Inspection on 17/10/06 for Farm View

This inspection was carried out on 17th October 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Farm View 07/12/05

Farm View 06/10/05

Farm View 07/02/05

Farm View 15/09/04

Farm View 06/02/04

Farm View 08/09/03

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

CARE HOME ADULTS 18-65 Farm View Highlands Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Mrs Sally Gill Unannounced Inspection 17 October 2006 08:45 Farm View DS0000023420.V300729.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 Farm View DS0000023420.V300729.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. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Farm View Address Highlands Farm Woodchurch Ashford Kent TN26 3RJ 01233 861515 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) Canterbury Oast Trust Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 4 People with learning disabilities aged between 18 - 65 years. Resident with acquired Brain injury to be restricted to one whose dob is 12/09/1973 7th December 2005 Date of last inspection Brief Description of the Service: Farm View is registered to provide accommodation for up to four adults who have a learning disability. The home is owned by Canterbury Oast Trust (COT), a registered charity, and is managed on a day-to-day basis by Ms Danielle Boakes who is not registered with the commission. The home is a purpose built property with all accommodation on the ground floor and suitable for wheelchair access. All bedrooms are single occupancy and one has full ensuite facilities. The residents have the use of a bathroom and shower room, a kitchen/diner and there is a comfortable lounge/diner, which has views across the garden and farm. The home is situated on the grounds of Highlands Farm, the home of the South of England Rare Breeds Centre, and a major tourist attraction in a rural area on the outskirts of the village of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, and approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs, the home also has transport which can be used for residents if they wish and a local bus service passes the farm. The site itself offers many opportunities for community contact, and specialist facilities such as snozelan and an art department are nearby. Some residents have unpaid work placements within the Trust Current fees are £934.58 per week. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place on Tuesday, 17th October between 8.45am and 5.50pm. The manager assisted throughout the visit. Those that live at Farm View wish to be known collectively as residents. Four people were living at the home. The inspector met and spoke to all four residents and three staff on duty. Observations included interactions between residents and staff. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to residents, families, and professionals involved in the home. Surveys were received from two residents (one completed with staff support), which indicated residents were happy with their care. One relative responded and was satisfied with the care provided. Professional feedback (GP surgery and a care manager) was also positive. There was one concern noted that a senior member of staff is not always available to confer with. Various records were viewed during the inspection. The inspector accessed the kitchen, lounge/diner, the bathroom, shower room and the office. What the service does well: What has improved since the last inspection? Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 6 COT have reviewed their recruitment procedure and practices which means that residents are now protected by a thorough recruitment process. The new manager who started work at Farm View in August 2006 is working hard to further improve the quality of life for residents. She has started work in several areas that will help. Danielle has also contacted some professionals to help the staff team and residents. One resident now has more opportunities to do different activities. Residents are now choosing a meal to help cook each evening. They are also doing more household chores for themselves with staff supporting. 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. Farm View DS0000023420.V300729.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 Farm View DS0000023420.V300729.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): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide is currently being up dated to reflect the changes in the home. Prospective service users have their needs assessed prior to admission. Each service user has a contract of terms and conditions in place although these are not always complete. EVIDENCE: The manager has begun work on up dating the statement of purpose and service user guide. She intends also to change the format of both documents to symbol and picture, which would be more suited to the residents. She has agreed to have this completed by 17th November 200. A copy of both documents should then be sent to CSCI. There has been one admission and one discharge since the last inspection. Both were well planned. Evidence of an assessment of needs was on file as was the care managers care plan. The manager acknowledged that for some residents their care management assessments had been archived recently and agreed to ensure these were retrieved and held on files. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 9 It is suggested that COT look to develop a written procedure that managers will follow when the prospective resident is transferring from another COT establishment. It is felt this will ensure a thorough process and also consistency within COT. Each resident has a contract of terms and conditions in place. However the paperwork is not always complete. Some were also not signed by the home or the resident/representative. A review of contracts is recommended to address this. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Minor alterations are needed so that care plans fully reflect all resident’s needs and that this, is the way they wish to be supported. Support to aid decision-making and participation could be further improved with increased staff awareness. Residents are supported to take risks to aid a more independent lifestyle. EVIDENCE: Each resident has a good detailed care plan in place, which tells staff how they will be supported. These had been reviewed within timescale. There is no evidence at present that residents are involved in the care planning process or that this is the way they wish to be supported. Handwritten changes should be dated. Recommendations have been agreed at reviews but are not all followed through into care plans. This was also the case of recommendations made by professionals, which were not followed through into practice. The manager is Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 11 currently in the process of reorganising files so that care plans will be more of a working document. She has also begun to work on introducing goal planning to enhance skills and independence of residents, which is needed. Residents stated and observations confirmed that they are involved in the dayto-day decision making within the home. Resident meetings were held monthly and this has recently been changed to fortnightly. Decision-making has also recently been further improved with all residents now choosing an evening meal, which they would like to assist in cooking. The manager acknowledges that further work can be achieved in this area and has plans to work with the staff team. A referral to the Community Learning Disability Team (CLDT) has been made to enhance communication and decision-making. Risk taking is well supported and evidenced in risk assessments. The manager is currently reviewing all risk assessments to see if further independence can be achieved safely for residents. Although one practice discussed which was implemented as a result of an incident has not yet been recorded in the risk assessment. Farm View DS0000023420.V300729.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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in a variety of appropriate activities both within the trust and also the wider community although opportunities may be enhanced with more suitable transport. Friendships and family contact is well supported. More thought should be taken to ensure resident’s rights are fully recognised and respected and that they all enjoy sociable mealtimes with a healthy diet. EVIDENCE: Residents have opportunities to participate in a wide variety of activities within the trust and also the wider community. For one resident opportunities have been increased recently. Residents enjoyed a holiday this year or day trips out whichever was their choice. Due to changes within the home the recommendation to seek paid employment opportunities with individuals who Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 13 have had significant work experience remains outstanding. The homes only car is not big enough to take everyone, which can reduce opportunities. This has been raised in the homes development plan and it is recommended this should be given consideration. Some families are involved with the trust. Residents talked happily of relationships including home visits with families and also other friends on the farm. Positive feedback was received from a relative that responded. Residents can choose to be involved in running the house or alone in private as they wish. Staff have made some good steps improving service user involvement with household chores. Many household activities were taking place without resident input. The manager said that staff were being coached to enable residents development, rather than doing the daily tasks themselves, which is still happening. Communication plans are being developed with the help of speech and language therapists. There was lots of background noise during lunchtime from TV and music, which should be considered as a barrier to effective communication. Some staff used terns of endearment when speaking to people, although their preferred name was known. Staff must be aware that their relationships remain adult-to-adult; this may be a training issue around equality. Lunch (a snack meal) was prepared and cleared away by staff, without resident’s involvement. Professional advice about a particular diet need was not being put into practice. Staff should be aware of benefits to all residents of encouraging a healthy diet. More thought should be given to ensure every resident can enjoyed their food hot. Farm View DS0000023420.V300729.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): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents confirmed they are happy with the support they receive. Health care needs are met although improvements in monitoring could be more effective. There are shortfalls in the medication system, which could leave residents at risk EVIDENCE: Care plans detail how care will be supported. It was apparent through discussions that times for getting up and going to bed are flexible. The key worker system has recently been reviewed at the request of residents. It was apparent that residents felt at ease in staffs company and told the inspector they liked the staff. Health care needs are met including regular checks. Feedback from the local doctors surgery and a care manager was positive. A range of professionals are currently involved in the care of some residents. As previously stated the Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 15 home must ensure that any recommendations are followed through into care plans and practice. Residents are weighed monthly although these would benefit from any significant changes highlighted and actions taken as a result of this recorded so this can be monitored. Only a small amount of medication is prescribed by the GP the rest is prescribed by other professionals. Staff need to understand the ethos of alternative medicines and treatments to enable them to promote and encourage a healthy lifestyle for residents. These medications also need to be put on a far more formal footing to ensure everyone is protected. The home must obtain full written information from the professional as they would from the surgery. Any changes should be given in writing. Instructions should be duplicated on the MAR chart. Better MAR charts could be introduced to avoid errors. Medication could then be logged in on the MAR instead of having a separate record. Where self-administration or part is taking place a risk assessment must be in place. Five staff are trained in administration of medicines. The manager is about to undertake competency checks and agreed to incorporate an observation of administration in these. Medication storage should be improved. It should be clear in the cupboard, which medication is over the counter and which is prescription meds. The cupboard should be dedicated to medication only. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 21 & 22 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s views are listened to and acted upon. Staff must be aware of all routes to report abuse to ensure residents are fully protected. EVIDENCE: No complaints have been received at the home since the last inspection. A symbol complaints procedure is displayed within the home. Residents are asked about all areas of their care and whether they want to change or improve things. Resident’s personal allowance balances and records were in order. All staff have received training in adult protection. However not all staff were aware of the route to report abuse outside of the trust and they must be. It is suggested that a flow chart be developed which includes contact details of adult protection and CSCI. Four staff are trained in NAPPI. The manager is in discussions with two professionals who have agreed to deliver training to the staff based on dealing individual behaviours. Details in accident/incident recording could be improved to aid monitoring. Although the manager is already working with a processional to develop a better recoding form. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a home, which is a clean, homely, comfortable and safe environment. EVIDENCE: The inspector accessed the kitchen, shower room, bathroom, office and lounge/diner. Meals can be taken in the kitchen or lounge/diner. Furniture is arranged to ensure it is homely. A cordless telephone is available so residents can make and receive calls in privacy of their own rooms. Residents confirmed that they are happy with their rooms. Staff confirmed that any maintenance work required is usually carried out fairly quickly. Any equipment required by residents to enhance their independence is provided. The manager is also working with the CLDT to improve the environment for those where their needs are deteriorating. Gardens are well maintained and it is apparent that residents enjoy them in good weather. Discussions highlighted that the garden is an area that several residents enjoyed and perhaps could be developed further. The manager talked about the development plans for the home, Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 18 which includes trying to improve the shower room, which is not very inviting or homely at present. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well cared for by a fairly new and developing team who are undertaking qualifications and training. However outcomes for residents could be improved if staff awareness of their role and also specific residents needs were improved. A robust recruitment procedure is now followed to protect residents. EVIDENCE: In addition to the manager there is one member of staff on duty 7am – 8am, 2 8am – 8pm, 1 8pm – 10.30pm and one member of female staff sleeps in 10.30pm – 7am. The home has undergone a period without a manager and the staff have slipped into a caring role rather than supporting. This must be addressed to ensure residents have the opportunity to achieve maximum outcomes. The majority of the staff team are fairly new with staff new to care or learning disability services. The staff team demonstrated that they are caring with some good interactions observed. However this was not consistent and at Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 20 times the staff’s focus was elsewhere. See also previous comments in the report. The manager has already realised this is an area that needs improvement and is taking steps to support staff to change the ethos of the home and improve outcomes for residents. All staff have achieved or are undertaking NVQ level 2 or above. There is a lack of staff training in Makaton and if a recent referral to the CLDT recommends the use of Makaton a recommendation will be made in future for all staff to be trained. One staff file evidenced a robust recruitment procedure is followed. The other staff file did not but this was prior to the review of the recruitment policy and practice by the trust and to the last inspection when a requirement was made. The manager agreed it would be a good idea to set up specialist information manuals for staff. Dementia and Autism training is booked. Managing aggression specific to residents is being discussed. COT is about to start delivering their new induction training, which has been developed with a local college and is to Skills for Care specification. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is committed to ensuring the home is run in the best interests of residents and undertaking the relevant qualifications to enable her to fulfil her role. Residents can be confident their views underpin the development of the home. Resident’s health, safety and welfare are promoted although there should be better reporting systems to ensure they are fully protected. EVIDENCE: The manager who took up post in August 2006 has 10 years experience within the trust two of which have been in a senior position. She has completed all training in core subjects plus assessors’ medication handling and autism. She Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 22 has acquired her NVQ level 4 in care and her A1/A2 assessor’s award. She is booked to start the RMA in January 2007. Staff comments about the manager included ‘you can talk to her’, ‘she is approachable and I can voice my opinion’, ‘she good at expressing herself’ and ‘she’s very efficient’. Staff felt she has bought structure and leadership to home. Danielle is committed to supporting and enabling her staff team to improve outcomes for residents. She understand the importance of getting the ethos right in Farm View which must be under pinned by staff understanding their role, good training and supervision. A variety of quality assurance systems are in place taking feedback from residents, families and professionals. A development plan is in place for the home. All staff are trained in manual handling, fire, first aid and food hygiene. Two are trained in infection control with another three places booked. The accident and incident reports viewed lacked sufficient detail in order that they would be valuable in a monitoring process. The manager acknowledges this and is developing with a professional a new form format for recording. Incidents/accidents that should be reported to adult protection and/or CSCI were discussed, as two further incidents had not been reported. It was suggested that the form be reviewed to contain a prompt to report outside. Various fire and health and safety records were checked. Farm View DS0000023420.V300729.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Requirement Review the statement of purpose and service user guide so they reflect the changes within the home Staff must promote residents independence and opportunities as stated in the homes SOP The home must have a safe procedure/practice for all medicines that come into the home All incidents/accidents must be reported to outside agencies appropriately Timescale for action 17/11/06 2 3 YA16 YA31 YA20 12(4) a 13(2) 17/11/06 17/11/06 4 YA42 37 17/11/06 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 YA5 YA6 Good Practice Recommendations Review individual contracts held on files to ensure they are complete and signed by the home and resident/representative Evidence resident involvement in the care planning process and that care plans show this is the way that they wish to DS0000023420.V300729.R01.S.doc Version 5.2 Page 25 Farm View 3 4 5 6 7 8 9 10 YA6 YA12 YA13 YA17 YA17 YA19 YA23 YA39 be supported Recommendations made by professionals and agreed at reviews and should followed through into care plans and day-to-day practice. Seek paid employment opportunities with individuals who have had significant work experience (brought forward from previous inspection) Consideration should be given to improving the homes transport to meet the needs of all residents Staff should promote and encourage a healthy diet Care must be taken to adapt meals to suit needs if necessary so that they are hot and enjoyable Significant changes in residents weight should be highlight and action to be taken recorded Staff should be aware of all routes to report abuse Further simplification of quality assurance for specific resident, presented in a manner they may understand, with pictorial aids as necessary, and hold relevance for the individual (brought forward from previous inspection) Farm View DS0000023420.V300729.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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