Care Home: 5 Dick o` The Banks

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What the care home does well Within the AQAA it states that ` the home revolves around the clear understanding that service users choice, independence, rights and inclusion is paramount`. During the inspection it was found that the home provides person centred care, within a homely environment. Staff spoken with during the inspection demonstrated a good knowledge of individuals needs and preferences. Advice is sought from health care professionals as required and people are supported to meet their personal and health care needs. Staff assist people in maintaining relationships with relatives and friends. The home operates a robust recruitment procedure and has taken appropriate steps to safeguard people living at the home. What has improved since the last inspection? Care plans have been re-written and now provide clear guidance to staff on the level and type of assistance required. Staff have received further training on communication and additional communication methods have been introduced to support people in expressing their wishes and feelings. People have been able to participate in a wider range of activities and have taken a greater role in the daily running of the home. What the care home could do better: Staff must ensure that hand written entries on medication records are signed and dated, and that these are checked by a second person whenever possible to reduce the risk of human error. The registered persons must ensure that any allegation of staff misconduct is notified to CSCI and the placing authority for that person. The registered persons must address the areas outlined within this report to reduce the possible risk of cross infection. This relates to the communal bathroom, en suite bathroom and laundry. Staff working at the home must receive regular updates in fire safety training. This is of particular importance for those staff that work during the night. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Dick o` The Banks Crossways Dorchester Dorset DT2 7BG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Jones     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 5 Dick o` The Banks Crossways Dorchester Dorset DT2 7BG 01305267483 01305267483 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dorset Residential Homes care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be acoommodated is 4. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home 5 Dick o the Banks Road is a care home providing personal care, support and accommodation to four people who have a learning disability. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. The Registered Manager is Peter Naylor. The building is a large bungalow, located in Crossways, a village approximately 5 miles from Dorchester. At the time of the inspection the current fees were 1434 pounds each week. The home should be contacted for any further information regarding weekly fees. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was completed over one day by one inspector. The inspection was unannounced. The focus of this inspection visit was to inspect against key standards under the Commissions Inspecting for Better Lives framework. This focuses on outcomes for people receiving the service and measures the service under four general headings of excellent, good, adequate and poor. During the course of the inspection we spoke with the registered manager and staff members. Due to the complex needs of people living at the home they were not able to provide direct feedback regarding the service, but observations were made of care practice and the interactions between people living at the home and staff members. We also conducted a tour of the premises, and examined records relating to people living Care Homes for Adults (18-65 years) Page 5 of 30 at the home, staff members, and health and safety. Prior to the inspection the service completed the Annual Quality Assurance Assessment. This has been completed appropriately and returned within the required timescales. Comment cards (surveys) were also sent to the home. Staff members assisted people in completing these. Information gathered from these documents was used to inform the inspection visit and has been included within report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 7 of 30 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has provided some inforrmation regarding the facilities offered. Further information is required to ensure that people and those involved in their care are able to make an informed decision regarding admission into the home. Evidence: The Statement of Purpose and Service User Guide have been updated since the last inspection. The Statement of Purpose requires some further amendment to ensure that it addresses each of the areas requried in Schedule 1 of the Care Home Regulations 2001. The Service User Guide has been reviewed and now contains more information in pictorial format. This includes the complaints procedure. The registered manager advised that copies of the written contract of terms and conditions are held at the providers head office and are made available to placing authorities. The home is fully occupied and there have been no new admissions for several years, Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: therefore it was not possible to assess the admission procedures during this inspection. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with clear guidance to enable them to fully meet peoples needs. The home has introduced further communication methods to support people in expressing their wishes and preferences resulting in people participating in more activities and taking greater involvement within the home. Evidence: Since the last inspection the registered manager has worked to update care plans. During this inspection three care plans were examined. Care records included clear guidance regarding peoples individual needs and preferences. The home has sought to involve people in the developing the plans of care as far as their wish to. Within the care plans it stated that people living in the home should be included within conversations regarding their care, even though they may not be able to verbalise a response to this. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: The home has introduced Intensive Interaction and the Picture Exchange Communication system for some people to assist them in expressing their wishes and preferences. The registered manager advised that this has has been very positive and there are plans to develop communication profiles for all of the people living at the home. Risk assessments had been completed for each person and there was evidence of responsible risk taking. One staff member spoken with during the inspection confirmed that people living at the home were now enabled to participate in a wider range of activities, and greater involvement in daily tasks within the home. Care records were up to date and information had been stored securely in accordance the Data Protection Act 1998. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to participate in range of activities relating to their individual needs and preferences. Meals are prepared by staff based on known preferences and provide a nutritious and balanced diet. Evidence: Within the AQAA it states that that there has been a significant increase in daily activites to ensure that communication participation adn engagemnent levels of individuals are met. Activity records were examined. There is a plan of activities for the month ahead. These include a range of activities both within and outside of the home. One person Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: had wished to go swimming regularly and this has been acted upon. Two of the people living at the home attend day services throughout the week and there are regular liaison meetings with staff providing this support. People are able to go away on holiday each year. Staff work with people to establish their preferences and to plan the stay. People living at the home are supported to maintain contact with family members. The home works flexibly with families to support contact arrangements, and ensures that people living at the home are informed of any changes made. Relatives are welcomed at the home and able to visit to enjoy meals or spend time with people living there. People are able to move around the home freely spending time within their room or communal areas. During the inspection one person was spending time within the lounge, whilst another choose to listen to music in their bedroom. People are encouraged to participate in household tasks and regularly assist with food shopping. Meals are prepared by staff. People are able to assist with this should they wish to do so. Staff members advised that some people like to participate in making cakes. People living at the home are able to access the kitchen with support from staff and are offered choices regarding the food and drinks proivded. The menu is developed using peoples known preferences and dietary needs. People living at the home also enjoy going out for meals. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home receive appropriate support to access health care services, and staff seek to promote peoples independence. The management of medication is generally safe, however some aspects require further action to ensure that this follows best practice. Evidence: Care plans included clear guidance regarding the level and type of assistance required to meet personal care needs and promoted independence. Specialist advise has been sought from the CTLD Nurse regarding the management of epilepsy for people living at the home and appropriate care plans had been developed. Epilepsy and nighttime observation charts had been maintained. People living at the home had received assistance to attend regular dental appointments and eye tests. Clear records had been maintained for all professionals visits, and the outcome from these. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: An annual health check is completed, and peoples weights are monitored regularly. Medication is stored securely. Medication Administration Records include a photograph of the staff member. A record had been maintained for all medication given and countdown sheets had been kept for medication that is not provided in blister packs. It was found that on two occasions a hand written entry had been made on the medication records, but had not been signed or dated, and that on a further three occasions that this had not been confirmed by a second staff member. All hand written entries must be signed and dated to establish who made this amendment and it is good practice for this to be checked and signed by a second staff member to reduce the risk of human error. The registered manager must also review the practice of storage of the keys to the medication cupboard so that these may only be accessed by appropriate people and that there is an audit trial for who has been responsible for these keys at any given time. There has been one medication error since the last inspection. This was reported to CSCI and appropriate action was taken to reduce the risk of this re-occurring. Care Homes for Adults (18-65 years) Page 17 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate policies and procedures in place to safeguard people living at the home. Evidence: The home has an appropriate complaints procedure and whistle blowing policy. These advise that people may contact external agencies should they wish to do so. Staff had recently received updated training on the protection of vulnerable adults at the team meeting on 2/12/08. Concerns had been raised regarding the conduct of one staff member, that resulted in staff disciplinary procedures being implemented. The registered persons must ensure that CSCI and the placing authority are notified when such incidents occur and are updated regarding the outcome of the investigation. The home assists each of the people living at the home with the management of their finances. A financial risk assessment had been completed, which establishes which areas people require assistance with. Money is held in individual accounts. Staff check money at the end of each shift. Transactions are supported by staff signatures and receipts are maintained. Finances are regularly audited by Dorset Residential Homes to ensure that people are not put at risk of financial abuse. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: Staff had recently received updated training on the protection of vulnerable adults at the team meeting on 2/12/08. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, comfortable and homely environment for people living these. Some actions must be taken to reduce the risk of cross infection within the home. Evidence: 5 Dick o Banks is a detached bungalow. Communal areas comprise of a large lounge room with dining area, kitchen and large utility room. Christmas decorations had been put up throughout the home. There were tactile items on the walls in hallways. Appropriate adaptations had been installed to meet each persons needs. Bedrooms are for single occupancy and have hand basins fitted. Bedrooms include photographs and pictures and have been personalised to reflect individual interests and preferences. One bedroom has an en suite bathroom. Other people living at the home share a communal bathroom. The home has been maintained to a good standard of cleanliness. However during the inspection it was found that some areas required attention to reduce the risk of cross infection within the home. This included repair of the paint work within the en suite Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: bathroom to ensure that there is a smooth surface that can be easily cleaned. Some of the sealant surrounding the bathroom was moldy or missing and requires replacement. Hand washing facilities of liquid soap and paper towels had been provided, but the bin was broken. A foot operated flip top bin should be provided. The communal bathroom requires a deep clean. The bath mat was extremely worn and requires replacement. Plugs and jugs within both bathrooms were moldy and require thorough cleaning. Paint on the skirting board requires repair. Toiletries stored within communal areas should be named and be used by that person only. The laundry facilities are situated in the large utility room that is also used for storage. Flooring around the washing machine has broken, meaning that this area is not easy to keep this area clean and hygienic. There were also no hand washing facilities for people to wash their hands after handling laundry. The tap the en suite bathroom and within kitchen were dripping and also require repair. These matters were discussed with the registered manager during the inspection who advised that these would be attended to. There is an ongoing programme of maintenance work at the home. A new boiler has been fitted recently. The registered providers Dorset Residential Homes plan to relocate the service to another property owned by them within the next 18 months. The new property is larger and will provide accommodation for a further two people. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a robust recruitment procedure to ensure that only appropriate staff are employed, and newly appointed staff are provided with thorough induction training. Staffing levels must be regularly reviewed to ensure that there are sufficient staff to meet peoples needs during evenings and weekends when all of the people living there are at home. Evidence: Duty rotas were examined during the inspection. There are generally two staff on duty during the day and one waking and one sleeping in member of staff during the night. Two of the people living at the home go to day services during the week, and one person regularly stays with family members during the weekend. The registered manager should keep staffing levels under review to ensure that staffing levels remain appropriate during evenings and weekends when all of the people are at home. There are two senior support workers who lead shifts, and in addition the registered manager also works some shifts throughout the week. The home is in a the process of recruiting a third senior support worker. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Two staff recruitment files were examined. It was found that appropriate information had been obtained prior to them commencing work and that the files contained all documentation required. A written record had been maintained of the interview, this is good practice. The home provides structured induction training. A first day induction is completed, then further areas within the first 12 weeks at the home. The registered manager advised that all staff at the home have either completed, or are in the process of studying for the LDQ qualification. Staff receive regular supervision and appropriate records are maintained. A staff training matrix has been maintained. All staff had received training in moving and handling and training had been planned for all staff to attend training on food hygiene. Other training provided included CPR, health and safety and equality and diversity. Care Homes for Adults (18-65 years) Page 23 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager provides good leadership to the home. The home seeks feedback regarding the service provided. Generally the home has taken appropriate steps to promote the health and safety of people, however some action is required. Evidence: The Registered Manager is Peter Naylor. He has many years experience of working with people who have a learning disability and has been in post as manager of the home for one year. He is studying for the NVQ level 4 in management and care. Staff spoken with during the inspection advised that the manager is approachable and that they are able to raise issues at the regular team meetings or during supervision. People living at the home have complex needs therefore it is not appropriate to hold residents meetings, however feedback on the service is gathered from observation of Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: people and feedback from relatives and professionals during individuals reviews. Fire safety records were examined. It was found that five out of the eleven staff employed had not received updated training on fire safety. This included three staff who regularly work night shifts and training must be provided to night staff as a priority. A record had been maintained of fire drills and visual checks of equipment. Fire safety equipment had been serviced and tested as required. A fire risk assessment had been completed. It is recommended that this is reviewed on an annual basis. Gas and portable appliances had been tested appropriately. The electrical hardwiring certificate stated that this was last examined in October 2002. Guidance from the Health and Safety Executive advises that this is checked every five years, therefore this should be reviewed and action taken as necessary. The home has an appropriate contracts in place regarding the testing for legionella and removal of clinical waste. Fridge and freezer temperatures had been recorded daily, however on some occasions these exceeded recommended levels. Staff should be aware of these limits and the actions to be taken in response to this. Accident and incident forms had been recorded and action taken as required. Care Homes for Adults (18-65 years) Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Regulation 13 (2) All handwritten entries on medication records must be signed and dated. The registered manager must review the storage arrangements for the keys to the medication cupboard. Medication records must be appropriately maintained. Keys to the medication cupboard must only be accessible to appropriate people and there must be an audit trail for who has been responsible for these. 16/01/2009 2 23 13 The registered manager must ensure that CSCI and the placing authority are informed regarding any allegations regarding staff members. 08/01/2009 Care Homes for Adults (18-65 years) Page 27 of 30 This is to ensure that people living at the home are safeguarded. 3 30 13 Regulation 13 (3)The registered persons must take appropriate action to address the maintenance issues outlined within this report. These actions are required to reduce cross infection within the home and to ensure that people live within a comfortable and hygienic environment. 4 42 23 Regulation 23 (4) [d] The registered person must ensure that all staff are provided with regular updates in fire safety training. This is to ensure that staff are aware of the actions to be taken in the event of a fire. 16/01/2009 27/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose requires some further amendment to ensure that it addresses each of the areas requried in Schedule 1 of the Care Home Regulations 2001. It is recommended that hand written entries on medication records are checked and signed by a second staff member. The registered manager should keep staffing levels under review to ensure that staffing levels remain appropriate during evenings and weekends when all of the people are at home. 2 3 20 33 Care Homes for Adults (18-65 years) Page 28 of 30 4 5 42 42 The Registered Persons must review the electrical hardwiring certificate and take action as appropriate. Staff should be aware of the actions to be taken should the fridge or freezer temperature exceed recommended levels. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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