Inspection on 08/05/08 for Thurleston Residential Home

This inspection was carried out on 8th May 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Thurleston Residential Home 17/10/08

Thurleston Residential Home 22/11/07

Thurleston Residential Home 20/06/07

Thurleston Residential Home 28/06/06

Thurleston Residential Home 20/01/06

Thurleston Residential Home 22/04/05

Thurleston Residential Home 02/12/04

Thurleston Residential Home 26/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Thurleston Residential Home Whitton Park Thurleston Lane Ipswich Suffolk IP1 6TJ Lead Inspector Pauline Dean Unannounced Inspection 8th May 2008 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.V364104.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.V364104.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 Manager 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.V364104.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. 29th January 2008 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. The current range of fees, as at the site visit were said to be £351 .00 per week (Suffolk County Placement Fee) to £450.00 per week (Private Fee). Hairdressing, chiropody, newspapers, private telephone, toiletries other than basic toiletries which are brought for by the home and Dial-a-Ride and transport expenses are at extra cost. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection of Thurleston Residential Home took place on 8th May 2008 over a ten-hour period. Prior to this inspection a pharmacist inspector from the Commission had conducted an inspection. A report from this visit has been sent to the home and is included in this report. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in November 2007, looking at records and documents at the care home and talking to the newly appointed manager, care staff, relatives and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in April 2008 was considered as part of the inspection process and a tour of the premises was completed at the site inspection. At this inspection a safeguarding thematic probe was conducted. This process is used by the Commission to gather additional information on particular theme from key inspections in the period 5th – 16th May 2008. Specific questions were put to three staff members, the manager and three people who use the care service on safeguarding. In addition staff recruitment files (3) were sampled and inspected, staff training and policies of safeguarding were considered. The results of this probe are detailed in this report and added to a Commission for Social Care Inspection (CSCI) recording tool for analysis. Surveys were sent to the home prior to the inspection and on the day of the inspection, the manager had asked an independent person to go around the home assisting residents to complete the surveys. These eight surveys were collected on the day of the inspection. Furthermore staff surveys were sent, as were relative surveys and healthcare professional surveys. At the time of writing this report, five surveys had been received from residents and none from staff or healthcare professionals. During the inspection three people who live at the care home, a relative, three care staff and a catering staff member were spoken with. What the service does well: The home was clean and bright and homely on the day of the inspection. All three residents spoken to said that they liked their rooms and they had been able to bring in some of their personal possessions. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 6 Residents are able to use all of the communal areas – the two lounges and the dining room and are able to take walks in the grounds (with support if necessary). The pre-admission processes were managed well, with assessments completed by the manager and visits arranged as possible, thus enabling people to decide if the home suited them. What has improved since the last inspection? What they could do better: Care planning and risk assessments require revision and review. Examples were seen where the care plan did not reflect the care required e.g. the needs of a person who was able to leave the building alone were not considered with regard to placing that person at risk. Medication administration and dispensing continues to give concerns, for gaps were found in medication record keeping; there was a lack of risk assessments relating to self-medicating; practices relating to the ordering of medication and storage of medicines and the general management of medication in the home were all judged as poor. Furthermore within health care record keeping there was evidence of poor record keeping which was lacking in detail and information. Residents would not be assured that their health care needs are met. Whilst residents and staff were positive regarding the appointment of the new manager, the home does need to review care practices, staff knowledge and understanding of the needs of residents. Staff recruitment practices do not ensure that residents are safeguarded. Please contact the provider for advice of actions taken in response to this Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 7 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.V364104.R01.S.doc Version 5.2 Page 8 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.V364104.R01.S.doc Version 5.2 Page 9 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): 1, 3 & 6. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed and these will be met. EVIDENCE: The admission paper work of one person who had entered Thurleston Residential Home was sampled and inspected at the inspection. These documents were sampled as the newly appointed manager had completed this admission. This was the only admission in recent months as accreditation by Suffolk Social Services is currently suspended for there have been concerns regarding care practices in the home. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 10 From inspection of the paperwork and discussion with the manager it was evident that the home had completed a pre-admission assessment. The prospective resident had been in hospital prior to admission and the manager said that the assessment had been completed at their bedside. The assessment had been conducted with a view to the home offering respite care prior to the resident returning home with an intensive care package. This assessment was seen to cover topics such as mobility, standing, continence, medication, mental state and cognition, hobbies, religious & cultural needs and other social contacts and relationships. The manager said the format used was one used by the home’s company - Guyton Care Homes Ltd. In the Annual Quality Assurance Assessment (AQAA) it was stated by the manager that there is a need for ‘Better paperwork- especially in the area of pre-assessment form, which feeds directly into residents care plan and identifies client suitability.’ The manager re-affirmed this on the day of inspection; for whilst detailed information was to found on this form, it did not readily feed into the home’s care planning paperwork. In addition to the above paperwork copies of records and notes from the hospital discharge team were seen on the file supporting the assessment completed by the home. Within the survey work conducted by the Commission for Social Care Inspection (CSCI), two residents said that they had had enough information about the home before they moved in to decide whether the home was the right place for them. Three residents said that they did not have enough information to make an informed decision and three residents said that their relatives had been involved in selecting the home, one of these did say ‘I came and had a look round.’ Another person said ‘My children phoned round and this was the only place available’. The need to have up-to-date information was recognised by the home’s manager in the AQAA, for it was stated that both the Statement of Purpose and the Service Users Guide are being reviewed and rewritten. At the inspection a leaflet briefly outlining the Aims, Accommodation, General Care, Staffing, Services and Facilities, Meals, Social Activities, Hobbies and Leisure Interests Visiting arrangements and directions was seen. The manager said that this was a new document. Whilst it did not fit the full remit of a Statement of Purpose or a Service Users Guide, it does go some way to give more information to prospective residents and their relatives and should prove useful for this purpose. No intermediate care is offered at Thurleston Residential Home. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 11 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. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home cannot be assured that their health and welfare will be safeguarded by the home’s medication practices and procedures and through their individual care plans. EVIDENCE: On the day of the inspection there were twenty-one residents living at Thurleston Residential Home. Three care plans were sampled and inspected. All three care plans had been devised and developed before the present manager had commenced employment at the home. The manager said that they had looked at the care plans in place, but had not had sufficient time to review and revise all care planning since they had commenced work six weeks ago. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 12 Within the AQAA it was stated that the manager would like to create new care planning documentation, which they expected to implement in the next 4-6 months. At the inspection all three residents were spoken with and were able to confirm that they knew of a care plan, although they weren’t very clear as to it’s contents. All three care plans seen had a similar format. Each had a General Information Sheet, which had only partially been completed with only telephone contact details entered for each Next of Kin, no address was to given and no photographs were available on two out of the three files inspected. The manager said that new photographs are being gradually added to the care planning files. The headings used in the three care plans were similar to the initial assessment topics e.g. Personal Hygiene/Dressing, Mobilisation; Eating, Drinking & Diet, Communication, Socialising, Medication, Continence, Phobias and Fears, Special Needs, Sleeping, Allergies and Observations. Consideration had been given to covering all aspects of care including health, personal and social care needs of the resident, but the care plan was lacking in the detail of the action to be taken by care staff to ensure that individual personal care needs are met. For one resident who had come to live at the home in December 2007 there was no evidence of the care plan being reviewed since their admission and this therefore created a risk that staff may not be fully aware of the resident’s needs. Alongside each care plan a manual handling risk assessment and a general risk assessment had been completed. Whilst an example was seen that a risk assessment had been reviewed in February 2008, very little information was noted in these assessments and a statement – ‘Current control measures are adequate’ was seen. These documents did not ensure that the safety and welfare of the resident and care staff working with the resident are safeguarded. When speaking to an individual it was evident that their emotional and physiological needs are uppermost in their care, but from the paperwork seen this was little in evidence. For apart from reference to this in the daily records, it was not clear what action the staff should take to ensure the well being of the resident. A care plan sampled had been updated in January 2008. Whilst it did reference the particular needs of the resident, it did not detail sufficiently the action to be taken by staff. An example of this was around mobilisation and a regular weekly outing. Whilst the manager was able to detail the action taken by the home to facilitate this it was not noted in the care plan. Furthermore this resident had been found confused and disorientated whilst out visiting a friend in hospital and whilst the manager said that the normal practice was for Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 13 the person to travel alone in a taxi on these trips, it was acknowledged that a review of their care was required to fully assess the risk and their needs for independence and their safety. A further example related to continence management. The care plan had little detail around stoma care practices required by staff and the resident. Whilst there was reference to diabetes little information was found in the care plan as to how this is managed and what action to take should there be any problems. A review date had been set for February 2008, but there was no evidence of a review. As with the other two care plans risk assessments around manual handling had been completed in January 2008 with a review conducted in February 2008. As with other residents a variety of assessments had been considered briefly. Whilst changes had been noted in this individual’s mobilisation, no reference to these changes was noted in the risk assessments or care planning. The only reference to the changes was to be found in notes relating to visits to the GP and hospital and it would be expected that these changes would be incorporated into the care plan for the person has had a change in ability. Within the surveys completed by relatives, one said that they felt that the home always met the needs of their relative; two said they usually met the needs of their relative, whilst one said they sometimes met the needs of their relative. Comments found in the five survey forms relating to this were – ‘Yes – Definitely’ (meeting the needs of their relative) and two relatives said that they had found the standard of care improved since the employment of the new manager and they no longer need to remain so vigilant as to the care their relative received. Health care records were seen on each care-planning file. Records sheets were available for the GP and District Nursing Service and some entries were noted on each file. However, these were lacking in detail and did not always give the full picture of the care given. An example of this was a visit by a District Nurse when it was said they would be returning in a week’s time but there was no evidence of this visit to be found on this record sheet or daily records. However, from speaking to the resident and the manager it was evident this problem had been overcome. Some health care issues were covered within the daily recording. These did help to supplement the health care records found elsewhere. A weight chart had been created for one resident on admission to the home in December 2007. From speaking to the manager it was unclear what the purpose of this was, for no other entries had been completed. The manager agreed that there is a need to complete nutritional screening including the monitoring of weight gain or loss within care planning as identified needed. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 14 Within the survey work conducted by the Commission for Social Care Inspection (CSCI) all eight residents were positive regarding receiving medical support when they needed it. Three residents said that they always receive medical support whilst the remaining five made comments such as ‘Yes’ and ‘I have a doctor when I want one.’ An unannounced pharmacy inspection took place on 28th April 2008. This inspection was to assess the home’s current medicine management practices. This inspection follows a series of similar visits undertaken during 2007 most recently 22/11/07 following the issue of a statutory requirement notice 21/08/07 in relation to medicine management practices. The manager was on duty at the time of this inspection and who was informed of the findings of this inspection at the visit. During the inspection a Code B notice was issued to and accepted and the actual medication administration records were taken from the home and once copied were returned to the home by recorded delivery on 06/05/08. At the time of arrival for inspection the ‘Clinic room’ in which medicines are stored was locked and medicines stored within were found secure. Since the previous inspection, back up supplies of medicines have been relocated to another cabinet within the clinic room, which is lockable. The previously identified non-locked cabinet in use for the storage of medicines is now used to store surgical sundries. It was evident throughout inspection that medicines prescribed for external application were being stored non-securely in resident’s rooms with the risk that cognitively impaired residents could access them and cause themselves harm. The medicine refrigerator temperature is recorded twice daily and was noted to be mostly within the accepted temperature range over recent weeks. On the day of inspection the digital device indicated the temperature was 5°C, however, the maximum and minimum was indicated as 0°C and 12°C respectively which is both below and above the limits of the accepted temperature range 2°C to 8°C. The manager was advised to ensure staff routinely reset the device after each reading. At the time of arrival, the lunchtime medicine round was about to start (scheduled for 13.00 according to medication charts). When asked, the manager confirmed that staff adhere to medicine schedule times. Following an initial discussion the medicine round was started at approx 12.30pm. At this time it was evident that records for the first medication charts in folder had not been completed for medicines administered at 08.00. These were later signed during the course of the inspection. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 15 When medicine administration to the first resident started in the dining room, it was noted that the keys were left in the medicine trolley door with the of monitored dosage system (MDS) containers non-secured on top of the trolley. Medicines were also left in a plastic pot on the table in front of the resident. Following discussion, the tablets were retrieved from the table. The medicine round was completed at 13.55pm. There were noted to be sufficient plastic pots on the medicine trolley for use for all residents. When asked, the manager confirmed that there is always an authorised member of care staff on duty 24 hours per day to enable the administration of medicines out of hours including those prescribed for PRN (as required) use. There were resident-identifying photographs alongside medication charts for most residents to assist with safe medicine administration but none were named and could easily become displaced in the folder. It was evident that steps have been taken to highlight medicines not supplied in MDS containers on the medication charts to assist in ensuring they are administered. Medicines prescribed for PRN (as required) are highlighted in green. There was also colour-coded information on the front of the folders indicating where residents usually have their medicines administered. It was evident that medicines given at less commonly prescribed intervals such as alendronic acid tablets given weekly were clearly set out on the medication charts. There were several residents that are currently self-administering some of their medicines. This included one resident self-administering insulin by injection and others self-administering inhaled medicines. For these there were no recorded risk assessments in place and no evidence that the resident’s ability to manage their medicines safely had been assessed and was being supervised. There was a recorded risk assessment in place for the resident self-administering insulin but this had most recently been completed 31/08/07. The absence of recorded risk assessment was confirmed by the manager. There was noted to be only one resident administered a medicine of limited life (Maxitrol eye drops), however, the opened container currently in use was not dated to establish how long it had been in use. The medicine label indicates the medicine was supplied 26/03/08 and so could have been in use for a period longer than its 28-day expiry time. On examination of medication charts, it was evident that some medicines had been out of stock and so were not available for administration as scheduled. There was also a medicine unavailable at the time of inspection. There was recorded evidence that on 25/04/08 some medicines were recorded as ‘none left’ on the reverse of the charts but administered from 26/04/08 with no subsequent record of the receipt of new supplies. Most medicines found not to have been available were painkilling medicines. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 16 There were noted to be omissions in records of the administration of medicines where it could not be determined if the medicines had been administered to residents. Most gaps in the records that were identified related to the evening of the day before inspection (27/04/08). There were several omissions relating to the lunchtime on the day of inspection. It was confirmed that some of these medicines had been given but others had not. These were checked with the manager. It was noted that whilst the home has separate medication charts for medicines prescribed for external application located in residents rooms these were mostly not completed therefore it was unknown if these medicines had been applied as instructed by prescribers. In addition, it was noted that for many medicines prescribed with variable doses (e.g. paracetamol tablets 1-2) the actual doses given where there is a choice of dose were not recorded. Therefore records cannot confirm the dose given and these medicines cannot be accounted for. The home also fails to accurately record why medicines scheduled for regular administration are not administered. For example, it could frequently not be determined why some medicines were not given where ‘F’ is recorded as a code for non-administration but where ‘F’ is not explained by further documentation. Similarly, ‘A’ is frequently recorded equating to ‘refused’ where the medicine has been removed from the MDS container and if not given will have been wasted. It would be expected that most medicines ‘refused’ would not be prepared for administration. A separate code should be used when medicines are prepared but then wasted. Some medication chart medicine entries were inadequate because the dose directions were not clearly written so the dose and its frequency could not be established at times when the medicine is selected for administration (e.g. Imodium caps (1 capsule) no directions, Dioralyte sachets –no directions). For a resident’s prescribed beclometasone inhaler the strength was not indicated therefore records do not indicate what dose was administered. During the inspection, sample medicine audit trails were conducted to establish if medicines could be accounted for by records thereby demonstrating they have been given in line with prescribed instructions. The home keeps annotated records of quantities of medicines ‘brought forward’ to next medication chart cycles to enable audit trails of medicines not supplied in MDS containers. Using these figures, and records for the receipt, administration and disposal, there were found to be a significant number of discrepancies (approximately 33 of the sample) where medicines could not be accounted for. The discrepancies identified were deficits suggesting higher doses have been administered than those prescribed. Many of the deficits included prescribed painkillers. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 17 On auditing medication charts against MDS containers available at the home there were also found to be some medicines remaining in MDS compartments where corresponding records indicated the medicines had been administered. This suggests these medicines had not been administered when members of care staff have recorded that they have been given to residents and that record-keeping practices are unreliable and unsafe. There was evidence that some medicines prescribed for administration at night-time were being administered at tea-time either because this has been changed on the medication chart or the night-time (blue) MDS container was on the tea-time rack for administration. There were also medicines prescribed and labelled for night-time administration that had been supplied by the pharmacy in tea-time (red) MDS containers. This raises concerns that some medicines are being administered earlier than intended by prescribers. The manager confirmed the reasons for this were unknown. There were several residents that are frequently refusing medicines prescribed for regular scheduled administration. The manager confirmed that in their view some residents were in need of medical referral for medication review, however, there were some records documenting GP interventions leading to changes in medication. They said they had already made some arrangements for reviews. This is particularly important for the residents who are currently prescribed psychoactive medicines that have the potential for sedative sideeffects. One resident prescribed Maxitrol eye drops for four times daily administration was found from the records to be having the medicine offered to the resident three times daily only and therefore is currently not being considered for administration as directed by the prescriber. There are currently nine members of care staff authorised to handle and administer medicines at the home. The home has an up to date specimen signature list of those authorised posted in the medicine storage room. Copies of attendance at training events were seen during the inspection, however, recent training provided for one member of staff in October 2007 was said to also be planned for the week following inspection for more of the authorised care staff. On examination of the contents of the training, it was evident that this training related to ‘Drug Awareness Studies’ and substance misuse. This was raised with the manager as it appeared not relevant to the home’s medicine management. They confirmed that to date there has been no monitoring of staff competence in relation to medicine management. During the inspection, the inspector observed situations when residents were treated with respect and dignity. At lunchtime residents were offered assistance as needed and two residents spoken said that staff were always polite and respectful. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 18 A resident said that should they are able to receive calls from their relative on the home’s cordless phone. This was also stated in a relative survey who said that ‘Staff take a mobile phone to …. to ring me se we can speak to each other.’ Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 19 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who live at the home can expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: All three residents spoken to at the inspection said that they were able to make choices around what they liked to do, the time they went to bed and got up and what food they ate. The manager said that they were devising a programme of daily activities and suggestions from residents had been sought. A copy of the monthly programme was posted on the notice board in the entrance hall and residents were said to be advised daily of what was on offer. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 20 One resident said that they now enjoyed regular games of scrabble with care staff and other residents if they wished and another resident said that they liked to go out for a walk in the grounds or the local countryside. During the inspection one resident went out shopping with a carer and another had a wheelchair ride in the locality. Within the survey work completed for the Commission six out of the eight responses from residents declined to take part in the activities saying that they preferred to ‘stop in my room, in my own chair’ and ‘I am a loner, prefer my family visits.’ Of the two residents who said that they always take part in the activities arranged by the home, one commented that they had had more in their previous home and the other said that Bingo was available. Two relatives raised the matter of their relative/friend being able to receive Holy Communion or have a visit from a pastoral visitor. They said that arrangements had been made for the resident to receive Communion and other residents had joined in too. The idea of a pastoral visitor is perhaps something the home might like to consider. Throughout the day, visitors were seen to come and go. They were made welcome by management and staff and refreshments offered. Residents were able receive visitors in their room, in the main lounge or smaller lounge. Within the surveys completed by relatives positive comments were made about the visiting arrangements in the home. One relative said that the home was ‘Very flexible regarding visiting times and any requests for help we make are readily responded to.’ The manager said that residents are encouraged to manage their own financial affairs for as long as they are able and they said that they are currently looking to obtain independent advocacy services for those residents who require this service. They said that they had found such a service and planned to introduce this service in the near future. During the inspection, the inspector was able to speak to a Kitchen Assistant. They spoke knowledgeably about the catering duties and tasks undertaken. The home is using the publication – ‘Making Food Safely’ to record tasks completed and planned action. In addition, temperature checks of all fridges and freezers were kept and recorded. These were within acceptable boundaries to ensure the safe storage of food supplies. Further records are kept of meat probe temperatures, the temperature of the delivery van when food supplies arrive and the Hot Trolley temperature as food is served. Within the home there was a good supply of fresh, frozen, tinned and dried food supplies. A major supermarket, wholesalers, butchers and a greengrocers are used to supply the home with their food and the kitchen Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 21 assistant said that changes had been made in supplies when residents had commented on the quality of the meat. An eight-week rotation menu was seen on display in the entrance hall and these detailed two choices for the main meal of the day – lunch with a hot or cold choice of soup or sandwiches at teatime. As well as a Sunday roast, there is a mid-week roast served. Record keeping detailed the choice of lunch and tea residents requested, but they failed to record any changes to the planned menu e.g. a change of dessert as served on the day of the inspection or what soup or sandwiches were served at teatime. In addition, the inspector was informed that there are no records kept of breakfasts eaten. This was discussed with the manager who agreed that additional record keeping is required to fully detail that all residents receive a wholesome and nutritious meal. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 22 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their concerns to be listened to however they cannot be assured that their complaints will be dealt with appropriately. EVIDENCE: Within the survey work conducted by the Commission relatives were asked if they knew how to make a complaint about the care provided by the home. All five said that they did know how to make a complaint and one person stated that a notice about making complaints had recently been placed in their relative’s room. Five of the residents completing the Commission’s survey said that they did know how to make a complaint. One person said the never complained, but ‘If I needed to I would tell one of the carers’ and another resident said that they have ‘not thought about it’. They continued – ‘They treat me well.’ The eighth person said that they were ‘not sure’ about making a complaint. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 23 The manager confirmed that copies of the home’s complaints procedure were to be found in each bedroom. In addition there is a copy on the Policy and Procedure file in the office and it is on display. This policy needs to reviewed and revised to be updated with the current accurate details of the Commission for Social Care Inspection (CSCI) and local Social Care referral processes. The manager recognised that this work was required and agreed to prioritise this immediately. Thurleston Residential Home has a complaint log and evidence was seen of two complaints received by the home since the new manager was appointed. One of these complaints had been received by the Commission in February 2008 and the proprietor had been asked to investigate these concerns around medication administration and the late delivery of a resident’s tea. Whilst it was not possible to substantiate the allegation relating to the late delivery of a resident’s tea, concerns have been raised regarding medication administration. See the previous section. The manager said that on joining the home they had been asked to investigate a second complaint about an allegation of theft and a carer getting residents up very early in the morning at 5 00am. The manager said that she had interviewed the staff member concerned and some of the elements of the complaint had been substantiated. They was however no evidence of a Police referral or investigation or records of the home’s investigations or outcome in the home. The adult protection policy seen at the inspection required revision and updating. This document detailed the definitions of abuse; abuse by a resident to another person; abuse by a resident to a member of staff; witnessing abuse and whistle blowing and abuse and staff action. It was recognised by the manager that the section on whistle blowing was limited and the home could benefit from a detailed whistle blowing policy to fully brief staff as to their responsibilities. Furthermore the manager acknowledged that there is a need to fully detail the Safeguarding Adult referral processes to include the role of other organisations such as the local authority and the Police and include local points of contact for referrals so that care staff can be assured they will have the information to hand should they need to make a referral. Three staff spoken to at the inspection were able to give a good definition of safeguarding adults. Two out of the three staff said that they had completed Safeguarding Adults training in February 2008 and the third person said they had completed this training in 2007. The manager said that a total of fourteen staff had completed a Safeguarding Adults training course, which was linked to the Skills for Care Common Induction Standards. Certificates of competence were issued and seen. The manager said a further six staff members are booked to attend Safeguarding Adults training in May 2008. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 24 A safeguarding thematic probe was conducted as part of this inspection. This process was used by the Commission to gather additional information on a particular theme from key inspections in the period 5th – 16th May 2008. Specific questions were put to three staff members, the manager and three people who use the care service on safeguarding. In addition staff recruitment files (3) were sampled and inspected, staff training and policies of safeguarding were considered. The results of this probe are detailed in this report and added to a Commission for Social Care Inspection (CSCI) recording tool for analysis. In recent months a number of allegations involving inappropriate behaviour by care staff, poor care practices, poor medication administration and management, abusive behaviour and neglect have been presented to the Commission. These have been processed through the local authority safeguarding adult unit and the Police. The home’s proprietor and manager have co-operated with the investigations. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 25 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Thurleston Residential Home have homely, comfortable and safe surroundings, which are kept clean and tidy. EVIDENCE: A tour of the premises was undertaken at the inspection. The property was clean and bright. There were no unpleasant odours in the occupied areas of the home, although a slight stale odour smell was noted by the inspector in a vacant room. The manager agreed to look into this before the room is occupied. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 26 Five residents who had completed the Commission ‘s survey said that the property was ‘always’ fresh and clean; two said that it was ‘usually’ fresh and clean and another person said that it was ‘clean enough.’ Two people had commented – ‘We have good cleaners’ and ‘They always keep this nice and clean for me.’ During the inspection, the inspector was able to speak with one of the home’s cleaners. They said that they worked four days a week with a second cleaner employed five days a week as a cleaner and kitchen assistant. They said that one of the cleaners had recently retired and the home was recruiting to fill this post. The manager confirmed this. In the meantime the two cleaners are covering the additional hours. Overall the property was well maintained. The inspector was told that carpet in the corridor highlighted at the last key inspection and a bedroom are to have new carpet fitted as in the remainder of building by the end of May 2008. Residents had been able to personalise their bedroom accommodation. There was evidence of personal possessions such as bedding, books, televisions, radios, pictures and photographs seen in several of the rooms. One resident said that they were also pleased to be able to bring in a small item of furniture too and this had gone to ‘make them feel more at home’. Thurleston Residential Home is a single storey property having all single bedroom accommodation, ten with en-suite facilities of a wash hand basin and toilet and the remaining fourteen with a wash hand basin. In addition there are two assisted bathrooms and separate toilets located around with house. At the front of the house, located near the kitchen there is a dining room. This was light and bright and it was furnished with good quality appropriate furniture. There are two lounges in the home, one at the front and a second towards the rear of the building. Residents are able to use whichever lounge they wish. The manager said that the rear lounge is used very little. In this room laundry, ironing board and steam iron were found and it was suggested that this does distract from creating a homely, attractive sitting area. The manager agreed to look into making alternative arrangements for the laundry and equipment whilst the lounge is in use during the day. The property is surrounded by countryside and is set in lawned parkland with some shrubs and ornamental trees. The grass was long and the manager said that they were expecting this to be cut shortly. On one side of the building, where there was short grass a gazebo was set up for residents to sit out under. The laundry room located towards the rear of the building was locked. The home has one washer and one dryer, both industrial models. The manager said that should the machines breakdown the home has a 24-hour breakdown service agreement they can call on. The washer has a variety of washing Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 27 programmes and is able to wash clothing and bedding at high temperatures. The laundry room is small whilst there is some space for airing clothes this is limited. Care staff and the manager confirmed that the folding and ironing of laundry is completed elsewhere, normally at night by care staff. One resident spoken to said that the laundry was done very well. They commented that ‘they (home) ought to charge for it.’ They said that their laundry was completed promptly and returned very quickly. If she should receive some one else’s clothing, then care staff easily remedied this. They added this was usually because items were not name labelled as requested. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 28 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be supported by sufficient staff with skills and knowledge to meet their needs. They cannot be assured that appropriate recruitment practice has been followed to safeguard their welfare. EVIDENCE: Staff rotas were sampled and inspected and it was seen that each day there are four carers detailed as being on duty in the morning, three carers in the afternoon/evening shift and two awake carers at night. The manager is on duty during the day in the week and on Saturday. On the day of the inspection, the manager said that a carer had gone home, as their child was unwell. A similar situation had occurred when the Pharmacist Inspector conducted the unannounced inspection on 28th April 2008 when a senior carer had gone off sick. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 29 The manager said that even though the home was down by one staff member they were able to meet the needs of the residents. During the day when the inspector spoke to three residents all said that if they need staff they were able to call and they would come to them. One carer working the morning shift acknowledged that being one down had made them re-evaluate their work, but activities such as individual outings could be accommodated in the afternoon. Within the surveys completed by residents, five residents said that they always received the care and support they needed, two said they usually received the care and support they needed and one person said – ‘I get on alright. People come as soon as they can.’ The manager said that the home is currently actively recruiting an additional care staff member to cover shortfalls and whilst at the home the inspector was aware of several enquiries. The need to continue to assess resident’s dependency levels was discussed with the manager and they were aware of the need for consideration is to be given to the Department of Health Guidance in calculating staffing levels and hours. Within the AQAA it was stated that the home has achieved the minimum ratio of 50 of staff with National Vocational Qualification (NVQ) Level 2 in Care. The manager said that nine care staff have completed a NVQ Level 2 in Care and five staff have a NVQ Level 3 in Care. All three care staff spoken to at the home had completed NVQ Level 2 in Care, one was holding a NVQ Level 3 in Care and the second person said they had enrolled on a NVQ Level 3 in Care. Staff recruitment files for three care staff were sampled and inspected. These files were of staff that had been recruited within the last eight years. Overall they were in good order and the manager was able to show the inspector the staff photographs, which are due to be added to each file. Some shortfalls were found, namely there was no records of the completion of Criminal Record Bureau (CRB) disclosures for two employees, one of which had started working in the home in January 2008. This person did have a record of the Protection of Vulnerable Adults (POVA) 1st Check completed as they had started however. The manager was unable to confirm whether these checks had been completed, but felt they were possibly still at the main office at another care home. They agreed to follow these checks up immediately. Evidence was seen that the home is looking to develop a staff training and development programme. New staff that join the home are expected to complete the Skills for Care Induction Training or produce evidence of existing skills from their induction in another care setting. A carer who had come to work at Thurleston Residential Home in January 2008 confirmed this. They said that they had to evidence this through copies of training attended and they were asked to demonstrate their skills and competences. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 30 All three care staff spoken to confirmed recent training events they had attended - Dementia Awareness and Fire Safety in February 2008, Manual Handling training in September 2007 and February 2008, Protection of Vulnerable Adults (POVA) training in 2008 and a distance learning package on Basic Food Hygiene had been completed by all bar one member of staff in April 2008. Some certificates are still awaited – e.g. Fire Safety training, but other certificates were found on staff files. All three care staff had a good understanding of the need to update their mandatory training e.g. Manual Handling, First Aid and Fire Safety training and confirmed that they had either attended an annual refresher course or they were due to attend this training. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 31 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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home should expect to be assured of good management with an ongoing quality assurance and quality monitoring system in place and health and safety systems in place to protect them. EVIDENCE: The manager of the home has been in post since March 2008. All three care staff spoken with were both supportive and positive regarding the influence the new manager had had on the home. Three people living in the home said that they found the manager approachable and they regularly came around the Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 32 home to see them. The manager confirmed that they had made every effort to get to know the residents and their relatives as they visited the home. Two relatives who had completed the Commission‘s survey commented on the appointment of the new manager. Both were positive. One said ‘We are pleased with recent improvements since the new manager was appointed and hope …. receives full owner/staff support to continue to improve standards.’ Another relative said that they hoped the new manager ‘will be encouraged by the owner of the home, by the staff co-operation and give the home the care it deserves.’ Quality assurance and quality monitoring systems have been adopted in the home. A resident’s questionnaire had been issued and completed in January 2008. An analysis of the findings had been completed and as a result some changes had been made. The manager gave an example – an afternoon cook is now employed and a choice of hot and cold dishes is now offered at teatime. The manager said that the home would need to continually review and monitor the care offered in line with seeking the views of the residents. They and the owner were thinking of organising an open day, inviting all relatives to the home to meet with them and the residents. The forum of residents meetings is also something the home is considering. Visits and reports as required by Care Homes Regulations 2001 – Regulation 26 are completed by the proprietor. These visits should be conducted as unannounced visits at least once a month. A report of a visit conducted on 22nd January and 5th February 2008 was seen. This was one report only. A further two visits were conducted in March on the 11th and 25th March and a second report was seen. Whilst each report had detail of interviews with three residents, a review of management arrangements and environmental issues it was noticeable that there were no mention of staff, staff training or recruitment. From these reports it was possible to see what shortfalls had been noted and what action had been taken. The manager said that the home is currently holding money for ten residents, with relatives and a solicitor managing personal allowances for the other residents. The record keeping and the monies held for three residents were inspected. Monies are held separately with records kept of monies spent. Receipts were seen for hairdressing, shopping and chiropody. One person regularly uses a taxi. Whilst this was noted in the records, no receipts had been requested. The manager was advised that if this practice is to continue receipts for fees paid should be requested. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 33 The manager said that she had undertaken supervision sessions with all staff apart from one night carer and a new member of staff. These had all been conducted within the first week of their employment – 20th & 21st March 2008. The notes seen were used to get to know staff, with information gathered around training, experience and skills. Staff had been asked for in put into this process by identifying what did they think they need. The manager said that she was looking to developing a programme of structured supervisions with senior staff involved in leading supervision sessions. As highlighted previously in this report, medication administration and record keeping continues to have shortfalls. Shortfalls, which raise concerns as to the safety of residents. Servicing and safety checks were sampled and inspected at this inspection. A report relating to Legionella had been completed in November 2008 and a review has been set for November 2009. Monthly hot water temperature checks are recorded and kept. The most recent entry was 25th April 2008. These temperatures were seen to be close to 43º C. A gas installation/ safety record was completed in January 2008 and a routine fire check repair had been completed in April 2008. The manager was aware of the need to continue with safety checks and monitoring to ensure the safety and welfare of residents and staff. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 34 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 35 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 OP7 Regulation 15 (2)(b)(c), Schedule 3 (1)(b), 13(4)(b) (c) Requirement People living in the home must be assured that all of their care needs will be set out with reference to identified detailed risk assessments in an individual care plan which details the action to be taken by care staff to ensure all aspects of the health, personal and social care needs are met. These care plans must be appropriately frequently reviewed. This is a repeat requirement – previous timescale 29/01/08. Medicines must be kept securely at all times. Medicines must not be left with residents for later unsupervised self-administration and medicines prescribed for external application must not be left non-secured in resident’s rooms. This is a repeat breach of this regulation. Enforcement action is now being considered. Timescale for action 27/06/08 2. OP9 13.2, 08/05/08 3. OP9 13.2, Medicines requiring refrigeration 08/05/08 must be stored within the correct temperature range at all times. DS0000060474.V364104.R01.S.doc Version 5.2 Page 36 Thurleston Residential Home Action must be taken to ensure minimum and maximum temperatures are within range. This is a repeat breach of this regulation. Enforcement action is now being considered. 4. OP9 13.2, For residents self-administering their medicines there must be risk assessments regularly undertaken to ensure residents can safely manage their medicines. This is a repeat breach of this regulation. Enforcement action is now being considered. Medicines that are of limited life once opened must be safely handled to ensure they are only used within their expiry times. This is a repeat breach of this regulation. Enforcement action is now being considered. 08/05/08 5. OP9 13.2, 08/05/08 6. OP9 13.1, 13.4 Action must be taken to ensure the non-availability of medicines is avoided at all times ensuring they can be administered as scheduled. This is a repeat breach of this regulation. Enforcement action is now being considered. 13.2, Records for the administration of medicines must be completed immediately medicines have been administered to ensure safe practice is adhered to. This must include medicines prescribed for external application. Full records must be kept for doses of medicines administered where they are prescribed with variable doses. This is a repeat breach of this DS0000060474.V364104.R01.S.doc 08/05/08 7. OP9 08/05/08 Thurleston Residential Home Version 5.2 Page 37 regulation. Enforcement action is now being considered. 8. OP9 13.2, Full and accurate records must be kept when medicines prescribed for regular administration are not given to residents. This is a repeat breach of this regulation. Enforcement action is now being considered. Medication record medicine entries against which medicines are selected for administration must fully and accurately state the prescribed dose and its frequency for administration. This is a repeat breach of this regulation. Enforcement action is now being considered. 08/05/08 9. OP9 13.2, 08/05/08 10. OP9 13.2, 13.4 Medicines must be given to residents in line with prescribed instructions. This must be demonstrated by the home’s record-keeping practices. This is a repeat breach of this regulation. Enforcement action is now being considered. 13.2, 13.4 Action must be taken to ensure all medicines are administered at times scheduled and intended by prescribers. This is a repeat breach of this regulation. Enforcement action is now being considered. 17(2) Schedule 4 (11) People living in the home must be assured that they are safeguarded by the care home recording all complaints, detailing the investigation and DS0000060474.V364104.R01.S.doc 08/05/08 11. OP9 08/05/08 12. OP16 27/06/08 Thurleston Residential Home Version 5.2 Page 38 the action taken. 13. OP18 12(1)(a), 13(6), 21 People living in the home must be assured that staff are made fully aware of safeguarding referral processes through comprehensive procedures in order to protect the people living at the home. People living in the home must be assured that they are safeguarded by thorough staff recruitment processes including a Criminal Record Bureau (CRB) Disclosure. 09/06/08 14. OP29 19(4) (c) 02/06/08 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. Refer to Standard OP35 Good Practice Recommendations People living in the home should be assured that the money held by the home for personal expenditure is appropriately recorded and accounted for through receipts and record keeping. This is to include taxi and transport fees. Thurleston Residential Home DS0000060474.V364104.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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