Inspection on 16/02/07 for Broadview

This inspection was carried out on 16th February 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broadview 16/02/09

Broadview 02/02/06

Broadview 19/07/05

Broadview 01/11/04

Broadview 08/06/04

Broadview 11/02/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Broadview King Street Winterton On Sea Great Yarmouth Norfolk NR29 4AT Lead Inspector Mrs Judith Last Unannounced Inspection 16th February 2007 03:15 Broadview DS0000027351.V331011.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 Broadview DS0000027351.V331011.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. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadview Address King Street Winterton On Sea Great Yarmouth Norfolk NR29 4AT 01493 393653 01493 393653 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) www.mencap.org.uk Royal Mencap Society Mrs Susan Shreeve Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: Broadview is a well-established care home, owned and managed by Mencap, providing care and accommodation for up to five adults with learning difficulties. The home is situated within its own grounds in the centre of the village of Winterton. All residents have single accommodation and there is ample communal space. Fees for the service are from £730 to £806 per week. Inspection reports are available in the service. Three of the four family members submitting written comments know how to access the inspection report for the home. (One person was not sure so this area could be improved.) Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The manager and staff were not told when the inspector was going to visit. The visit lasted nearly six hours. Some information came from the things people wrote in their comment cards. There were four comment cards from visitors, and two messages from health professionals who are in contact with the home. The inspector spoke to the manager and the staff member on duty as well as to the people living at the home. Some other information was gathered from records for three residents, staff files, and from observation. What the service does well: What has improved since the last inspection? The manager has developed some new care plans that are easier to read and have pictures in them to help people understand what they say. The last inspection did not lead to the manager needing to do anything to comply with the law. However, between then and this visit, there had been some difficulties dealing with behaviour which led to difficulties in making sure that all residents had the opportunities and support they needed. The team has worked hard to overcome some of these difficulties and is working closely with other professionals to make sure the same thing does not happen again. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents would have their needs assessed and so they could be sure these would be met. EVIDENCE: There have been no new admissions against which to assess the standard. However, there are systems in place for recording the needs of service users and for carrying out risk assessments. The home has good and regular links with other health and social care professionals from the learning disabilities team, and with relatives. This means that there are sources of information open to the service for gathering information about needs. One health professional considers that the management of the home takes appropriate decisions when they can no longer meet the needs of residents. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 9 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know their assessed and changing needs, as well as goals, will be set out in their plans (although some reorganisation and development of the recent work will make the information more accessible). Residents are able to make decisions although the process could be enhanced by increasing existing use of photographs in discussion, and in being more creative about building on these for bigger decisions (e.g. where to go on holiday and who with). EVIDENCE: Service users have individual plans. A lot of work has gone into developing the new format using simplified language and pictures to try and make these more accessible to service users. However, there is a lot of other information in files that needs “rationalising” so that staff have easy access to the most up to date information. There is an undated communication plan in one file that contained limited information, and did not record other phrases a staff member says are “warning” phrases. It is important that this information is updated with the management strategies being developed so that there is no unnecessary Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 10 confrontation that may lead to incidents of aggression that might otherwise be avoided. A recommendation has been made. Some files have goals such as to go to the Gateway club, or to go out for a drink occasionally. These reflect opportunities for activities but not goals to which service users can work with staff support over a range of time, and which will increase their independence. In the new format of plans this is better addressed. There are appropriate goals – such as for one person to learn how to brush their teeth – which could more usefully be broken down into small steps. This would mean the home is better able to identify progress and how they are supporting residents to enhance or acquire skills. See also personal and health care section. A recommendation has been made. Observation shows that efforts are made to use day-to-day activities as learning opportunities for residents, for example, in money recognition when getting ready to go out. This is commended as good practice. Information obtained from the home’s own quality assurance survey shows not all stakeholders are very satisfied with how well people are supported to meet their goals. The changing format of care plans may help to address this issue. Some of the information has been “signed” by service users showing that they are involved when their care needs are reviewed. A recent report by an external consultant looking at the service showed that there is room to improve the decision making process particularly for service users’ holidays. The manager says that people have been choosing holidays from various holiday camp brochures. She says that residents like the space and the entertainment such holidays offer. The manager says that some people do not so much enjoy sitting through shows as joining in with dancing. However, records for one person show that they do enjoy shows. A recommendation has been made. A “decision making” sheet records routine decisions service users make about their day-to-day lives. This includes things like what to do, where and when to eat, and what activity to join with. Pictures and photos are in use to help. The manager and staff assist service users in managing their money. The manager is appointee for all four residents. However, there is evidence in records that service users are encouraged to go with staff to the post office to collect their monies and also to pay their rent. There are risk assessments for those activities in which residents participate. These are somewhat long winded but staff are aware of potential risks based on discussion with the person on duty and the manager (also on shift). Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 11 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity for suitable educational and recreational activities, inside and out of the home. Additional efforts may be needed to promote a wider range of choices for holidays. They are able to maintain links with friends and family. Their rights are respected and they are encouraged to join in the day-to-day running of their home. Residents have a healthy diet and enjoy their food. EVIDENCE: Records were seen that show some residents attend college. One person spoken to confirmed this. Staff are creative in using day-to-day tasks as opportunities for promoting and encouraging skills, such as money recognition. There are files of information in the home about shows or other activities in which residents have participated, and good use is made of photography to Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 12 help residents understand options available and to remember what they have done. This includes records of holidays and other important events such as birthdays. Records show they use community facilities, for example the post office and pub. One person has a magnetic board (awaiting fixing) to which photographic reminders of their weekly programme and which day it is, can be attached. This is good practice in encouraging some awareness of routine. The telephone directory for most commonly used numbers has photographs so residents can be encouraged to use it. Two residents confirm that they help to tidy and clean their own rooms. Records also supported this. Observation on the day showed that they were encouraged to participate in activities such as ironing their clothes and preparing the meal. Records support this happens regularly. One person was supported to make a jelly for the following day and was proud of their efforts. Throughout the fieldwork visit the staff and manager on duty communicated directly with service users rather than predominantly with one another. Discussion with the staff also shows some flexibility in routine, for example, where and when to eat, and who with, for one person who sometimes finds company difficult to handle. This is good practice. Some of the bedrooms have suitable locks fitted although none of the service users currently holds a key. The standard cannot be wholly met as this option is not available to all those who live at the home. This was discussed with the manager, as there is potentially scope for fitting locks for other people and providing mechanisms such as coiled key rings that can be attached to belt loops for other people who might achieve some self esteem by holding a key, even if they need staff to support them with opening their doors. Risk assessments in this area could be improved to take into account the ability of service users to manage some or part of the task. A recommendation has been made. Residents comment cards say that the food is good and three people spoken to confirmed this. There is a separate and homely dining room, and one person was given the option of sitting elsewhere and the choice of which person on duty they wanted to sit with, as they sometimes find this easier. Photographs are used to remind service users how to undertake those tasks that they are working towards. This includes one person making tea, another making buns, and one making their own porridge for breakfast. This is good practice. Several people need to make use of supplements to maintain bowel function. Advice could usefully be sought regarding high fibre diets and how the menus may be adjusted. A recommendation has been made. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive the support with personal and health care that they need (although there could be improved evidence in that the revision of the care plan system needs to be linked with revised goals and daily notes). There are systems for the safe storage and safe administration of medication so that residents are protected. EVIDENCE: Discussion with staff and the manager shows that people understand the personal and health care needs of service users. Throughout the fieldwork visit people on duty were heard knocking on doors and asking permission to enter residents’ rooms. Personal care plans need to take account of the specific skin and hair care needs of those for whom this is appropriate. A recommendation has been made. There is evidence on file and from a visiting professional that staff work with other professionals to meet service users’ needs. This includes securing advice from the continence nurse, consultant psychiatrist and the Community Learning Disabilities Team. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 14 There is some room for improving how some personal care issues are recorded and monitored in daily records. For example, one person has a goal in the new care plan format to learn how to brush their own teeth. This is not yet broken down into small steps with clear guidance for each stage of the process showing what prompt or support is needed at each stage so that progress can be more easily recognised and achieved. Notes of care delivered need to show how this is done. A recommendation has been made. Specialist input has been arranged for one person. Work is still underway to determine the appropriate strategy. However, it is clear that staff sometimes find difficulty in achieving consistent responses. There is guidance for the use of PRN medication on file (which needs dating). The staff member spoken to confirmed that there is training and staff complete a workbook for the administration and use of medicines. The process of checking and administering medication is set down in the beginning of the medication folder, with the medication administration record (MAR) charts. The medication was locked away and keys are kept separately in the staff sleep in/office. The staff member responsible came upstairs to administer one person’s medication. He said at this time, when there is no other staff member available to supervise, the practice is to lock the medication in the bathroom. This denies service users (albeit temporarily) access to this facility. A recommendation has been made. MAR charts are consistently signed. Records of administration of medication needed occasionally (PRN) were cross-referenced with daily notes and were accurately maintained. Two people have medication that needs to be given with food. In one case this is not clearly shown on the MAR chart. A recommendation has been made. The receipt of medication is recorded on the MAR charts. This included in one case where PRN medication was carried forward. This medication was checked and the balance was accurate. Information was seen on file about the person’s inability to manage medication and that staff assumed responsibility for this. The observed dependency or behavioural issues for residents mean that it is unlikely any of the current residents would be able to safely manage their medication. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents could be confident that staff would take their concerns seriously and that they are protected from abuse. This represents an improvement upon the situation that had developed between this and the previous inspection. EVIDENCE: The complaints procedure has been simplified for residents and is included in their folders called “this is where I live”. All four relatives responding say that they are aware of the complaints procedure. The staff team has recently come through a difficult time and been under scrutiny to see whether the rights of service users to be free from abuse (including from one another) are upheld. This has clearly been distressing as people considered they were working in the best interests of the residents. The manager says the whistleblowing procedure has been gone through in supervision with staff and staff spoken to are clear about their obligations to speak out and how to do this if they have concerns about care. The manager has improved the systems for notifying incidents between residents that should help the providers, specialists involved or the Commission provide advice where there are incidents between service users that may constitute physical abuse. Residents all completed written comment cards with staff assistance and say that they feel safe at the home. Two spoken to say they like living there. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 16 The pre-inspection questionnaire shows that training has been delivered in the last 12 months in the awareness of abuse of vulnerable adults, and in the theory and physical de-escalation of violence. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is based on the history of compliance and the limited observations made on the day. Residents live in a homely, comfortable, safe and clean environment. EVIDENCE: The premises were not inspected in detail, as there is a good history of compliance. There is evidence from paint and tablecloth samples and discussion with the manager that residents are consulted about décor. Communal areas and corridors were decorated in a homely and pleasant style. The cupboard in the first floor WC has a door off that needs refixing. Areas of the home seen were clean and there were no unpleasant smells in those areas. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 18 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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff say they receive regular training although some evidence is missing that they are competent and qualified to support residents. Service users are generally protected by recruitment processes, although again some records are missing to wholly support this. At present there are sufficient staff on duty to meet people’s needs when residents are at home. Outcomes would be good were the statutory staffing records to have been available. EVIDENCE: The training files for staff do not all contain adequate evidence of training and qualification. For example, there is no evidence in one case of the achievement of satisfactory competence in induction/foundation and one person said to have achieved NVQ did not have a certificate on file. There were also shortfalls in the statutory staffing records – for example evidence of proof of identity and an up to date photograph. The inspector acknowledges that proof of identity has to be checked in order to obtain Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 19 enhanced criminal records bureau checks (and these were seen). This means that the manager will have seen such proof. However, legally the home is required to keep the information on file. Other recruitment checks are appropriate. There is evidence that a proper interview process is followed with records kept. The process includes questions the residents want answered even if they do not fully participate in the interview. This is good practice. References are taken up and a full employment history is obtained. A requirement is made about shortfalls in records. The answerphone message has been updated with an emergency contact number should a service user need to return to the home during the day. Daily records showed that one person had been able to stay at home when they were unwell. At the time of the visit, there were two staff (one of whom was the manager) on duty. The duty roster shows that this is the case for the majority of the time that service users are expected to be in the home. The manager believes that there is some scope for increasing hours should the needs of service users change. This was discussed in the light of past behavioural difficulties and recent developments. She has undertaken to keep this under review with other stakeholders in the light of changing need, and so the service can respond flexibly to people’s wishes. Two of the four relatives responding do not think there are always enough staff on duty Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home where efforts are made to take their view into account (or those of their representatives) and their safety and welfare is promoted. EVIDENCE: The certificates for the manager’s qualifications were seen. These confirm that she has NVQ level 4 in care and has “topped this up” with the Registered Managers’ Award. She has considerable experience with the client group and at the home, and participates in relevant training from time to time, based on discussion and the pre-inspection questionnaire regarding training. There has recently been a full audit of the quality of the service following concerns last year. Understandably, the manager, staff team and regional manager have been distressed by this but have taken the steps needed to improve the service, and the detail provided to the Commission from monthly visit reports has improved. The process is ongoing and there was evidence on Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 21 file that surveys of stakeholders (including family/friends, residents and professionals) are undertaken. Records associated with health and safety, such as risk assessments, electrical maintenance and fire safety were sampled. These show that risks are generally taken into account, although the assessment system is long winded and may result in staff overlooking the methods they need to adopt to ensure safe working practices. Fire detection and alarm systems are tested regularly and there are monthly checks for compliance. Staff receive regular updates to first aid training. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 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 2 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 3 x 3 x x 3 x Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA32 YA34 Regulation 19 Sch 2 Requirement The registered persons must maintain the records for staff employed that are required by regulations as amended. Timescale for action 31/03/07 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. 3. 4. 5. Refer to Standard YA6 YA6 YA6 YA18 YA6 YA7 Good Practice Recommendations The registered persons should ensure all documentation is dated and signed so that the need for routine review is identified. The registered persons should ensure that communication plans are updated to take into account additional information known to staff or set out in daily records. The registered persons should use the “new” care plan system to identify and break down specific goals that will help enhance the skills and independence of residents. The registered persons should ensure care plans are organised in such a way that the most up to date information is clearly accessible. The registered persons should continue to explore methods of increasing the decision-making process reflecting known interests but also presenting options for new experiences. DS0000027351.V331011.R01.S.doc Version 5.2 Page 24 Broadview 6. 7. 8. 9. 10 YA9 YA16 YA17 YA18 YA20 11. YA20 The registered person is recommended to review all risk assessments to try and make them less repetitive and complicated. The registered persons should complete the fitting of locks to bedrooms doors and then look at the ability of residents to manage keys in whole or in part. The registered persons should seek advice about the fibre content of main meals for residents for whom this is an issue, and look at reflecting this in nutritional plans. The registered persons should make provision in care plans for specific personal care needs arising from the background of service users. The registered persons should look at alternatives for ensuring medication is secured when it is left unattended. (This may include staff needing to consider the order in which medication is given based on the location of residents within the home.) The registered persons should ensure that MAR charts provide reminders in all cases where medication needs to be given before, with or after food in order to ensure it is effective and side effects are minimised. Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Broadview DS0000027351.V331011.R01.S.doc Version 5.2 Page 26 - 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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