Inspection on 18/09/07 for Threeways

This inspection was carried out on 18th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Threeways 14/02/07

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

CARE HOME ADULTS 18-65 Threeways Threeways Care Home 5 Brighton Road Salfords Surrey RH1 5BS Lead Inspector Sandra Holland Unannounced Inspection 17th September 2007 12:00 Threeways DS0000068365.V345466.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 Threeways DS0000068365.V345466.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. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Threeways Address Threeways Care Home 5 Brighton Road Salfords Surrey RH1 5BS 01737 760561 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) devpurmah@yahoo.co.uk Mr T Purmah & Mrs B M Purmah Mr Tecknarainsingh Purmah, Mrs Bibi Mimma Purmah Mr Tecknarainsingh Purmah Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2007 Brief Description of the Service: Threeways Care Home is registered to provide care and accommodation to six service users with a learning disability. The home is a 2 storey, detached house in Salfords, near the town of Redhill, Surrey. There are four bedrooms on the ground floor and two on the first floor. All bedrooms are for single occupancy, with four having en-suite bathrooms, one having an en-suite toilet and wash hand basin and one having a wash hand basin sited in the room. There is an additional bathroom with an easy access bath on the ground floor. There is a large communal lounge/dining room, a kitchen and facilities for laundry. There are garden areas to the rear and the front of the property with ample room for parking at the front of the home. The fees at this service range from £1500.00 per week to £2500.00 per week. This fee does not include activities such as visits to the cinema, theatres, swimming etc., hairdressing, toiletries, dry cleaning, magazines and papers. The fee may include the provision of a yearly, seven day holiday but this will be dependant on each service user’s individual funding arrangements. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. A full analysis of all information held about the home was carried out prior to the site visit to the home. Mrs Sandra Holland, Regulatory Inspector carried out the site visit over four hours. Mr & Mrs Purmah, Registered Providers were present representing the service. Mr Purmah is also the Registered Manager of the home. For clarity Mr Purmah will be referred to as the manager throughout this report. A CSCI Annual Quality Assurance Assessment (AQAA) was supplied to the home and this was completed and returned. Information supplied in the AQAA will be referred to in this report. Information supplied in the AQAA stated that the home has a policy regarding equality and diversity, that service users are offered opportunities to practise their faith and that diets appropriate to individual religious and cultural needs can be accommodated. A number of records and documents were sampled including service user’s individual plans, staff recruitment files and medication administration records. All areas of the premises were seen and the one service user living at the home was met with. As the inspector could not discuss the home with the service user due to communication difficulties, their responses were assessed by observing interaction with staff, facial expressions and body language. The inspector would like to thank the providers and service user for their hospitality, time and assistance. What the service does well: A very detailed assessment was carried out before the current service user was admitted to the home. The home has been recently refurbished and is very well presented. The providers are involved in the day to day running of the home, so are accessible to service users. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A very detailed assessment of the prospective service user’s needs was carried out before they were admitted to the home. EVIDENCE: There is currently only one service user living at the home, but it was clear that their needs had been comprehensively assessed before they moved into the home. A detailed assessment had been carried out when the providers went to visit the prospective service user, and during the service user’s visits to the home. The prospective service user made a number of visits to the home, including for an overnight stay. This enabled the service user to see if the home suited them and enabled the staff to more fully assess the service user’s needs. In addition to the home’s assessment, an assessment had also been carried out under the care management process and a copy of the assessment was held on file. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An informative individual plan has been drawn up detailing the support needs of the service user. EVIDENCE: A comprehensive individual plan has been developed to guide staff to the support needs of the service user. The plan includes a person centred plan which is written from the service user’s perspective. This indicated the ways in which the service user communicates, the service user’s likes and dislikes, important relationships, things that matter to the service user and what staff need to know and how to provide support. Other areas of the plan provide guidance to staff on the specific support required by the service user and this includes a health action plan, detailing how the health needs of the service user are to be met. The plan recorded aims for the service user, such as the development of communication and Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 10 other skills, the development of relationships, to increase choices and to access community activities. The providers advised that the service user is supported by staff to make decisions, by offering choices, such as of clothes or foods, and that staff take into account the service user’s known likes and dislikes. A number of risks to the service user have been assessed such as keeping safe, maintaining health and wellbeing and being protected from abuse or exploitation. The assessments have recorded the level of the risk and actions to be taken to minimise the risks. Guidelines have also been drawn up to advise staff how to manage certain risks or behaviours, and these link with the risk assessments. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 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. 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. A small number of activities have been made available to the service user, although other activities are being explored. The service user is supported to maintain family contact and make an individual choice for meals. EVIDENCE: A number of activities both in and out of the home were recorded on the weekly activity plan which was incorporated in the service user’s individual plan. Those listed included music appreciation, art group, cooking sessions, gardening. Attendance at a local college or day service is being explored the manager stated, as this would enable the service user to learn new skills and meet new people. The providers advised that some of the activities have not yet been arranged as the service user had only recently moved into the home, and their preferences were still being assessed. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 12 Daily notes included as part of the service user’s individual plan recorded that the service user had taken part in shopping trips, going out with relatives, helping in the home and going out for drives. A four weekly menu plan has been drawn up, but this is not being followed as yet to enable the service user to have an individual choice of meals, the providers stated. A record is maintained of meals taken other than those listed on the menu, to enable the diet of service users to be monitored. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 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. 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. Personal support is provided as preferred by the service user and medication appeared to be managed appropriately. EVIDENCE: The service user appeared relaxed and comfortable in the company of the providers who were both on duty at the time of inspection, although direct verbal communication was limited. The providers appeared to have a good understanding of the ways in which the service user communicated and the service user was included in conversations that were taking place. The manager stated that the service user has been registered with a local general practitioner (GP) and other healthcare professionals as required. Medication in the home is supplied by a local pharmacy the manager stated, and was seen to be stored appropriately. Most medication is supplied in “blister” packs which contain individual doses of each medication, for ease of monitoring. Printed medication administration record (MAR) charts are also Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 14 supplied by the pharmacy. Medications were sampled at random and the amounts present accurately matched the record held. A detailed medication policy has been developed to guide staff in the safe administration of medication. It was noted that the medication policy made reference to the actions staff should take if a medication error occurred, but this did not include seeking medical advice. It is recommended that this is reviewed to ensure staff are aware that seeking medical advice is essential in maintaining the health and well being of service users. It was positive to note that other guidance was also available to staff, including the Pharmaceutical Society Guidelines. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 15 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. An accessible complaints policy and procedure has been developed, but no complaints have been received. EVIDENCE: Information supplied in the AQAA stated that a complaints policy and procedure is available, although no complaints have been recorded. The procedure has been supplied and explained to the service user living at the home and a copy of the complaints procedure was included in the service user’s individual plan, in a format to suit the needs of the service user. No information has been received by CSCI regarding any complaint made to the home. The complaints policy and procedure states that the aim in the home is to resolve any dissatisfaction at an early stage to prevent escalation into a formal complaint. A detailed policy and procedure has also been drawn up regarding the safeguarding of adults living at the home. This was seen to link with the local authority multi-agency procedure and to other procedures, including whistleblowing and bullying. The manager stated that in the event of a suspicion or allegation of abuse, the home would follow the local authority multi-agency procedure. An up to date copy of the procedure is held in the home for staff to refer to if required. The Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 16 manager advised that he has not undertaken the local authority multi-agency training in Safeguarding Adults. It is strongly recommended that the manager receives this training, so that he is aware of the actions to take and is better equipped to support his staff, if abuse is suspected or alleged. Small amounts of money are held for safekeeping on behalf of the service user, the manager stated. This is stored securely and a written record is maintained of the management of the money. The amount of money held was checked with the record held and was found to be over by a very small amount. The record sheet has space for staff to sign to show they have made the transaction, for a witness to sign and for a service user to sign. It was noted that for each transaction, only the staff member had signed the record form. It is recommended for the protection of service users and staff, that two staff are involved in each transaction of service user’s money and for each to sign the record. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was very well presented, is decorated and furnished in a homely manner, was very clean and appeared hygienic. EVIDENCE: The providers advised that the home has been totally refurbished and equipped with brand new furniture and fixtures. Four bedrooms are available on the ground floor and two on the first floor. Four of the bedrooms have ensuite bathrooms, one has an en-suite toilet and basin and one bedroom has a wash-hand basin in the room. There is a spacious communal lounge / dining room which overlooks the large rear garden. All rooms appear to be comfortably furnished, cheerfully decorated and were very clean and tidy. The providers said that service users are welcomed to bring their own belongings into their rooms to make them more personal and the only limitation would be the space available. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 18 Information in the Service User’s Guide stated that all bedrooms meet the current recommendations for size. Adaptations have been made to the home to provide access for those with limited mobility, including a ramp to the front door and an easy access bath in the downstairs communal bathroom. It was noted that in one bedroom, the door to the en-suite bathroom was glazed with small panels of glass. Unless there is a specific need for this, it is recommended that this is replaced with a solid door, to protect and promote the service user’s privacy. It was observed that personal protective equipment such as gloves and aprons, were provided for staff in the kitchen. Paper towels and liquid soap were also available in the kitchen to maintain hygiene. There is no provision for paper towels or liquid soap in bathrooms at present, but the manager stated that these would be supplied when more service users move into the home and the bathrooms are being used. A small laundry room is situated just off the office, which is close to the kitchen. This is kept locked when not in use and is also used to store cleaning products and other items potentially hazardous to health. The manager stated that the laundry room is not accessed through the kitchen, but through the rear door into the office. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A small team of staff have been recruited to meet the needs of service users, although few are working in the home. EVIDENCE: The registered providers were both on duty at the time of the inspection site visit. They stated that a small number of care staff have been recruited, but few are working as only one service user is currently living at the home. The providers advised that the existing staff will work more often and other staff will be employed, as more service users move into the home. The providers themselves are currently acting as the staff on duty for the majority of shifts, even though they both have full time jobs elsewhere, they stated. The staff rota was seen to be incomplete and is referred to at Standard 41 which relates to record keeping. Information supplied in the AQAA stated that experienced and competent staff have been recruited and that they will undergo relevant induction and mandatory training. The AQAA also indicated that two staff have achieved a Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 20 National Vocational Qualification (NVQ) to level 2 or above, and one member of staff is working towards this. The staff recruitment files were sampled and most of the required information and documents had been obtained. It was noted however, that for one member of staff only one reference had been obtained and for another member of staff, one of their references had been written by one of the providers. It was also noted that although staff have written and signed statements that they are physically and mentally fit to work in the home, no detailed questions are asked about their health. It is recommended as good practice, to formulate a health questionnaire to supply to those applying to work at the home and to ensure that the responses are followed up. The manager stated that the staff recruited so far have only been recruited within the last two months and have not received any training other than an induction into their role. Requirements have been made regarding Standard 34, that a person must not be employed to work at the home unless and until the specified information and documents have been obtained in respect of that person and regarding Standard 35, that staff must receive mandatory training. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The providers are committed to a quality service, but need to ensure that records including the rota are effectively maintained and the health and safety of service users is protected and promoted. EVIDENCE: The providers advised that they are both involved in the day to day running of the home as the manager and deputy manager. Both providers stated that they are also continuing with their existing fulltime jobs until such time as more service users move into the home. It is not clear how the home is being effectively staffed, given that the providers are recorded on the rota as being regularly on duty in the home. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 22 The staff rota was seen and it was observed that this had not been completed in advance and did not indicate which staff would be on duty for the forthcoming days. It was also noted that for two separate days, no staff were recorded as working, either day or night, although this was during the period after the service user had moved into the home. The manager stated that he was “probably here”. The staff rota must be maintained as an accurate record of the staff on duty at all times and must record the hours actually worked by staff. The rota was marked to indicate that two staff should be on duty during the morning and afternoon shifts, one member of staff on waking night duty and one member of staff sleeping in at the home. The providers stated that these staffing ratios were not being followed as only one service user was resident and it was clear that at times, only one member of staff was on duty. This contradicted other information which was recorded elsewhere in the home, which indicated that two staff should be on duty at all times to safeguard both the service user and staff. As the home has only been open for less than a year, no system of quality assurance has been established yet, the manager advised. The AQAA supplied by CSCI which was completed and returned, contained short responses to each outcome group, but gave little indication as to “What we could do better” or “Our plans for improvement in the next 12 months”. The AQAA stated that the “new service was still in the developmental stage and we shall do our best to provide a first class service”. Information in the AQAA also indicated that systems in the home have been serviced or checked to protect and promote the health and safety of those living and working in the home. These included the fire detection and fire fighting equipment, premises electrical circuits, the heating system and gas appliances. Records of fire alarm testing were maintained as required. The home’s certificates of registration and insurance were displayed in the office and the insurance for the home was seen to be valid. A Health and Safety at Work poster was received by the home on the day of inspection and will be displayed, the providers stated. An accident book which conforms with the requirements of the Data Protection Act has been obtained, but has not needed to be used. Most of the radiators in the home have been covered to safeguard against burns, although it was observed that a towel rail which can be heated in the service user’s en-suite bathroom, was very close to the basin and bath. The manager stated that the rail is not used as a heated rail. It was also noted that two windows on the upper floor were not restricted and did not safeguard against anyone falling from them, although these rooms are not currently being used by service users, the providers. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 23 Requirements have been made regarding Standard 41, that the staff rota must be an accurate record of the staff on duty and must record the hours actually worked and regarding Standard 42, that windows must be restricted to prevent anyone from falling from them. Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 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 2 x 3 X 3 X 2 2 X Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 (1) (ac) Requirement A person must not be employed to work in the home unless and until all the specified information and documents have been obtained in respect of that person, including two written references. Timescale for action 02/10/07 2 YA35 3 YA41 18 (1) (c ) Persons employed to work in the (i) home must receive training appropriate to the work they are to perform, including mandatory training. 17 (2-4) The staff duty rota must be Schedule accurately maintained and must 4 record the hours actually worked by individual staff. 13 (4) (a) All parts of the home to which service users have access must be kept as far as reasonably practicable free from hazards to their safety. Specifically, windows must be restricted to prevent anyone from falling from them. 21/12/07 02/10/07 4 YA42 02/10/07 Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 26 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 YA20 Good Practice Recommendations It is recommended that the medication policy should guide staff to seek medical advice immediately if a medication error occurs. It is recommended that the manager undertakes training in the local authority multi-agency Safeguarding Adults procedure. A detailed health questionnaire should be developed and supplied to applicants to work at the home. 2 YA23 3 YA34 Threeways DS0000068365.V345466.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Threeways DS0000068365.V345466.R01.S.doc Version 5.2 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. 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