Inspection on 29/06/05 for 186 Meadow Way

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

186 Meadow Way 30/05/08

186 Meadow Way 18/04/07

186 Meadow Way 09/05/06

186 Meadow Way 04/11/05

186 Meadow Way 26/02/05

186 Meadow Way 26/08/04

186 Meadow Way 15/03/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 178 Meadow Way Jaywick Clacton on Sea Essex CO15 2SF Lead Inspector Gaynor Elvin Unannounced 29th June 2005 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. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 178 Meadow Way Address Jaywick Clacton on Sea Essex CO15 2SF 01255 431301 01255 431301 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) Mr S T Lewis Mr S T Lewis Care Home (CRH) 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD), 3 of places 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Mental disorder, excluding learning disability or dementia, 18 - 65 years, 3 people. Date of last inspection 26th February 2005. Brief Description of the Service: 178 Meadow Way is a small care home, which is registered to provide accommodation, support and personal care to three service users with a mental health disorder. The home is located in a residential area in Jaywick Sands, within close proximity to the beach, shops, cafés and public house.A local bus service provides access to the nearest town of Clacton on Sea, approximately 2 miles away, for local amenities such as day centres, local hospital, sports centre, swimming pool, library and colleges and the town centre. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on one day in June 2005, commenced at 10.30 and lasted for three and a half hours. The Registered Manager was absent and the inspection was accommodated by the support worker on duty and later taken over by the assistant manager, who was on a day off and called in by the support worker. The inspection process included a discussion with the support worker and the assistant manager, observation, a tour of the home, examination of service users and staff files, records and supporting documentation. There were only two service users accommodated at this time, the third had moved on to another establishment closer to family. It was stated that one service user was in bed asleep and was not seen throughout the inspection. The other service user was unwell during the inspection and being attended to by the support worker. It was not possible to seek the views of the service users during this inspection. The outcomes for service users looked at on this occasion were limited to those areas assessed at the previous inspection, which had not met with Regulatory Requirements and National Minimum Standards. The purpose of this inspection was to identify the Registered Person’s progress in meeting these Requirements and National Minimum Standards. What the service does well: What has improved since the last inspection? Requirements and recommendations with regard to environmental issues and their impact on service users, highlighted in previous inspections, had been addressed. The deputy manager was no longer resident at the home and his accommodation had been refurbished and utilised to improve and upgrade the service users’ facilities. A large conservatory had been erected along the back of the house looking out over the vast open meadow views, providing additional communal space for the service users and contributing towards meeting needs with regard to choice, privacy and lifestyle. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 6 Following an immediate requirement the home had received a satisfactory enhanced disclosure from the Criminal Records Bureau for the support workers employed at Meadow View. 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. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Outcomes not assessed on this occasion. EVIDENCE: 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9. The home did not have a care planning system and therefore evidence of the care and support provided is limited. Staff had minimal understanding of the care planning process specifically with regard to review, monitoring or reconsidering the most appropriate approaches to be taken to engage with the service users, to ensure the delivery of appropriate care and support, to anticipate or prevent a crisis and promote social inclusion. EVIDENCE: The care management and assessment records of the two current service users were examined; they had not developed any further since the last two inspections and repeat requirements had not been addressed with regard to this area. The care plans were not linked to the Care Programme Approach (CPA) for people with mental health problems, combining a full assessment of needs and intervention jointly agreed by the service user and Care Co-ordinator. The multi professional CPA review panel had recently reviewed a service user on an enhanced CPA. Support with daily living skills, emotional psychological support, skill training and support to maintain achieved independent living skills were identified as the interventions required, to be carried out by the home, to meet the assessed needs of this individual. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 10 A clear and detailed plan for this service user was not in place to provide staff with precise information on how to consistently provide appropriate support to the service user in order to develop and maintain skills and meet personal, social and psychological needs. When asked about how and what type of support was provided for the service user, a staff member replied they were supported in doing laundry, accompanied out to the shops and did jig saw puzzles. During further discussion it became apparent this individual displayed challenging behaviour, risk assessments and structured risk management strategies for crisis prevention and intervention were not documented informing staff of how to manage this individual’s behaviour appropriately and effectively. From discussion with the Deputy Manager it was clear that the people running and working within the home did not have the knowledge or understanding of the care planning process. It was very concerning to hear that care plans were still not in place because an inspection was not expected and the home was waiting for the appropriate software to arrive to produce them. The deputy manager was advised that computer software is unable to generate an individualised plan of care and that care planning is an active process within a framework to be used to monitor and review the care being delivered. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 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) 11, 12, 13, 14 & 15. The home did not demonstrate a commitment to provide motivation and did not offer opportunities and support to establish a structured and purposeful lifestyle and promote well-being. EVIDENCE: No further action had been taken to address previous requirements with regard to motivating and assisting service users to participate in fulfilling activities and develop and maintain daily living skills. At the beginning of the inspection, approximately 10.30am, one service user was stated to be in bed, and remained there. The inspection finished at 02.00pm and the service user was not seen. Staff indicated this was the usual routine and this was the service user’s choice. They also expressed difficulties in managing this individual’s alcohol misuse and attempts to stimulate resulted in challenging behaviour. Mental health problems and associated problematic alcohol misuse prohibits motivation, however it was evident from the daily report book that the service user was motivated to get up early and visit family independently and routinely every week. Staff need to explore various approaches to prompt and motivate as part of the service user’s support 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 12 programme to build self-esteem, social skills and ability to participate in meaningful daytime activity and promote optimal independence. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 13 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 Service user’s were provided with assistance and support, respect and dignity, in a kind and understanding manner. No progress had been made on improving arrangements to ensure that the healthcare needs of the service users were identified, planned for or monitored appropriately. Liaison with specialist community healthcare professionals for correct advice and guidance to meet healthcare needs was not evident EVIDENCE: Care plans did not contain detailed information with regard to physical and emotional health needs and management enabling staff to deliver consistent appropriate care and know how to recognise, manage and reduce associated potential risks. For one service user the severity of alcohol misuse, its effects on mental health problems and associated risks were not identified; harm reduction approaches or therapeutic interventions had not been implemented. The continence needs and management for service users were not reflected in a care plan and records did not show that the continence advisor had visited the service users or assisted with assessments. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 14 One service user has had three long-term hospital admissions in the last year and was last discharged home in April. A care plan reflecting his healthcare needs was not in place. This individual continues to have problems with vomiting and weight loss and is on a liquid diet with supplements. It was indicated that he is weighed regularly, weight had now increased and was static, and a monthly weight chart in the care files was last completed in February. It was indicated that the home had liaised with a dietitian although supporting documentation was not evident providing details of advice and guidelines given to support the care given. Food was liquidised and thickened together, advice was given to soften and serve food items separately. The service user was observed to vomit straight after lunch. Their personal and health care needs were managed appropriately and promptly with dignity and respect, the support worker showed care and understanding. The deputy manager said he was monitoring food intake and how often vomiting occurred for healthcare professionals. There was no documentation supporting this or to provide accurate information for healthcare professionals. Daily care records did not relate to a care plan or record the care being provided. From discussion with the deputy manager it was clear he was fully aware of the health care needs of the service users and held mental notes of the monitoring and outcomes for the individuals. This approach to meeting care needs is heavily dependant on one person and his communication, which may fail in his absence. Service users are potentially at risk if these informal systems break down. The deputy manager supported this individual throughout admissions into hospital on a regular basis, relieved anxieties by accompanying and communicating with him during investigations, especially when taken off medication for mental health problems. The home needs to improve the recording of supportive documentation and related care planning arrangements to meet, monitor and review current and changing health care needs. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff had an awareness of protecting vulnerable adults from abuse, neglect and self-harm. EVIDENCE: To address previous requirements with regard to staff awareness in the protection of vulnerable adults, staff had undertaken an open learning programme and an externally marked exam in relation to protection of vulnerable adults (POVA) issues. The deputy manager was advised of POVA and local guidelines awareness training run by Local Authority and the benefits to staff of active peer group participation, specifically with regard to the isolation of the small staff team at Meadow Way. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28 & 30. The home was clean and tidy and provided a comfortable and homely environment. Communal and personal accommodation meets service users’ needs and promotes their independence. Laundry facilities were inadequate to control the spread of infection and promote health and safety. EVIDENCE: Considerable progress had been made in improving individual and communal accommodation for the service users. Alterations had been made to the smaller two of the three bedrooms to acquire the useable floor space required to meet National Minimum Standards. New furniture and lockable wall safes had been purchased for each bedroom suitable to meet service users’ needs and lifestyles. An additional bathroom was in the process of being installed for the use of the service users and a shower room for staff. A new large conservatory provided an additional sitting room and there were plans to install heating for use in the winter and facilities for service users to make their own drinks and snacks. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 17 The home was clean and tidy despite refurbishment being carried out. Laundry facilities were sited in a purpose built shed, outside, at the front of the house. Facilities were no longer appropriate or in line with infection control guidelines to promote health and safety of the service users or staff and meet the continence needs managed within the home. Soiled clothing was carried out down the stairs and through the front door. The laundry facilities did not provide sluice or hand washing facilities or a washing machine with a specified programming ability for dealing with soiled clothing and linen. Appropriate bins were not provided and soiled, wet clothing and bed linen, left by a service user, were observed on the ground outside the shed door by the front entrance of the house. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 Staff were appropriate in numbers to meet the needs of the current service users. Criminal Record Bureau (CRB) were in place for all staff employed. Staff were not equipped to understand and meet the needs of the service users more effectively. EVIDENCE: One member of staff was on duty supporting the two current service users. The staff team was small and comprised of the deputy manager and one support worker and a sleep in support worker during the night. The duty rota indicated the Registered Manager covered full time the day to day running of the service. Advice was given with regard to the need to regularly reassess staffing levels in the case of changing needs of service users or an additional service user is admitted. Satisfactory CRB checks were evident in staff files. Individual or collective staff training and development needs had not been identified in line with the service aims and service users needs. The support worker said she was commencing NVQ level 2 in September 2005 and the Deputy Manager was going to resume NVQ level 4 in management and care. So far this year staff had completed open learning in POVA and attended a 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 19 workshop in Personal Safety at Home. A list of booked training indicated First Aid and in house Management of Challenging Behaviour was arranged for later in the year. The deputy manager said he had experienced difficulty in accessing appropriate accredited training, especially in Mental Health. A Social Worker had extended an invitation to a workshop for mental health professionals being held at the hospital. He was advised that this might not be an appropriate level for staff to begin with and would be more beneficial once an introduction and a foundation in Mental Health had been achieved. He was advised to liaise with other home managers and approach local colleges. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42, & 43. Sufficient investment had not been put towards essential elements of management, structured training, individualised care programmes and related documentation. The home is not managed efficiently and there are concerns in respect of increasing requirements and failure to take the home forward in ways expected by the National Minimum Standards and in the best interests of service users. EVIDENCE: Following repeated requirements, expressed concerns and a meeting with the Registered Manager enormous financial investment had been placed into improving the environment for the service users, and this improvement is noted. However this inspection highlights very little investment had been placed into the essential key areas for positive effective practice and quality care outcomes. Clarity and understanding of the priorities of requirements required to meet service users needs and aspirations were not demonstrated. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 21 From discussion and observation, it was apparent that the deputy manager still played the key role in the management and running of the home and the role of the Registered Manager remains of concern to the CSCI. An invoice was seen for the purchase of two places for NVQ level 4 training in care and management with a private company, although there was no confirmation of payment or places booked with a commencement date. Core staff training needs with regard to protecting and promoting the health, safety and welfare of service users remained unmet on this and the last three inspections. Documentation supporting risk assessment and management had not been completed for staff to refer to ensuring awareness and understanding of safe working practice. Risk assessments were not in place with regard to building works being carried out. The home had still not progressed in addressing quality assurance and qualitymonitoring systems, as required in the last and previous inspections. An essential process for measuring the quality of the service provided. A commercially produced quality assurance and monitoring manual had been purchased since the last inspection to assist the home in this area. It was advised that quality assurance and monitoring must be service specific and focus on service user outcomes. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 1 x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 1 1 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 1 Standard No 11 12 13 14 15 16 17 1 1 2 2 3 x x Standard No 31 32 33 34 35 36 Score x 1 3 3 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 178 Meadow Way Score 2 2 x x Standard No 37 38 39 40 41 42 43 Score 1 1 1 x x 1 1 I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Timescale for action The Registered Manager must 1st demonstrate the home’s capacity September to meet the assessed needs and 2005. aspirations of individuals admitted to the home. This is a second repeat requirement not met within set timescale of 1st December 2004 and 1st June 2005. 1st The Registered Manager must ensure a comprehensive care September plan is generated from the Care 2005. Management Assessment and in accordance with the Care Programme Approach, drawn up with the service user, to incorporate skill development, risk management, choices and aspirations, mental and physical health needs, regular review and evaluation, identifying changing needs and focusing on outcome. This is a second repeat requirement not met within set timescale of 1st December 2004 & again 1st June 2005. The Registered Manager must 1st ensure service users are September supported to find and keep 2005. appropriate jobs, education or training, and/or take part in Version 1.30 Page 24 Requirement 3, 8, 11, 13 12 & 14 2. 6, 7 , 9 & 11 13 & 14 3. 12, 13 & 14 16 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc 4. 18 & 19 5. 32 & 35 18 & 12 6. 39 24 7. 37 & 39 12, 8 & 9 valued and fulfilling activities. This is a second repeat requirement not met within set timescale of 1st December 2004 & 1st June 2005. The Registered Manager must ensure service users receive additional specialist support and advice as needed and are supported to gain access to up to date information and advice about health issues especially with regard to continence and alcohol related issues. This is a repeat requirement not met within timscale of 1st June 2005. The Registered Manager must ensure that all staff have the knowledge, skills and experience necessary for supporting and meeting the needs of the service users with mental health problems. This is a second repeat requirement not met within timescale of January 2005 and 1st June 2005. The Registered Manager must ensure further development of effective quality assurance and monitoring systems. This is a fourth repeat requirement. The Registered Manager must ensure that the home complies with the Care Standards Act and Regulations.The Registered Manager must ensure that action is progressed within agreed timescales to implement requirements identified in CSCI inspection reports. This is a repeat requirement not met within timescales. The Registered Manager must commence NVQ 4 in both 1st September 2005. action plan detailing courses planned and places booked. 1st September 2005. 1st September 2005. 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 25 8. 42 12 & 13 management and care prior to December 2005. Thisis a repeat requirement not met within timescale. The Registered Manager must ensure safe working practices; risk assessments with regard to health and safety in the workplace must be reviewed, dated and signed and staff receive the appropriate training. This is a repeat requirement not met within set timescales. 1st September 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard peat Good Practice Recommendations 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester, Essex CO1 1RJ 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 178 Meadow Way I56-I05 S17724 178 Meadow Way V231248 230605 Stage 4.doc Version 1.30 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. 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