Inspection on 21/06/05 for Ashfield House

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ashfield House 15/05/07

Ashfield House 28/11/06

Ashfield House 13/06/06

Ashfield House 10/01/06

Ashfield House 09/12/04

Ashfield House 28/09/04

Ashfield House 29/06/04

Ashfield House 26/05/04

Ashfield House 16/12/03

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Hillview Farm

Dalewood Respite Care

Orchard,The

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Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Bell House 105 Ashley Road Ashley New Milton BH25 5BL Lead Inspector Sue Kinch Unannounced 21 June 2005 10:30 st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bell House Address 105 Ashley Road, Ashley, New Milton, BH25 5BL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01425 619256 Bell House Homes Ltd CRH 9 Category(ies) of LD - 9 registration, with number of places Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 2004 Brief Description of the Service: Bell House is a care home providing personal care and accommodation for service users with a learning disability.It is owned by Bell House Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area.The home is located on the outskirts of the town of New Milton, and with relatively easy access to the shops and other public amenities.The home comprises a detached, double fronted property with care parking for 4 vehicles to the front of the building and a well-maintained and accessible garden to the rear.All bedrooms are occupied on a single basis, and seven of these have an en-suite facility.There is a lounge with a television easily accessible to service users, and a separate quiet lounge and dining room.The home also has another room which is freely accessed by service users and is used for recreational activities. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following the last statutory inspection on 9/12/05 Bell House Homes was issued with an enforcement notice in relation to care plans, risk assessments and physical interventions. Subsequently a meeting was held with Bell House Homes management and the Commission was provided with an action plan. A further visit was made to the home by Sue Kinch and John Vaughan on 14/4/05 to monitor compliance with the notice and it was concluded that adequate progress had been made. Some further recommendations were made and each issue was monitored further at this inspection. During this unannounced inspection further progress was noted in all areas addressed in the enforcement notice. This is referred to in the relevant sections of the report below. Six service users were spoken to. Service users were observed interacting with staff. Three sets of care plans were viewed. One was viewed with a service user and a staff member. Three staff, the manager and area manager were spoken to. Records were sampled. Shared areas and two bedrooms were seen. Comment cards were received from six service users and five relatives. Most comments were favourable. What the service does well: What has improved since the last inspection? Both inspectors noted that the atmosphere in the home had noticeably changed since the last inspection. Service users and staff are more relaxed in their day-to-day interactions. Significant work has taken place to improve the care plans at the home involving the service users more and increasingly, establishing their goals. More risk assessments have been carried out and action plans set up in relation to them. There is increasing evidence of wider consultation regarding Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 6 risks. Where the action plans in risk assessments lead to physical interventions these are recorded more specifically and relate to specific training. Service users are more involved in the day-to-day routines of the home based on individual wishes and preferences. The range of training for staff has been reviewed and they are increasingly receiving training in relation to Learning Disability as well as other key areas of practice. Staff records have improved demonstrating a more rigorous recruitment practice. Quality control has begun with other staff from Allied Care monitoring practices in the home, providing action plans and planning to follow this up. The physical environment and space for service users has improved considerably. They now have a second lounge and the activities room is unlocked for free access. Service users are also being involved in choosing the colour schemes as bedrooms are decorated. Fire checks and procedures have improved. An application has been received to register the manager with the Commission. What they could do better: Some improvements are needed but these are significantly fewer than after the last inspection. Two requirements have been made in respect of medication Attention is still needed to medication practices in the home to ensure that procedures are robust and that the system is followed through accurately. Clear procedures need to be available and followed for situations in which a service user does not wish to take medication. The second area for improvement is the charging policy for service users transport. There needs to be evidence that this is calculated fairly and service users should have more control where possible. A requirement has been made in respect of this Recommendations have been made to progress with person centred-planning and to arrange care plan files so that day to day information is easily accessible. Please contact the provider for advice of actions taken in response to this Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) Not assessed. The home has not had a new admission since the last inspection. EVIDENCE: Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) 6,7,8,9,10 Service users are increasingly involved in planning support and day-to-day decision-making. They are increasingly supported by individualised effective interventions. EVIDENCE: There is evidence of progress towards a more individualised service at the home. Service users are being encouraged to make more decisions on a dayto-day basis. One service user had decided not to be involved in an activity in the morning of the inspection. Four service users have decided to and have been encouraged to help with some of the cooking. One service user spoke of being given and taking the option to change bedrooms recently. Two staff members confirmed that choice had increased and examples given related to food and activities. House meetings held every Thursday were reported by staff to include discussion about local events that service users may wish to go to. In the last six months much work has taken place to revise the care-plans, develop risk assessments and produce action plans at Bell House. There is Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 11 more evidence of service user’s involvement. In the two care plans observed regarding service user’s personal goals there was increasing evidence that these were being developed. Two goals had been set for each person. The manager was aware that more work was needed to establish goals for all service users. As required in the enforcement notice support and action plans for meeting everyday needs are also increasingly in place with more recording of outcomes for service users. This was observed in the three files viewed. Following the enforcement notice the inspectors continued to seek evidence of action plans for dealing with more challenging behaviour and noted in the last visit and at this visit that individual interventions are being recorded in more detail (although descriptions of techniques were still not available). Plans include distraction and de-escalation techniques and some were linked to physical intervention plans. The latter, where sampled in the care plans, were noted to be preceded by risk assessments. Conversations were held with the manager regarding having written evidence of those involved in deciding on a specific technique for a service user. Some work has taken place on this but will be addressed further as the staff undergo re training in physical interventions in the summer. The inspectors have noted a reduction in the number of reports to the Commission for Social Care Inspection, which relate to physical interventions. One member of staff commented that the approach to challenging behaviour at the home had changed to much greater use of deescalation and distraction techniques. Examples of the positive impact on service users were also provided to inspectors from a staff member who described one person as much calmer. The inspectors advised that the care plan sections of the personal files were separated from the assessment work. The current layout and indexing is confusing and would not necessarily aid staff to find the most up to date information or guidance quickly. The manager agreed to address this. The enforcement notice required action in respect of risk assessments. Improvements have been made. An increasing number of risk assessments have been completed for a range of activities relating to individual needs including action for staff to take to minimise risks. There is some written evidence of service users involvement in this, although this was less clear to establish in conversation with service users. However, one resident described how support was given for one activity and this matched a staff member’s view and details in the risk assessment. Work has taken place, and continues, to involve other professionals in the risk assessments and to obtain evidence of consultation. Risk assessments are updated regularly. The enforcement notice also referred to locked areas of the home and the need for risk assessments to demonstrate that this was necessary. Subsequently the Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 12 activity room was unlocked and risk assessments have been written regarding the kitchen. As the home deals with a range of risks much of the time the enforcement notice had included a requirement that sufficient staff had received training in risk assessment for each shift. Steady progress has been made in respect of this and the manager reported that only four staff needed to complete the training. That was planned for 23/6/05. At the last inspection a requirement was made about confidentiality in day-today interactions. During this inspection inspectors noted nothing that caused concern in this area. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) 11,12,13,14, Service users benefit from opportunities to join in with a range of activities in the home and local community, which take into account personal preferences. EVIDENCE: Opportunities for personal development are increasing at the home as individual goals are increasingly addressed. This has also been helped, in the last year, by Bell House having a designated staff group focussed only on the needs and wishes of Bell House service users. Service users were supported out in the community during the inspection. Some were supported in a group to feed the ducks locally and to go to the seaside in the afternoon. Another person was supported individually. Activities take place in the local community and further a field. Activities referred to included attending college for various courses, shopping locally, going for walks, visiting the stables, gardening, and visiting local places. Service users spoke positively about the activities. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 14 In the two care plans sampled activity plans were available. From discussions with staff and the service users it was evident that these plans were being followed, taking service users wishes into account. Outcomes were recorded for both service users. A staff member said that it was increasingly possible to have one to one time with service users. Some of this was reflected in the support needed in some of the individual action plans. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) 19,20 Systems in place to ensure that service users health needs are met would be further improved by accuracy in medication. Reviews of care provided and increased consultation with service users has a positive effect on emotional health providing a more relaxed environment. EVIDENCE: Aspects of health care were discussed with two service users who confirmed that they were receiving support to see health professionals such as dentists, the district nurse and opticians. It was confirmed that staff support was available for this. The inspectors noted from observation of two of the care plans, that health needs and evidence of visits to doctors are documented. It was more difficult to find records of visits to the dentist, optician and chiropodist. Staff confirmed that these occur and some appointments were in the diary but the manager thought that the information had been archived. She agreed to ensure that recording procedures were put in place. As required at the last inspection the medication procedure had been documented and an investigation into an error had been carried out. Another requirement had been made about ensuring that the system was implemented accurately. Elements of the medication system were checked by an inspector and discussed with a member of staff and the manager. Some errors were Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 16 found. For example, one medication was not being recorded and it was unclear whether another medication was ‘as required’ or twice daily. Further work is needed to tighten procedures. This is underlined by an error having been reported to the Commission since the last inspection. A further requirement was made again regarding disguising of a prescribed medication that a service user did not wish to take. The manager has taken some steps to address this but a referral is still needed to the psychiatrist for capacity to consent issues to be addressed. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) ,23 Increasingly effective systems in the home to provide protection to service users, but more work is needed to ensure that the systems in place offer service users a fairer organisation of personal monies. EVIDENCE: The protection of abuse policy and procedures were reported by the manager to have been discussed in the January staff team meeting. Records were available to demonstrate this. The home’s training plan showed that four more staff were due to complete training in adult protection during June 05. Discussions were held with the manager regarding the changes in Physical Intervention training planned for July 2005. The change would involve a review of all interventions with a different training regime providing new strategies and recording. The plan to train the staff in two halves was advised to be reviewed in order to ensure that adequate numbers of staff are ready to implement the new physical interventions once re assessed. The home would otherwise be at risk of not having enough trained staff in the new techniques to meet service users needs. Money is held for service users. Checks were made of tins against records and these were accurate and reported by the manager to be regularly monitored. Further work is still needed to assist service users to have more involvement in spending and individual plans. Following the last inspection in December 2004 requirements were made in respect of service users financial arrangements. At this inspection more information was available regarding service users DLA money. Although pooled in an account individual records are held. The inspectors were informed that it Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 18 is the intention of the management to have this money paid to individuals. The inspectors remained concerned that current actual payments for transport were made on all service users behalf based on estimates rather than actual cost. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 standard(s) 24,28,30 The wider range of spaces made available to service users offers more choice regarding where they want to be and who they want to be with. EVIDENCE: Since the last inspection the range of shared areas of the home have improved. The main lounge has been redecorated and provided with new seating which was liked by the service users asked. Alterations have been made to the home to convert the old administration office into a smaller office for staff and a second, freshly decorated lounge for service users. This is now freely available to service users as is the room to the rear of the home. New furniture was also reported by the manager to be awaited for the new lounge. Reports from staff were that service users increasingly used the new lounge. They were using it during the inspection. The dining room has been redecorated and new furniture has been ordered. Two bedrooms were seen with service users and both were happy with their rooms. The rooms were clean, neat, tidy and included personal belongings. They had adequate facilities. One service user had a key and the other did not The manager confirmed that a key was to be purchased. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 20 The home was adequately clean in all of the areas visited during the inspection. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35 A more stable staff team receiving appropriate guidance and training is supporting service users in an increasingly consistently manner. EVIDENCE: The care staff team at Bell House has changed considerably in the last year although change has now slowed up. Of the ten support workers all but two have been recruited to Bell House in the last 15 months. Two had previously worked at the home. In records seen staff with relevant experience were being recruited. The management are now concentrating on support and training. The rotas seen showed that a minimum of four staff (sometimes five) are on duty between 9am and 10pm including weekends and the staffing level does not drop below three in the mornings between 7.30 and 9.30am .Two staff sleep in at night. Four staff were on duty at the time of the inspection. This appeared to be adequate to meet the needs of the 6 service users. There are 10 fulltime support workers and bank staff covering approximately 455 hours per week. Some of the manager’s hours are included in this. There are also ancillary staff to cover kitchen duties, cooking, housekeeping and maintenance. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 22 With the pre inspection questionnaire the inspector was provided with a training plan. This included plans to train staff in aspects of learning disabilities, as required in the last inspection report. Topics some staff were reported to have been trained in included induction and foundation training based on The Learning Disability award framework, Aspergers syndrome, communication, and Autism. Other training in core subjects such as physical interventions medication, fire, first aid, health and safety were also reported to be planned and to have taken place. Staff made positive comments about the training received. Records are held in the home. Records for three staff were viewed. These demonstrated evidence of the training plans being followed. Two sets of staff records were sampled, as improvements were required in the last inspection report. These had been satisfactorily completed where checked. The manager reported to have tightened procedures to ensure that adequate checks of staff are made before commencement of employment. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39,42 The manager in the home is enabling an increasingly consistent service to residents. Residents are protected by an increasingly effective system of regular safety checks and maintenance. EVIDENCE: The current manager has been in post since June 2005 although there has been a significant delay in submitting an application for registration. However this has now been received by the Commission and was being processed at the time of the inspection. A staff member spoken to said that management were approachable and supportive. Another said that service users were more involved in decisions by the manager. Both felt that the service users were benefiting from changes. In the last inspection report a requirement was made to have an effective quality assurance system in place to demonstrate that care practices were being monitored. At this inspection it was noted that work has started in respect of this. Allied Care has begun to implement an auditing system and Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 24 that visits to monitor progress were planned. The manager showed evidence of consultation with service users and relatives. Regulation 26 visits are taking place monthly (but not always sent to the Commission) by the line manager and this is a subject of separate correspondence to identify an alternative to this. Samples of records in respect of health and safety were examined to see if these are carried out adequately. A pre inspection questionnaire had been submitted indicating that services had taken place at the home. Weekly water checks are taking place and records showed that these had been completed on 6th and 13th June 2005.The specialist Legionalla check was last completed in February 2005.Water temperatures were checked by an inspector in one en-suite facility and were not too hot. A sample of fire records was viewed. Fire instructions were in place. A member of staff was reported to be updating the fire risk assessment. A weekly test of the fire system was due on the day before the inspection, but had been completed three times so far in June 2005 as required. Significant gaps were in the records for May 2005 and the manager was advised to revise the systems to ensure that tests are carried out weekly at all times. Other fire checks were sampled and were found to be in place. There was evidence of fire training. Advise was given to ensure that records for the fire drill detailed who was involved, duration what happened and the scenario. Some irrelevant documents were noted to be I the fire file and advice was given to remove them. Some general risk assessments were requested for viewing and were found to be in place for items sampled. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bell House Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13(2) Requirement Evidence of consultation must confirm that consent issues have been addressed regarding disguising medication in a service users food. This is a repeated requirement. The manager must ensure that the medication system is implemented accurately and fully. This is a repeated requirement. A rationale for charging service users for transport must be developed and implemented. This is a repeated requirement. Timescale for action 21/8/05 2. 20 13(2) 21/8/05 3. 23 20(1)(a)( b) 21/8/05 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 6 Good Practice Recommendations The care plan files need to be reorganised so that the most up to date information is prominent and easy to find quickly. Further work is needed on person centred planning. Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 27 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bell House H54 S12384 Bell House V231812 210605.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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