Inspection on 19/12/06 for Cintre Community

This inspection was carried out on 19th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cintre Community 03/08/07

Cintre Community 10/01/06

Cintre Community 21/06/05

Cintre Community 30/12/04

Cintre Community 22/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Cintre Community Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG Lead Inspector Sandra Jones Key Unannounced Inspection 19 , 20 & 21 December 2006 09:30 th th st Cintre Community DS0000026532.V324564.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 Cintre Community DS0000026532.V324564.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. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cintre Community Address Cintre Community 54 St Johns Road Clifton Bristol BS8 2HG 0117 9738546 0117 9467842 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) Cintre Community Management Co Mr Gordon Charles MacDonnell Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 7 persons, aged 18 - 45 years. Date of last inspection 10th January 2006 Brief Description of the Service: The Cintre Community is registered with the Commission for Social Care Inspection to provide care for 7 adults who have a learning disability. The property is a large detached house in a residential location within walking distance of local amenities. There are 7 single bedrooms set over three floors. One of these rooms consists of an independent living flat. There is a large lounge divided into a homely seating area. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key visit was conducted unannounced in December 2006 and focused on the assessment of key safety standards. The main purpose of the visit was to check on the welfare of the residents and to examine health and safety procedure. During the site visit, the records were examined and feedback was sought from residents and staff. “Have your say” surveys were sent to residents in the home prior to the inspection and four were returned. Visitors and relative questionnaires were sent to people that are involved with the person that uses the service. Information from these sources has been collated and where possible detailed throughout the report. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the pre-inspection questionnaire and notified incidences in the home, (Regulation 37’s). An Immediate Requirement was issued during the inspection to assess the quality of the Control and Restraint (CNR) technique and, through risk assessments and reactive structures develop an approach that best suit the people using the service. The manager was also instructed through the Immediate Requirement to cease practices that are potentially harmful to residents. Following from the Immediate Requirement and feedback of the inspection findings, senior staff have taken significant steps to develop existing practices. What the service does well: Four completed “Have your Say” surveys were received and two indicated that they always make decisions about what they do each day. Residents indicated that they know who to approach if they are not happy and how to make a complaint. Two residents felt that the staff always listen and act on what they say. Relatives that responded through comment cards made additional comments about the standards of care. One relative stated that the staff are dedicated and friendly. Another stated that the care provided is consistently high. Members of staff giving feedback reported that having a stable team, consistency of care was offered to the residents and the culture ensures that residents are not medicated to manage behaviours that challenge the service. It is evident that the organisation ensures that the staff are skilled to do the tasks they are to perform. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 6 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cintre Community DS0000026532.V324564.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 Cintre Community DS0000026532.V324564.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Statement of Purpose must be reviewed to provide clear information about their ability and accountability to deliver services that it undertakes to provide EVIDENCE: The Statement of Purpose was commercially purchased and adapted for the home. It is regularly updated by the manager to ensure potential residents, their relatives and placing agencies are able to make decisions about moving into the home. The Statement of Purpose must be reviewed to create a platform that sets the approach for meeting the registered category of needs. Once this is achieved policies and procedures must be devised to support the intended style and approach to meeting the needs. Since the inspection the manager and responsible person have taken steps to review the Statement of Purpose. Cintre Community DS0000026532.V324564.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. For residents to be at the centre of their planning for life, care plans must be developed using a person centred approach to meeting needs. Risk assessments, protocols and strategies that follow the Department of Health guidance for Restrictive Physical Intervention must be developed. In order to support residents with making decisions, care plans must include the method of communications for residents that have communication needs. Resident’s records that describe outcomes of visits, activities and observations of staff to support that the home promotes the provision of residents’ health and welfare must be introduced. Risk assessments are in place, action plans must reflect the level of risk to ensure resident’s rights are respected. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 10 EVIDENCE: Residents care records were examined during the inspection visits and contain signed copies of the Service User Guide, full assessments of need, service user plans and reviews of plans. Residents sign their care plans and participate in review meetings. While it is acknowledged that staff explain the content of the care plans to residents that are unable to understand, their accessibility must be considered for these residents. The manager must ensure that formats used can be understood by for whom it is intended. During the inspection the manager and assistant manager recognised that care plans must be clearer about meeting needs and the way the care provided is evidenced. It was understood from the manager that care plans are to be developed using a person centred approach to meeting needs. Care plans will in future contain historical overviews, medication, mental and physical health care needs. Budgeting, educational and occupational needs will also be included within the care plans. Strategies for managing situations will be incorporated into care pans for residents that present aggressive and violent behaviour. It is stated within the Statement of Purpose that the home offers accommodation for people that exhibit aggressive and violent behaviour. The manager confirmed that five residents exhibit some forms of aggressive and violent behaviour. The policy and procedures about Challenging Behaviour were commercially purchased and not relevant to the home. The manager said that the responsibility for reviewing policies and procedures fall onto the organisations Human Resources department. A Challenging Behaviour and Physical Intervention policy must be developed as a matter of priority. Policies and procedures must describe the context for using restrictive physical interventions. Individual reactive strategies’ that describe the signs and triggers that may be exhibited with a brief description of the staff action is in place. The risk assessments in place are not sufficiently specific for staff to consistently manage aggressive and violent behaviour and to offer reassurance to the individual. Risk assessments, protocols and strategies that follow the Department of Health guidance for Restrictive Physical Intervention must be developed and introduced into the home’s approach to meeting needs. During the inspection there were incidents where residents became aggressive. Members of staff were observed using diffusing techniques to manage the situations. Concerns arose when an incident appeared to be escalating and staff came to assist. Following the incident a discussion took place with the manager and deputy about members of staff not asking residents that were congregating in the area, to leave. It was understood that this is not usual practice as residents may choose not to leave. Decisions must be made about the manner in which situations are handled, the purpose and the Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 11 responsibilities of staff that come to assist. In allowing residents to observe the incident, their safety is compromised and the person’s privacy and dignity is not promoted. One resident was sectioned under the Mental Health Act. However, the care plan is not clear about this person’s mental health care needs and the impact the section has on this individual. Where residents have mental health care needs, care plans must detail triggers and signs of deterioration, with implications for breeches of the imposed section. There is a keyworker system in operation at the home and residents consulted knew the name of their keyworker and the role they perform. The Choice policy in place purports to offer residents opportunities to exercise choice and make decisions for themselves. The manager states that residents currently accommodated are able to make decision and have the right to access advocacy. One person must be assisted to make decisions and to communicate uses forms of Makaton. However, members of staff are not trained in Makaton. For residents with communication needs, care plans must describe method of communication and staff must be able to communicate with individuals. The Risk taking policy in place stated that record keeping and risk assessments are integral parts of the process. Risk assessments are in place for travelling independently and using kitchen equipment. The manager reported that it is company policy to lock the kitchen knives and at night, the lounge and dining room are locked. Movement sensors are used for one person that may leave the building at night without staff support. One resident consulted during the visit confirmed that at night the lounge and dining room doors are locked. It is therefore evident that limitations on facilities exist. Risk assessments must be clear about the risk and the actions to be taken must reflect the level of risk. The home maintains an accident book and the manager periodically analyses the number of accidents. From the analysis of the accidents, risk assessments are reviewed and where appropriate amended. Running reports are only kept for three residents whose behaviours are being monitored. Members of staff record behaviours exhibited, which are dated but not signed. Entries made by staff must be signed and dated. The systems that maintain consistency of care were discussed with the manager. It was understood that systems in place that ensure staff are kept informed include communication books, memos and handovers when shift changes occur. However, individual reports of events are not maintained. For the manager to demonstrate that the home promotes the provision of the health and welfare of residents, individual records must be maintained. Staff must record outcomes of visits, activities and observations of the staff. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Opportunities exist for residents to experience meaningful activities. Members of staff support residents to access facilities in the local community. Residents are enabled to strength relationships with family and friends. The Service User Guide must inform potential residents about the house rules in place. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 13 EVIDENCE: The aim of the home is to increase residents’ level of independence. It is evident from the care plans in place that residents’ aspirations and wishes with education and occupation are sought. Residents attend college; day care centres and are in voluntary employment. In-house activities are discussed at residents meeting, which are arranged, on a weekly basis. One member of staff giving feedback stated that arts and crafts, 1:1 and cooking are activities organised in-house. It was understood from this member of staff that inhouse activities are integrated into the individuals learning. Residents giving feedback during the inspection confirmed that they undertake community based and in-house activities. It was understood from the deputy manager that the residents are mobile and independent with moving around the home. Five residents are able to leave the home without staff support. The residents have concessionary bus passes and three residents use public transport independently to pursue interests. Members of staff support residents to access local community facilities, residents visit local shops, pubs, theatres and organised events. The home’s visiting arrangements are described in the Service User Guide. Members of staff stated that with the exception of one person, residents have regular contact with family and friends. Relative/Visitors comments cards were used to seek the views of the people involved with individuals that use the service. Five comments cards from relatives were received and indicated that staff welcome visitors, visits can take place in private and they are kept informed about important matters. Three relatives made additional comments regarding the care and support provided by the staff. Relatives at the home during the inspection reported that the home has a “homely atmosphere” and standards remain consistent. There are house rules in place and residents are provided with copies of the rules. Residents giving feedback confirmed that house rules are in place and reported they sign the document to evidence their awareness. House rules are not currently included in the Service User Guide. House rules must be appended onto the Service User Guide to inform potential residents, their relatives and placing agencies about the expectations of the home. Residents were consulted about the practices that respect them as individuals. It was understood that bedrooms are lockable, members of staff knock and wait for an invitation to enter bedrooms and their post is handed to them unopened. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff monitor residents health care and where appropriate seek referrals to specialists. EVIDENCE: Residents have medical profiles and contain a pen picture of the individual, medical history and personal information. A record of visits from health care professionals is maintained. Residents’ access NHS community facilities, staff ensure that visits to the homeopath, dentist, optician and chiropodist are regularly arranged. There is also input from the Community Learning Disability team (CLD) team. Cintre Community DS0000026532.V324564.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents feel that their views are sought and acted upon. Members of staff are trained to recognise forms of abuse and to take appropriate action. EVIDENCE: The Complaints procedure is included in the Statement of Purpose and residents are provided with copies of the procedure. It is acknowledged that the address of the CSCI is included within the procedure and to fully comply the telephone number must also be added. The Complaints procedure provided to residents is written in a simple format with pictures to ensure they can understand it. Residents giving feedback during the inspection confirmed that they were provided with copies of the Complaints procedure. Four “Have your say” questionnaires were received from residents and their comments indicated that they know who to speak to if they are not happy and they know how to make a complaint. There were two recorded complaints since the last inspection and the records indicate that they were successfully resolved. Policies and procedures that refer to safeguarding adults include the Vulnerable Adults and Whistleblowing procedure. A commitment to protecting residents from abuse is demonstrated through the policies and procedures. These policies and procedures need to be reviewed to ensure they follow “No Secrets” guidance. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 16 The manager and assistant manager have attended external training in Safeguarding Adults for managers and providers. The organisations training manager provides in-house safeguarding adults training to support staff. Members of staff are provided with a Safeguarding Adults pack and during the training, signs of abuse and reporting incidents is covered. Members of staff consulted during the inspection were aware of the forms of abuse, how to recognise it and the action to be taken. A care coordinator made a safeguarding adults referral regarding one resident at the home. Concerns were expressed about the systems in place that enable triggers to be recognised and types of physical interventions used. The manager acknowledged that systems which evidence that the home follows good practice guidelines must be further developed. Cintre Community DS0000026532.V324564.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): Quality in this outcome area is (excellent, good, adequate or poor) This judgement has been made using available evidence including a visit to this service. EVIDENCE: Key standards that relate to the environment were not assessed at this inspection. Cintre Community DS0000026532.V324564.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Members of staff must be trained in physical intervention techniques that are not pain based. EVIDENCE: The opportunity arose, during the inspection, to discuss with the trainers the home’s training programme. The training manager stated that they are responsible for organising and coordinating training at Cintre. It was understood that the Common Induction Standards is provided in-house to new staff. Support workers attend in-house Safeguarding Adults training, with physical intervention and challenging behaviour training also provided in-house to all staff. Regarding Safeguarding Adults training, it was understood that this is accredited by the Local Authority. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 19 In terms of the physical intervention techniques taught at the home, it was understood that training methods of Control and Restraint (CNR) are not currently registered with the British Institute of Learning Disabilities (BILD). The Department of Health Guidance for Restrictive Physical Interventions states that physical intervention strategies should be implemented by staff that have undertaken appropriate training provided by an organisation accredited by BILD. For this reason an Immediate Requirement was issued to assess the quality of the CNR technique and, through risk assessments and reactive structures develop an approach that best suit the people using the service. The manager was also instructed through the Immediate Requirement to cease practices that are potentially harmful to residents. While it is acknowledged that staff have access to training that is appropriate to the work they perform, consideration must be given to the benefits of providing some of the training externally. A recently employed member of staff was consulted and gave feedback about the induction undertaken at the home. This person reported that the induction covered a familiarisation of the property, statutory training and Common Induction Standards. Cintre Community DS0000026532.V324564.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents feel that the skills of the manager ensure the home’s stated purpose is met. EVIDENCE: Feedback was sought about the way the manager ensures the home meets its stated purpose. Four completed “Have your say” surveys were received from residents and three stated that staff usually treat them well and one indicated that it was always. During discussions with residents, it was stated that the staff look after residents well and showed genuine concern for each other. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 21 Relatives at the home during the inspection stated that the staff acts upon suggestions made. Members of staff giving feedback on the conduct of the home stated that the manager was approachable. The staff also felt that by having a stable staff team that support each other, consistency of care was offered to residents. One member of staff further stated that the deliver of care is not based on medicating residents. The approach is to prevent behaviour that challenge, which includes relaxation and diet. Cintre Community DS0000026532.V324564.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 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 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X 3 X X X X X X Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 23 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 YA1 Regulation 6 Requirement The Statement of Purpose must be reviewed. The information must be clear about the delivery of care. The Service User Guide must include house rules. Reports of significance must be maintained to describe outcome of visits, observations of the staff and activities undertaken. Risk assessments, protocols and strategies must follow good practice guidance. The action plans must reflect the level of risk for risk assessments completed for activities that may involve an element of risk must a) The care planning process must be updated provide a person centred approach to meeting needs. b) For residents with mental health care needs, triggers, signs of deterioration and implications for any breeches of imposed sections. c) Care plans must describe the manner residents with communication needs make decisions. Timescale for action 01/04/07 2 3 YA16 YA7 5 12(1) (a) 01/06/07 30/01/07 4 5 YA7 13 (7) 13 (4) (b) 01/04/07 01/04/07 YA9 6 YA7 15 01/04/07 Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 24 7 YA7 13 (7) 8 YA42 23(4)(d) a) A policy and procedure must 28/02/07 be developed about Challenging Behaviour and Physical Intervention is managed at the home. b) The procedure must also include the responsibilities of the staff that assist to manage aggressive and violent behaviours. Ensure fire training is carried out 28/02/07 within the timescales dictated by the fire brigade. (Not checked at this inspection). a) Physical restraint techniques must not be harmful to residents. b) CNR techniques used must be BILD registered. 30/01/07 9 YA35 13(6) 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 YA6 YA42 Good Practice Recommendations Change the service user guide and statement of purpose to ensure residents know that Cintre is not a home for life. Contact the Fire Brigade for a logbook and to request that they check and agree the fire risk assessment. Cintre Community DS0000026532.V324564.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Cintre Community DS0000026532.V324564.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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