Inspection on 25/04/06 for 2a & 2b Mayfair

This inspection was carried out on 25th April 2006.

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 no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2a & 2b Mayfair 12/02/09

2a & 2b Mayfair 26/04/07

2a & 2b Mayfair 07/11/06

2a & 2b Mayfair 23/01/06

2a & 2b Mayfair 07/06/05

2a & 2b Mayfair 04/11/04

2a & 2b Mayfair 21/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

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

CARE HOME ADULTS 18-65 2a & 2b Mayfair Tilehurst Reading Berkshire RG30 4QY Lead Inspector Jill Chapman Announced Inspection 25th April 2006 10:20 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 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 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 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. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 2a & 2b Mayfair Address Tilehurst Reading Berkshire RG30 4QY 0118 945 3743/4 0118 9453743 nick_debourg@hotmail.co.uk londonroad@tiscali.co.uk Milbury Care Services Limited 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) Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd January 2006 Brief Description of the Service: Mayfair provides twenty-four hour care to ten adults, of both sexes, with learning and associated difficulties. The home is owned by Milbury Care Services Limited. The house consists of two properties, joined internally via a corridor and has bedroom accommodation on the ground and first floors. The home is in a suburb of Reading approximately fifteen minutes from the town centre. Local shops and facilities are available within walking distance of the home. The home has its own transport and is on public transport is readily available. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a short notice announced inspection carried out on a weekday over a period of just under seven hours, by two inspectors. The focus was to follow up progress from the previous inspection and to inspect the key standards. The inspection was announced to give inspectors the opportunity to speak with the Manager and Service Manager. A tour of the building was carried out; inspectors spoke with staff on duty and met most of the service users. Some of the daytime routine was observed. The Service Manager attended for feedback during the afternoon. Service user surveys were sent out and all were returned. In all cases service users were assisted to fill these in by members of staff because they were unable to complete them due to their disabilities. There were ten requirements from the previous inspection. The Manager said that these issues were being addressed but there was insufficient written or outcome evidence from this inspection to show that progress is being made. These requirements will be raised again in this report. What the service does well: Service users are satisfied that they have had enough information to decide whether to come and live in the home. They are helped to keep in touch with families and friends. They are provided with meals that they help choose. Service users medication is kept and given by staff that have been trained. Recruitment procedures check the suitability of potential staff. Health and safety systems are generally good. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home needs to make sure that all new service users have a full and recorded assessment to make sure they can meet their needs. Service users support plans should be kept up to date and daily notes should show that these are being carried out. Service users choice should be identified and respected where possible. Risk assessments should be kept up to date to keep service users safe. Service users activity programmes should be carried out and their community access could be improved. Service users would benefit from a more consistent approach by staff and from up to date behaviour support plans. They would benefit from annual health checks and from their weight being monitored. Service users equality and diversity needs are not fully met. These would improve if proper assessments are carried out, care plans and behaviour guidelines are kept up to date and if service users are helped to dress to their individual taste. Staff and service users would benefit from further information on how to make and deal with complaints. Further work needs to be carried out with the staff team to help them protect service users from abuse. Improvements are needed to bring the premises and furnishings up to standard. Support plans should be in place try to help some service users who have difficulty using toilet paper appropriately. The programme of NVQ training needs to be further developed and core training should be kept up to date. Ongoing work to develop care practice will improve consistency of care for the service users. There is not enough evidence of day-to-day management and service development being carried out. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 8 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 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 9 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): 2 Quality in the outcome area, Choice of Home, is overall poor. Service users are consulted about whether they want to move into the home and receive enough information about the home. Service users cannot be sure that their needs are fully assessed. EVIDENCE: Some service users assessments were still not available at this inspection. There were examples that the home is unable to meet all of the needs of service users appropriately. One service user has not had the choice of a bath for over a year because the proper equipment is not available. In discussion with the service manager it was evident that the service users needs had not been fully identified at the time of admission. Another service user has not slept in bed for over a year and there was no documented evidence to say whether this meets the service users’ needs or choice. Assessment that were in place do not always reflect current needs of service users. There is one female service user and nine males. It is not clear from records seen whether this issue is considered when reviewing how the home is meeting her needs. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 10 From the surveys, the majority of service users said they were asked if they had wanted to move into the home and felt they had enough information about the home prior to moving in. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 11 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 & 9. Quality in the outcome area, Individual needs and choices, is poor. Individuals needs and choices are not always identified or respected and there are examples where their equality and diversity needs are not being adressed. Service users safety is compromised because risk assessments are out of date. EVIDENCE: Care plans sampled were not up to date. The Manager said that reviews have been held for nine of the ten service users but review notes were not always available. The result of reviews were not known by staff spoken to or seen to be used as a basis for the care programmes. The quality of daily recording is poor and does not always show that care plans are carried out. There were examples where service users choices are restricted and these show that their equality and diversity needs are not being met. One service user does not have the choice of having a bath because the right equipment is not available and he is being asked to pay for equipment that he would have free if he originated form the local geographical area. Staff have decided not to provide toilet paper in an upstairs bathroom rather than try to work with 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 12 service users behaviours regarding this. Service users are still dressed in similar type of clothing and this does not reflect their individual personalities. Service users likes or dislikes were not always noted on the files. Surveys show that service users feel they are sometimes or always able to make decisions about what they can do each day. Risk assessments sampled were found to be out of date, some were pertaining to the service users previous home. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 13 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): 12, 13, 15, 16 & 17 Quality in the Lifestyle outcome area is overall poor. Service users do not benefit from meaningfull activity programmes or have sufficient access to the community. They have good contact with friends and families. Service users are provided with meals that they help choose. EVIDENCE: Although service users have activity programmes, records sampled show that these are not fully carried out. Records also show that service users have limited access to the community. Service users rights or choices are not always respected (i.e. toilet roll not provided, lack of individual clothing choice or being asked to pay for mobility equipment) From looking at records and in discussion with staff it was seen that service users continue to have good contact with families/friends. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 14 Menus seen and meals sampled were satisfactory. Staff said that menus are planned weekly with the service users in each side of the house. Menus appeared varied and nutritious. Staff spoken with were aware of service users food allergies. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 15 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 Quality in the outcomes area Personal Care and Support for service users is overall poor. Service users cannot be sure that their personal support needs are identified as up to date or that staff will be consistent in their care. Service users health needs are not fully monitored or kept up to date. There is a system to make sure staff can give and look after service users medication safely. Further discussion is needed with the GP to see if one type of medication is still needed. EVIDENCE: Personal support needs were not updated on care plans sampled. Behaviour plans are either not in place or are not up-to-date. Contradictory care practice by staff was observed. A staff member confirmed that behavioural guidelines are not clear for one service user and that each staff uses his own experience or knowledge to respond to a service users challenging behaviour. Service users have not had annual checks, the Manager has discussed these with the GP but none have been arranged. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 16 Service users weight has not been recorded since 2005, staff said that the scales are not working. One Service user was losing large amounts of weight in 2005 and the GP’s request for a hospital weight check has not been complied with. The arrangements for medication were seen and found to be satisfactory. A system of training and checking makes sure this is administered safely. It was seen that a number of service users are written up for PRN Rectal Diazepam and that they have not rqequired this for a number of years. It is recommended that this matter is reviewed with the relevant GPs’. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 17 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 Quality in the Complaints, concerns and protection outcome area is poor. Service users cannot be sure that complaints are dealt with properly. Not all service users know how to or are able to make a complaint without staff help. Not enough action has been taken to make sure the staff team know how to protect service users from abuse. EVIDENCE: The Manager said that he has discussed the complaints procedure in staff meetings and the complaints procedure has been made more accessible to staff. The complaints record however is still not up to date with previous complaints that were outstanding at the last inspection. Surveys show that not all service users know how to make a complaint but in some cases it was clear that staff would help them to do so. The requirement to ensure that the complaints procedure is adhered to will be raised again. A requirement was raised that ‘the manager and staff are able to effectively protect service users (from abuse) and to produce a plan to evidence this’. A written plan has not been forwarded to CSCI. The Manager said that staff are to be sent on training in June or July but no dates have been confirmed yet. Given the severity of a past vulnerable adult incident which raised issues about some staff members attitude to abuse, this is an unacceptable delay of almost nine months until staff will receive training. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 18 The record of the staff meeting held on 6/02/06 shows that the Manager intends to raise care practice standards and to include focussing on POVA issues. There is no further evidence of team discussions about this. However there is evidence in supervision notes sampled, that the Manager has spoken individually with staff about POVA issues. The Manager said that he is working alongside staff on shift to help staff improve care practice. There is insufficient evidence from this inspection that the Service Manager and the Manager are working with the staff team to ensure that they are working together to protect service users. This requirement has not been met and will be raised again. There is a system in place to look after service users monies. Inspectors sampled the records and cash for four service users. The cash records and receipts were accurate. There were a number of large withdrawals made by Milbury, which the Manager said were retrieval of overpaid monies. These amounts however did not have receipts to identify why the withdrawals were made and to validate the record. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 19 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 & 30 Quality in the Environment outcome area is overall adequate. Some improvements are needed to bring the premises and furnishings up to standard. Hand washing and drying facilities are being improved in toilets and bathrooms. Some service users have been deprived of the opportunity to be helped to use toilet paper. EVIDENCE: A tour of both sides of the home was carried out and all communal areas and most of the bedrooms were seen. The home has benefited from refurbishment and extension in recent years. A requirement to clean the carpets and to redecorate as necessary has not yet been met. The carpets have been cleaned but the dark stains remain. The Manager said that Milbury have decided to replace the soiled carpets during the period April- June 2006. Redecoration is planned in the period July2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 20 September 2006. These timescales will be raised as requirements from this report. The lounge furniture is stained and worn and the manager said that this is to be replaced. This will be subject to requirement from this report and a timescale given. Service user survey feedback about whether the home is clean varies from sometimes to always. Some bedroom furniture, bedding and curtains are in need of replacement and in speaking with the Manager he was unclear as to whether it was Millburys’ responsibility or the service users to replace these items. Regulation 16 shows that it is Milburys’ responsibility. In the event that a service user wishes to purchase particular items then records should evidence that consultation has taken place with the service user, relative or advocate validating any decision. There were a number of outstanding maintenance issues but these were being addressed on the inspection day. The home was generally clean and hygienic, however there were some shortfalls. Not all toilets and bathrooms had hand washing or drying facilities. Soap dispensers and paper towel dispensers had been delivered and a workman came to fit these during the inspection. Care plans and risk assessments need to be developed for the men using the upstairs bathroom in house 2a, so that they are not deprived of the opportunity to use toilet paper. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 21 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): 32, 34 & 35. Quality in the outcome area Staffing is overall adequate. There are adequate numbers of staff on shift but some practice development is needed to make sure that all staff are competent to meet the needs of the service users. The staff recruitment procedure makes sure that checks are carried out to make sure that staff are suitable to work with service users. The registered persons need to make sure that staff benefit from suitable training to help them meet service users needs and improve care practice. EVIDENCE: The numbers of staff deployed on each shift appears satisfactory. The Manager confirmed that there are still a high number of staff who work part time. This still causes consistency and flexibility issues in planning the staff rota. The manager said he is working with staff to improve care practice and to resolve some longstanding staff problems. He said that some staff are responding well to this development and that management strategies will be put in place if others fail to respond. Most staff practice observed appeared satisfactory but an inappropriate staff response to an incident at lunchtime was reported to the manager. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 22 There is a Milbury recruitment procedure in place. From speaking to staff and sampling records it was seen that the procedure is carried out. References and POVA/CRB checks are carried out to ensure staff are suitable to work with vulnerable people. Survey feedback about whether staff treat service users well and listen to them varies from always, usually and sometimes. There is a programme of NVQ in place. Out of a staff team of seventeen only four staff have got NVQ 2 and two are taking this. This is an area that needs further development In talking with staff and from information supplied by the manager it is apparent that core-training updates are overdue. Dates for this training are not yet confirmed. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 23 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, 39 & 42. Quality in the Management outcome area is poor. The new manager has not yet applied to be registered. There is not enough evidence of day-to-day management and service development being carried out. A Quality Assurance system has been developed. Health and safety arrangements are generally good. EVIDENCE: A new Manager has been appointed in February 2006 but he has not yet submitted an application to be registered. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 24 The Manager said he is working with staff individually to improve practice. Some evidence of this was seen in supervision notes sampled and from speaking to staff. There was insufficient evidence to show that team development is taking place. Only one staff meeting has been held since the last inspection and the staff communication book does not show that the manager is addressing day-to-day issues with the staff team. This is an area that needs further improvement. A requirement was made that the Quality Assurance System be completed. The Service Manager said that this has been carried out but a copy was not available to be seen. A home development plan was seen but this relates to addressing the requirements from the inspection report rather than looking at the overall development of the service. Health and safety records sampled were generally up-to-date. The boiler service and P.A.T. testing certificates were not in place. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 25 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 Standard No Score 1 x 2 1 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 1 1 x 1 x 2 x x x x x 2 LIFESTYLES Standard No Score 11 x 12 1 13 1 14 x 15 3 16 1 17 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000011045.V289942.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 2a & 2b Mayfair Score 1 1 3 x 2 x 2 x x 2 x Version 5.1 Page 26 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 YA13 Regulation 16.2 (m) (n) Requirement To further review daily activity programmes for service users. (Outstanding timescales 01.01.05,01.08.05, 01/04/06) To ensure that the manager and staff are able to effectively protect service users and produce a plan to evidence this. (Outstanding timescales 01/07/05, 01/04/06) To evidence that the home is able to meet the assessed needs of new service users. (Outstanding timescale 01/07/05, 01/04/06) To keep the service users plans under review and ensure they are up-to-date. To ensure the service users support needs are met To ensure that the health needs of the service users are met. (Outstanding timescale 01/04/06) DS0000011045.V289942.R01.S.doc Timescale for action 24/06/06 2. YA23 13.6 24/06/06 3. YA2 14 24/06/06 4. YA6 15.2(b) 24/07/06 5. 6. YA18 YA19 12.2 .3 13.1 24/07/06 24/06/06 2a & 2b Mayfair Version 5.1 Page 27 7. YA22 22 To ensure that the complaints procedure is adhered to. (Outstanding timescale 01/04/06) Replace the stained carpets by To review the ‘make-up’ of the staff team and to look at the attitudes and competence of staff members. To complete the quality assurance system. Carry out redecoration as necessary by Receipts should be available for withdrawals from service users personal accounts Replace worn beds, bedding, linen and bedroom curtains as necessary. Replace the soiled lounge furniture by Support plans and risk assessments need to be developed for the men using the upstairs bathroom in house 2a, so that they are not deprived of the opportunity to use toilet paper. The Manager should submit an application to be registered. 01/07/06 8. 9. YA24 YA32 23.2(d) 12.5(b) 18.1(a) 01/07/06 24/07/06 10. 11 12 13 14 15 YA39 YA24 YA23 YA24 YA24 YA30 24 23.2d 16.2(l) 16.2© 16.2 © 13 (3) 01/09/06 29/09/06 24/07/06 24/08/06 24/10/06 24/07/06 16 YA37 9 24/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011045.V289942.R01.S.doc Version 5.1 Page 28 2a & 2b Mayfair 1 Standard YA20 Review the need to hold stock of Rectal Diazepam with with the service users GPs’. 2a & 2b Mayfair DS0000011045.V289942.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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. 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