Inspection on 30/11/05 for Coppice House

This inspection was carried out on 30th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coppice House 10/05/07

Coppice House 21/11/06

Coppice House 06/06/06

Coppice House 10/06/05

Coppice House 08/10/04

Coppice House 01/05/04

Coppice House 23/02/04

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 Coppice House Main Road Huntley Glos GL19 3DZ Lead Inspector Ms Tanya Harding Unannounced Inspection 30th November 2005 1.30pm Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Coppice House Address Main Road Huntley Glos GL19 3DZ 01452 831196 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) Orchard End Limited Mr Bassam Adib Khalil Jubrail Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th June 2005 Brief Description of the Service: Coppice House is a residential care home for eleven adults with learning disabilities who may also have challenging behaviours. The home consists of the main building and an adjacent bungalow which is a few yards from the main house. Coppice House is situated approximately eight miles from Gloucester city in a rural location and is surrounded by extensive grounds. The main house accommodates seven service users, all having first floor single rooms. There are also two bathrooms and a small office on this floor. On the ground floor there is a large lounge, dining room, kitchen, laundry, office and bathroom. The bungalow accommodates four service users in single rooms. There is a lounge/diner, conservatory, kitchen and two shower rooms. Close to the main house there is a large patio and landscaped garden. Coppice House is one of four homes which are part of Orchard End Limited, a subsidiary of C.H.O.I.C.E Ltd. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 1.30 pm and lasted over four hours. The registered manager was present for the duration of the visit and the quality assurance co-ordinator was present to receive the inspection feedback. The majority of the service users were in the home and several were greeted. Two service users were away on holiday. The main purpose of this visit was to assess progress with the requirements made in the last inspection report. There was evidence that a number of the requirements have been addressed and progress has been made in other areas. Care plans, medication records and other documents were looked at and two members of the staff team were spoken with as part of the inspection. What the service does well: What has improved since the last inspection? What they could do better: There are concerns about the ability of the home to accommodate people who may display extreme aggression. Consideration should be given to the range of Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 6 needs which can be successfully supported. The Statement of Purpose needs to be amended to reflect this. Greater emphasis needs to be given to enabling and supporting the service users to be more independent within their own home. Risk assessments should be empowering rather than restrictive. Further work is necessary to develop a person centred approach to care planning in order to ensure care plans reflect the needs as well as aspirations of the individuals. This needs to include systems by which people can be consulted about their views in a meaningful way. Prescribed medication must be administered to service users as necessary and any decision to change dosage or times of administration needs to be checked with the person’s GP or consultant. Staff supervisions are taking place but need to be carried out more frequently. 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. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 Information about the range of needs which the home can accommodate may need further clarification to ensure placements are not offered to people whose needs cannot be met. EVIDENCE: At the time of the visit there were ongoing difficulties with supporting one person who moved into the home earlier in 2005. The manager confirmed that the placement has been reviewed and alternative options are being looked at. The Statement of Purpose for the home states that the home intends to meet the needs of people who may present behaviour challenges. However, there is evidence that the home finds it difficult to accommodate people who may display extreme aggression. The Statement of Purpose needs to be reviewed to expand the detail about the types of behaviour challenges the home can support effectively so that any prospective service users can be confident of the homes’ ability to meet their assessed needs. Alternative placement is also being sought for another person, whose needs have changed and can no longer be managed safely in the home. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Some strategies which are in place to protect people from risks may act as a barrier to empowerment and independence. EVIDENCE: The manager has provided an update about the aim of the Organisation to introduce person centred planning. To date the management team, including team leaders, have attended three sessions about person centred planning and a further meeting has been scheduled to discuss how this approach will be incorporated into the current set up. A training session to raise staff awareness of this subject has been planned for January 2006. The requirements made in the last report about what information is detailed in care plans and consultation with service users are repeated. It is acknowledged that steps have been taken to begin educating staff about a different approach to care planning (see also Standard 35). The manager advised of attempts to use the Widgit software in the home with aim to increase the opportunities for the service users to be involved in what is important to them. This has not been successful and other options are being looked at. This includes getting feedback and information from families. The manager advised that some relatives have given feedback about the service at the home and this has been positive. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 10 Two service users files were examined in some detail and were used as subject of discussion with care staff. There was evidence that information on file was being reviewed. Staff spoken with demonstrated good awareness of what information is kept on files. Staff felt that access to information held about service users can be improved. Examination of care files showed that there was a considerable amount of information present and a lot of duplication. This made it difficult to find the necessary guidance quickly. Care files should be structured in a way which is less confusing. Discussion took place with the manager and the quality assurance co-ordinator about providing real evidence in risk assessments as proof that the limitations which are imposed on service users are valid and are in their best interest. This may mean that the approach to risk assessment and evaluation of risks in the home will need to change. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 There are limitations in place which do not promote independence and restrict the potential for the service users to take on ordinary roles and responsibilities. Better clarity of guidance on how people should be supported at mealtimes would ensure better consistency of approach. EVIDENCE: Staff spoken with felt that there is a focus on enabling service users to be as independent as possible. One example was given of supporting one service user to write a letter to their family. There were examples of choices being offered to service users with regards to activities. Discussions with care staff and observations made during the visit showed that service users access to some areas of the home is restricted permanently. For example, prior to this visit it was the inspector’s understanding that service users can enter the kitchen with staff support or independently (for at least one person) to choose a pudding out of the fridge or to make themselves a drink. However, it became evident that no service users are allowed in the kitchen. Risk assessments which talk about restrictions are limited in detail. There seems to be lack of assessment with regards to possible benefits for Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 12 individual service users if the restriction was not in place. This could be a good starting point when reviewing risk assessments. On the day of the inspection service users were observed having their lunchtime meal in the dining room. Individual service users were being supported by care staff where necessary. The mealtime appeared relaxed and unrushed. Staff advised that one person requires feeding. A care plan for how this support needs to be provided was assessed to be very limited in detail and must be reviewed to ensure that the person is enabled to do as much as possible for themselves safely and the staff offer the required support consistently. The manager advised that steps have been taken to re-establish contact with a relative at the request of a service user. The person’s care manager has been approached for help with this. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People’s emotional and psychological needs may be compromised by behaviour challenges of one person. Prescribed medication may not always be administered correctly and this may put people at risk of harm. EVIDENCE: Discussions with care staff and observations during the visit provided evidence that one person’s behaviours have been having an adverse impact on other residents and on the staff. It has been recognised that the person’s needs cannot be met effectively in the current set up and a new placement is being considered. The person was observed displaying behaviour challenges on the day of the visit. Part of the response in such instances is to remove other more vulnerable service users from the area or to stop them accessing the hazardous area. There was also evidence that many of the service users are very upset by this. For example one person has been finding it hard to be in the home that day and asked to go out for a drive with a member of staff. This person was able to self-advocate, whereas the majority of the service users at Coppice House are not able to do this effectively. Previous discussions have taken place with the Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 14 home manager about an increase in incidents of challenging behaviours displayed by other service users and whether this was an indication of people’s distress and unhappiness. See also Standard 22. Staff confirmed their awareness of the additional health needs some service users have, such as epilepsy. Staff spoken with said that they have not received any formal training about epilepsy. The training coordinator is now addressing this. The home manager advised that the team leaders have accessed the advanced BTEC course in administration of medication and this included an element of assessment. The medication procedure has been further clarified to offer a step-by-step guidance for staff. Procedures are now in place to ensure that medication keys are kept securely at all times and can only be handled by authorised personnel. Medication audits are taking place and records of these were seen for October and November 2005. The manager has agreed to add to his audit checklist monitoring of ‘as required’ protocols, to ensure these are up-to-date and remain relevant. It is also recommended to expand the information on how people would like to be supported to take their medication and what staff would do in case of refusal. A less invasive option should be explored for the service users who are prescribed rectal valium. A record of disposal of any unused medication is kept. Examination of medication administration sheets showed that prescribed medication for one person was not being administered on some occasions. There were a number of gaps in signatures and some medication remained in the blister packs. The manager confirmed that he was aware of this and that it had been sanctioned as acceptable practice for this particular service user not to be given their midday medication if the person was out of the at the time of prescribed administration. This is because on some occasions the staff who would be supporting the person were not trained to give medication out. The manager must ensure that all prescribed medication is administered as necessary. Any changes to how prescribed medication is administered must first be sanctioned by the relevant medical professional, such as GP or a consultant. Following this visit the above concerns have been brought to the attention of the Group Care Manager for further investigation. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Service users who can express their needs verbally are listened to. Systems for protecting people from abuse are in place, but may not always be effective, thus leaving the service users and staff at risk of physical attacks and emotional distress. EVIDENCE: One person has voiced their unhappiness about the behaviour of another person. They have been supported to put their concerns in writing to the Operations Manager, who has responded to the service user formally. Staff spoken with demonstrated awareness of the complaints process and understood the right of the service users to voice concerns. Discussions took place with the home manager about whether the service users at Coppice House are at an elevated risk from physical attacks. It was evident that a number of strategies were in place to manage the extreme behaviours of one particular service user, and care guidance which staff were expected to follow was comprehensive. The manager felt that the service users were not at risk of harm. However, there have been several incidents of physical violence during which staff and other residents have been targeted and hurt. Staff spoken with were very concerned about the difficulties in supporting the resident and how this has affected the team morale. There was also evidence that inconsistencies in how staff support this and other residents remain. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 16 The same issues of concern have been highlighted in the last inspection report. The home has initiated a review of the person’s placement. However, there was evidence that advice has not been sought from the Adults at Risk team. It is the view of the inspector that there has been lack of proactive and decisive action about improving the situation and this has compromised the physical and psychological wellbeing of the other service users in the home. Since the inspection the manager has been in touch with the Adults at Risk team and progress has been made with finding the person alternative placement. Staff spoken with confirmed that they would not get involved in any restraint until they have completed the required training. The inspector was also advised that ‘prone’ restraint in no longer taught as part of M.O.R.E. course and this is seen as a very positive step. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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): Not assessed. EVIDENCE: Decoration of the hallway and the dining room was in progress on the day of the visit. No progress has been made with regards to planned improvements to the lounge area and to the facilities in the bungalow as discussed in the last report. The home has been asked to provide an action plan for these improvements with timescales for reference. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 36 Better staffing levels and more robust induction offer better protection to service users. The team would benefit from more regular supervision. EVIDENCE: New staff spoken with confirmed that they received an introduction to the home which included looking at areas such as health and safety and meeting the service users. During the first week of employment new staff are asked to observe more experienced staff and do not get involved in supporting people with personal care. A new staff member said that there was no specific discussion about the values and philosophy of the home but they were given an opportunity to read service users’ files. Staff spoken with were aware of how to raise a grievance and where to go for support and advice. There is a now a weekly progress meeting with the home manager for the first six weeks of employment. The required training in physical intervention and de-escalation is provided for all new staff in the first few weeks of employment. The Organisation has robust recruitment procedures and staff spoken with confirmed that the necessary checks are carried before employment commences. Eight new staff have been recruited since the last inspection. Staff spoken with advised that they are required to review two service user’s files before each supervision meeting where their knowledge of relevant care Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 19 guidance would be tested by a team leader. A matrix of formal staff supervisions showed that staff are being supervised. However, the frequency of these sessions is considerably below those stated in Standard 36.4 and this needs to be addressed. The Organisation has developed a comprehensive policy on staff supervisions in line with the relevant standards, and this should be followed. Staff rotas for October and November 2005 provided evidence that the necessary staffing levels are being maintained with staffing shortages being much less frequent. Further changes to the staff complement is anticipated with one team leader leaving the home in December 2005. There are also plans to recruit a deputy manager. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 43 Additional management support to the home and comprehensive polices and quality assurance checks offer better protection to the service users. EVIDENCE: The Organisation provides the home with regular formal support. This includes monitoring of placements for the first few months of any new service user moving in, guidance on issues picked up through Regulation 26 visits, recommendations about staffing levels, training and recruitment. There is also input from the assistant psychologist, who has the remit of providing guidance to staff with regards to managing and responding to challenging behaviours. The home manager is a trained nurse and has attended a three-day course in TEACHH (specialist behaviour approach) in September 2005. There are plans to put this training into use by introducing different methods to supporting service users. Staff commented that they find the home manager approachable. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 21 A number of requirements are carried over from the last inspection report. Progress has been evident in some areas for example in the changes to supervision arrangements for new staff. However, this report also comments about lack of progress in areas such as service user empowerment, promoting of independence and concerns about the effectiveness of risk assessments. A significant concern has been highlighted to the registered manager, the group manager and the quality assurance co-ordinator about the practice of not administering of prescribed medication to one service user and a follow up investigation into this matter is requested. Quality assurance visits carried out in line with Regulation 26 are detailed and self-critical. This means that the service provided in Coppice House is scrutinised in detail and identifies actions for improvement. Copies of Regulation 26 reports are forwarded to the CSCI as necessary. In addition there are regular policy and staffing reviews, care reviews with outside professionals and management meetings. There are clear lines of accountability in the home and staff spoken with confirmed their understanding of these. The Organisation has developed systems both locally and more centrally for monitoring and overseeing the service provided at Coppice House. The Organisation maintains regular contact with the Commission and continues to demonstrate its commitment to meeting the National Minimum Standards and the Care Homes Regulations 2001. Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Coppice House Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 X 3 3 X X 3 DS0000055593.V269834.R01.S.doc Version 5.0 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 4 Requirement The Statement of Purpose must be revised to provide more detailed information about the range of challenging behaviour needs which the home is able to accommodate. Copy of the revised Statement of Purpose to be forwarded to the Commission. Care plans must demonstrate that people have been consulted about what is important to them and distinguish between the aspirations of the individual and expectations of others. (Timescale of 31st October 2005 not met). Agreed care plans, risk assessments and other support protocols must be adhered to and implemented consistently by all staff. Where there is a discrepancy between what is written in care plans and what is done in practice, this must be reviewed and revised guidance re-issued / clarified to all staff. (Inconsistencies in staff approach are still evident – DS0000055593.V269834.R01.S.doc Timescale for action 01/03/06 2. YA6 15 31/03/06 3. YA6 13(6) 01/03/06 Coppice House Version 5.0 Page 24 Timescale of 31/08/05 not met) 4. YA8 12 Systems must be in place to formally seek views of service users in the way which is meaningful to each individual (Timescale of 31st October 2005 not met) Provide greater detail of the support required for one service user during meal times. Staff to be provided with awareness training in epilepsy. All staff must be clear about how to respond to violent or other behaviours appropriately and in accordance with agreed behaviour management plans. (Original timescale of 31/08/05. To be assessed at the next visit). Non-slip flooring must be provided in the shower room. (Timescale of 31/10/05 not met) Staff require further skills and development in the area of Total Communication and relevant training must be provided. (Timescale of 31/12/05 not met but progress has been made) Ensure that all prescribed medication is administered as necessary. Any changes to how prescribed medication is administered must first be sanctioned by the relevant medical professional, such as GP or a consultant. Carry out an investigation into the practice of non administration of prescribed medication and provide a written overview of the findings to the Commission (by 31/01/06) Provide an action plan for environmental improvements. Ensure all staff are appropriately supervised DS0000055593.V269834.R01.S.doc 01/03/06 5. 6. 7. YA17 YA19 YA23 12 18 13(6) 15/02/06 01/03/06 01/03/06 8. 9. YA24 YA35 23 18 15/02/06 01/03/06 10. YA20 13(2)(6) 30/11/05 11. 12. YA24 YA36 23 18(2) 01/03/06 01/03/06 Coppice House Version 5.0 Page 25 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 YA23 YA36 YA6 YA9 Good Practice Recommendations Person centred planning with the use of Total Communication strategies should be used for all service users with communication needs Feedback from relatives and involved professionals about care provided should be sought and recorded Staff should receive a formal supervision at least six times a year and more frequently for night staff. Care files should be structured in a way which is less confusing. Review the approach to risk assessment and evaluation to provide evidence that the risks are real and any limitations which are imposed as a result of a risk assessment are valid. Better information should be provided on how people would like to be supported to take their medication and what staff would do in case of refusal. A less invasive option should be explored for the service users who are prescribed rectal valium. 6. YA20 7. YA20 Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coppice House DS0000055593.V269834.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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