Inspection on 31/10/05 for 20 Allington Way

This inspection was carried out on 31st October 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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

20 Allington Way 13/05/08

20 Allington Way 20/12/06

20 Allington Way 14/04/05

20 Allington Way 07/10/04

20 Allington Way 04/06/04

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

CARE HOME ADULTS 18-65 20 Allington Way 20 Allington Way Maidstone Kent ME16 0HJ Lead Inspector Lynnette Gajjar Announced Inspection 31st October 2005 09:50 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 Adults 18-65. 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. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 20 Allington Way Address 20 Allington Way Maidstone Kent ME16 0HJ 01622 686681 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) MCCH Society Limited Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th April 2005 Brief Description of the Service: 20 Allington Way is one of a number of registered care homes managed by MCCH Society Ltd in the South East of England. The home offers 24-hour care for 3 adults 18-65 year of age, who have a learning disability. The home has one sleep over staff at night. The houses accommodation comprises of a large kitchen / dining area, single bedroom, bathroom with WC and lounge on the ground floor. There are two further single bedrooms, bathroom with WC and staff sleepover / office on the first floor. The home has a large rear garden and ample off street parking for three cars (two of which are Service Users own mobility vehicles). There is also unrestricted street parking. Service Users are encouraged to take part in daily activities to the best of their abilities and access the local community and amenities. The home is situated near the main A20, with easy access to public transport regularly into Maidstone town centre. Maidstone town centre is approximately 2.5 miles. There are also a small row of local shops and amenities accessible in Allington. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09:50am until 16.20pm. The home currently has two permanent service users in residence and a new service user who is currently working through the settling in/trial period. The visit was spent talking directly with two service users privately and collectively; two casual care staff, the newly appointed manager and the visiting service co-ordinator. The new service user withdrew from any contact with the inspector or staff during this visit. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussion with staff and evidencing records held at the home. A tour of the premises was undertaken. The home has experienced unstable management support over the past four months due to the suspension of the previous registered manager pending internal investigation and disciplinary action, which has led to the manager’s dismissal. A service users current behaviours and actions give concern to the safety of other service users but also to the appropriateness of the placement meeting their personal care needs. This is an area requiring vigilant monitoring by staff, service managers and placing local authority through their duty of care to all three individuals. A new manager has been transferred from within the organisation and has been officially in post for two weeks and the commission acknowledges the steady progress made to identify and improve the service. What the service does well: What has improved since the last inspection? Safe access to the rear garden has been improved through the installation of grab rails to the back pathway. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 6 There home has had a new manager appointed who is confident in working with this service user group, staffing and general management of a care home and good monitoring systems to audit the service provided. 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. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3,4, Service users do not get the information in a format that they understand to be able to make an informed choice about whether the home will be able to meet their needs or their compatibility with fellow tenants. EVIDENCE: The home has a written statement of purpose and service user guide. This still requires transferring into a simpler, object referencing and pictorial format that will be understood and easily followed by the current service users. The homes admission process follows MCCH procedures. A new service user is still within their settling in period. This is being closely monitored and reviewed with the local placing authority, MCCH senior management and the newly appointed manager. Due to additional behavioural management that have been identified, the current staff team do not have the confidence, skills and consistent staffing to support the individual. Interaction between new and current service users was not evident. Body language observed showed a service user moving sideways every time the other walked pasted them and anxiety when in the same room. The third service user returned to their room when not a mealtime, which had reduced considerably on the previous inspection with more social time in the dining area with staff and peers. There is clear affection and fondness between two service users towards each other. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 6,7,8,9,10 Through the lack of direct management support care plan records currently do not offer clear and concise information to the staff to meet the needs of the service users. Risk assessments and guidelines are not detailed enough to ensure consistent approaches by staff. EVIDENCE: Care staff have worked hard to continue to review monthly and maintain care records to the best of their ability relating to individual service users. Records seen had formal local authority reviews for June 2004 but no records of reviews for 2005. The current format holds information that requires updating. The new manager is planning to introduce a more object referencing, simpler to use and recording format. This will be introduced slowly with staff support, training and mentoring by the manager. Risk assessments have been completed but too require to be reviewed, with many seen to be no longer relevant. A simpler and easy to follow format is to be introduced by the new manager. Service users have limited encouragement to take risks to promote their independence due to staff current lack of confidence. Particularly due to presenting behaviours that can 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 10 challenge the support and service provided for all three-service users. Individual needs and choices are being compromised. Appointeeship for all service users is managed by either local authority financial services or powers of attorney. Financial records seen today are not as clear and easy to track or link to statements of savings accounts. Petty cash held in the home tallied with records on this occasion. The new manager is exploring new service user bank accounts and a simpler record system for service user monies and monitoring. Clear guidance and expectation have been given to staff to follow. Previous financial discrepancies are currently being investigated through the adult protection protocols and police investigation. Records are stored securely in the home. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 11,13,14,15,16, Service users have limited opportunity to make a range of choices about their lifestyle. Service users do not have staff that is confident and skilled in managing behaviours that may challenge the service and minimise the risk to face everyday activities. EVIDENCE: A service user despite being tied to three days attending kidney dialysis continues to attend tuck by truck on remaining mornings and thoroughly enjoys this. Other activities are currently limited to shopping and occasional trip for a pub meal. Further staff support to undertake more social time with friends, building of networks, using local amenities and services such as hairdressers should be explored. Community participation and leisure opportunities for others are limited due to personal restrictions through autistic tendencies and dislike of changes to routines and familiar situations. Staff had achieved increased activities with a service user in the previous inspection. However following changes in the group dynamics this has decreased. Mainly through staff time being spent 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 12 with two diverse autistic care / support needs and managing of behaviour that can be seen as challenging. Staff do not feel confident to support service users in the local community and maintain their and others safety. The quality of life and opportunities for all service users have suffered as a result of this. A service user is supported to return home and stay over night with their parents once a week. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 18,19,20 Service users healthcare needs are managed well. However emotional and psychological care needs are not being met. Medication practices have been reviewed to ensure safe working practice and storage. EVIDENCE: Talking with service users privately, it was evident that individual preferences regarding personal care continue to be taken into account, but also encouraging good standards of personal hygiene and self-respect. Observation indicated high standards of personal presentation and dress. Both service users indicated key-worker and family support in going shopping for personal items and clothing but this has been limited due care needs of individuals and most shifts having two staff on duty. Referrals to community learning disability nurses and local psychiatrist have taken place to support with behaviour management and medication reviews. Service users today were observed not to interact with each other. Physical withdrawal and anxiety through body language of moving away from each other, leaving the room when entered by another, physically covering their ears when spoken too and walking away, banging of table. Indicating they are leading very separate co-existence in the home. The quality of life and 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 14 emotional and psychological support / opportunities for all service users are suffering as a result of this. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 22,23 The home operates in an open manner and has not had any formal complaints since the last visit. Service users are at risk of being supported inappropriately due to the lack of confidence from staff in managing current individual behaviour. EVIDENCE: The complaint procedure is clearly on display around the home. A service user spoken with clearly understood who to talk to if they wish to make a complaint. But quickly stated they had “no complaints, all the staff were lovely”. Staff spoken with expressed a good understanding how to prevent abuse and raise an alert, thus safeguarding service users from the risk of harm or abuse. Through using the whistle blowing process and instigating the current adult protection investigation. Also through this awareness, staff have raised their concerns at the lack of knowledge and confidence in working with current challenging behaviour and promoting a safe home, maintaining service users rights and personal safety. Senior management and placing authority are aware of these concerns. There is currently an adult protection alert being monitored through Kent and Medway Adult protection protocols and a police investigation, this is not related to the current manager. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 the following standard(s): 24,25,26,27,30 Service users have sufficient facilities to meet their current needs with minor alterations that would benefit further safe and comfortable surroundings. EVIDENCE: There is continued commitment from the manager and staff to maintain the home to a good standard. Work required from the previous inspections has been implemented. A service users bedroom has been decorated in the colours of their choice. Service users would benefit from having their own washbasins in their bedrooms. This would be specifically beneficial to the ground floor to promote good infection control measures and hand washing facilities. But even more so for personal space and reduce the risk of conflict for the service users on the first floor who are routine orientated and often clash in using the communal bathroom facilities. Due to recent behaviours experienced service users have had their bedroom doors locked at night for personal safety. This restricts personal choice and dignity. This must be risk assessed particularly in relation to fire safety and agreed within through a multi-disciplinary process. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 17 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 Staff do not feel confident in the their skills and current staffing levels to provided a safe and happy home. EVIDENCE: The home has experienced continued difficulties in maintaining a stable staff team. Rosters are heavily reliant of MCCH bank staff to cover core hours. This has not provided consistent staffing and stability for the service users particularly those with autistic tendencies who require routine and familiarity. Staff working in the home has tried hard to offer good care within this framework. Staff openly shared their concerns around this. Staff do not feel confident to manage current behaviours being presented by a service user and the effect this is having on the other service users. Consequently service users individual and joint care needs are not being met. The service co-ordinator discussed current action being taken to address the permanent staff vacancies to have a stable staff team. Including the advertising for a senior support worker. Stability will be affected further with a long-term staff member starting maternity leave in the coming week, who is looked upon very fondly by service users. There are currently two staff on duty during the day and one staff sleeping over. Waking night cover due to service users behaviour was withdrawn from this week. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Through the newly appointed manager there is the leadership and support systems being implemented, to enable the management of the home to develop and grow into good care practice, and so reduce the potential risk to service users. EVIDENCE: The home has undergone a period of uncertainly and poor management, identified through adult protection and internal MCCH investigations leading to termination of the previous manager contract. The newly appointed manager has many years experience in working with this service user group. Who is strongly motivated in good management practice and monitoring systems. Staff reflected this through action taken in the past two weeks and feeling of more having more structure and direction. Concerns were discussed regarding the locking of service users in bedrooms at night (as agreed with care management) following recent threatening 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 19 behaviour towards a service user. Alternative monitoring and sound activating devises should be explored, to ensure personal safety but also to work with personal rights and dignity as well as fire safety. Full multi agency assessment and agreement should be recorded where such restrictions are considered to protect and ensure service users safety. Regular maintenance of equipment is undertaken with records held to monitor this. Staff have a good understanding of regulation 37 process and completion of accident / incident records. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 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 2 1 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 1 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 X X 2 LIFESTYLES Standard No Score 11 2 12 X 13 2 14 1 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score 1 1 X 2 1 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 20 Allington Way Score 2 1 3 X Standard No 37 38 39 40 41 42 43 Score 2 2 X X X 2 X DS0000029146.V260512.R01.S.doc Version 5.0 Page 21 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 YA4YA3 Regulation 12(3) Requirement The registered person shall, for the purpose of providing care to service users and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Particularly through the in the admission process and review of placements and compatibility of tenants. To be completed by timescale date. 2 YA9 13(4) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety In that environmental risk assessments will be undertaken and appropriate action taken, particularly in that individual risk assessments be expanded upon in scope. To be completed by timescale 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 22 Timescale for action 31/12/05 31/12/05 date. 3 YA14 16(2)(m) The registered person shall having regard to the size of the care home, the number and needs of the service users: Consult with service users about their social interests, and make arrangements to enable them to engage in local social and community activities. To be completed by timescale date. 4 YA24YA42 23(4)(c)(d) The registered person shall after consultation with the fire authority make adequate arrangements for; For evacuation in the event of fire of all persons in the care home and safe placement of service users by reviewing practice of locking bedroom doors at night. To be completed by timescale date. The registered person shall ensure that: All parts of the home to which Service Users have access are so far as reasonably free from hazards to safety. Unnecessary risks to the health and safety of Service Users are identified and so far as possible eliminated. . By installing washbasins to all service users bedrooms by the timescale indicated. To be completed by timescale date. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 23 31/12/05 31/12/05 5 YA24 13(4) 31/03/06 6 YA28 23(1)(l) Suitable facilities are provided 31/12/05 for Service Users to meet visitors in communal accommodation, in private accommodation, which is separate from the Service Users own private rooms. Action plan to be submitted by timescale date. The registered person shall having regard to the size of the care home, the statement of purpose and number and needs of service users: Ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that all there is a permanent care staff team trained and competent to meet the current service users care needs. Action plan to be submitted by timescale date A person shall not manager a care home unless he is of integrity and good character, qualified and holds the necessary skills for managing a care and has been deemed fit by the commission. Application from the newly appointed manager is to be submitted to the commission with in the set timescale to under take fit person process and registration under the Care Standards Act 2000. 7 YA32 18(1)(a) 31/12/05 8 YA37 9 16/12/05 9 YA39 26 Where the registered provider is DS0000029146.V260512.R01.S.doc 30/11/05 Page 24 20 Allington Way Version 5.0 an organisation or partnership, the care home shall be visited in accordance with this regulation by – (c) An employee of the organisation or the partnership that is not directly concerned with the conduct of the care home. Visits under paragraph (1) or (2) shall take place at least once a month and shall be unannounced. The person carrying out the visit shall (a) Interview, with their consent and in private, such of the Service Users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home; (b) inspect the premises of the care home, its record of events and records of any complaints; and (c) prepare a written report on the conduct of the care home. Submit a copy of the report to the manager and commission. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 25 No. 1. Refer to Standard YA1 Good Practice Recommendations The statement of purpose and service users guide is further developed on other formats to meet the needs of current service users, especially for those with limited reading skills. This is an ongoing recommendation from the previous inspection. The contract is in a format/language appropriate to each Service Users needs, and /or reasonable efforts have been made to explain the contract to the Service User. This is an ongoing recommendation for the previous two inspections of 2004. The care plans continue to develop in a format/language appropriate to each Service Users needs, and /or reasonable efforts have been made to explain the care plan to the Service User or representative. This is an ongoing recommendation from the previous inspection. It is recommended that staff and management demonstrate how individual choices have been made and record instances when others make decisions and why. Limitations on facilities, choice or human rights to prevent self harm or self neglect or abuse or harm to others are made only in the persons best interest, consistent with the purpose of the service and the homes duties and responsibilities under the law. It is recommended that the daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual care plan and contract. It is strongly recommended that specific instructions be recorded and agreed with the GP wherever possible for the administration of PRN medicines, particularly sedatives, and other medicines of this type. It is strongly recommended that physical and verbal aggression by a service user is understood and dealt with appropriately, and physical intervention is used only as a last resort by trained staff in accordance with Dept of Health guidance, protects the rights and best interests of the service user, and is the minimum consistent with safety. It is recommended that staff continue to be facilitated to attain NVQ qualifications as stated in the standard 2. YA5 3. YA6 4 5 YA7 YA7 6 YA16 7 YA20 8 YA23 9 YA32 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 26 10 YA32 11 12 YA33 YA36 It is strongly recommended staff receive training in the management of behaviours that may challenge and techniques in which to divert behaviours and minimise the risk of using physical intervention. It is recommended that regular staff meetings take place and are recorded with action taken. It is recommended that staff have regular, recorded supervision at least 6 times a year with their senior or manager in addition to regular contact on a day to day practice covering areas detailed in this standard. These records are signed and dated by staff. It is strongly recommended that methods for formal feedback to be collected from staff and service users be devised. It is recommended that there is an annual development plan for the home, based on systematic cycle of planning action, review and reflecting aims and outcomes for service users. It is recommended that views of other persons involved with service users is actively sought through a quality assurance survey at least once an year and the feedback is summarised and submitted to the commission and included with the service users guide for prospective service users reference. 13 YA38 14 YA39 15 YA39 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 20 Allington Way DS0000029146.V260512.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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