Care Home: Ashdale

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What the care home does well From observations made during this visit, and from information provided by the manager in the AQAA, there was evidence that the manager and staff in this home are working towards improving the service. All the residents spoken to were extremely positive about their experiences in the home, and about the way the home was run and managed. All feedback from residents stated satisfaction with the services provided. They were very complimentary about the way in which staff provided care and support. One resident said, "I am very happy here, the girls (staff) are so good. I am a faddy eater, but the food here is very good". A relative commented on the homely and warm feeling in the home. She said, "The staff are all lovely and pleasant. I feel I can raise concerns if necessary. I am very happy with the care and we feel the home is meeting care needs. First impressions are that it is wonderful". There was a relaxed and welcoming atmosphere noticeable during this visit. Families and visitors were made welcome by staff. Staff and residents in the home expressed confidence in approaching the manager with any issues of concern. Care plans provided staff with information on how residents wanted to be supported. There was evidence during this visit that residents and their families were involved in making decisions about the way support and care was provided. The home continues to provide training for all staff. There was evidence of ongoing training opportunities for all staff working in the home. What has improved since the last inspection? Some improvements have been made in the decoration of the home. Some lounge areas and hallways had been painted in bright neutral colours, providing a pleasant environment for residents and their relatives. A room has been specifically designated as a smoking area to promote the health and well being of the people who live and work in the home. The standard of hygiene in the home is of a high standard. Meals served in the home are of a good standard and offer a choice for residents. What the care home could do better: Appropriate storage that meets current legislation must be in place for controlled drugs. Hand written entries on medication records should be countersigned to check for accuracy and to ensure that medication is given safely. Work to the kitchen area as required by the environmental heath must be undertaken in order to provide a safe environment for residents and staff. Doors must not be wedged, and appropriate automatic door closures must be fitted where necessary. All staff need to receive training in safeguarding adults to ensure the safety and well being of residents and to ensure that staff know the policies and procedures when dealing with an allegation of abuse. CARE HOMES FOR OLDER PEOPLE Ashdale 235 Mottram Road Stalybridge Tameside SK15 2RF Lead Inspector Ann Connolly Unannounced Inspection 13th June 2008 01:55 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 Ashdale DS0000063124.V362000.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. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashdale Address 235 Mottram Road Stalybridge Tameside SK15 2RF 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) 0161 338 2621 0161 338 2621 Progressive Care Limited Mrs Helen Crowshaw Care Home 20 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (20), of places Physical disability over 65 years of age (4) Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 20 service users to include: *up to 5 service users in the category of DE(E) (Dementia over 65 years of age). *up to 4 service users in the category of PD(E) (Physical disability over 65 years of age). *up to 20 service users in the category of OP ((Old age not falling within any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with or who has a registration application pending with the Commission for Social Care Inspection. 14th June 2007 2. Date of last inspection Brief Description of the Service: Ashdale is a large Victorian detached building, located close to the centre of Stalybridge. It has been extended and adapted over the years to meet the needs of 20 older people. The aids and adaptations to meet the needs of the residents include: handrails, adapted baths and toilets, and a passenger lift. There are 18 single and one double bedroom. Four of these bedrooms also have en-suite facilities. The bedrooms are situated on different levels of the building. On the ground floor there are a lounge and dining room. Car parking is to the front of the building and there are accessible gardens to the side and rear of the house. Ashdale is owned by Progressive Care Ltd, which also runs care facilities in other parts of the country. Fees for accommodation and care at the home range from £331.75 to £356. Additional charges are also made for hairdressing and chiropody services, newspapers, personal toiletries and trips. Ashdale DS0000063124.V362000.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 2 star. This means the people who use this service experience good quality outcomes This was a key inspection that included a site visit to the home. The visit took place on 13th June 11:15a.mm until 15:45p.m. The manager was not told beforehand that we were coming to inspect, this is called an unannounced inspection. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the service provided at the home since the last inspection. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the manager, staff working in the home, and some relatives who were visiting. A tour of the home was undertaken and residents were asked for their comments and views about the environment. Several residents living in the home were spoken to in private during the visit, and discussions took place with them to find out what they thought about the home, and what they felt about how the staff supported them. The Commission for Social Care Inspection has not received any recent concerns about this service. Since the last inspection there were five complaints that had been made direct to the home. These had been recorded and documentation confirmed that these had been responded to within 28 days. This provided evidence that complaints had been managed, and that procedures were followed. What the service does well: From observations made during this visit, and from information provided by the manager in the AQAA, there was evidence that the manager and staff in this home are working towards improving the service. All the residents spoken to were extremely positive about their experiences in the home, and about the way the home was run and managed. All feedback from residents stated satisfaction with the services provided. They were very complimentary about the way in which staff provided care and support. One resident said, “I am very happy here, the girls (staff) are so good. I am a faddy eater, but the food here is very good”. A relative commented on the homely and warm feeling in the home. She said, “The staff are all lovely and pleasant. I feel I can raise concerns if necessary. I am very happy with the Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 6 care and we feel the home is meeting care needs. First impressions are that it is wonderful”. There was a relaxed and welcoming atmosphere noticeable during this visit. Families and visitors were made welcome by staff. Staff and residents in the home expressed confidence in approaching the manager with any issues of concern. Care plans provided staff with information on how residents wanted to be supported. There was evidence during this visit that residents and their families were involved in making decisions about the way support and care was provided. The home continues to provide training for all staff. There was evidence of ongoing training opportunities for all staff working in the home. What has improved since the last inspection? What they could do better: Appropriate storage that meets current legislation must be in place for controlled drugs. Hand written entries on medication records should be countersigned to check for accuracy and to ensure that medication is given safely. Work to the kitchen area as required by the environmental heath must be undertaken in order to provide a safe environment for residents and staff. Doors must not be wedged, and appropriate automatic door closures must be fitted where necessary. All staff need to receive training in safeguarding adults to ensure the safety and well being of residents and to ensure that staff know the policies and procedures when dealing with an allegation of abuse. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashdale DS0000063124.V362000.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 Ashdale DS0000063124.V362000.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): 3 (Standard 6 intermediate care is not provided at Ashdale) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met. EVIDENCE: Three care plans were examined and they contained assessments carried out by the care manager from the placing authority. In addition, the manager of the home carried out an assessment of care needs, and the information obtained was used to develop a detailed care plan for each resident. The pre admission assessment included personal details and information on personal care, past history, continence issues, mobility difficulties and medical history. The manager said that it was her intention to develop the documentation used for pre-admission assessments so that there was sufficient room to include Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 10 more information if this was required, and so that important details were not missed out through the lack of space on the assessment proforma. The admission details included an individual profile with important contact numbers and background information relating to the reason for admission. There was also a checklist which served to remind staff to provide full comprehensive information to any prospective resident including service user guide, terms and conditions, and information on care planning. The manager provides written confirmation to all prospective residents that the home is able to meet the assessed needs of the individual. This ensures that any prospective resident can feel confident that the home can meet their care and support needs. Ashdale DS0000063124.V362000.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being met and personal care and support was offered in such a way as to promote and protect residents’ privacy, dignity and independence. EVIDENCE: The information in the care plans provided information and details about each resident’s care needs. There was evidence that changes in care needs were promptly identified, and that where necessary appropriate referrals had been made to the medical profession. There was evidence that all care plans had been fully audited and each plan was divided into sections, which made it easy for staff to use as a reference tool to monitor the health and well being of residents. Care plans included risk assessments, which are undertaken by staff. This ensures that any risks that are taken by residents can be done in a safe way where possible. Care plans identified the care and support needs and the Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 12 intervention required to meet these. Records and discussion with residents showed that a variety of health workers visit the home to assist with residents’ care. These are people such as dentists, opticians and dieticians. Staff who were spoken to had a good understanding of the care planning process, and the importance of involving residents in planning their care. The manager recognised the importance of constantly monitoring the care plans to ensure that staff are provided with adequate up to date information about residents. Examination of residents’ medication administration records showed that medicines were administered in a safe way. Medication was administered from a monitored dosage system in blister packs. This means the individual medication is put into a sealed bubble of plastic by the local supplying pharmacist. Stock levels balanced with the Medication Administration Records (MAR), and there were recording systems in place to record the receipt and disposal of medication. Some hand written entries had been made on the MAR sheets. These need to be countersigned so that a second person checks the accuracy of the information and medication and dosage. The current storage arrangement for controlled drugs is an electronic safe. This does not meet the requirements of current legislation. Appropriate safe storage for controlled medication must be in place and must meet current legislation. The Primary Care Trust (PCT) has carried out medication audits. In an audit carried out by the PCT in December 2007 it had been noted that improvements had been made in the way the home managed medication systems in the home. Staff were observed engaging in meaningful conversations with residents, and at all times, communication appeared respectful. Residents spoke highly of staff. One resident said, “The staff have always been very nice with me. I am very happy here, the girls (staff) are really good and very friendly”. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in a manner that supports residents to live a lifestyle that reflects their social, cultural, religious and recreational interests and needs. EVIDENCE: An experienced activities organiser is employed to support resident to access a wide range of activities and leisure opportunities. She is employed to support residents to engage in activities 3 to 4 days per week. The programme is imaginative and includes art and craft, creative talking and local history, flower arranging and making scrap books. Residents said they enjoyed the activities and could choose which activities they participated in. Information in the AQAA stated that the home plans to develop and maintain the activities programme. Feedback from residents was positive about the meals served in the home and they confirmed that there was always a choice. All residents spoken to during this visit were complimentary bout the meals. Comments included: Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 14 “The meals are excellent”. “The meals are really good”. Mealtime was a pleasant social occasion, there was a relaxed and calm atmosphere throughout. From discussions with staff there was evidence that there was a commitment to supporting residents to maintain their independence where possible and in supporting them to maintain contact with family and friends and the local community. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to ensure that residents are protected, and systems are there to support residents to make their concerns known. EVIDENCE: There is a complaints procedure in place, which is displayed prominently around the home. This gives details and timescales by which a complainant can expect a response and also provides the contact details of the Commission for Social Care Inspection. There is a complaints record, which logs all complaints which are brought to the attention of the manager. It details the nature of the complaint, the action taken and the outcome for the complainant. Since the last inspection the home had received five complaints. Some of the complaints were of a minor nature, however, the response from the manager shows that all complaints no matter how small are taken seriously. The commission have not received any complaints about this service. The staff who were spoken to had a good understanding of issues around abuse and what to do in the event of an allegation of abuse and were fully aware of the procedures. The manager stated that all staff were being updated on adult protection and safeguarding, to ensure that all staff have a detailed Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 16 knowledge base, so that they know what happens once an allegation has been reported to the manager. The manager is booked on training for the 17/06/08 Residents who were spoken to during this visit indicated that they felt confident in approaching the staff and the manager with any concerns. Relatives who were spoken to said they felt they could talk to the manager or a member of staff at any time with a concern because they were, “ Very approachable”. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a clean and pleasant environment. EVIDENCE: A brief tour of the building and ground was undertaken. The home was clean and tidy and many bedrooms showed signs of personalisation. Since the last inspection there had been some improvements made to the decoration in the home. The lounge areas had been painted in pleasant neutral colours, which provided residents with a bright fresh environment. New dining room furniture had been purchased and some soft furnishings had been replaced. In March 2007 the environmental health department visited the home and made several requirement for improvements in the kitchen. Since then, the Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 18 provider has negotiated an extension on the timescales with the purpose of fitting a new kitchen. Throughout the building it was noted that paper towels and soap dispensers were not provided in all of the bathrooms. In order to promote infection control it is strongly recommended that these be supplied to all sink areas and bathrooms. There is a designated smoking room, however, an extractor fan should be fitted to ensure the health and safety and comfort of residents using this facility. Some doors were seen to be wedged open. Where it is deemed necessary for doors to be kept open, appropriate door guards must be fitted which are integral to the fire alarm system. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a well-trained staff team, and are protected by robust recruitment procedures. EVIDENCE: During this visit, there was sufficient staff on duty to meet the needs of the residents. Staff were seen spending one to one time with residents and providing support for those residents with high dependency needs. The manager said that staffing levels were constantly reviewed, and the dependency levels of the residents were taken into consideration when setting the rota. Information from the manager indicated that at least 50 of staff had achieved a National Vocational Qualification (NVQ), at level 2 or above. In addition to this, the manager has obtained the Registered Managers Award. All new staff undertake induction training in accordance with the Skills for Care Council training. Staff who were spoken to confirmed that they had received induction training, and that there were ongoing opportunities for training and development. There is an individual training plan in place for each member of staff which helps the manager to monitor staff training and development. Some staff had received training in safeguarding adults, however, the manager said that this Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 20 training was scheduled for all staff. This is important so that residents can be confident that all staff are fully aware of policies and procedures to safeguard and protect their well-being. The manager is qualified to deliver in house training in the following subjects:dementia training ‘Yesterday, today, tomorrow’ , moving and handling, care plan training and mental capacity. Three staff files were looked at. The files were well organised and contained all the documentation required by legislation including Criminal Record Bureau (CRB) checks and two written references. The residents in the home spoke highly of the staff team and comments suggest that the staff had worked hard in establishing meaningful relationships with residents. One resident said, “The staff have always been very nice with me. I am very happy here, and the girls are very good”. A relative said, “It’s a small homely environment and the staff- well all of them are lovely and pleasant”. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is run in the best interests of the residents and the management ensure that the safety and welfare of residents and staff is promoted. EVIDENCE: The registered manager holds the appropriate qualifications for their role. Staff who were spoken to said that they found the manager approachable and that they could talk to the manager about any concerns. There was documentary evidence of regular staff and residents meetings. The meetings were used as a forum to exchange views, and to seek the views of residents about how the service could be developed. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 22 Information in the AQAA provided evidence that good standards were maintained for the maintenance of equipment for health and safety including fire prevention equipment. The organisation completes an internal quality assurance audit, which ensures that the views of residents are sought formally and informally on a regular basis. The manager said that there were development plans to produce a formal report to record the findings of quality assurance exercises, so that the people using the service were kept fully informed. Staff in the home confirmed that they were in receipt of regular supervision sessions and there was documentary evidence available to support this. Information provided by the manager in the AQAA, provided evidence of a manager who was committed to developing the service so that residents had positive outcomes. Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Appropriate safe storage that meets current legislation must be in place for controlled drugs. This will ensure that medication is managed safely by the home. Timescale for action 02/01/09 2. OP19 13 Work to the kitchen area as 01/10/08 required by the Environmental Health must be undertaken to ensure the health safety and well being of staff and residents in the home. Doors must not be wedged open, 20/07/08 and must be fitted with appropriate door guards as recommended by the local fire authority. 3. OP19 13 Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 Good Practice Recommendations Hand written entries on the MAR sheets must be countersigned so that a second person checks the accuracy of the information and medication and dosage. The staff should have specific training in the protection of vulnerable adults. It is recommended that paper towels and soap dispensers are provided in all bathrooms to promote infection control. It is recommended that an extractor fan is fitted in the smoking room to promote the health and safety and comfort of residents. OP18 3. 4. OP19 OP19 Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashdale DS0000063124.V362000.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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