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Inspection on 19/06/07 for 7 Hyde Road

Also see our care home review for 7 Hyde Road for more information

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at Hyde Road lead positive and independent lifestyles. Scope provides detailed and clearly written information on all the services, which include Hyde Road. Staff are trained and supervised so that they can give the best possible help and support to the people using the services. The service users say that they are treated with respect and are well supported in maintaining as independent a life as possible. There are effective systems in place to monitor the quality of services and that the needs and wishes of the two residents are met. Care plans detail the assessed health needs of service users and records seen also demonstrated evidence of good multi-disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear, comprehensive arrangements in place to ensure service users` medication needs are met.Scope excels in ensuring good links with the community, which supports and enhances the service users` social and educational opportunities. SCOPE are proactive in keeping up with all relevant guidance, legislation and training and continue to present and campaign for the rights of all people.

What has improved since the last inspection?

Since the last inspection the lounge has been refurbished and is now a comfortable room for the service users to enjoy.

What the care home could do better:

The current standards provided within this service have been well maintained and it is important the staff and manager continue to provide this level of quality services to ensure positive outcomes for the two people living at Hyde Road. There are however, maintenance issues which need to be addressed e.g. the kitchen and bathroom need to be refurbished and once these works have been completed this will further strengthen the quality of the service provided. Please note the Manager has already identified with the Housing Association the work required and plans are coming to fruition for the scheduling of the work.

CARE HOME ADULTS 18-65 Hyde Road (7) Gillingham Dorset SP8 4BX Lead Inspector Marion Hurley Key Unannounced Inspection 19th June 2007 10:00 DS0000026754.V339833.R01.S.doc Version 5.2 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 DS0000026754.V339833.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. DS0000026754.V339833.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hyde Road (7) Address Gillingham Dorset SP8 4BX 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) 01747 825104 01747 mulberry.court@scope.org.uk www.scope.org.uk SCOPE Russell Grant Masters Care Home 2 Category(ies) of Physical disability (2) registration, with number of places DS0000026754.V339833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2006 Brief Description of the Service: 7 Hyde Road is the home of two service users who have been married for a number of years. Their home is a 2 bedroom bungalow in a residential part of Gillingham, approximately 1 mile from the centre of the town. The service users live independently for the most part, receiving around 40 hours staff support during the week, plus periodic visits to monitor their health and welfare. The bungalow is owned by a local housing association, and the service is operated by SCOPE, a not-for-profit organisation providing services to people who have physical disabilities. Management and staffing of the home is undertaken from Mulberry Court, which is the administrative centre for the group of related services operated by SCOPE in Gillingham. Service users have copies of Commission for Social Care Inspection reports in their home. Fees for the service, as of July 2007 range between £25,237 and £37,911 per annum. Variable additional charges are payable for holidays, hairdressing, toiletries, activities, trips, magazines/papers and public transport. The Office of Fair Trading fees and fair terms of contracts can be accessed via the following web link: www.oft.gov.uk. DS0000026754.V339833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit at Hyde Road was announced and took five hours and formed just one part of the overall inspection process. The inspection looked at those standards, which the Commission for Social Care Inspection regard as key minimum standards. The inspection included a visit to Hyde Road, examination of various records and time spent talking with both the services users who live at Hyde Road, care staff and the Service Manager. The inspection also took account of information gathered about the service since the last inspection including a detailed questionnaire completed by the Manager. CSCI questionnaires/ comment cards were made available for the service users, families, health and social care professionals and all those received were very positive about the quality of services provided though Scope. The inspection involved time spent at Mulberry Court, which is the administrative and staff base for Hyde Road What the service does well: People living at Hyde Road lead positive and independent lifestyles. Scope provides detailed and clearly written information on all the services, which include Hyde Road. Staff are trained and supervised so that they can give the best possible help and support to the people using the services. The service users say that they are treated with respect and are well supported in maintaining as independent a life as possible. There are effective systems in place to monitor the quality of services and that the needs and wishes of the two residents are met. Care plans detail the assessed health needs of service users and records seen also demonstrated evidence of good multi-disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear, comprehensive arrangements in place to ensure service users’ medication needs are met. DS0000026754.V339833.R01.S.doc Version 5.2 Page 6 Scope excels in ensuring good links with the community, which supports and enhances the service users’ social and educational opportunities. SCOPE are proactive in keeping up with all relevant guidance, legislation and training and continue to present and campaign for the rights of all people. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000026754.V339833.R01.S.doc Version 5.2 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 DS0000026754.V339833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Hyde Road are given information about the services available to them. New people considering accessing any of the services offered by Scope would be provided with comprehensive information available in the Statement of Purpose and Service User Guide. Any admission to the service would follow a process of assessment and suitability. EVIDENCE: The two people living at Hyde Road have done so for a number of years so the admission process has not been “tested”. However, Scope have a clear and documented admission process, and staff demonstrated an understanding of the need for a good assessment prior to admission. In addition the Service User Guide clearly states “all prospective service users are invited to visit where they can stay overnight giving them a chance to meet with other service users and staff, view their bedroom, common areas and garden and have a meal”. During this visit (with family, friends, advocate and interpreters as DS0000026754.V339833.R01.S.doc Version 5.2 Page 9 appropriate) they will have a chance to discuss how the service can meet their needs and see the type of records that are kept about service users. The records of one of the service users was looked at in detail and held a great deal of detailed assessment information including multi-disciplinary care management assessments obtained prior to admission. DS0000026754.V339833.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The two service users at Hyde Road make appropriate decisions about their lives and are involved in the assessment and planning process. The two service users are supported to take risks as part of an independent lifestyle. Records are in place, which show that changes to the service user’s needs are identified and acted upon and this ensures staff have the information to help service users make safe choices about what they do each day. DS0000026754.V339833.R01.S.doc Version 5.2 Page 11 EVIDENCE: The manager explained that the main principle behind the work she and the staff do is based on enabling people to take control of their own lives. Both the people who live at Hyde Road were spoken with during the inspection and confirmed that they make their own decisions about the care and support they receive and take full part in reviews. The records examined held detailed daily records, care plans and review documents, which together with appropriate risk assessments gave evidence that both the service users are supported in enjoying an independent lifestyle. Each service user is linked to one specific member of staff known as their key worker and they will then have regular key worker meetings to review their care and support plans. The care plans and other documentation for the two people living at Hyde Road are stored in their home. The care plans are well presented and cover all aspects of the person’s lifestyle and personal care and health needs. The Plans are clearly set out with an index, sections include, health care, emotional care, care needs, my home, social and daily activities, risk assessments, annual review, action plans and monthly round up/monitoring meetings. The risk assessments in place show how each person is encouraged and supported to take responsible risks, both in the home and local community. One of the people living at Hyde Road discussed and showed the inspector their care plan and verified that the records were an accurate reflection of their lifestyle and personal needs. Staff spoken with were aware of the specific needs of the people living at Hyde Road and understood their desire for greater independence within safe boundaries. Scope have policies and procedures on the confidentiality of information. DS0000026754.V339833.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff support the two people living at Hyde Road to lead positive lifestyles both in their own home and in the local community. EVIDENCE: The manager explained that the service has a strong commitment to enabling the couple who live at Hyde Road to maximise their abilities and potential and to fully develop social, emotional, and independent living skills. Part of the responsibility of the key worker is to encourage each person to develop their own preferred lifestyle and activities within the local community. The two people living at Hyde Road have both chosen to work at Thorngrove Garden Centre. During this visit one person was met in their work place and the other was visited at Hyde Road. DS0000026754.V339833.R01.S.doc Version 5.2 Page 13 Discussions with both of the service users demonstrated that they are given the opportunity to develop and maintain important personal and family relationships and have clearly established some good relationships with people living in their neighbourhood. They described to the inspector how most Saturday evenings will be spent with their neighbours playing cards. Staff support within this small home is minimal and is limited to certain times each day however if a specific need arises staff are available to respond and are always flexible in the times and level of support offered. Discussion with the manager showed that individual rights and choices are promoted, and both the verbal and written reports confirmed that the couple are supported to make informed choices about things, which are important to them, i.e. their lifestyle, relationships, and meaningful activities. As there are just the two people living at Hyde Road both take it in turns to cook and both are quite capable of producing a good meal. They share the household shopping and again manage this quite independently though staff will undertake routine checks to ensure a reasonably balanced and healthy diet is followed. Staff undertake regular health and safety and food hygiene checks though the couple complete many of these tasks with staff only undertaking a monitoring role. Staff have completed the Basic Food Hygiene Certificate and there is an annual “in house refresher course”. It is recommended that only the current monitoring sheets are in the health & safety file and previous records could be stored in an archive system for the home. DS0000026754.V339833.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service provides appropriate personal & healthcare support and this ensures the assessed health and personal care needs are met and people are supported to stay well and healthy. EVIDENCE: The records seen during the visit showed that the healthcare needs of the two people living at Hyde Road are monitored and action taken to resolve any problems. The couple keep their own files and the records include: • A record of any care or treatment from doctors, nurses and others such as dentist, opticians, chiropodist. • Personal medical information • A detailed guide about how to support each service user. • Specific medication requirements. DS0000026754.V339833.R01.S.doc Version 5.2 Page 15 Even though the couple living at Hyde Road require minimal support to manage their personal care and hygiene the records indicated that staff regularly monitor the couple’s on going abilities to ensure positive lifestyles. The records show that the manager and staff ensure that the couple receive effective and individualised personal healthcare support using a person centred approach. The manager explained that care plans are developed and written with the involvement of the person and discussions with both the service users verified this and further evidence was obtained from checking the records, which demonstrated that the care plans, were individualised, person centred, and had been regularly reviewed and updated. Service users have a choice of GP, although the couple both attend the local village surgery. One care file evidenced that the service user has been given the support and opportunity to manage their own medical condition as much as is feasible within a risk management framework. Staff have been provided with detailed and thorough information in relation to one of the service users health needs/ condition. There is a clear action plan to be followed and daily checks to be made. The records evidenced that the service users’ health is monitored closely and problems dealt with at an early stage. Scope have policies and procedures on the administration of medication and all staff receive appropriate training. DS0000026754.V339833.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Procedures are in place to deal with any complaints or adult protection issues that may arise. These ensure that service users and / or their relatives are listened to and that services users are protected from possible harm. EVIDENCE: The manager said the home have not received any formal complaints nor made any referrals under the adult protection procedure since the last inspection. The complaints book was seen during the visit. Staff spoken with during the visit were aware of what action to take if they received a complaint or were concerned about an adult protection issue. Those asked stated they would normally refer their concerns to the senior member of staff on duty. The records show that the manager has developed a clear complaints procedure provided in a format that the people receiving services from Scope can understand. The document starts with “ Complaining isn’t wrong – it’s a right”. It highlights the importance of complaining and/or making suggestions for improvement that benefit people living and working for the Scope services. The document continues to add “Complaints are really positive – they give us an opportunity to improve things, both for ourselves and for other people” DS0000026754.V339833.R01.S.doc Version 5.2 Page 17 The document received a Crystal Mark for its clarity by the Plain English Campaign. Both the service users living at Hyde Road assured the inspector that they had no major concerns or complaints and are confident the manager and staff do listen to them. From these discussions it was clear that they do understand how to make complaints and are not inhibited in doing so if the need should arise. The manager intends for Hyde Road to maintain their own complaints/concerns file, which the couple can write directly in. Currently complaint records for all the local Scope services are kept at Mulberry Court. The records show that quality monitoring systems are in place to make sure staff are fully aware of the policies and procedures provided in relation to protecting and safeguarding the rights of the people living at the home. Observations made on the day indicated that the views and experiences of people living at the home are valued. Scope has a full Adult Protection Policy and Procedure on which staff receive training. The training records further evidenced this information. Service users are also encouraged to attend training and be aware of the procedures. All service users accessing Scope services have either a bank or building society account, which they can access cash from. Most people have two accounts one for service fees and benefits and the other for their personal allowances and income. The management of finances is an important area for the couple living at Hyde Road who strive for total independence however it is necessary for staff to ensure safe handling of money and therefore they do provide support and monitoring of the household and personal budgets. DS0000026754.V339833.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The two service users enjoy living in their home, which suits their needs. However, aspects of the fabric of the home require attention i.e. the kitchen needs to be refurbished. (It should be noted this work is scheduled) EVIDENCE: Hyde Road is a 2-bedroom bungalow located in quiet cul-de-sac close to the centre of Gillingham, Dorset. Although the bungalow has some adaptations to meet the current service users’ needs, it would not be suitable for accommodating people who used a wheelchair. The property has two bedrooms, the service users themselves use one, and they use the second as an office. There is a kitchen and a lounge. The bathroom is adequate for their needs and has recently had a new shower fitted. The toilet is in the bathroom. There is a small garden/ yard to the rear of the property. DS0000026754.V339833.R01.S.doc Version 5.2 Page 19 The bungalow has a “lived in feel” and the decoration and fixtures and fittings clearly represents the couple and their interests. The standards of cleanliness and hygiene throughout the bungalow were satisfactory. The couple are pleased with the newly decorated living room and are especially pleased as a relative has recently given them a television. The building is owned and maintained by a local housing association. The external fabric of the building appears to be reasonably maintained though the front and rear garden would benefit from some additional planting and general maintenance. The kitchen and bathroom are in need of refurbishment and it is understood the Housing Association have agreed for the completion of this work. Both the people living at Hyde Road said they are happy with their home. DS0000026754.V339833.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A team of properly recruited and supervised staff who are qualified and well trained support the two people living at Hyde Road. EVIDENCE: The manager and support staff spoken with during the visit were aware of their roles and responsibilities in caring for service users. It was evident that the staff on duty were aware of the service user’s capabilities; service users were seen approaching staff and were comfortable in their company. Staff spoken with were able to talk in detail about the needs of the service users and how these needs were to be met. Staff also said they were able to discuss any concerns/worries with the manager and they would seek advice to ensure services users receive the help they needed. Records seen showed that thorough recruitment procedures are in place including obtaining two references and Criminal Record Bureau disclosures before any new staff start working for Scope. DS0000026754.V339833.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff working for Scope are trained, skilled and there are enough of them to support the people who use the service. The couple living at Hyde Road enjoy a positive and independent lifestyle with appropriate support to ensure their health and safety and general welfare is maintained. EVIDENCE: Staff spoken with said they receive support and supervision from the manager and that he will address issues about their performance with them. They also said the manager(s) are “very committed to providing a good home for service users to live in” DS0000026754.V339833.R01.S.doc Version 5.2 Page 22 Scope has a range of policies and procedures, which include health and safety, adult protection and managing service user’s finances. A number of health and safety records were examined to confirm that up to date maintenance / checks and records were in place including fire safety checks and staff training. There are several quality assurance systems in place which focus on the needs of the service users including care planning, review, regular service user meetings, regulation 26 visits, involvement of relatives and advocates and regular surveys. DS0000026754.V339833.R01.S.doc Version 5.2 Page 23 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 3 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 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 x LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 x 4 X 4 X X 4 x DS0000026754.V339833.R01.S.doc Version 5.2 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA15 Good Practice Recommendations Policies, which have been in draft for some 18 months, on sexuality and personal relationships should be verified and made available to staff in order for them to guide and support Service Users appropriately. The refurbishment of the kitchen and bathroom need to be completed as soon as possible to ensure the service users live in a homely, comfortable and safe environment. 2. 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