Care Home: The Haven

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What the care home does well People living in this home told us they were well cared for by a committed and competent care team. They were very satisfied with the care and approach of staff. The management team take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. People said they enjoy their food, which is fresh, varied, well presented and nutritious using fresh ingredients. There was a system to show regular reviews of care are carried out, which fully involved individuals and their family carers when it was right to do so and wherever possible. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. What has improved since the last inspection? A great deal of effort has been made to train staff about the Mental Capacity Act 2005 and ensure that all care records address the issue of people having capacity and deciding how they wish to spend their lives. New carpets, chairs, beds, tableware have been purchased to improve the quality of the environment. A new call system has been provided New domestic washing and drying machines have been provided to improve the laundry service. New kitchen equipment has been provided. What the care home could do better: Improvements and action to address the requirements from the last inspection had taken place. There were however requirements and recommendations as a result of this inspection visit. The management team must ensure that medication storage is up to date and medication records correctly maintained. They need to do more to find out from the people living in the home what activities they would like to see and provide an activity programme which suits them. The manager also should consider providing a maintenance and refurbishment programme to identify areas of the environment, which need refurbishing/replacement as a result of wear and tear. They need to consider introducing internal quality assurance audits to monitor medication and care. CARE HOMES FOR OLDER PEOPLE The Haven The Bungalow 19 Lincoln Road Metheringham Lincs LN4 3EF Lead Inspector Tobias Payne Unannounced Inspection 24th July 2008 08:00 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 The Haven DS0000002444.V368804.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. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Haven Address The Bungalow 19 Lincoln Road Metheringham Lincs LN4 3EF 01526 322051 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) Mrs M Dobbs Mrs M Dobbs Care Home 29 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (23) of places The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2006 Brief Description of the Service: The Haven is a large, extended, chalet-type bungalow set at the end of a shared drive in the village of Metheringham. The village is on a bus route to Lincoln and Sleaford and has shops, a G.P. surgery, a church, a library and other amenities available. The home is run as a family business; the owner, who is also the manager, is actively involved on a day-to-day basis with the help of a deputy manager. The home provides personal care for up to twenty-nine people of both sexes, over the age of 65 years, some with dementia. The accommodation consists of thirteen single and eight double bedrooms. All bedrooms have hand washbasins but none of them are en suite. There is a small car parking facility at the front of the property. The gardens, both in front of the home and surrounded by the bedrooms at the back, are well tended and colourful. The home’s philosophy of care is to encourage as much independence as possible and fully acknowledge the rights of the individual residents as to their personal preferences and lifestyles, whilst ensuring that all care and other support is provided by friendly, caring and suitably trained staff. The fees charged by the home on the day of our inspection visit ranged from £351 to £398. Extra costs were for hairdressing, which ranged from £6.50 to £23 and chiropody £10. Information about the home including the statement of purpose, service user’s guide and a copy of the last inspection report can be obtained from the manager of the home. The Haven DS0000002444.V368804.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 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and started at 8.00 a.m. our visit was planned using a review of all the information available to us about The Haven Care Home. The inspection visit took place over 6½ hours. We spoke with 11 people living in the home. We spoke with 3 staff members the owner who is also the manager and the deputy manager. The main method of inspection used on our visit was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also reviewed the annual quality assurance assessment (AQAA) that was sent to us by the manager before this key inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear and detailed. Prior to this inspection visit we also made an unannounced random inspection to the home on the 2/8/2006 as a result of concerns brought to our attention about care, medication and infection control. The outcome of our visit clearly showed that staff were well trained and implemented health and safety practices routinely within their working roles. We had no concerns as a result of this visit. What the service does well: People living in this home told us they were well cared for by a committed and competent care team. They were very satisfied with the care and approach of staff. The management team take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. People said they enjoy their food, which is fresh, varied, well presented and nutritious using fresh ingredients. There was a system to show regular reviews of care are carried out, which fully involved individuals and their family carers when it was right to do so and wherever possible. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is information to enable people to make a decision about whether or not to come into the home. People coming into the home receive an assessment and know their needs can be met. They are also involved in this process. EVIDENCE: The manager showed us how people coming into the home are assessed by the management team and that efforts are made to ensure that the home can meet their assessed needs. This was done using a very detailed assessment record and the signature of the person showed that had been involved in the process. There was a clear and detailed statement of purpose and service user’s guide, which included information about the aims and objectives, accommodation and information about the home. Records showed each person also received information about their terms and conditions. We noted that the complaints procedure referred to our old address The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 9 rather than our Cambridge address. We also saw that people had not been given written confirmation that, based on the assessment completed the care team could meet the person’s needs. The manager agreed to take action to ensure these issues were addressed during our visit. We spoke with one person during our visit who had recently moved into the home. The person told us who they were assessed correctly and arrangements were made for a smooth admission to the home. The manager confirmed that the home does not provide intermediate care. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. People benefit from being fully involved in identifying their own needs and choices. Clear care plans, created from assessments of need help to ensure that people’s health and welfare needs are fully met. Medication is safely given by staff who know what they are doing but the way the medication is recorded poses a risk to the people receiving support with their medication. EVIDENCE: The manager told us about how efforts have been made to ensure that each care record identified each persons needs and addressed their capacity to make decisions for themselves. Each person had a care record. This was very detailed and included a detailed base assessment, health information (including nutrition), each person’s routines by day and night and how each person communicates, for example using expressive language skills. Care plans also showed peoples interests and included risk/moving and handling assessments, which the care team uses to support people to do what they want to do in a safe way. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 11 Records showed peoples signatures were obtained to show that the people who live at the home agreed with the way care was being provided, and each care plan was being reviewed each month. All entries were dated with clear and up to date information. Each person also had a key worker, which the manager told us is used to help provide greater consistency and better understanding of peoples needs. People are registered with a local GP and professional relationships had been established with GPs and community nurses as well as other healthcare professionals. The manager told us that support is given to help people to be as independent as possible with their medication needs but that most people did need support in order to take their medicines safely. There was a detailed medication policy and each of the 8 staff who support people with medication had received training after being assessed by the management team. During our visit we saw that one person had chosen to self medicate. Records showed that the person is given support to manage this safely. During our visit the manager confirmed that people do not currently have a need for controlled medications, but did not have a suitable locking facility to store controlled medication should they be needed. With this in mind we advised that the home needs to obtain a suitable cabinet for the storage of any controlled drugs. Records we looked at about how people are supported to take medicines had no gaps but we saw there were errors, which could potentially cause a risk to the people in the home. Whilst all medication taken was recorded with clear instructions, in a few entries the name of the drug on the card did not match with the name of the actual medication on the label. We spoke to the manager about this issue, who agreed to immediately commence regular internal audits to be to reduce the possibility of error and address quality. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 12 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): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are encouraged and supported to make choices. However, More structured activities need to be available to ensure that individual, social and cultural needs are met at the home for all the people. People choose from and enjoy a well-balanced nutritious diet. EVIDENCE: As a result of the last inspection report the manager showed that the care team had taken action to improve the variety of activities provided in the home. For example, they had introduced visits by local brownies to the home, which had proved very popular. The manager also provides religious services every 4 weeks from local churches. Staff had also been trained to take time to understand the needs of people with dementia difficulties through observation, which we saw being used to check whether people were distressed or enjoying their day. The manager confirmed that the team actively encouraged people to have greater involvement in their affairs through the help of outside agencies. The manager told us that they are trying to develop more community activities. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 13 Some people told us they could choose to do what they wanted but others said they would like to have more activities. Specific comments were “It would be very nice if we could do something, we just sit here and do nothing”, “very little goes on, why can’t we do something in the afternoon?” and “there is very little to do apart from the television”. During our inspection visit there were no organised activities taking place and most people were seen to be sitting, talking to one another, asleep or reading. The home received 2 stars from North Kesteven District Council following the last inspection on the 17/12/2007. All requirements regarding the kitchen, store room and freezer room had been addressed. Records available showed that the cook was undertaking a catering qualification and there were menus available in the home for people to choose from. Records showed there is information that the cook uses to make sure peoples nutrition and dietary needs are met. People we spoke with told us they enjoyed the food and there was a choice and people could have a hot meal at breakfast if they wished this. People commented, “I like the food”; “the food is cooked the way I like it”. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 14 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and most feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. People are protected from abuse by the correct recruitment procedures. EVIDENCE: There was a detailed complaints procedure in the statement of purpose, service user’s guide and on the back of each person’s bedroom door and on the front desk. We noticed that our address was wrong. We asked the manager to change this and she agreed to take action straight away to update the record. No complaints had been received by the home or us. A complaints register was being kept. All staff had formal training on abuse prevention. We spoke to 2 members of staff who knew clearly what abuse was and what to do if abuse was suspected. The home had a copy of Lincolnshire’s Adult Protection Procedures. People told us that they felt they could approach staff if they had any concerns or worries. Comments we received included “I find most of the staff are polite and keen to help” and “most of the staff are ok”. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 15 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): Standards 19, 20, 23, 24,25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in clean and safe accommodation. However, the lack of a maintenance/refurbishment programme leads to areas of the home, which are in need of redecoration and beds and furniture needing replacement. EVIDENCE: Since the last inspection the manager told us about how efforts have been made to improve the environment in the home. This has included providing new carpets, chairs, kitchen work tops, new tableware, new beds, fridge and washer dryers, call bell system and fire alarm system. Despite these improvements there were still areas of the home, which had worn carpets and chair coverings. We also saw that there were no signs in the home to show where toilets and bathrooms are located in order to help people to be as independent as possible in supporting their own needs. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 16 The report recommends that a maintenance and refurbishment programme is produced which identifies improvements to the home. We also recommend that the management carry out internal audits of the environment to identify areas of the home, which require attention. We spoke with people in the home and two people commented about the state of the beds. One person said, “I find the mattress is very uncomfortable”. One person also told us “we have no means to summon help when we are in the lounges” and “if I need to go to the toilet I cannot call for help”. We discussed these comments with the manager who confirmed whilst a new call system had been provided in the home, there was no call system in the lounges. They felt as staff often went into these rooms they were able respond to requests for help. We asked that this issue be addressed so that people could get help discreetly whenever they needed it. This will help support their privacy and dignity. The manager agreed to take appropriate action. People told us they liked their rooms and found the home clean. People also said they felt their rooms gave them privacy, however rooms did not have locks so that people could choose to lock their room if they wished. We found it to be clean throughout and the manager showed she employs people who make sure regular cleaning takes place. The central gardens were very attractive and accessible from the lounges and a number of ground floor bedrooms. Staff had gloves and aprons and there were infection control procedures in the home. The manager confirmed that a recent fire officer’s inspection report had been addressed. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a safely recruited, well-trained staff team available who have the skills to meet the needs of the people living in the home. EVIDENCE: Records we looked at showed that all staff had received dementia awareness and mental capacity training. The manager told us that a great deal of effort has been put into training staff in order to ensure that they have the skills to meet the needs of the people living in the home. The training plan in place showed us that staff receive the right sort of training to support them to do the jobs they do. The duty rota showed that there were sufficient levels of staff to meet the needs of the people in the home. There were no concerns about the levels of staff. The people we spoke with were in the main satisfied with the approach of the staff. We looked at staff records for one member of staff which showed a separate file with an application form, references, Criminal Records Bureau check, interview notes, induction programme and thereafter records of training provided. We spoke with a member of staff who confirmed that she was recruited correctly. Comments were “I received a good supported induction and I enjoy working at the home and the training I receive is good”. We also The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 18 noted that many staff had obtained a qualification in care (National Vocational Qualification). As a result 75 of staff had a nationally recognised qualification and were progressing further to achieve different levels of training. Each member of staff receives 3 paid training days a year. The managers training plan included risk assessment, understanding behaviours, adult protection, first aid, food hygiene, and The Mental Capacity Act 2005, medication and fire prevention. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 19 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): Standards 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and staff benefit from the positive leadership of the management team. Management record systems show that residents’ health, welfare, safety and choices are promoted. The management team ensures that that people have the opportunity to voice their views and opinions. The manager uses feedback from questionnaires to make improvements. EVIDENCE: The home is owned and managed by the same person. This person is actively involved in the day-to-day management of the home. She is assisted by a deputy manager. She has obtained a management and care qualification to NVQ level 4. In addition she is studying for a Health and Social Care degree. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 20 People we spoke with were satisfied about the management of the home and staff received regular formal supervision sessions every 8 weeks. Comments we received were “I receive regular supervision and support” and “I can approach the manager if I have any concerns”. An annual survey is sent out to each person living in the home. The last one was on the 8/6/2008. The home received 10 completed questionnaires all of which were satisfied with the care and services provided. The report recommends that the quality assurance system be further expanded to include internal audits of medication, care records and the environment as well as obtaining the views of the people about the activities provided for them. There were up to date policies and personnel procedures produced by an outside consultancy. There was an equal opportunities policy, which covered equality and diversity. Where personal monies were being looked after by the home clear records were being kept with details of the item, balance and total. Entries were dated and included signatures. We found that management systems and the office could be organised better as some records although available were difficult to find. The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 3 The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 22 No 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 OP9 Regulation 13(2) Requirement Timescale for action 24/09/08 2 OP9 13(2) 3 OP12 16(2)(n) Suitable arrangements must be made for the safe storage of controlled drugs. Such storage must meet the requirements of the Misuse of Drugs (Safe Custody)(Amendment) Regulations 2007 (9.4, 20.6) When medication is given to 24/08/08 people who use the service care must be taken to ensure that the name of the medication on the medication administration chart is the same as the actual medication. This will ensure that errors are avoided. People living in the home must 24/09/08 be consulted about the range and type of activities they want provided in the home. As a result of these consultations a varied programme of activities must be provided which suit their needs, preferences and capacities taking into account the needs of people with dementia. Up to date information about these activities must be made available to the people in the home. This will provide stimulation and help DS0000002444.V368804.R01.S.doc Version 5.2 The Haven Page 23 to prevent boredom. 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 OP19 Good Practice Recommendations A maintenance and refurbishment programme should be introduced. This is to identify areas of the home such as carpets, furnishings and beds, which are showing wear and tear and as a result are replaced or attended to. Appropriate signs to orientate people living in the home to toilets and bathrooms should be introduced in order to promote independence especially in the case of people who have a dementia. Lounge and dining areas and other areas which people have access to should have an accessible alarm facility provided. Doors to the people’s bedrooms should be fitted with locks suited to their capabilities and accessible to staff in emergencies. In addition keys should be offered to each person unless their risk assessment suggests otherwise. The quality assurance system should be extended to introduce internal audits concerning medication, care practice and the environment. The way the office and policies and procedures are kept should be reorganised to ensure that records are made more accessible. 2 OP22 3 4 OP22 OP24 5 6 OP33 OP37 The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Haven DS0000002444.V368804.R01.S.doc Version 5.2 Page 25 - 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. 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