Inspection on 10/08/07 for Breakaway

This inspection was carried out on 10th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Breakaway 15/08/06

Breakaway 27/01/06

Breakaway 02/09/05

Breakaway 31/08/04

Breakaway 23/03/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Breakaway 23 Park Lane Aveley Essex RM15 4UB Lead Inspector Mr Trevor Davey Unannounced Inspection 10th August 2007 09:10 Breakaway DS0000018070.V348237.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 Breakaway DS0000018070.V348237.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. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Breakaway Address 23 Park Lane Aveley Essex RM15 4UB 01708 861520 01708 868857 breakaway@east-living.co.uk 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) East Living Limited Manager post vacant Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service category: Care Home only. Service user categories: learning disability and physical disability. Maximum number of registered places: 4 (both sexes). Placements must be arranged to ensure that the two categories of service users (learning disability and physical disability), are not accommodated together in the home for the same period of short-term care. The home is to provide short-term care for periods of no longer than four weeks at a time. 15th August 2006 5. Date of last inspection Brief Description of the Service: Breakaway is owned and managed by East Living Ltd. The property is detached which has been adapted and refurbished as a care home to provide respite care for up to four adults with a learning or physical disability. The home is situated close to local amenities with good bus and train links to the area. A vehicle provided with a tail lift is available and is used regularly for the benefit of guests to give them easier access to the local community and surrounding area. The accommodation, which is situated at ground floor level, includes four single bedrooms, a lounge and dining room, kitchen, bathroom and shower facilities. The accommodation and facilities have been specifically designed for disabled people. There is a large garden with a patio area to the rear of the property and off-road parking to the front. Information about the home is made available to prospective service users in the Statement of Purpose and Service User’s Guide. The current service charge for a one day and night stay is £399 50 per person. This is a standard rate and is subject to variation to accommodate need. Guests bring in their own pocket money to cover any additional expenditure such as hairdressing, toiletries and chiropody. The Fax. No. for the home is 01708 868857. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 5.50 hours and covered all Key standards. The manager together with other staff, residents and visitors were spoken with during the site visit. Their comments and contributions received were helpful in assisting the Inspector to prepare this report. As part of the site visit, a tour of the premises took place and some of the personal care records and other official records within the home were also assessed. Survey forms were left by the Inspector to find out what people think of the home and the service provided. One of these was completed during the site visit. It is understood that the home also carries out their own survey with individual guests and relatives on completion of respite care but feedback of this information was not made available during the inspection. Responses received by the Inspector from guests and visitors, was positive regarding the care and support given by the staff team. Guests were able to make decisions about the activities they wished to take part in during their stay and some said they would like to come back to Breakaway in the future. A self-assessment form (annual quality assurance assessment) was is in the process of being completed by the manager for return to the Commission for Social Care Inspection. This form gives homes the opportunity of recording what they do well, what they could do better and what has improved in the previous twelve months as well as including information of plans for improvement planned for the next year. What the service does well: The home is able to demonstrate its ability to effectively communicate and support guests who attend for respite care. Good working relationships have been established between the staff team, guests and relatives. Staff are able to use their creative skills and knowledge to encourage guests to choose and take part in a variety of social and recreational activity. Comments given by guests in survey forms were positive and confirmed that they were involved in making decisions and choose what they want to do during the day. Guests enjoy their respite stays in the home A visiting professional was complimentary regarding the ability of staff to give appropriate input by supporting guests as well as effectively managing disruptive behaviour. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 6 Positive comments were also made regarding the skills of staff, how they work together and support each other as a team. 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 Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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 Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience adequate quality outcomes in this area. Guests, families and interested parties cannot be assured of a robust preadmission assessment process to give staff sufficient information to meet the needs identified. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is a clear pre-assessment procedure and documentation for considering applications for respite care. From the sample checks made, information had been gathered regarding family background and social history, emergency contacts which included doctors and dentists. Details were available of specific disabilities and assistance required for bathing accompanied by a personal safety plan. A community care assessment of needs had also been completed by the funding Authority which included an overview and assessment details involving personal care, health and safety issues. Following a recent emergency admission from another respite unit, there was ongoing contact between the two staff teams. Information had been updated soon after admission regarding daily routines including health care, communication and behavioural issues. As part of the pre-assessment information, certain phobias Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 10 had been identified relating to medical care and treatment as well as other issues but risk assessments had not been completed to show staff how they should respond when these situations occur. This could lead to inconsistency of practice between different staff as well as raising the anxiety level of guests. Responses to survey information received by the Inspector, confirmed that guests had been consulted regarding their admission for respite care and that they had received enough information about the home before they moved in. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People who use the service experience adequate quality outcomes in this area. The process of review and amendment to documentation is not robust and therefore care plans and risk assessments did not always reflect current care needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home is still in the process of updating their personal care record system into a new format which was referred to in the previous inspection report. From the sample checks made, some of the detail was clearly laid out, easy to follow and had been personalised to reflect individuals wishes with their agreement and signature. In some cases, document review sheets were up to date including support plans with photographs which covered all aspects of living. Safety essentials had been listed which included updated food risk Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 12 assessments. For other records inspected, there were gaps where reviews had not taken place for some time or where signatures and dates had been omitted. The most recent monthly monitoring report completed by the visiting representative on behalf of the Responsible Individual, also identified that whilst there is a good risk assessment tool in place, forms had remained unsigned and some questions were not answered. This report also identified that some forms or sections were not entirely relevant to the needs of the guests being cared for. One individual risk management assessment was last reviewed on 28th of April 2006. A bathing/shower risk assessment had been partially completed and signed but the action required had not been recorded or the outcome of the assessment. Similar omissions had occurred with risk assessments for transport, outings and behaviour, medication and leisure activities. Where concerns had been identified in the initial and community care assessments regarding kitchen health and safety as well as phobias relating to health care, treatment and immunisations, no risk assessments had been completed. Verbal unacceptable behaviour needs had been identified but a care plan was not in place. Where reviews had taken place, these had not always been signed by those involved. Personal care and support information needs to be properly documented and regularly updated to ensure that the needs of guests are met consistently and safely. The staff team are able to demonstrate their ability to interact well with guests by building good working relationships and have been successful in modifying unacceptable behaviour and enabling residents to enjoy new experiences. Other professional staff visiting the home during the inspection, confirmed that recent guests had settled in well and were engaging positively with the staff team. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 People who use the service experience good quality outcomes in this area. Guests can expect to be supported in participating and experiencing a variety of social and leisure activities. Guests are provided with a balance varied diet. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home was able to demonstrate that guests are encouraged and supported enabling them to lead a fulfilling and meaningful lifestyle during their respite stay. Responses received from surveys by the Inspector, confirmed that guests can choose what they wish to do throughout the day and those spoken with during the inspection, confirmed that they enjoyed their stay in the home. Where possible, daily activity books had been completed by guests with staff assistance. The format of these books also included tasks they had completed during the day, places they had visited and reminders of what was acceptable as well as unacceptable behaviour. Leisure facilities in the community and Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 14 planned activity programs included decorating gift bags, skittles, shopping, cake making, dancing and jewellery making. Guests spoken with also enjoyed the opportunity of being able to participate in the daily routines of the home which included domestic tasks in the kitchen and washing of individual laundry. Staff were able to demonstrate their skills in engaging and communicating with guests which had positive results in people being able to benefit from the service provided. Log reports were well documented, detailed and showed clearly the support provided by staff during the day and night. It was noted that the community care assessment for one guest had identified that there could be a risk when going out in to the community and they would need to be accompanied. A risk assessment was not in place to address this issue. Records of meals provided to guests were available which took into account individual preferences and dietary needs. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 People who use the service experience good quality outcomes in this area. Guests can expect to receive good health and personal care support. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Personalised care plans included details of health care professionals who could be contacted as well as other supporting services. Emergency grab cards were also available with essential information if guests required emergency hospital treatment. Staff were aware of specific needs of guests staying in the home at the time. This included medical phobias such as treatment required by doctors and dentists as well as claustrophobia in certain situations. Although staff had an understanding of these issues, there were no risk assessments in place or information contained in care records to indicate how staff should respond and deal with these situations. Clear instructions and the response required should be recorded in the plan of care as already mentioned previously in this report. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 16 Medication procedures were being followed and secure lockable facilities had been provided in each bedroom. Medication administered records had been properly completed and were up-to-date. It was noted from the sample check made, that a protocol had not been completed for PRN (to be taken as required) medication. Advice was given by the Inspector to staff as to how this practice could be improved in accordance with Royal Pharmaceutical Guidance. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 723 People who use the service experience good quality outcomes in this area. Guests can expect to have their complaints taken seriously and be protected by the home’s ‘safeguarding adults from harm’ procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a complaints procedure and copies of this are available in the home. There has been no recorded complaints since the last inspection. Compliments have been received and appreciation from families whose relatives use the service. Information received from surveys completed by guests indicate that they know who to speak to if they have any concerns. Staff spoken with understood the concept of safeguarding adults from harm and were confident about what they would do should a suspected incident be detected. The reporting procedure and agencies to be contacted were displayed in the office. Breakaway DS0000018070.V348237.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 People who use the service experience good quality outcomes in this area. Guests can expect to live in a clean, comfortable and safe environment. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Bedrooms, communal areas and all facilities are situated at ground floor level and provide easy access to all guests, including those who have a physical disability and are wheelchair dependent. Bedrooms are spacious and suitably furnished which includes ensuite facilities as well as space and storage for personal items and equipment. The home was clean in hygienic and staff are aware of infection control procedures. Plastic aprons, gloves and disposable arrangements were in place. One of the guests showed the Inspector their room which they were pleased with. A summer house has recently been erected in the garden which has not yet been taken into use. It is intended that this will be an extra facility to provide social activities. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 19 At the recent monthly monitoring visit carried out on behalf of the Responsible Individual, gaps had been identified between the weekly health and safety checks and some forms had not been signed. Recommendations were made in the report for ensuring that health and safety checks are regularly carried out and properly recorded. Breakaway DS0000018070.V348237.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): 32,33,34,35 & 36 People who use the service experience good quality outcomes in this area. Guests are supported and cared for by a team of trained and well motivated staff. This judgement has been made using available evidence including a visit to the service. EVIDENCE: At the time of the site visit, one of the support workers was in charge of the shift and another member of staff who had been on wake duty the previous night, was covering for another member of the team who was unable to come in owing to sickness. Another member of staff came in at 11 a.m. and sufficient cover was available to meet the needs of guests who were in the home at the time. A rota was in place which reflected the staff on duty and changes which had been made. The home also has access to bank staff who also work for the Registered provider. Staff communicate well together and were positive about their work and the opportunities they had for supporting guests who come on a respite basis. Comments were made that the work can be challenging particularly as there is a regular turnover of different guests. At the same time staff found the work rewarding because of the variety it offers Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 21 and the many compliments received from families. Another member of supporting staff who was on secondment, stated that they had been impressed with how the staff team worked well together and show respect for the dignity of guests who stay in the home. Survey information showed that residents felt staff treated them well. It was not possible to inspect the recruitment or training records for staff as only the manager had access to this information. The manager did call into the home briefly but he was on annual leave at the time. At the request of the Inspector, the home has since sent written confirmation by facsimile transmission to the CSCI that full recruitment checks had been obtained by the Registered Provider for two of the most recent staff who have joined the home. National vocational qualifications have also been obtained in care levels 2 & 3. Staff spoken with during the inspection confirmed that regular courses are provided for moving and handling, epilepsy as well as other refresher training. Some members of staff mentioned that they do not receive regular staff supervision. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 22 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): 37,39,42 & 43 People who use the service experience adequate quality outcomes in this area. Current local management process and systems need development prompting better care planning documentation and policies/procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager has been in post for some time and it is understood that application has been made to be the registered manager. At the inspection, the manager advised the Inspector that he was shortly beginning a four month secondment to another service. This has since been confirmed by the Registered Provider. It is important that both the people who use the service Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 23 and the staff team can be reassured that effective management cover is going to be provided and the service will not suffer as a consequence of this. The Commission for Social Care Inspection need to be advised as soon as possible regarding the arrangements which are to be put in place by the Registered Provider. The feedback from people who use the service was positive confirming the staff team work well together and are committed to providing high quality care. Management systems in the home need to be regularly monitored to ensure that personal care records are consistent, regularly reviewed and updated to meet current needs. Although regular checks are made regarding health, safety and servicing of equipment, these are not always recorded as identified in the most recent monitoring visit on behalf of the Responsible Individual. Portable appliance testing is carried out but certificates had not been issued. Recommendations and requirements following this monitoring visit were listed, including action plans to improve these procedures. Outcomes resulting from quality assurance surveys/monitoring of the service should be made available together with clear objectives and action plans. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 24 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 2 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 3 23 3 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 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 2 3 Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 25 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 YA2 Regulation 14 13(4) Requirement The Registered Person must ensure that full consultation takes place so that identified needs of service users are accompanied by appropriate risk assessments. This is to ensure that any activities in which service users participate are free from avoidable risks & other service users are protected. The Registered Person shall complete up-to-date care plans & risk assessments which must be kept under review & properly documented. This is to explain clearly how current & specialist requirements will be met. (previous timescale of 30/11/06 not met) The Registered Person shall ensure that persons working at the care home are appropriately supervised. This is to enable staff to receive support, professional guidance, identification of training & development needs. The Registered Person shall appoint an individual to manage the care home who is fit,has the DS0000018070.V348237.R01.S.doc Timescale for action 31/10/07 2. YA6 15 & 13 31/10/07 3. YA36 18(2) 30/11/07 4. YA37 8&9 31/10/07 Breakaway Version 5.2 Page 26 5. YA42 13(4) qualifications, skills & experience necessary. Notice must be given to the Commission of the name of the person appointed and the date this takes effect. This is to ensure there is consistency & regular monitoring in the delivery of care in accordance with the home’s policies & procedures. The Registered Person shall 31/10/07 ensure that all parts of the home to which service users have access are so far as reasonably practicable, free from hazards to their safety. Unnecessary risks to the health & safety of service users must be identified and so far as possible eliminated. This is to ensure the home environment is safe & properly maintained for service users & staff. 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. 2. Refer to Standard YA20 YA43 Good Practice Recommendations Protocols for P.R.N. (to be taken as required medication) should be available as part of the medication records, as outlined in the Royal Pharmaceutical Society Guidance. Outcomes of quality assurance surveys should be made known to users of the service & an action plan agreed for improvement. Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Breakaway DS0000018070.V348237.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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