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Inspection on 22/11/07 for Thurleston Residential Home

Also see our care home review for Thurleston Residential Home for more information

This inspection was carried out on 22nd November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was clean and there were no offensive odours on the day of the inspection. People`s bedrooms and the communal areas were homely and generally well kept. People who live at the home were able to make use of the lounge, dining area and surrounding grounds (with support as necessary) as well as their own rooms.

What has improved since the last inspection?

There have been improvements in a number of areas since the last inspection. In particular there was noted improvement in the systems for the management of medication. There were also improvements in the quality of assessments, care plans and the social activities arranged by the home. The procedures for the recruitment of new staff had improved, helping to make things safer for people who live at the home. People who lived at the home said things had got `much better` since the new manager arrived.

What the care home could do better:

There were still gaps in the records relating to the administration of medication, this presents as a potential risk to the health of service users. A number of people who live at the home have mental health problems, the skills and training of staff does not help them to support these people. Some of the procedures and systems that should be in place to promote the best level of care were not in place. This includes Quality Review system, the owners responsibilities in respect of monitoring the home, supervision of staff and responding to actions identified in risk assessments.

CARE HOMES FOR OLDER PEOPLE Thurleston Residential Home Whitton Park Thurleston Lane Ipswich Suffolk IP1 6TJ Lead Inspector Jenny Elliott Unannounced Inspection 22nd November 2007 09:30 X10015.doc Version 1.40 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 Thurleston Residential Home DS0000060474.V355446.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 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. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thurleston Residential Home Address Whitton Park Thurleston Lane Ipswich Suffolk IP1 6TJ 01473 240325 F/P 01473 240325 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) Guyton Care Homes Ltd Post Vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 One named person under the age of 65 as detailed in the application for variation dated 2nd February 2006. 28th June 2006 Date of last inspection Brief Description of the Service: Thurleston Residential Home is registered as a care home for older people. The home can accommodate up to a maximum of 24 service users. Guyton Care Home Ltd, with Mr Balaratnan as the Responsible Individual, owns the home. The home is located to the north east of Ipswich about three miles from the town centre. The easiest approach is from the Norwich Road and Whitton Church Lane areas. The home was first registered in July 1996. It is a single storey building located in parkland, some of which is lawned and includes shrubs and ornamental trees. Some of the rooms look over adjacent fields, others over the grounds. The whole setting is tranquil and pleasant. There is parking at the front of the home. The original bungalow has been developed with the addition of ten bedrooms. The building is of wooden design built on stilts and incorporating beamed walls and ceilings. The main lounge and dining areas are located within the original bungalow and another lounge is situated in the new part of the home. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 22nd November 2007. A specialist pharmacist inspector accompanied the regulatory inspector due to concerns about the administration of medication within the home. A total of 10 hours was spent at the service between the two inspectors. During the inspection time was spent looking in detail at the procedures in place for the receipt, administration and recording of medication. In addition time was spent talking with people who lived at the home, people who worked there (including the manager), looking at records and on a tour of the premises. What the service does well: What has improved since the last inspection? There have been improvements in a number of areas since the last inspection. In particular there was noted improvement in the systems for the management of medication. There were also improvements in the quality of assessments, care plans and the social activities arranged by the home. The procedures for the recruitment of new staff had improved, helping to make things safer for people who live at the home. People who lived at the home said things had got ‘much better’ since the new manager arrived. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 6 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. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who want to move to this home can expect to have their care needs assessed before they move in. EVIDENCE: Records belonging to three people living at the home were inspected in detail. All of the records included an assessment of needs. The quality of information on the assessments was variable. For example, for one person the assessment of their communication needs included both ‘no problems’ and ‘has some problems’, and under swallowing problems ‘yes’. These examples do not provide the home with sufficient information about what the person’s needs are, and therefore they cannot say with any confidence whether or not they can be met. There was though, good information about included in a risk Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 9 assessment headed ‘slips, trips and falls’. The home can use this to make a clear decision about their ability to meet this persons needs. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can usually expect their care plans to provide staff with good information about how to help them. People who live at the care home cannot always expect medication to be administered in a safe way. EVIDENCE: The inspection of the medication standard was conducted by the Commission’s pharmacist inspector. This is the second pharmacy inspection following the issue of an enforcement notice relating to poor medicine management practices previously identified at the home. These practices were placing the health and welfare of residents at serious risk. The notice required compliance by 31/08/07. During this inspection the inspector found that the home continues to make improvements in its medicine management practices. A new medicine Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 11 administration system has recently been implemented and steps are in place to improve communication between members of staff when handling medicines. The manager said that members of staff authorised to handle medicines had received training on the new medicine system provided by the supplying pharmacy. It was noted, however that some medication-related information had not yet been transferred to the new system. This includes photographs of residents, which should be used to assist in ensuring medicines are administered to the correct person. It was found that where residents are handling their own medicines there are recent risk assessments in place to ensure supervision by staff. Continued improvement was also noted in relation to ordering and obtaining medicines for residents ensuring that whenever possible the appropriate medication was available for people living at the home. The home also has improved record-keeping practices and continues to provide a system for accounting for medicines so that audits can determine if they are being given to residents in line with prescribed instructions. Using this system, sample audits were conducted during the inspection looking at current medicine charts. There were still found to be a significant number of discrepancies (for 8 medicines) of one or two tablets that had arisen over the most recent 11-day period. This raises concern that some medicines are not being accounted for and may not be given in line with prescribed instructions. Since the previous inspection the home has indicated in its written plan, received by the Commission on 18/10/07, that it is conducting its own internal audits on a regular and frequent basis. However, the manager confirmed that this was not in place. The home has recently had visits from a Primary Care Trust clinical pharmacist to undertake medication reviews. However the medication treatments for two residents were discussed with the manager during inspection. One of these residents was noted frequently not to be administered medicines because they were often asleep in the mornings. On discussion, the manager agreed to arrange medication reviews for the resident. It was noted that for some residents there are no records of healthcare professional contact with the home. It was noted that a medicine storage cabinet located in the clinic room (said to be locked at all times when unattended) is still without a lock. Within the cabinet there were found to be some medicines stored that were no longer prescribed but that had not yet been disposed of. There is a risk that they could be given to residents in error. All of the records inspected in detail included care plans. Some parts of the plans provided good information for staff about how to help people. For example one personal hygiene plan described what the person could do for themselves and what staff should do to support this independence. The Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 12 Information under communication was equally good it said ‘… [resident] needs to have time to think about what [they] need to say, staff need to be patient …’ For another person an observation at end of care plan read ‘ … will not complain or ask for help even if [they] need it’. Staff have been advised to ‘ask … once a week if there is anything [they] require and to reassure [the person] that we are here to help.’ These are good examples of care planning that addresses the individual needs of people living in the home. There were other areas where the care plan was clearly out of date, and if it had been followed could present a risk of harm to the person concerned. For example one plan described a person as able to medicate themselves. It was clear that this person was not able to safely do this independently and that careful supervision was required. The care plan for the same person described them as ‘quiet’ and ‘private’, their daily routine consisted of staying in their bedroom except when in the dining area for meals. The manager said this person ‘with encouragement will join in with activities and enjoy [themselves]’. Failure to promote this could have a detrimental affect on the person’s emotional wellbeing. The care plans had been signed as being reviewed, but no changes had been made. A number of documents were unsigned and undated, making it difficult to tell how up to date they were. Risk assessments were in place for issues such as falls or walks outside of the home. One of the people living at the home said they were very happy and it was like a ‘4* hotel’, they said the food was ‘very good’ and that the staff ‘couldn’t be better’. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the people who live at the home have the opportunity to participate in some form of activity during the day. EVIDENCE: The manager advised that there had been investment in the provision of activities within the home, including the purchase of handheld percussion instruments the manager felt these helped get people moving and provided some armchair exercise. On the day of the inspection a ‘sing-a-long’ session was held in the afternoon, some of the people in the lounge were very engaged with this. One of the people living at the home said they went to the lounge once a week to play bingo, which they enjoyed, this activity was reflected in their daily notes. Another person said they would ‘often lie down on [their] bed during the day’, but they got up for meals and sometimes sat in the lounge. On the day of the inspection this person spent the day in their room. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 14 The daily notes kept for each person showed that special events, such as birthdays, were celebrated and that there were frequent visitors to the home. It was not clear from observation, daily notes, care plans or discussion with the manager how the social needs of people with dementia and other mental health needs were addressed. Some of the language used in daily notes did not promote the dignity of people who lived at the home. Notes were written in a way that suggested staff did not understand challenging behaviour. People who live at the home have a range of physical as well as mental health needs. Some of the people living at the home are very independent. One person goes to the local shop regularly and swaps newspapers with another person who lives in the home. Most people had televisions and/or radios in their rooms. Some people were in their rooms watching TV or listening to the radio, others were sitting facing the door and watching the world go by. The dining area had been improved since the last inspection. New, more appropriate, furniture was in use. People did not appear to be rushed into finishing their meal and the menu remains suitable for the needs of people living there. One person told me the ‘food is very good here’. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect the manager to handle complaints properly, but cannot be assured that all staff will have up to date information on how to protect them. EVIDENCE: The manager advised that no complaints had been received by the service since the last inspection. The Commission had not received any complaints during this period. Although more staff had attended training to help them protect vulnerable people, a significant number still had to complete this. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be provided with a satisfactory standard of accommodation. EVIDENCE: A tour of the building was undertaken during the inspection. It was clean throughout, and no unpleasant odours noted. The manager said that the provider had been supportive in terms of funding new furniture, and some was delivered on the day. The shared areas of the home were bright and generally well decorated. The carpet in the corridors was threadbare in some places and further deterioration was likely to lead to this becoming a trip hazard. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 17 People had brought some of their own belongings into the home personalising their rooms. One person told me they were happy with their room and had all they needed. There Laundry room was not lockable, this could present as a hazard to people who are confused about their surroundings. The room is also very small, too small to fold or iron laundry, so these tasks had to be carried out in other areas of the home. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect new staff to be recruited in a way that protects them. People who live at the home cannot be confident that all staff will have the skills necessary to meet their needs. EVIDENCE: The manager advised the Commission that there had been some investment by the provider in staffing levels. This included the recruitment of a senior and the extension of cook’s hours to help with the provision of tea. Just under half of the care staff employed by the home had attended a dementia awareness training session in the last 12 months. Most, but not all staff had attended moving and handling training in the last 12 months. A very small number of staff had completed National Vocational Training qualification in Care. These are key areas of knowledge and understanding to enable the staff of this home to provide care for the people who live there. The recruitment papers for two new members of staff were complete. The home had carried out checks to assess the suitability of people to work with vulnerable adults. This is a positive improvement. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 19 One of the new members of staff had commenced the homes induction programme, but only four of the eighty five points to be addressed had been covered. The person was booked on the Skills for Care Common Induction Standards, which all employees new to care are expected to complete. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at the home cannot be confident that it will be run in their best interest. EVIDENCE: The manager of the home had been in post since May 2007. There was evidence throughout the inspection of general improvement in the home. People who live in the home said ‘things have improved since the new manager came’ and ‘the boss’ lets me have ‘whatever I want’. New staff were also positive about the manager. The manager has significant experience of Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 21 providing care to vulnerable people and managing staff, although not in a residential setting. The manager advised the Commission that she had experienced some difficulties introducing new practices to the home, but these were largely resolved. There was no evidence of any staff supervision in the home, and the manager said this was something she had not yet implemented. Supervision is a very important part of management, particularly where improved practice is required. The owner of the home suspended the manager from duty about two weeks after the inspection. The owner failed to notify the Commission of this or to advise the Commission of arrangements that would be put in place to ensure the home was adequately managed. Owners are required to advise the Commission of such circumstances, and any action taken, so that the Commission can make a judgement about the safety of people who live at the home. The owner of the home had not completed the monthly reports they are required to by regulations. These reports should help the manager and owner identify any concerns and plan for improvement as well as demonstrate that the owner is carrying out their legal responsibilities. The home does not have an effective quality assurance and monitoring system in place. The manager said they had sent out questionnaires but not had a good response so far. The home should find a way of securing the views of people who live there about the care they receive. Manager said she had experienced some difficulties with staff who had worked at the home for some time and were resistant to change, but felt the worst of this was over now. Some staff had left and others were working more positively with the new manager. Reports and certificates were seen in respect of Environmental Health, the servicing of fire fighting equipment and electricity. The home had commissioned a Fire Risk Assessment that included a range of recommendations to improve the safety of the home. A number of these recommendations had not been carried out. The manager advised that some of these would be included in planned building works. Others such as the smoking area for staff being moved away from the (wooden) building had not been implemented and there was no clear reason why this was so. Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 2 1 X 2 Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 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. Standard OP9 Regulation 13.2 & 13.4 Requirement People who use the service must have their medicines administered as intended by the prescriber at all times to safeguard their health and welfare. This must be evidenced by record keeping practices enabling all medicines to be accounted for. This is a repeat requirement. Staff must have the training and understanding necessary to protect people living at the home from abuse. Equipment, fixtures and furnishings supplied by the home must be in a good state of repair. This refers particularly to flooring which could present a trip hazard. People who work at the home must have the appropriate skills and knowledge to care for the resident’s range of care needs. The home must seek the views of people who live there so that it can improve its care in line with those wishes and needs. Timescale for action 14/01/08 2. OP18 13.6 31/03/08 3. OP19 23 31/01/08 4. OP30 18 31/03/08 5. OP33 24 30/04/08 Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 24 6. OP36 18(2) 7. OP33 37,38,39 8. OP30 18 The home must ensure that staff are supervised to ensure that they are providing care in the best way for each of the people who live there. The home must ensure that it advised the Commission of any incidents that could affect the wellbeing of the people who live there. This particularly refers to the management of the home. Staff working at the home must receive a comprehensive induction to the role to enable them to care for residents properly. This is a repeat requirement. 31/01/08 31/12/07 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that resident information including identifying photographs is placed alongside medication charts to assist in the safe administration of medicines. It is recommended that frequent and regular audit trailing of medicines is conducted and recorded by a senior member of staff to promptly identify and resolve medicine discrepancies arising. It is recommended that arrangements are made for medication reviews for two identified residents. It is recommended that steps are taken to ensure records of healthcare professional’s interventions are recorded in care notes. It is recommended that arrangements are made to secure an unlocked medicine cabinet located in the clinic room. It is recommended that medicines no longer in use are promptly removed for disposal from the medicine storage cabinet and not retained for use. This could be achieved by creating a designated and clearly marked area in the cabinet for medicines awaiting disposal. DS0000060474.V355446.R01.S.doc Version 5.2 Page 25 3. 4. 5. 6. OP9 OP9 OP9 OP9 Thurleston Residential Home Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Thurleston Residential Home DS0000060474.V355446.R01.S.doc Version 5.2 Page 26 - 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!