Inspection on 24/05/05 for Wardley Street

This inspection was carried out on 24th May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wardley Street 05/06/07

Wardley Street 11/07/06

Wardley Street 07/09/05

Wardley Street 25/01/05

Wardley Street 31/08/04

Wardley Street 24/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Wardley Street 2 Wardley Street London SW18 4LU Lead Inspector Sharon Newman Unannounced 24 May 2005 11:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wardley Street Address 2 Wardley Street London SW18 4HR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8875 1233/1133 Odyssey Care Solutions for Today Ms Comfort Bonti Care home only (PC) 7 Category(ies) of Physical disability over 65 years of age (PD(E)) registration, with number Learning disability (LD) of places Physical disability (PD) Learning disability over 65 years of age (LD(E)) Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2005 Brief Description of the Service: The home is located in Wandsworth, in a small cul-de-sac off the main road from Wandsworth to Tooting. It is situated across the main road from a day service run by The London Borough of Wandsworth, close to local shops, post office, public transport, pubs, and other amenities. Wandle Housing Association owns the building and Odyssey Care Solutions for Today, a charitable organisation manage the home. It is registered to provide care for up to seven service users with learning disabilities. The home is a purpose-built three-storey building. There is no passenger lift. All bedrooms are single and there are two wheelchair accessible bedrooms on the ground floor, both with en-suite facilities. The home has an open plan lounge/dining room and a patio garden to the rear. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 24th May 2005 and was conducted by one Regulation Inspector. There are currently seven service users residing at the home, The inspector was able to talk to service users, home staff and a member of the Community Assist Team (CAT). Documentation examined included care plans, medication records and health and safety information. Also, a tour was taken of the premises. All staff on duty were very helpful, open and welcoming throughout the inspection visit. This home has a pleasant relaxed atmosphere and service users spoken to indicated they were happy. Service users were also very helpful and assisted with the inspection. One service user helped show the inspector around and another showed the inspector his bedroom, which he said he liked. 10 Requirements and 3 good practice recommendations have been made as a result of this inspection visit. What the service does well: Staff at this home have a very professional attitude and this is reflected in the good care given at the home. The staff have a good rapport with the service users and also a good knowledge of their individual needs. Service users likes and dislikes were well known by staff. The service users independence is promoted at this home. There is a varied programme of activities and service users are encouraged to take part in local community work projects and attend local day centres. There are very good community links at this home, some of which are provided by the CAT team. The members of this team visit the home and work with service users in the community setting helping them to become more independent. On the day of the inspection a member of the CAT team took one service user bowling in the morning and another service user shopping in the afternoon. Both service users indicated how happy they were about these community visits. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5. There are appropriate procedures for the assessment and admission of service users. A thorough assessment process ensures service users are consulted about moving to the home. EVIDENCE: A Statement of Purpose is in place and states that it ‘offers a service to seven men with a learning disability’. It contains information about: staffing, supporting service users, care plans, personal care, hobbies and interests. A Service users Guide is in place and contains a summary of the Statement of Purpose. Input from health and social care professionals including: GP’s, dieticians, occupational therapists, dentists and nurses was evident in the service users files A member of staff from the Community Assist Team (CAT) was providing one to one support to service users on the day of inspection. As found at the previous inspection contracts/tenancy agreements are still not in place for all service users. Full and detailed assessments were in place in each of the two service user files examined. All staff spoken to were aware of individual service users needs, likes and dislikes. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 9 Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9. Service users choice is respected and they are well supported by staff in achieving independent living skills. A more user-friendly care planning format would be of benefit to staff and service users. EVIDENCE: Care planning documentation for two service users was seen at this inspection visit. They contained information including: a service users profile, a weekly timetable, a maintenance plan, a development plan, risk assessments, strengths and needs assessments and details of reviews. Although very large in quantity, some shortfalls in this documentation were found. Some of the information in the care plans requires updating. A maintenance plan had not been updated since 13/02/02. In one of the care plans an application and assessment package was in place but the information did not contain much detail. For example in answer to the question ‘Do you show concern for others. How?’ The response was ‘yes’. This does not give a good idea of the needs of the service user. Also, some of the documentation was undated so it could not be seen whether it required review. Some risk assessments in both service users documentation were also found to require review. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 11 As reported in the last inspection report discussions with staff revealed that they do not find the care plan documentation user friendly. The care planning documentation should be more understandable to ensure ease of use. Additionally all care staff should receive individual training regarding care planning. All service users have a monthly report document in place that was initiated by the Manager. The key worker is responsible for this monthly review and care plans are adapted as necessary. It contains details about the service users health, relationships, family and friends, success and achievements and activities. The Manager stated that the home is moving towards providing a more person-centred care approach and that the documentation will be easier to use. Service user meetings take place regularly and are fully minuted. Some service users also meet separately with the Manager and full records of these meeting were seen. Issues discussed included whether service users wished to vote in the General Election, activities such as going to the pub and preparations for Odyssey’s 20th Anniversary party. All service users and staff were invited. One of the service users spoken to at the time of the inspection stated they had ‘enjoyed the party’ and they were looking forward to getting the photos made into an album. He also said he was ‘happy’ at the home. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16, 17. Links with the community are good and these support and enrich service users’ social and educational opportunities. The home provides a very good environment for service users to develop their social skills. Staff encourage and support service users to be as independent as possible. EVIDENCE: Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 13 The Manager stressed the importance of empowering the service users and helping them achieve their maximum independence. There is a key worker system at the home and all staff spoken to at the inspection visit demonstrated a very good understanding of the service users and their needs, likes and dislikes. A very good rapport was seen between the staff and service users. Evidence was seen of a variety of options for service users as regards leisure activities. Most of the service users were out participating in activities at the beginning of the inspection visit. One service user had gone shopping, another had gone bowling with a member of the CAT team, others were out at local day centres. Other activities enjoyed by service users include: going to the pub, cinema, walks and shopping. A service user returned from going bowling and indicated he had enjoyed it and that he had won. This is an activity he evidently enjoys very much. One service user goes out to work at Dust Busters and said he liked to spend some of his money on lottery tickets and scratch cards. He said he had not won yet but really enjoyed buying them. Another service user goes out independently to the pub and this activity is included in the care plan. In the lounge/dining area a television, music centre and video are available for service users. Relatives are encouraged to visit and the Manager said that most of the service users have a lot of involvement from their families. Another service user stated they liked the food both at the home and at the daycentre they attend. Full menu records were seen at the home on the day of inspection. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20. The health and emotional needs of service users are well met and there is evidence of multi-disciplinary working with healthcare professionals. However, omissions in the administration records could compromise service user safety. EVIDENCE: Evidence was seen in the care plans and meeting minutes of health and social care input from professionals including: GP’s, hospital consultants, dentists, social workers and chiropodists. There is a medication policy in place in the home and the medication cupboard was locked securely. A staff signature list is also in place. On one Medication Administration Record the allergies section had been left blank, this must be completed for all service users, however if the service user does not have any allergies then this should be written in the relevant section. A topical cream was found to contain the instruction ‘as directed.’ All medication must be labelled with full instructions as per Royal Pharmaceutical Guidelines. Also, omissions were found on one MAR sheet where antibiotics had not been signed for so it was not known whether the service user had taken this medication. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Policies and procedures are in place to protect service users from abuse and harm. Service users complaints are taken seriously. EVIDENCE: A complaints policy is in place and there have been no formal complaints at this home since the last inspection visit. When service users have a disagreement with another service user these are logged along with the outcome. Service users views, likes and dislikes were seen to be discussed in their meetings. Wandsworth’s Protection of Vulnerable Adults procedures are followed at this home and a copy of this procedure was available at the home. An organisational abuse and Whistleblowing policy were also seen to be in place. Staff spoken to at this inspection visit were aware of the importance of these procedures and had a good knowledge of the appropriate action to take if abuse was suspected. A staff member indicated that they had not undergone formal training in Abuse Awareness for a considerable time. All staff must ensure they are up-to-date in this area. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28, 30 This home provides a comfortable, clean and homely environment, however the storage of equipment in the communal landings could present a risk to the service users. EVIDENCE: The home is a purpose-built three-storey building. All bedrooms are single and there are two wheelchair accessible bedrooms on the ground floor, both with en-suite facilities. The home has an open plan lounge/dining room and a patio garden to the rear. The pleasant lounge/dining areas are spacious and bright and lead out to the garden. An unused bed base and mattress were seen in the garden, these items need to be removed. The Manager said she was addressing this issue and had requested that these are taken away. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 17 Equipment including: electric heaters, a large television and a computer were found to be stored in the communal hallways this could present a hazard to the safety of the service users. Alternative storage space must be found. A radiator was found to be leaking on the first floor landing and this must be repaired. The manager telephoned the maintenance department regarding this radiator during the inspection. Bedrooms were seen to be clean and well personalised to individual service users taste, one of the service users showed me his room and said he ‘liked it’. The premises were observed to be clean, hygienic and free from offensive odours on the day of inspection. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 36. Staff are clearly committed to delivering high standards of care and helping service users meet their goals. The standard of care is good. However, improvements can be made regarding training to ensure all staff have up-todate knowledge in areas such as manual handling, first aid and food hygiene. EVIDENCE: The Manager said there is a vacancy for a full-time member of staff at the home. She said they are using agency staff to cover some of the shifts and they ensure a permanent member of staff works alongside any agency staff members. Staff spoken to showed a strong commitment to the welfare of the service users and demonstrated a very good rapport with them. The staff rota was displayed on the office wall and this corresponded with the staff who were on duty on the day of inspection. Staff files were not available for inspection as the inspector was informed these are kept at the head office. The Odyssey organisation provides an extensive rolling staff training programme. However, there was insufficient evidence of updated staff training in areas such as abuse, moving and handling, first aid and food hygiene. The home must ensure that all staff are up-to-date with all this training. A staff member stated they are due to attend training in Moving and Handling. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 19 Staff meetings were seen to take place monthly and are fully recorded. Issues discussed at the last meeting included training, maintenance, care plans and discussions about the individual service users. A record of supervision was seen at this inspection visit, it indicated that not all staff are receiving one-to-one supervision at least six times annually. However, it is recognised that the frequency of supervision has improved for some staff members and progress is being made in this area. A member of staff stated they receive regular supervision. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42. The home is appropriately managed and the Manager is suitably experienced. The Manager is very enthusiastic about ensuring that the service users are listened to and that they are empowered to achieve their own level of independence. The home will benefit from full implementation of the quality assurance system. EVIDENCE: Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 21 The Registered Manager has been managing the home for four years, and has completed the NVQ Level 3 and is currently undertaking the NVQ Level 4. She has a very good rapport with both service users and staff. The atmosphere at the home is very open and relaxed. Staff were seen to interact positively with service users and their needs are well-documented. Staff meetings take place regularly and a staff communication book is also in place. A formal quality assurance programme is not in place at the home yet but the manager said this was being addressed. First aid box checks and fridge and freezer temperature checks were in order. The portable appliance testing certificate was found to have expired, an up-todate legionella check certificate could not be found. These must be in place. Hot water temperatures were always checked weekly and a bath on the first floor was found to have a temperature of 47.6 degrees centigrade on the day of inspection. The Manager rang the maintenance department during the inspection to ask them to attend to the bath temperature. Fire drills are taking place regularly. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wardley Street Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (1) (b) Requirement The Registered Persons must ensure that every service user is issued with terms and conditions of residence which must include details of the rooms to be occupied. The Registered Persons must ensure that: 1. A thorough process of evaluation and review must be implemented at the home in order to demonstrate that service users needs are being met on an on-going basis. 2. The Registered Person should ensure that files are archived and remove any inappropriate documentation. The registered person must ensure that: 1. Staff complete the administration record appropriately for all medication administered by staff within the home. 2. The allergy section on the administration record is completed for all service users. The Registered Persons must ensure that all maintainence issues outlined in Standard 24 of Timescale for action 1st July 2005 2. YA6 15 (1) (2) 1st August 2005 3. YA9 13 (2) 1st July 2005 4. YA24 23(2)(b) & (d) 1st July 2005 Page 24 Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 this report are addressed. 5. YA35 18 (1) The Registered Persons should ensure that staff training is upto-date. Refresher training must be provided for staff as required with regard to Abuse, Manual Handling, First Aid and Food Hygiene. The Registered Persons must ensure that all care staff receive supervision at least six times annually with full records kept. (pro-rata for part-time staff). The Registered Persons must ensure that a formal system for reviewing the quality of care in the home is fully implemented. (Previous timescale of 01/02/05 not met) The Registered Persons must ensure that hot water temperatures are tested weekly. The Registered Persons must ensure that a risk assessment is completed with regard to Legionella for the home. (Previous timescale of 28/02/05 not met). The Registered Persons should ensure that Portable Appliance Testing is up-to-date. 1st August 2005 6. YA36 18 (2) 1st August 2005 7. YA39 24 (1) (2) (3) 1st August 2005 8. 9. YA42 YA42 13 (4) 13 (4) 1st July 2005 1st August 2005 10. YA42 13 (4) 1st July 2005 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 YA6 Good Practice Recommendations It is recommended that the care planning system in place be reviewed to ensure that it is an effective working document for staff to use in conjunction with the service user. It is recommended that individual service user risk assessments be subject to the same review process as in place for care plans G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 25 2. YA9 Wardley Street 3. YA20 The home should request the prescriber of any medication for service users to write full and precise instructions on the prescription. The use of ‘as directed’ should be avoided as per Royal Pharmaceutical Society Guidelines. Wardley Street G54-G04 S10236 Wardley Street V221927 240505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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