Inspection on 16/01/06 for Bursted Houses

This inspection was carried out on 16th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bursted Houses 30/10/08

Bursted Houses 01/11/07

Bursted Houses 26/05/06

Bursted Houses 17/03/05

Bursted Houses 09/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Bursted Houses 227-235 Erith Road Bexleyheath Kent DA7 6HZ Lead Inspector Wendy Owen Unannounced Inspection 16th January 2006 10:00 Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bursted Houses Address 227-235 Erith Road Bexleyheath Kent DA7 6HZ 020 8331 5196 020 8331 5196 s.ashburn@mcch.org.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) MCCH Society Limited Mrs Susan Ashburn Care Home 25 Category(ies) of Dementia (2), Learning disability (25), Learning registration, with number disability over 65 years of age (5) of places Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Maximum number of service users accommodated at any one time should not exceed 25, of which 5 may be over 65 years of age.. 31/08/2005 Date of last inspection Brief Description of the Service: Bursted Houses is run by Maidstone Community Care Houses (MCCH) and offers accommodation for adult service users with a learning disability. It is made up of four selfcontained properties, three of which are bungalows and one a house with stairs. These properties are laid out within a quiet cul-de-sac facing each other. Each house is staffed independently and caters for service users with differing needs. One house caters for service users with particularly challenging behaviour, another house is staffed to care for those service users who are older with greater physical care needs and require a quieter environment in which to live. The remaining two properties, one houses all men and the other accommodates both men and women with complex needs. The home has also recently varied its registration to include dementia and has developed a small unit to care for two service users. This has affected the amount of communal space in one of the homes. Each house has domestic style facilities, such as a kitchen, dining area, lounge, bathrooms and toilets. The management responsibility for Bursted Houses rests with the Registered Site Manager who has an office adjoining one of the houses on the site. Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and included a visit to two houses and inspection of records in the houses and the main office. Discussions were held with staff and residents within two of the houses, the Manager and a senior member of staff on duty providing supporting information. What the service does well: What has improved since the last inspection? What they could do better: Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 6 There are a number of recurring requirements which have been raised in previous inspections and remain outstanding. These include amending of the Statement of Purpose; the development of contracts for residents; lack of progress on the improvements to the environment; inadequate system for reviewing and monitoring the quality of care and the need to ensure recruitment procedures are more robust with the home maintaining details of the checks undertaken. The home also needs to ensure more robust pre-admission practices, including full assessments and that the identified needs of residents are reflected in the care planning records produced. Medication procedures also require improvement to ensure the health needs of residents are not compromised. Residents must also be safeguarded through development of a Whistle-Blowing Policy and ensuring the Commission are notified of events which may affect the well-being of the residents. 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. Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 & 5 The information provided by the home for prospective service users does not give full information on what the service provides and the costs of service. This makes informed decision making difficult for those looking for appropriate placements. The pre-admission procedures do provide adequate information and guidance to staff to ensure appropriate care is provided. EVIDENCE: Since the last inspection one new resident has been admitted. Whilst there was information regarding the resident’s assessed needs located on the file, there was no evidence of any assessment undertaken by the home. Nor was there any confirmation provided to the residents or their representative, that the home was able to meet the individual’s needs. The current practice enables residents to move from one home within the organisation to another in a rather informal way, often without the completion of a formal assessment by the home. This is not good practice. There was evidence that the prospective resident was able to view the home, meet with staff and other residents and have flexible stays to ensure they felt comfortable within the home. (See requirement 1) The Commission is still waiting for the organisation to produce a contract or terms and conditions for residents and, as yet, there is no information relating Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 9 to the fees, what they include or any additional charges. This has been outstanding for a number of years and has still not been addressed, leaving residents and /or their relatives without information on core areas. (See requirement 2) The last report required the organisation amend the Service Users’ Guide to ensure they are more user friendly and contain relevant information for each home, such as fees, key contract terms; relevant qualifications and experience of the Provider, Manager and staff; service users’ views of the home and how holidays are paid for. The Statement of Purpose also required amending to include all of the areas detailed in Schedule 1, including details of the Registered Manager; qualifications and experience of the Provider, Manager and staff. This has not yet been addressed (See Requirement 3 &recommendation 1) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Information for staff to provide the support and care required by residents has improved. However, further improvement is required to ensure information is provided to fully meet the individual’s needs. Residents are able to make decisions as to how they wish to lead their lives through promoting their independence and providing choice in aspects of their care. EVIDENCE: Two care plans were viewed during this inspection. There has been some improvement in the details included in the assessment of daily living, which covers many of the areas required. However, in one case this was difficult to read due to the layout and amount of information contained in such a small space. The file included an assessment of daily living; guidance on the resident’s need in written and pictorial form and risk assessments. However, these were assessments only and should have had this information transferred to more detailed care plans, showing how the identified needs are to be met. Risk assessments have been produced including falls and moving and handling. (See requirement 4) Service users open own mail whenever possible and practicable and are able to make telephone calls or receive calls in the home. Residents are able to have keys to their rooms unless their dependency and capability makes this Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 11 unrealistic. Due to the security risk residents do not hold keys to the houses. Currently two service users have the support of advocates but the home does not have any details of advocacy services or how the can be accessed. (See recommendation 2) The manager stated that no residents manage own fiancé and therefore MCCH are the appointee. The records were not checked on this occasion. Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,16 & 17 Residents lead full and active lives within the community with activities well organised for many providing them with stimulation and active environment. EVIDENCE: The last inspection highlighted concerns regarding the lack of activities, in one particular house, within the project. Since this time the Manager has implemented an activity schedule where the staff document activities undertaken. This is beneficial and shows that some activities are taking place but very much depend on the individual’s choices and dependency. Many residents have had a holiday this year and staff are busy with residents exploring opportunities for the coming year. There is, however, still some concerns regarding how these holidays are paid for and the costs to individual residents where they must also pay the member of staff’s holiday. (See recommendation 2) It was clear from observations made and through discussions with staff that, whenever possible, residents’ independence is promoted and encouraged. Obviously, this is very much dependent on the individual’s capability. Service users are encouraged to open their own mail with the support of the care staff; Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 13 rooms are locked for privacy and residents choose what activities, if any they wish to pursue. Residents were seen entering and leaving the houses and within the individual houses residents were seen to be moving around freely. Each house has a menu which is where practicable, decided upon by the residents within the home. Participation in the practical aspects such as purchasing and preparing the food is also very much dependent on the individual. The main meal of the day occurs in the evening as this is the time when the residents are generally all together. Each house keeps a diary of food provided to each resident. This helps in determining the nutritional intake for each person. The files did not contain any risk assessment in relation to nutritional needs although they did contain good information on the individual’s likes and dislikes. Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 Shortfalls in the medication procedures and full guidance on the personal support required leave residents potentially at risk. EVIDENCE: Some residents have higher dependency than others and therefore require more physical and personal support. The guidelines for such support are quite basic and should be more detailed to ensure staff have the full information on what support to give to residents. (See recommendation 3) Medication procedures were audited in 233a and 233-233a. One record showed that temazapam, although in the controlled drugs cupboard, was hand transcribed on the medication record. There was no signature, no dose recorded or the amount or date carried forward. The medication records were also in many cases incomplete, with no details of GP or allergies. The audit of the medication in 233 also showed that the records required improving. Some records showed medication to be taken “ as required” but no further details as to when to be taken, how much and maximum amount. The guidelines for administering rectal diazepam were produced in 1999 and although the Manager stated that they had been updated, could not be Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 15 located. The last inspection identified an overstock of medication. This was no longer the case in this house. (See requirement 5) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Whilst service users are protected through the homes adult protection procedures and training provided there is a need to ensure staff are trained in other related areas to ensure risks to service users are minimised. EVIDENCE: The home has procedures in place for the protection of the residents living in the home. These should be reviewed and amended to take into account the Protection of Vulnerable Adults register and procedures. The Manager was not able to locate any procedures in relation to Whistle-Blowing. This must be addressed to ensure staff feel secure in raising any concerns whilst at work. (See requirement 6) Discussions with staff, viewing of induction training and discussions with the Manager showed that staff are aware of adult abuse and their role in protecting the vulnerable person. Discussions with staff also identified that whilst some residents do present with some aggressive behaviour at times there is no physical intervention used. There are guidelines in place to support staff. However, staff felt it would be beneficial to attend some form of training in this area, particularly relating to the specific needs of individuals in the home. (See recommendation 4) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 There has been some progress in the redecoration and refurbishment required. However, this progress has been very slow in some areas and therefore does not provide all service users with comfortable, well decorated or well-furnished environment. EVIDENCE: The last inspection highlighted a number of improvements were required with some requiring more urgent attention than others. Some progress has been made and continues to be made. Redecoration has occurred in refurbishment of one bathroom. However, the shower room in 231 was required to be repaired and refurbished at the last two inspections, has still not been repaired and is an extremely poor state for clients to use. There appears to be lack of urgency or prioritising in respect of this issue. There is also still an outstanding requirement from the last inspection relating to the need to increase the communal area in one unit and the carpeting in another. House 227-229 has had new carpet fitted; new lighting and a new cooker. One Provider report highlights the need for bathrooms and kitchen to be refurbished and the boiler requires repair or renewing to ensure it does not “break down” and that it warms the house adequately. 235-bathroom needs redecorating Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 18 House 235 requires replacement of the carpet in the corridor, lounge and dining room. However, this has recently had a kitchen fitted and flooring installed. House 233 has recently been decorated and has had new carpets fitted in the lounge. The standard of cleanliness throughout the units remains mixed, despite the home developing a cleaning schedule for night staff to adhere to. In one home the schedule had not been completed since before Christmas and in another whilst staff had recorded completion of the task the previous night, the area appeared to the inspector and Manager, not to have been cleaned satisfactorily. This should be monitored to ensure that the actual tasks are being undertaken. None of the houses have been fitted with thermostatic valves for the radiators. (See requirement 8 & 9) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 The reduced use of agency staff has provided a more consistent work force providing care and support to residents. The recruitment procedures are not robust enough to ensure service users are fully protected from harm. EVIDENCE: Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 20 The home is working well with a high number of staff with NVQ 2 or above. MCCH also provides induction training for all new staff. Whilst this includes the areas required under TOPSS, staff said these training days were often cancelled leaving a significant amount of time between training. The other issue raised is that the induction is not specific to learning disabilities as desired by the Learning Disability Award Framework. Staff did say that training in relation to Challenging Behaviour does occur albeit not regularly. (See recommendation 5) No new staff have received moving and handling training yet despite the personal support required by a number of service users. This training is not included on induction but accredited trainers within the home are expected to undertake this aspect of training. (See requirement 11) The Manager discussed the improvements in the recruitment of staff which has meant a reduction in the use of agency staff. The home is still struggling to appoint a deputy manager despite several advertising campaigns. A brief audit of the recruitment records showed that there are some shortfalls in the checks required. The application form had little space for references; there were no interview schedules; no criminal records bureau checks and in one instance only one reference and the other no references were attached. One contained a pro-forma stating the checks which had been completed but had only been partly filled in. (See requirement 10) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 21 Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Practices within the home do not adequately promote the health, safety and well-being of service users. There is no adequate system in place to provide for reviewing or continuously improving the quality of care provided to ensure the needs of the residents are being met by the home. EVIDENCE: Previous comments made in the report relate to the issues with the boiler in one of the houses. This broke down during a very cold weekend. However, the Commission was not made aware of this, as they should have been under the Regulations. (See requirement 13) The report has also raised concerns regarding moving and handling for new staff during the induction period. This needs to be addressed by the organisation. The main requirements relating to fire safety were in order, with the exception of the number of fire drills taking place. The fire records showed only two were undertaken over the last twelve months. The last report highlighted the need for the service to implement a quality assurance system and to ensure the monitoring as required under Regulation Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 23 26 were taking place. These have not been undertaken consistently nor has the Commission been supplied with a copy of the reports. There must be further system in place to ensure residents are receiving a good quality of care and to identify any shortfalls in the service provision. (See requirement 12) Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 2 2 2 3 x 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 X X LIFESTYLES Standard No Score 11 x 12 3 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X 2 X X X 2 X X 2 X Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 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 Requirement The Registered Person must ensure that the home obtains the professional assessment relating to the prospective user prior to admission. The preadmission process must include the home’s assessment of the individual’s needs. This was a requirement raised on previous inspections and remains outstanding. The Registered Person must ensure that service users are provided with terms and conditions of the placement. This was a requirement raised on previous inspections and remains outstanding. The Registered Person must amend the Statement of Purpose and Service Users’ Guide to ensure it contains all the information required under the Regulations. This was a requirement raised on previous inspections and remains outstanding. DS0000038151.V275287.R01.S.doc Timescale for action 01/04/06 2 YA5 4 01/04/06 3 YA1 5 01/04/06 Bursted Houses Version 5.1 Page 26 4 YA6 15 5 YA20 13 6 7 YA23 YA27 13 23 8 YA24 23 9 YA24 23 10 YA34 17 & 19 11 YA42 13 The Registered Person must ensure that care plans are fully reflective of the individuals’ needs and the current personal support required. The Registered Person must ensure that there are safe systems in place for the administration and recording of prescribed medication. The Registered Person must ensure that there is a WhistleBlowing policy. The Registered Person must ensure that the shower room in 231 is refurbished and redecorated. This was a requirement raised on previous inspections and still not complied with. The Registered Person must provide the Commission with an action plan detailing the improvements to be made in the redecoration and refurbishment of the houses. This must include the fitting of thermostatic valves. The action plan must include timescales for implementation of the action plan. Please supply without delay. The Registered Person must ensure that there is adequate heating within the houses. The boiler in House 227-229 must either be replaced or repaired to ensure it provides efficient, effective and sufficient heating. Please provide the Commission with your action plan to resolve this issue. The Registered Person must ensure that adequate recruitment checks are carried out on new members of staff employed. The Registered Person must DS0000038151.V275287.R01.S.doc 01/04/06 01/04/06 01/04/06 01/04/06 01/04/06 01/04/06 01/03/06 01/04/06 Page 27 Bursted Houses Version 5.1 12 YA39 24 13 YA42 37 ensure that all new staff receive moving and handling training prior to commencing as part of the staff team. The Registered Person must investigate the implementation of a system for reviewing and improving the quality of care within the home. The system must include consultation with service users. The Registered Person must ensure the Commission is notified of any events which may effect the well-being of the service users. 01/04/06 01/03/06 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 Refer to Standard YA1 YA7 YA19 YA35 Good Practice Recommendations The Service Users Guide should be amended to include all areas detailed in Standard 1. This information should be supplied in formats which are accessible to service users. The home should provide residents and their representatives with details about advocacy services, including how these services may be contacted. The care plans should provide more comprehensive guidance on how residents wish to be supported; guided and moved. Staff should be provided with regular training in how they can meet the needs of service users who present with challenging behaviour, including how to manage violence and aggression. The induction training should include areas required by the Learning Disability Award Framework. 5 YA32 Bursted Houses DS0000038151.V275287.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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