Inspection on 06/02/06 for Abbotsford

This inspection was carried out on 6th February 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Abbotsford 15/08/07

Abbotsford 04/09/06

Abbotsford 16/08/05

Abbotsford 07/02/05

Abbotsford 18/10/04

Abbotsford 22/03/04

Abbotsford 01/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Abbotsford 7 Bracken Road Southbourne Bournemouth Dorset BH6 3TB Lead Inspector Sophie Barton Unannounced Inspection 6 & 7 February 2006 13:50 th th Abbotsford DS0000004002.V282727.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 Abbotsford DS0000004002.V282727.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. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Abbotsford Address 7 Bracken Road Southbourne Bournemouth Dorset BH6 3TB 01202 417847 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) wells4269@fsnet.co.uk The Stable Family Home Trust Mr Mark Wells Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2005 Brief Description of the Service: The registered service provider is The Stable Family Home Trust [S.F.H.T] a registered charity that provides residential care, a day service and related services for adults with learning disabilities. The day and residential services are interdependent with support from specialist staff at the day service being available to the staff and service users in residential care services to provide training, guidance and help with among other things, issues such as employment; risk assessments and personal relationships. The home is located in the residential area of Southbourne, within walking distance of the local amenities and cliff top. Local amenities include shops, a post office and places of worship. Public transport is readily available and Bournemouth town centre a ten-minute bus ride away. The accommodation provides for up to eight people in a detached house converted for use as a residential care home. Bedrooms are located on the ground, first and second floors of the premises. The home is centrally heated and all users have single rooms, en suite facilities and the use of a lounge and dining room. There is a small garden area to the side of the property and a garden and patio area to the rear. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act 2000. The home was not given any prior warning of the inspection. The inspection was carried out over two days by one inspector Sophie Barton – 1:50pm to 4:20pm on the 6th February 2006 and between the hours of 3:40pm and 6:10pm on the 7th February 2006. The Registered Manager was present in the home during the inspection. Four service users were spoken with in a group and one individually. Two further service users were observed in the communal areas of the home. Two staff members were seen but not spoken with privately. The manager was spoken with at length and care files and records examined. Comment cards were received from 4 relatives to gather further views on the care provided by the home. What the service does well: The homes ethos, culture and practice is aimed towards promoting independence, respecting service user rights and ensuring service users lead as full a life as possible. They are certainly meeting these goals with service users leading meaningful lives and being encouraged to be as independent as possible. Three of the four service users spoken to confirmed that they liked living in the home. One service user stated he has wanted to move into more independent living and that this is now imminent which he was very pleased about. Service users are consulted informally and formally about the running of the home, and are active decision makers when it comes to the household routines. The staff provide person centred support to service users in meeting their daily support (personal care) needs. The guidelines written for staff ensure staff promote dignity, privacy and encourage independence. Staff are supported well by the manager, with regular supervision and appraisals taking place. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: There were sixteen standards assessed and eleven have not been met. Of most concern to the inspector is the limited care planning documentation for service users. The home has person centred plans for service users however these have not been completed in sufficient detail and do not record the service users needs, goals and aspirations. Where goals have been highlighted (in care meetings and reviews) it has not been recorded how the home is to meet these needs. The service can therefore not review its progress in whether appropriate support is being delivered to service users. Although risks are highlighted and assessed there is a lack of a formal reviewing of assessments and therefore service users preferred activities could be restricted unnecessarily. The lack of recording also affects whether the health needs of service users can be assessed as being met. There was a lack of evidence that service users have attended routine health appointments or that the outcome of health tests had been actioned. Further shortfalls were identified in relation to staff recruitment information and staff training. There was a lack of evidence that safe recruitment procedures had been followed. (Please also below) Staff have also yet to complete a sufficient amount of training to ensure that the service users are supported by an effective and competent staff team. In general health and safety procedures were sufficient in that regular checks and servicing take place of equipment. However improvement is needed in fire training. It must be noted that three requirements have been made for the second year running, with the Provider being notified of the shortfalls in 2004. The providers have yet to address them fully. Of most concern is the recruitment information and the Commission will be considering enforcement action. Abbotsford DS0000004002.V282727.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. Abbotsford DS0000004002.V282727.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 Abbotsford DS0000004002.V282727.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): 1 and 5 (standard 2, 3 and 4 are not applicable at this time) The home needs to continue to develop its information for prospective service to enable them to make positive choices about where they live. Current service users have yet to be provided with a contract, resulting in service users not being fully informed about the terms and conditions of their residency. EVIDENCE: The inspector was shown a copy of the Statement of Purpose that has been developed to meet the regulations and National Minimum Standards. The manager confirmed that this is now available to prospective service users. The Service User Guide has also been developed further, although some additions are needed (photos). There was no evidence provided to show that current service users have agreed a contract with the Provider. As there have been no new service users admitted to the home for several years standard 2, 3 and 4 are not applicable and cannot be assessed. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 and 9 Care planning within the home is limited, with service users having inadequate individual plans or details about their goals and aspirations. There are good systems in place for highlighting and assessing risks, but service users rights could be limited by restrictions not being reviewed regularly. The home’s culture promotes service user participation in all aspects of their lives, with service users consulted about decisions that affect them. EVIDENCE: The National Minimum Standards detail that the key to achieving an individually appropriate lifestyle is the Service User Plan (an individual plan that sets out the service users needs, goals and aspirations and how these are to be met by the home). The inspector examined two care files and noted that the Person Centred Plans being used by the organisation had not been completed in any form of sufficient detail for these two service users. There was no record of their goals or aspirations, and no record of how the home was to meet their needs. There was only information relating to personal care needs. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 11 There was no evidence that the Person Centred Plans are reviewed 6 monthly, although there are yearly reviews of the service user’s progress at the Day and residential services. There was no evidence that the decision making from these reviews have been incorporated into the individuals plans. This was also reflected in the risk management systems. Identified risks were assessed in detail, however there lacked regular reviews of the risk assessments. A service user was assessed as being at risk if they went to Southbourne by themselves. However there was no evidence that this had been reviewed since 2003, and could therefore restrict the service user inappropriately. There was evidence however that service users are enabled to take responsible risks where appropriate, in order to not limit their preferred activities (in relation to staying at home alone, going independently to the shops and using public transport). Positively, there were guidelines for staff to follow for assisting service users with their daily support and ensuring a consistent and respectful approach. For instance where a service user needs clear boundaries, in order to minimise any distress, the preferred way of working with this service user was recorded and available to staff. These guidelines focused on positive behaviour and were detailed and informative. The inspector observed service users participating in the running of the home (deciding on visitors to the home, cooking, activities). The resident meeting minutes also evidenced that service users decide between them the household routines, job rota, health and safety issues and maintenance needed. Service users have voiced the wish to remain at home some days and the manager is being proactive in attempting to meet these requests within the constraints of the budget. There is evidence that service users are involved in their annual reviews and in discussion with the manager he articulated how the service (and staff) value service user’s rights and enables choices. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home actively promotes independence and individual choice. Service users rights are respected by staff and by the organisation. EVIDENCE: In discussion with three service users they all confirmed that their privacy is respected and that they enjoy living in the home. They confirmed that staff knock on their doors before entering and allow them private time. Service users are able to lock their doors if they wish to and where appropriate have a key to the front door of the home. Staff were observed interacting closely with service users. Service users have unrestricted access to the home and grounds. They are also encouraged to keep the house clean and tidy and take responsibility for household chores. There is a daily rota for housekeeping chores. Service users are encouraged to be as independent as possible with shopping, and cooking their own meals. Staff have provided the service users with training and encouragement to enable them to be as independent as possible (in relation to cooking, shopping, staying in the home by self, and using the telephone). Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 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 and 19 The home provides personal support to service users which is sensitive, consistent and maximises service users privacy and independence. Due to a failure in recording there is a lack of monitoring and assessment of service user’s health needs, and therefore health needs can be unmet by the home. EVIDENCE: The personal support guidelines and plans for service users are easily available to staff. They inform staff of how to support service users, and state service users preferences about how they are guided. These guidelines further evidence that the support given promotes independence and choice and that the rights of service users are fully promoted. The inspector observed that mealtimes are flexible and service users further confirmed that times for getting up, baths and other activities are also flexible and depend on the wishes of the service user. The minutes of the ‘Residential PCP Meetings’ also evidenced that referrals are made to other specialist services (chiropody, psychology, physiotherapy and Health Living Foundation) on behalf of service users. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 14 The inspector noted that the records relating to health needs, health appointments and outcomes of any health support were very limited. There were notes in the staff communication book about visits to the GP and blood tests for two service users but this had not been written in the service users own health records. For another service user there was a record made in February 2005 that a urine sample was taken to the GP but no notes have been made on the file since then. For three service users there was no evidence that they had seen a dentist for 18 months. One note related to a service user needing to see an optician in 2 months time, but the records stated that he did not attend for another 9 months. The inspector was also made aware that a service user did not attend a doctors appointment on the previous day as this appointment had been overlooked by staff. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 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): 23 The home’s practice following incidents of physical injury to service users has not followed good practice guidelines and therefore this can place service users at risk of further harm. EVIDENCE: On an examination of a service user’s care records there was a record made of two incidents where the service user stated she had been harmed by another service user. The service user was supported by a member of staff at the time of the alleged incident however there was no record confirming the action that had been taken following the incident or of the outcome of the incident. There was no evidence to show how any future risk would be managed. No record was made either as to whether the service user’s representatives had been informed or any independent investigation considered. The incidents had not been notified to the Commission, either Dorset or Hampshire office. The manager confirmed that all staff have completed training in the Protection of Vulnerable Adults in July 2005. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 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): 30 The home is clean and hygienic offering service users a comfortable place to live. EVIDENCE: The Manager confirmed that staff have completed training in infection control. The home has a separate laundry area which is situated outside of the kitchen and which also has hand-washing facilities. Fouled laundry is able to be washed at appropriate temperatures to control the risk of infection. On the day of the unannounced inspection the home was found to be hygienic and free from offensive odours. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 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): 33, 34 35 and 36 The staffing hours provided are limited and restrict the potential for service users to lead the lives they choose. The home needs to better evidence safe recruitment practices to show that best practice is being followed and service users interests safeguarded. The staff are not trained to a sufficient level to ensure that service users benefit from a qualified and competent staff team. They do however benefit from staff that are well managed and supported. EVIDENCE: The manager informed the inspector that there is a staff team of 4 support workers and a full time manager. The home is staffed between the hours of 5pm to 10pm with two members of staff, through the night with one sleep in staff member and 7am to 9am with one member of staff. During the day the home is not staffed. Four service users can stay at the home without staff being present, and four cannot (with two being assessed as having high support needs). The inspector was informed of at least two service users who would wish to stay at home some days but cannot due to lack of staffing. The Manager confirmed that the fee levels service users pay do not allow for staff during the day, but that he has arranged for 14 staff support hours every other week to be provided during the day. The manager also confirmed that social activities are not restricted due to service users wishing to do the same Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 18 activities and that other staff can be pulled in if necessary. However this is not conducive to person centred planning or meeting individual needs that may arise. The Manager has however been proactive and requested re-assessments from the funding authorities for two service users who he assesses as needing more staff support than they are currently providing. Staff recruitment records are now being copied and kept in the home for inspectors to examine. The inspector examined the files for newly appointed staff. There continues to be some information missing from the files (Criminal Record Bureau certificates, and two references), and the manager confirmed that these have been obtained but are at the head office. All other relevant information was present – application form, and copies of identification. There was evidence that staff have received regular supervision, with relevant and detailed discussions taking place. Staff are subject to a probationary period and review. There are also residential meetings between the organisational services and house staff meetings. The manager is available daily for informal supervision including working a late shift to see staff and service users at a more appropriate time. Staff training has yet to meet good practice recommendations. Three staff members have started the Learning Disability Award Framework training, although this has not been completed in the recommended timescale of six months from appointment. None of the staff have a NVQ 2 or equivalent qualification but three are registered on the course. Statutory training in first aid, food hygiene and manual handling have been completed with additional training provided in medication and Adult Protection. Staff have not been offered training in autism although there is a service user who has particular needs relating to autistic spectrum disorder. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 19 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): 40 and 42 The organisation has yet to fully develop all its policies and procedures leaving staff and service users with insufficient guidelines to follow to safeguard service users interests. The home’s fire training practices need to improve so that the health and safety of service users can be better protected. In other areas of health and safety the home follows good practices and service users live in a safe environment. EVIDENCE: The staff regularly and appropriately check the fire equipment and water temperatures. There is a recent fire risk assessment for the home and up to date servicing of fire equipment, and gas and electrical appliances have been carried out by competent agencies. The good practice recommendation is that there is formal fire training for staff twice a year plus informal fire training following accidental setting off of the fire alarm. The home has only provided formal fire training once a year, and the records of informal training do not detail the scenarios or action taken in detail. Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 20 Fire drills have taken place in the home monthly but have not been carried out at night. The manager confirmed that the home’s policies and procedures are being developed to meet the National Minimum Standards. The most recent new policies are Personal Relationships and Sexuality and Service User Rights. Other policies needed are not yet available including one on staff recruitment. The inspector also noted that the complaints procedure needs to include details of the Commission. (Note: Standard 39 has not been assessed at this inspection but there is a statutory requirement outstanding from the previous inspection) Abbotsford DS0000004002.V282727.R01.S.doc Version 5.1 Page 21 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 2 2 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 2 ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Abbotsford 1 x 3 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 x Score Score 3 2 x x 37 38 39 40 41 42 43 DS0000004002.V282727.R01.S.doc x x 1 2 x 2 x Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 A draft Service User Guide has now been produced. The homes details and pictures now need to be included to produce a final version that can be given out to service users. Previous timescale of June 2003 not met. Each service user must have an individual care plan, setting out their needs, goals and actions and how the home is to meet the needs. The Commission must be notified of any incident that affects the welfare of a service user. As the manager has agreed that recruitment information is to be kept in the home, he must ensure that these records contain the documents specified in Schedule 2. Previous timescale of June 2003 not met. The registered provider must develop an annual plan for the home in order that the success in achieving the aims and objectives set out in the Statement of Purpose can be measured. Previous timescale of June 2003 not met. DS0000004002.V282727.R01.S.doc Timescale for action 1. YA1 5 01/06/06 2 YA6 15 01/07/06 3 YA23 37 01/04/06 4 YA34 19 01/06/06 5. YA39 24 01/06/06 Abbotsford Version 5.1 Page 23 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 Standard Good Practice Recommendations It is recommended that the draft contract includes details of service users contributions to their fees and that the contract is distributed to service users so they are clear about the terms and conditions of their residency. This recommendation is again carried forward from the inspection in 2003. Risk assessments should be reviewed regularly. There should be a clear record of the health needs of service users including outcomes of health appointments and tests. Service users should be supported to attend routine health appointments. With any incident that affects the welfare of service users there should be a clear record made of any investigation, action taken and the outcome. Where service users suffer physical harm their representative should be informed and Adult Protection Investigation considered. Staffing levels should allow for the assessed needs of service users to be met and to meet service users appropriate requests for time at home during the day. This recommendation is carried forward from the previous inspection dated August 2004. Staff should complete the LDAF training with 6 months of appointment. Staff should have an NVQ 2 or equivalent qualification in care. Staff should receive training in autism. It is recommended that the registered provider should produce written policies and procedures for all the topics set out in Appendix 2 to the National Minimum Standards (2nd Edition). This recommendation is carried forward from 2003. Formal fire training should take place twice a year. The training content should be recorded and staff should sign to show they attended. Informal training should also take place with scenarios introduced. Fire drills should take place 6 times a year, with four drills at night. DS0000004002.V282727.R01.S.doc Version 5.1 Page 24 1. YA5 2 3 YA9 YA19 4 YA23 5. YA33 6. YA35 7. YA40 8 YA42 Abbotsford Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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