hygienic on the day of the visit. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Clients will soon benefit from a full staff team who are trained to meet their needs. Recruitment practices still need to be improved. EVIDENCE: The home has had some staffing difficulties recently but has recruited two members of staff to make up the full staff team. There is one staff member who carries out day care activities who was present on the day of inspection. There is no longer a waking night shift, but two staff sleep in due to the changing needs of the clients. Two members of staff have completed their National Vocational Qualification in care level 2, and two staff have completed level 3. One staff has nearly finished their level 2. The manager must ensure that there are at least 50 of the staff team who are qualified in care. The inspector met one member of staff who had started that day. They were undertaking induction training. As stated earlier, the home decided to start the staff member due to the shortage of staff. Their staff file was examined and two references had been obtained corresponding to the application form; a Protection of Vulnerable Adults initial check was clear; two interview forms had been completed, and a letter stating that employment was on the condition of satisfactory police checks was on file. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 19 It is advised that the home consider developing a system to ensure that this situation does not arise as frequent as it could do, such as a bank of staff or instating an agency to cover shifts when necessary. Training records were looked at. For many staff, there is no clear record of what has been undertaken. Further, statutory training is in need of updating or initial completion to ensure that all staff are aware of current practices within care homes. The manager assured that this will be taking place within the next two months whereby all staff attend the courses over a two-week period which covers all areas. A member of staff told the inspector that they were able to attend a course in driving the home’s vehicle. Despite not needing a specific licence to drive it, it is larger than a normal vehicle and this boosted the staff’s confidence. The manager further confirmed this. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 Clients benefit from living in a well run home. Monthly visits need to be regulated and records need to be continually monitored to ensure they are upto-date. Policies need to reflect current practices. EVIDENCE: The manager was present for some of the inspection and has now completed her NVQ Level 4 and Registered Manager’s Award. Mrs Smith has been in post for a number of years and is very knowledgeable of the clients’ needs and how the home runs. A previous requirement for monthly visits to take place has not been met due to various reasons. It was confirmed with the manager that the provider is able to carry these out, as he is not directly involved with the day-to-day operations of the home. The requirement remains, and copies of the report must be sent to the Commission regularly if enforcement actions to be avoided. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 21 Some policies and procedures do not correspond with the practices. This was discussed with the manager who said that the policies are due to be reviewed shortly. This will be a focus of the next inspection. Clients’ and staffing records are kept in the office in locked cabinets. Generally, records are kept up-to-date, but the manager must continue to monitor certain areas such as risk assessments; policies, and key worker reports. The fire logbook was examined and was found to be good order. Fire drills are carried out frequently and contractors are contacted when necessary. Checks on the fire safety system are carried out within the appropriate timescales. There are also weekly checks on clients’ electrical appliances. Generic checks such as the ‘Gas Safety’, ‘Portable Appliance Testing’, and Fire Alarm system were all in date. Safety Data sheets were in place for hazardous cleaning products and are due review this month. However, there is a need for staff to undertake fire safety training on a regular basis. The last recorded training was in August 2005 for just three members of staff, one of which has left. Day staff must have this every 6 months and those who work nights must have this every 3 months. There are notices in the kitchen to remind staff to check the temperatures of cooked meats, however, the last recording was in October 2005. As discussed with the manager, staff must check the temperatures to ensure that food is cooked properly. Fridge and freezer temperatures are recorded. The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 22 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 2 2 3 2 X The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard YA6 YA9 YA23 YA23 Regulation 14(2a) 13(4abc) 13(6) 19 Sch 2, p.7 19(1b) Sch2 18(1a,c) Requirement Key Worker reports to be kept up-to-date. Risk assessments to be updated. All staff to undertake Protection of Vulnerable Adults training. To confirm with the inspector that new staff members have POVA and CRB checks. (outstanding requirement) Timescale for action 28/02/06 31/03/06 31/03/06 31/03/06 5. 6. YA34 YA35 7. YA39 26 Recruitment practices to follow policy and comply with regulations. All staff to complete statutory training: food hygiene; health and safety; first aid; manual handling. Monthly visit reports by responsible individual to be sent to CSCI. (outstanding requirement, previous timescale 1/9/5) 31/03/06 30/04/06 28/02/06 8. YA42 23(4d) All staff to undertake fire safety training. 28/02/06 The Thomas More Project DS0000026652.V279974.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA6 YA9 YA33 YA40 YA42 Good Practice Recommendations Daily reports making up the key worker reports to contain more detail about the resident. Review risk assessments for all clients’ activities. The home to consider a system which will prevent employing staff without the correct documentation. Policies to reflect current practices. Ensure staff check food temperatures. 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