Inspection on 18/01/06 for Elysian Villas

This inspection was carried out on 18th 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elysian Villas 28/02/07

Elysian Villas 25/07/05

Elysian Villas 06/01/05

Elysian Villas 28/07/04

Elysian Villas 29/03/04

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 Elysian Villas 21a King Street St George Bristol BS15 1DL Lead Inspector Andrew Pollard Unannounced Inspection 18th January 2006 09:30 Elysian Villas DS0000020356.V270861.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 Elysian Villas DS0000020356.V270861.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. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elysian Villas Address 21a King Street St George Bristol BS15 1DL 0117 9619977 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Ms Sarah Cryer Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. StaffingNotice dated 28/08/2001applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate up to 13 persons with learning disabilities aged 18 and over who are ambulant and may have a mental disorder. 25th July 2005 Date of last inspection Brief Description of the Service: Elysian Villas is operated by Aspects and Milestones and comprises of three houses accommodating thirteen residents needing social or nursing care. The residents have learning difficulties or a dual diagnosis including mental disorder. The villas are set in secure grounds and the home is situated in a residential area that is close to local amenities and a main bus route. Each house has four or five single rooms including one bed sit, a lounge and dining room, bathroom, kitchen and laundry. The home is not considered a home for life as some residents may move less supported environments in the future or become more physically frail. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering have been used in the production of this report; observation, discussion with residents and staff and residents, tour of the home and sampling policies, records, care plans. Limited conversations were possible with a number of residents who had no complaints and appeared happy in the home. The home has stabilised and staff morale is good. The staff team continue to be committed to improving the quality of life for the residents. Work to enhance the facilities in the home has started and will continue until the end of March. What the service does well: What has improved since the last inspection? The service user guide has been updated. NMC validations for RNs working in the home are properly checked. Work is ongoing to produce the service user guide in a general photographic format. That resident accident and incident forms are properly completed. Staff accident forms are filed in the main office. The introduction of the villa management structure has raised staff commitment and job satisfaction. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elysian Villas DS0000020356.V270861.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 Elysian Villas DS0000020356.V270861.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): 1,2,5 Prospective residents and their families are given relevant information in written or verbal form about the home. Contracts and terms and conditions of services are provided to all residents. EVIDENCE: The Statement of Purpose and Service User Guide have been updated to include the new management structure on the villas and give full information to potential purchasers. A photographic version of the guide, which will be more accessible to potential residents, is being produced. All residents are referred through the community learning disability team. There have been no permanent changes in the resident group since the last inspection, however one person has been admitted as a temporary residents whilst a permanent placement is identified. There are a diverse range of needs and abilities amongst the residents currently accommodated. The home employs a number of Registered Nurses (RN’s) who have knowledge and experience in relation to both learning disabilities and mental health needs. Many of the support staff are very experienced with the resident group and all will be training toward NVQ level 3. All residents have standard Trust terms and conditions and licence agreements in their case files. The staff read the provisions to the residents; some of who are able have signed or marked the documents. Elysian Villas DS0000020356.V270861.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): 6,7,9 Residents are involved with the assessment and care planning/goal setting and review process as much as they are willing and able. The homes philosophy promotes resident’s individual development and selfdirection and empowerment. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 10 Full and detailed assessments are carried out on potential residents prior to admission written by home staff qualified to do so. Assessments by social workers, nurses and other health care specialists are available. Elysian Villas operates a team working and key working system. Each resident has a named RN and support worker who co-ordinate their care planning and reviews of the care package. There are monthly villa meetings to evaluate care plans and a small number of residents play some part in this process although all are invited to do so. The residents are in general unable to or do not wish to make a significant contribution to the management of the home in a formal sense. However, staff share information and seek to empower residents in making decisions and participating in choices related to day-to-day life. The home uses a person – centred approach to care planning: The development of essential lifestyle planning to enable a more holistic approach to service provision has been discussed but not implemented at present. There was evidence to indicate that most care plans and risk assessments are reviewed at regular intervals and that residents and the multidisciplinary team are involved in this process. Records seen on the villas were in general written to a good standard. Nurses have a free day each month in part to ensure care documents and risk assessments are kept up to date. Staff handovers take place on the villas in the morning and evening. The midday handover is held in the main office to maintain a team ethos and up to date awareness as to what is happening on each villa. The residents have a diverse range of needs and some are more independent than others. Independence is promoted through the risk assessment framework and staff seek to broaden experiences where possible. Risk assessments and care plans document reasons for any limits to resident’s rights or related to management of behaviours that challenge. Residents are involved as much as they are willing or able in making these judgements. Each villa has a bed sit for residents who are developing more independent living skills and one of the long term aims of the home will be to prepare some residents to move to the minimal support flats to be built on villa three. Elysian Villas DS0000020356.V270861.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): 12,13,15,17. Residents have opportunities to take part in a range of community and leisure activities. The recreational and occupational arrangements in the home are well organised individualised and varied. The menus are varied, offer balanced diet and include individual choice. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 12 The level of activities have been maintained for those residents who enjoy an active lifestyles. Two people attend the Enterprise workshop and work at Elm Farm one person goes to a local RAC. Residents often go out to make use of community leisure facilities such as pubs, walking, swimming and cinemas. A bi-weekly bowling club has been established and various day trips and short breaks arranged. The home is set within a secure perimeter and has a key coded lock. The majority of residents on villa three are able to go out into the local area independently. Other residents’ ability to access community facilities varies some need more support to do so safely and others 2:1 escort. Three day care workers attached to the home four days per week working with individual residents or small groups either in or out of the home. Care plans and risk assessments are in place, which detail weekly activities. A number of the residents attend local churches periodically. People are helped to maintain links outside the home with family and friends. There are some strong family links in place and all residents have some level of contact with their relatives, which include some home visits for several of them. A number of relatives are involved with care reviews. A Bar BQ in August, Christmas parties and birthday parties are arranged to which family are invited. A team day is taking place soon to which relatives are invited to contribute. There are limited friendships outside of the home. A number of the residents have severe problems in creating relationships or lack social skills. The home has a commitment to healthy eating. The dietician has visited and given advice to enhance the balance of the diet. The residents of villa one in particular have strong views about what they will and will not eat. Menus are devised on a four weekly rotational basis other than on villa one where the menu is planned on a day-by-day basis. The records show that resident’s eat a balanced diet with a good variety of meals on offer. There is one culturally sensitive diet and a number of diabetic diets provided. Three residents have tea and coffee-making facilities, microwaves and fridges in their bed-sits. One on the residents partially self caters. Elysian Villas DS0000020356.V270861.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): 19,20 The staff provide appropriate personal and nursing care in a sensitive manner to maintain residents health and well-being. Appropriate arrangements are in place for residents to access primary and secondary healthcare services if need be. The staff properly manages and administer medication. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 14 The home does not cater for people with major physical disability but where possible will manage some levels of short-term ill health. Those residents whose mobility or general health significantly deteriorates and have a need for additional facilities may need be to transferred. Care plans also detailed support needed for personal care including continence, bathing, dressing and help at night. All residents have an annual OK Health check assessment but there were no formal health action plans developed. All residents are registered with the same GP practice and generally see Dr Goyder who carries out health reviews and is considered very supportive. Dr Cook is the responsible Psychiatrist, however in general the SHO visits although more on an as required basis rather than the more regularised visits previously. One resident has been referred to the clinical psychology service following a marked change in behaviour. Many of the residents attend community opticians, chiropodist, and dentist. In general all residents need staff support to access medical and paramedical services. Nurses administer medication in each villa and a nominated Nurse is responsible for the upkeep of the system. All the Villas operate a monitored dosage system. Records are kept in relation to the storing, administering and disposal of drugs. There is a system in place for stock control of medication given on a PRN basis. The Trust has medication policies available. In addition to this there are individual medication profiles. The CSCI pharmacy inspector carried out a full inspection in June05. There are no formal arrangements in place yet to deal with the disposal of surplus medicines in accord with the recently introduced regulations. Elysian Villas DS0000020356.V270861.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): 22,23 There are robust and comprehensive policies in place to manage complaints or allegations of abuse. There are good arrangements in place for staff training and awareness of POVA matters. EVIDENCE: Aspects and Milestones have an established complaints procedure that details actions taken if concerns are raised, within set down timescales. All residents have access to a copy of the organisations complaints procedure – which include the contact details of the CSCI and Trust officers. There is a pictorial version of the complaint procedure. It is unlikely that the residents could or would make use of formal procedures and in general would rely upon staff or other significant people advocating on their behalf. The manager has maintained a complaints logbook. There have been no complaints received since the last inspection. Aspects and Milestones have a Protection of Vulnerable Adults policy and there is a copy of Bristol City Council’s “No Secrets” guidance that would be followed in the event of suspected or alleged abuse. There are no issues pending. There is a policy titled “Doing the right thing” which encourages staff to report bad practice without fear of being discriminated against. Nurses are aware of the NMC codes of conduct. Copies of the GSCC code of practice have been issued to care staff. Aspects and Milestones also have a code of conduct. Elysian Villas accommodate a number of residents who display complex and sometimes challenging behaviour and there is a “ Behavioural Risk Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 16 Management policy” in place. This outlined trigger points, which may lead to challenging behaviour, escalation points and strategies to reduce the likelihood of this occurring. There was a recent serious assault on a member of staff and the matter was referred to the Bristol intensive response team, however no formal outcome from that appears to be available. All staff have received “Positive Response Training” (PRT) which incorporates theory and the law and some restraint techniques, which may need to be used as a last resort if residents’ behaviour becomes physically challenging. Staff updates occur bi-monthly. There are no recent records of restraint being used. A PRT review and update forum has been set to which all staff are invited. Elysian Villas DS0000020356.V270861.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): 24,27,28,30 The home is generally well maintained clean, safe and comfortable. There are extensive building works underway on all villas. Bedrooms bathrooms and communal areas suit the needs and tastes of the residents. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 18 The home comprises three purpose built houses, which are suitable for their purpose and well laid out. Each villa has a bathroom, dining room and lounge area. The villas are set in quite large and well-presented grounds, which are fenced and secure to which residents have unlimited access. A number of the residents are able to use the keypads, which secure the villas and gates. Resident’s rooms are decorated and furnished according to their taste. One person’s room is in a state of disrepair due to their current mental state and will be upgraded as the situation is stabilised. A number of people have recently acquired new bedroom furniture. Each house is appropriately furnished and decorated. There are proper arrangements in place to maintain and repair the houses and the standard of décor is generally good. Building work on the villa 3 commences later this year to create the new flats and en-suites on the first floor and creating a further two en-suite in ground floor bedrooms. The conversion work on villas 1 and 2 has started to improve the bathrooms and offices. There are suitable laundry facilities and well-equipped kitchens in each villa. The Environmental Health Officer inspected the site last year; there are no matters outstanding. The carpets in the lounge areas are marking and although cleaned are not greatly improved and replacement may be required after the building work is complete. There is only one dining room where smoking is allowed on villa 1. No adaptations are required other than the fixed hoist fitted in one bathroom and a number of grab rails. All the residents are ambulant although one person uses a rollator. Two residents have recently acquired electric armchairs. All three villas were clean and in good order. Residents are encouraged to take care of their own rooms where they are able. All doors have locks with thumb turns. A small number of residents are able to use a key. A copy of the Infection control manual is available. There are proper arrangements in place to dispose of clinical waste. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 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): 32,33,35,36 The home is adequately staffed with appropriately trained and experienced staff. Proper training arrangements are in place for care staff and clinical updating for RN’s. Staff supervision and appraisal takes place. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 20 The home is operating in accord with the Health Authority staffing notice. The staffing levels are sometimes enhanced above the minimum levels on a monthly basis to allow RN’s to concentrate on supervision, appraisal and evaluation of care documentation or attend training. At present there is only one support worker vacancy. Staff sickness level low and the improvement in staff morale is continuing. The introduction of the villa management structure has raised staff commitment and job satisfaction. There has been limited use of agency and bank staff and in general are able to maintain continuity of supply. There is a reducing use of agency staff. Aspects and Milestones have a robust and established recruitment procedure. CRB /POVA and NMC checks are carried out by the personnel department. The four assistant team leaders to deputise for the villa managers are now in post. The trust has a satisfactory induction and orientation programme, staff work through the LDAF induction process prior to completing NVQ level 3. Records of such are kept. A detailed in-house induction programme has also been produced. The majority of the support staff have now commenced or are part way through NVQ level 3 courses. Those waiting to undertake NVQ’s are completing Trust competency training. There are enhanced opportunities for clinical updating/learning disability specific training of the RN’s place. Training records have been brought up to date for all staff. 3rd year student nurse has completed a very successful placements continue in the home. The staff supervision and appraisal process is in place. The Trust’s community manager makes monthly visits for supervision purposes and as required by regulation 26.however the annual personal development plans (PDP)process is not fully operational. There are regular team meetings and RN meetings. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 21 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, 42. The management arrangements are effective and there are clear lines of accountability. There are various methods and systems in place to obtain clients/relatives views. There are appropriate arrangements in place to service and repair plant and equipment. The home has good Health and Safety arrangements. EVIDENCE: Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 22 Ms Cryer remains the registered manager and has many years of experience managing a nursing home for people with learning disabilities and has attained several additional qualifications each villa has a team leader and designated staff team. There is no formal deputy manager but one of the three villa managers will deputise in her absence. A managers meeting has been arranged to review the Trust quality standards audit tool, which is being introduced and will be completed by the end of February. It is accepted that the document may not be entirely relevant for Elysian Villas but will give a baseline and help develop action plans for continued improvement. A new survey format for residents and relatives is being sent out periodically. Each Villa manager either delegates or takes responsibility for health and safety issues. There is a checklist to assess environmental health and safety. The accident and incident reports were properly completed. Any use of positive intervention is fully documented. There have been no incidents where PRT has been used recently. Staff are alll trained in this technique. Staff forms accident and incident forms are all held in the office.. Resident accident/incident forms are kept on the villas. The manager is aware of the provisions of regulation 37 which have been submitted when required. There is fire risk assessment available on the villas and individual risk assessments in relation to each resident and fire safety. The gas safety certificate is up to date. There were up to date records of hot water checks and bath temperatures. The load test on the hoist is up to date. Liability insurance certificates were on display and in date. There is no insurance in place for residents property unless privately arranged. Both an internal and independent external audits of financial records and proceedures take and no irregularities have been identified. Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 23 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 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elysian Villas Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 x DS0000020356.V270861.R01.S.doc Version 5.0 Page 24 Yes see 1 below. 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 YA20 Regulation 13.2 Requirement Timescale for action 28/02/06 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. . Refer to Standard YA19 YA36 YA22 Good Practice Recommendations Develop health action plans for each resident. Reinstate annual PDP’s for all staff. Submit a copy of the B.I.R.T. report Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Elysian Villas DS0000020356.V270861.R01.S.doc Version 5.0 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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