Inspection on 19/09/05 for 14 Norfolk Road

This inspection was carried out on 19th September 2005.

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

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

Other inspections for this house

14 Norfolk Road 30/09/09

14 Norfolk Road 15/10/08

14 Norfolk Road 28/02/07

14 Norfolk Road 16/06/06

14 Norfolk Road 02/02/06

14 Norfolk Road 21/03/05

14 Norfolk Road 16/08/04

14 Norfolk Road 19/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 14 Norfolk Road Carlisle Cumbria CA2 5PQ Lead Inspector Gordon Chivers Unannounced 19 September 2005 09:20 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 14 Norfolk Road Address Carlisle Cumbria CA2 5PQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01228 592515 Community Integrated Care Fiona Byers Care Home 6 Category(ies) of LD - Learning Disability registration, with number of places 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD (Adults with learning disabilities) 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 21 March 2005 Brief Description of the Service: 14 Norfolk Road is a detached three-storey property. The care and services are provided by Community Integrated Care. The home is registered to provide care for six people with a learning disability. Service users only use the ground and first floors, with staff accommodation on the top floor. It is situated in a residential street approximately one mile from the City of Carlisle and is indistinguishable from other properties in the area. A staircase provides access between the floors. There is a private and enclosed garden area to the rear of the building and car parking to the front. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, commencing at 09.20 and lasting seven hours. The inspection took place in the presence of the Deputy Manager, Stuart Dyson. The inspection included a tour of the premises, reference to a range of documents including a sample of service users’ case files, an interview with two members of staff and observation of the service users, all of whom have complex and challenging needs and very limited communication. The inspection focused upon the requirements and recommendations made, and those standards which were not assessed, by the last inspection. The inspector would like to thank the service users and staff of 14 Norfolk Road for their welcome and cooperation during this inspection. What the service does well: What has improved since the last inspection? What they could do better: The most important areas in need of improvement are the chronic staff shortages which the home has experienced over a long period of time, and the identified repairs and improvements to the internal environment which appear to have been continually deferred and delayed for some time. Neither of these 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 6 are within the direct control or responsibility of the home’s manager. There are also some operational, administrative and management issues which are in need of improvement. 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. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The home undertakes full assessments and care plans which identify and address the needs of the service users, although there are some aspects of the recording and review systems which could be improved upon. There are also issues about the admissions procedure, including that of information, which need to addressed and resolved. EVIDENCE: A Statement of Purpose and Service User Guide were developed and sent to CSCI for approval last year but the home has received no response from CSCI to date. There were no copies of these (draft) documents in the home. This matter will be pursued to ensure that the information required by service users and their families is made available. The admission procedure requires that admissions should take place on the basis of assessments of the needs of prospective service users. The home undertakes full assessments of their social and health needs once a placement has been made. Full risk assessments are also undertaken. All assessments are updated over time. Behaviour management plans, including safe holding strategies, and Essential Life Plans are in place, but staff have encountered problems in completing meaningful Person Centred Plans because of the difficulties in eliciting the aspirations of service users with severe cognitive and communication disabilities. The service managers have arranged for all the staff to receive training from Paradigm on how to develop and implement Person Centred 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 9 Plans for service users with such profound disabilities. Full care plans are in place but the CIC care plan format is extremely cramped with insufficient space available to clearly and fully record the extensive lists of needs and actions to meet those needs. Care plans are reviewed monthly by the home’s staff, but they have not consistently managed annual, comprehensive, holistic reviews, ideally with independent advocates of the service users. Plans to meet service users’ health needs are currently being transcribed into a Health Action Plan format. In response to the recommendations made by the last inspection for speech and language therapist input, the home asked one of the G.P.s from the practice where all of the service users are registered to make such a referral. Staff at the home stated that this request was refused. It is therefore recommended that the home seek a referral through the Community Health Team of specialist ‘learning disability’ nurses. The last admission of a ‘new’ service user to the home was approximately four years ago on an emergency basis. It was not possible, therefore, to track the process of an admission from the records in the case files. However, C.I.C.’s admission policy and procedure contains a reference to only one pre-placement introductory/familiarisation visit for the prospective user and their family. This is insufficient and does not meet the good practice standard of a series of visits of successively increasing duration before a decision about the feasibility of a trial placement can be made. All of the service users have contracts of the terms and conditions of their service provision. However, in the case of two service users who have no family prepared to sign on their behalf, these have been signed by representatives of the home, rather than by a representative who is independent of the service provider. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 10 Confidential, personal information about service users is managed appropriately. EVIDENCE: Current information about service users is kept in locked cabinets in the home’s office which is also kept locked when not in use. Archive information about service users is kept on the upper floor of the home to which service users have no access. The home has a policy regarding confidentiality of which staff are fully aware. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The service users are supported in making choices and undertaking activities they enjoy. They are also encouraged to contribute to everyday life of the home. EVIDENCE: The service users are able to lock their bedrooms, and some of them have lockable wardrobes. The key workers encourage and support the service users to participate in the up-keep of their bedrooms and contribute to the domestic tasks in the communal parts of the home. Activities for service users are planned on a weekly basis, based upon what service users are known to enjoy and benefit from. However, if a service user chooses not to undertake a planned activity at the time, then that choice is respected. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 As far as can be ascertained the service users are supported in the ways which they prefer. The home makes great efforts to access appropriate health care for the service users. Medication is managed by the home according to procedure, but an additional metal storage cabinet is required. EVIDENCE: Because of the severe communication disabilities experienced by all of the service users, it is difficult for the staff to be sure as to what is their preferred style of support. In an attempt to address this issue the staff have developed communications charts which record and look for patterns of service users’ responses to different activities, situations and styles of interaction/ personal contact. This technique has been found to have some merit but is not always reliable because the behaviour of some of the service users can be contradictory and inconsistent. Ultimately, appropriate care and support is dependent upon the home having sufficiently experienced and skilled staff who have developed a working knowledge of the behaviours, moods, signals and temperaments of the service users. Case recordings and interviews with staff provide evidence of how the home attempts to gain access to generic and specialist health assessment and treatment on behalf of the service users. The family of one service user has been very involved in these issues. The home is in the process of transferring the information and actions it has on individual service users into Health Action Plans. The home has enlisted the advice and guidance of a member of the 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 13 community Behaviour Intervention Team. Patterns of behaviour and temperament are now monitored to provide the basis for interventions to reduce anxiety and thereby ameliorate extreme and unpredictable behaviour. There have been only two occasions during the last twelve months when a service user had to attend the A. & E. department of the local hospital. None of the service users are capable of managing their own medication. All the staff in the home have been trained to administer medication. The home has now adopted a system of dispensing medication based upon advice received from Boots Pharmacy. The home’s procedure for returning medication to the pharmacy has been fully adhered to, as required by the last inspection. Some medication is stored in a wooden cupboard with a lock which is not fit for purpose because the required metal storage cabinet has insufficient space to accommodate the considerable volume of medication prescribed for all of the service users. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The home implements policies and procedures to protect service users from abuse, but staff should receive more regular training. EVIDENCE: The home has a record of all the POVA and CRB checks on members of staff that have been received. The home has a policy and procedure based upon Cumbria’s multi-disciplinary ‘No Secrets’ document. CIC provide in-house training to staff based on this policy and procedure on an annual basis, although the last training received by staff in the home was in March,2004, and the next training is not scheduled until January, 2006, (almost two years later). 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 Some improvements to the home have been made since the last inspection. Recommendations for necessary repairs and renewals have been developed by two separate surveys and these should be implemented as soon as possible. EVIDENCE: There is a homely atmosphere within 14 Norfolk Road, although more pictures or hangings on the walls of the communal rooms would be a positive addition. All the furnishings are comfortable and in good condition. The stained bedroom carpet has been replaced and the hallway redecorated as required by the last inspection. An extensive, comprehensive and detailed programme for repairs and renewals as required by the last inspection was produced on behalf of CIC in March 2005 by Atisreal, with priorities, timescales and costings. A further survey was undertaken by architects Johnson and Wright of Carlisle on June 16, 2005. All of the recommendations in these reviews should be implemented as soon as possible because many of these issues have been outstanding for many months. Arrangements should be made for the regular cleaning of the area above the false ceiling /canopy between the two lounges. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Each member of staff is clear about their respective roles and responsibilities. The home has had to cope with staff shortages for a long period of time: and the service providers should review their strategies to recruit and retain staff in order that these service users with highly complex and multiple disabilities are consistently supported by a full compliment of staff. The recruitment procedures are adhered to, although some aspects could be reviewed. EVIDENCE: There is a job description for each grade of worker in the home and each member of staff has their own job description. There are also guidelines covering the duties involved in key-working, sleep-in, on-call and ‘designated person’, which is a support worker in charge of the home when neither the manager, deputy-manager or senior support worker are on duty. Of the fifteen members of staff (not including the manager), five have attained NVQ in care to level 2 or above and three are currently undertaking the course. The home is on course to having 50 of staff qualified to the required standard by the end of 2005. The manager is a NVQ assessor and the deputy manager is undertaking the assessors award. This resource will greatly facilitate the process of all staff attaining the minimum required qualification. Two members of staff are undertaking the LDAF Induction and Foundation course. The inspection of March 2004 required that the home provide a minimum of four staff on all early and late shifts. Since then there been numerous 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 17 occasions when this has not been achieved, including the day of this inspection. Moreover, the requirement that there be at least one male member of staff present on all shifts, due to the occasional aggression and chauvinistic attitude of some of the male service users, is not always met. Throughout this period staff have been working extra shifts, ‘bank’ workers have been drafted in and managers constantly deployed on shifts. The home is currently operating at four and a half whole time equivalent (w.t.e.) staff below its establishment level; a situation partly exacerbated by the recent loss of two members of staff (one an experienced senior support worker) for reasons beyond the control of the home’s management. CIC are constantly attempting to recruit from a labour market where all providers are experiencing difficulties. Norfolk Road has just appointed one and one half (w.t.e.) new support workers and is due to interview two more prospective support workers three days after this inspection. The long term picture is of a home struggling to cope with the effects of almost constant staff shortages, and this must have a wearing effect upon existing staff working in a very demanding environment. Staff interviewed suggested that improvements in the terms and conditions of employment would constitute a recognition of the workload and assist with recruitment and retention. The home has the appropriate recruitment procedures in place and a recently recruited member of staff was able to confirm that these had been adhered to in her experience. The person specification for prospective support workers has recently been revised and is now more appropriate/relevant. New staff are required to ‘shadow’ existing staff during induction and until their CRB check has been cleared. Prospective staff are first screened in (or out) by formal interview, and are then invited back to look around the home, but for only a short period of time, before being asked to accept any formal job offer. Families of service users do not contribute to the process of selection of new staff. The appropriateness and effectiveness of this second stage in the process should be reviewed. The manual handling training recommended by the last inspection has taken place. The manager maintains individual training records and monitors the training needs of the staff but ,because of the staffing issue referred to above, arranging cover so that staff can be released to undertake training is a constant difficulty. It is not clear whether all staff have undertaken the annual refresher training on health and safety issues. Staff receive formal supervision although the records for some staff are not currently kept together in the same personal file. Not all staff have been receiving supervision on at least six occasions each year. Annual appraisals are not yet undertaken although the service is currently training and preparing managers and staff to implement such a system. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39 The manager is highly regarded by the staff but is constrained from fully attending to all the management tasks and duties. The home does not produce an annual Development Plan based upon feedback from key stakeholders. EVIDENCE: The manager and the deputy manager are currently undertaking the Registered Managers Award. Staff in the home have a positive opinion of the management, describing it as open, accessible and supportive. The manager leads three shifts (which constitutes more than half of the basic working week), partly because there is only one senior support worker. This inevitably reduces the amount of time available to attend to core management responsibilities and may explain why many of the standards relating to management and administrative systems are not being fully met. It was noticeable during the inspection that the filing and administrative systems are not as efficient as they ought to be. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 19 The home holds monthly staff meetings which are recorded. CIC invites feedback and comment from families of service users but the home has never seen the results of these. The home does not survey the families of the service users directly as recommended by the last inspection, nor does it produce an annual Development/Business plan. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 2 2 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x 3 x Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 14 Norfolk Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x x F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 15 Requirement Health and social care plans must be reviewed on a holistic basis at least every year and involve an independent advocate for each service user. Contracts/terms and conditions of residency must be signed by a representative of the service user who is independent of the service provider An additional metal cabinet for the storage of medication must be installed. The recommendations made by two recent surveys should be adopted as the basis of a programme of repairs and renewals which must be implemented as soon as possible. Previous requirement of 1/6/2005 not met. The registered person must ensure that there are sufficient staff on duty at all times to meet the assessed needs of the service users The registered person must review the strategies for the recruitment and the retention of F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Timescale for action Immediate 2. 3. 5 5,20 30/11/200 5 4. 5. 20 24 13 23 30/11/200 5 31/12/05 6. 33 18 Immediate 7. 33 18 30/11/200 5 Page 22 14 Norfolk Road Version 1.40 8. 9. 36 37 18 10 staff in order to overcome the many periods of staff shortages experienced by the home over a long period of time. All staff must be formally supervised at least six times a year. The registered person must ensure that the manager is enabled to fully attend to all of the managerial and administrative systems. Immediate 30/11/200 5 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. 3. 4. 5. 6. 7. Refer to Standard 3 3 23 24 34 39 4 Good Practice Recommendations The CIC care plan format should be revised to allow for sufficient space to fully and clearly list all the needs and actions. The home should refer the service users for speech and language therapy through the Community Health Team. The registered person should ensure that all staff receive training on the protection of vulnerable adults according to CICs own policy. Arrangements should be made for the regular cleaning of the area above the false ceiling /canopy between the two lounges. The appropriateness and effectiveness of the second stage of the selection process should be reviewed. The home should produce an annual Development Plan based upon feedback from key stakeholders. The registered person should amend the admissions procedure so that prospective service users undertake a series of visits of successively increasing duration before a decision about a trial placement is made. 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 14 Norfolk Road F58 F10 s22573 14 norfolk road v247797 190905 ui stage 4.doc Version 1.40 Page 24 - 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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