Inspection on 06/03/07 for Glendale

This inspection was carried out on 6th March 2007.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glendale 21/11/07

Glendale 24/11/05

Glendale 09/05/05

Glendale 01/12/04

Glendale 30/06/04

Glendale 13/01/04

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

CARE HOME ADULTS 18-65 Glendale 138 Stockton Road Hartlepool TS25 5AX Lead Inspector Paul Emmerson Unannounced Inspection 6th March 2007 11:00 DS0000021746.V308263.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 DS0000021746.V308263.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. DS0000021746.V308263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Glendale Address 138 Stockton Road Hartlepool TS25 5AX 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) 01429 271366 londonroad@tiscali.co.uk Milbury Care Services Limited Sonia Morrell Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000021746.V308263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. For younger adults up to the age of 65 years Date of last inspection 24th November 2005 Brief Description of the Service: Glendale is a detached bungalow set in its own large gardens in a residential district close to the centre of Hartlepool. The property blends in well with other houses in the area. The home is registered to provide residential care and support for up to 4 people with a learning disability. Accommodation is provided in single bedrooms. From information provided by the home, the current scale of charges ranges from £900 to £1500 per week. Additional charges, between £8 (if service users receive lower rate Disability Living Allowance benefit) and £25 (if service users receive higher rate Disability Living Allowance benefit) per week are made as a contribution towards the home’s wheelchair adapted minibus. DS0000021746.V308263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours, on the morning and afternoon of Tuesday 6th March 2007. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for service users. The inspector looked around the building and a number of records were examined. The manager and 5 members of staff were interviewed. Within the limits of their communication and understanding service users were also spoken to. 6 relatives / visitors completed and returned CSCI’s ‘Comment Cards’ about the service. What the service does well: What has improved since the last inspection? The home is settled. The manager and staff have worked hard to improve the quality of life of the people who live at Glendale. Service users have been offered new opportunities, for example one person who had never been on an aeroplane has now done this and is now looking forward to a holiday abroad. The home is running well. Key-working arrangements are well established. Care plans have been developed to a very good standard. Clear lines of responsibility have been set up in the home. Staff training has continued. All staff (except one recently appointed support worker) have NVQ (National Vocational Qualifications). The home’s staff are committed to their work and to the people who live at Glendale. They have redecorated the home, which looks well. Care plans and information about the home have been written in pictorial formats and with photographs. Staff have made a DVD film about the home. DS0000021746.V308263.R01.S.doc Version 5.2 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. DS0000021746.V308263.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 DS0000021746.V308263.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 at least once during a 12 month period. 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. Admissions to the home were appropriately managed. EVIDENCE: Glendale is registered to accommodate up to 4 people with learning disabilities. There are no vacancies. The 4 people who live at Glendale have been there for nearly 7 years, since the home opened. The inspector was unable to communicate with the 4 people who live at Glendale about their experience of moving in to the home. However, appropriate assessments were conducted. The home has its own assessment and care planning documents for this purpose. These are informing the delivery of people’s care. Copies of assessment documentation, care plans and other relevant information from the local authority social services department and health professionals, confirm that people’s care needs are regularly reviewed. Although the inspector was unable to communicate with service users to any significant degree, the inspector spent time in their company and spoke to the manager and staff on duty in the home. Service users were seen to be well cared for and comfortable. Most of the home’s staff have worked at Glendale for a number of years and know the service users well. DS0000021746.V308263.R01.S.doc Version 5.2 Page 9 Although there are no vacancies, service users considering a move to Glendale would be welcome to visit with relatives, have a meal and stay overnight if necessary. In this way they could get to know the home before moving in. Any move into Glendale would be on a six-week trial basis. At the six-week stage a formal review meeting would be held to consider permanency. Glendale has a Statement of Purpose and a Service Users’ Guide to provide service users and any potential service users with information about the home. These documents have been produced in easy to read, pictorial formats and with photographs. Staff have made a DVD film about the home. The home’s activity in this area is commended. Standard ‘Service Agreement’ / ‘Contract’ forms have been prepared by the parent company and show fees payable. However, these should be amended to include any other additional payments required. For example, additional charges made for use of the home’s transport - £8 per week for people on Lower Rate Disability Living Allowance (DLA) and £25 per week for those on the Higher Rate of DLA. DS0000021746.V308263.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 at least once during a 12 month period. 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. Service users’ needs are met. They are offered choice and any decision-making is appropriately supported. EVIDENCE: The service users accommodated are on the whole dependent upon staff, family and significant others to make choices and decisions on their behalf and best interests. Most decisions are limited by the individuals’ learning disability and understanding. However, any such limitations or restrictions are noted on personal files. From observations made during the inspection, within the limits of their communication and understanding, service users are offered choices. Any preferences are provided for. When the inspector arrived at Glendale, 1 person had been shopping with staff, 2 people went to use a nearby ‘sensory room facility’. Later in the day, all 4 people were going bowling. Food and snack choices were offered during the day. In this albeit small way, staff were seen to be respecting service users’ rights to choose. DS0000021746.V308263.R01.S.doc Version 5.2 Page 11 Care plans have been prepared for all service users and these documents contain much information. Likes, dislikes and lifestyle preferences are recorded. Since admission, care reviews have been regularly held. Risk assessments have also been prepared and risk management arrangements ensure that service users can live as independent a lifestyle as possible. The home operates a key-worker system, which works well. From discussions with people in the home, staff are familiar with the needs of the people accommodated. Day-to-day communication within Glendale ensures that any changes in need are identified and brought to the attention of other staff. To enhance this communication, and provide an additional forum to consider care planning arrangements and any other issues in the home, house meetings are also held. DS0000021746.V308263.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 at least once during a 12 month period. 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. Appropriate activities are arranged. Service users live as part of the local community. Contact with family / friends is supported. Dietary needs are met. EVIDENCE: Activities are arranged and records are kept to evaluate them. Service users make use of ‘sensory equipment’ at another nearby home run by Milbury Care. Since the last inspection of Glendale, service users have enjoyed a holiday to Blackpool. One person enjoyed a flight to Stanstead Airport and this year he and another service user will be going on holiday abroad. Wherever possible, contact with family and friends is supported. Relatives provided positive feedback. In a CSCI Inspection Comment Card a relative wrote, “I am really very grateful the way my brother is looked after. The staff are wonderful to him. I know if my Mam was alive today she would be overjoyed too. My brother is always dressed immaculately. He seems really happy in himself. Thank you so much”. Another person wrote that their DS0000021746.V308263.R01.S.doc Version 5.2 Page 13 relative, “Is very well cared for at Glendale. I know he is very happy there and enjoys plenty of outings”. Service users’ rights are upheld. All 4 service users regularly attend church. Responsibilities are also recognised. As part of their care planning arrangements, service users’ bedroom management is diarised – with appropriate support provided by staff where required. A wholesome and nutritious diet is provided. Fresh fruit was seen to be available. Where service users require assistance with dining it is provided. The inspector saw that this was given appropriately. DS0000021746.V308263.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 at least once during a 12 month period. 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. Personal, emotional and healthcare needs are appropriately met. Any medicines required are dealt with correctly. EVIDENCE: Although the inspector was unable to communicate with service users to any significant degree, the inspector spent time in their company. The service users accommodated have a high level of care needs. They were seen to be well cared for and comfortable in their home. The people who live at Glendale are on the whole dependent upon staff and others to make choices and decisions on their behalf and best interests. However, within the limits of their communication and understanding, service users’ preferences are accommodated. The inspector observed that staff’s commitment to team-working, and good communication between them, ensures that service users’ personal and health care needs are met. From discussions with management and staff, where personal support is required it is provided appropriately. Care plans show that wherever possible, DS0000021746.V308263.R01.S.doc Version 5.2 Page 15 service users are provided with guidance and encouragement to undertake their own self-care tasks, thus promoting independence in a dignified and respectful manner. Care plans in the home are detailed and well written. They are easy to read and make good use of pictures and photographs as an aid to understanding. They document service users’ emotional, personal and health care needs and the actions required and being taken to meet them. Care plans are thus a record of the care provided, but are also informing the delivery of care within the home. Care plans incorporate principles of ‘Person Centred Care’. Goals and objectives are included. Copies of assessment documentation, care plans and other relevant information from the local authority social services department and health professionals, confirm that people’s care needs are regularly reviewed. One service user is supported to ‘self-medicate’ and take any medicines he needs. Although none of the other service users retain, control or administer their own medication, because of their needs and dependency this is considered appropriate. Appropriately trained senior support workers administer medication in the home. Other staff have received instruction to understand the medicines prescribed, potential side effects etc. There are adequate policies and procedures in place relating to the receipt, recording, storage, handling, administration and disposal of medicines. The home uses a monitored dosage system. Medicines are stored appropriately. However, it is recommended that the home should obtain a refrigerator to separately store any medicines that need to be kept below a certain minimum temperature. DS0000021746.V308263.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and adult protection procedures in the home serve to safeguard service users. EVIDENCE: The home, through its parent company Milbury Care Services Limited, has detailed complaints and adult protection procedures. Copies of these were seen to be available for staff use. Information about complaints, how and who to make them to, is also provided in the home’s ‘Service Users Guide’. Milbury has ‘I’m Worried Please Contact Me’ cards for service users to contact senior managers. Any complaints or concerns are appropriately managed. Policy and procedure documents relating to adult protection provide information and guidance to staff. Staff interviewed voiced a commitment to the service users they work with and to upholding service users’ rights. Nearly all staff have NVQs (National Vocational Qualifications) and have attended, or are about to attend, updated POVA (Protection of Vulnerable Adults) training. However, it is recommended that the home’s policies and procedures on the protection of vulnerable adults should be reviewed to reflect local protocols, contact information etc. Senior staff should also receive additional training regarding the action to be taken, things to do / things not to do, if an allegation of abuse is received. DS0000021746.V308263.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Glendale is homely, wellmaintained, clean, tidy and safe. Bedrooms have been personalised. However, current bath / shower room facilities do not meet service users’ needs. EVIDENCE: Glendale is a large detached bungalow set in substantial gardens in a residential area close to the centre of Hartlepool. The property blends in well with other houses in the road. The home is registered to provide care and accommodation for up to 4 adults who have learning disabilities, in four single bedrooms. The property was purchased and converted about 7 years ago and is in generally good order. Glendale has a homely environment. Since the last inspection, most areas have been redecorated by the home’s own staff. The inspector had a good look around the property, which was found to be clean, tidy and generally free from odour. Service users’ bedrooms have been personalised to reflect their personal styles. However, it was noted that the carpet in the main lounge needs to be cleaned or replaced. DS0000021746.V308263.R01.S.doc Version 5.2 Page 18 Bedrooms and communal living areas are spacious. There are large gardens to the front and rear. Glendale is homely and is a pleasant place to live. However, as people living there get older some adaptations are needed. For example, to provide adequate bathing / shower facilities. As highlighted in the previous inspection report, bathroom / shower facilities must be redesigned to meet the needs of the people accommodated and to allow staff sufficient access to provide assistance. It is also recommended that from time to time the homes living environment should be reviewed to consider any other adaptations required to meet the changing needs of the service users accommodated. The financial implications associated with this need to be considered within any business plans and budgetary arrangements for the continued running of the home. DS0000021746.V308263.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed. The home has a settled, well-trained and well-led staff team. Recruitment procedures are satisfactory and appropriate staff training is provided. EVIDENCE: Care is provided by a committed, well-trained staff team. Many of the staff have worked at Glendale for a number of years and know the service users well. Since the last inspection, staff training updates have been arranged in areas such as First Aid, People Handling and POVA (Protection of Vulnerable Adults). In house instruction, for example about dementia has also been arranged. Virtually all staff (90 ) have NVQs (National Vocational Qualifications) at level 2 or 3. Most staff have also completed LDAF (Learning Disability Award Framework) training courses. Activity in this area is commended. Recruitment procedures through Milbury’s regional office are considered to be satisfactory and safe. Appropriate references are obtained and CRB (Criminal Records Bureau) disclosure checks are carried out. DS0000021746.V308263.R01.S.doc Version 5.2 Page 20 Due to the needs of the service users accommodated, the agreed staffing levels for the home require 2 staff to be on duty throughout the waking day, with an additional member of staff when outside activities demand. With night staffing arrangements (1 person awake) this equates to 296 weekly care hours for the home. Although staffing levels should be kept under review, in particular night time staffing and as service users get older, from discussions with staff, rosters and other documents examined these staffing levels are considered to be adequate to meet the current needs of the people currently accommodated. DS0000021746.V308263.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although Glendale is a wellrun care home, and quality assurance systems are in place to rectify issues raised, the parent company has failed to respond to requirements made by CSCI to ensure the home meets the needs of the service users accommodated. EVIDENCE: The home’s manager has an NVQ (National Vocational Qualification) level 4 in care and also has a Registered Managers Award qualification. She provides sound leadership to the home’s staff team. Staff interviewed spoke of good communication, effective teamwork and significant improvements since she became manager. One member of staff interviewed said, “I’ve nothing but praise for her”. Procedures are in place to ensure service users’ health and safety is protected. For example, risk assessments and control measures relating to activities outside the home are appropriately carried out. DS0000021746.V308263.R01.S.doc Version 5.2 Page 22 Milbury Care Services Limited has policies, procedures and systems relating to quality assurance. Regular audit checks are undertaken and forwarded to the regional office. Monthly visits and reports required under Regulation 26 of the Care Homes Regulations 2001 are completed and detail the action needed and being take to address any shortfalls in the home. However, despite all these systems to highlight issues that need to be addressed, the parent company has failed to respond to the need to provide adequate bathing facilities. Milbury Care Services Limited has also failed to respond to requirements made by CSCI, to ensure the home’s bath / shower rooms meet the needs of the service users accommodated. As highlighted in previous inspection reports, bathroom / shower facilities must be redesigned to meet the needs of the people accommodated and allow staff sufficient access to provide assistance. This work is required to ensure that service users’ needs can be met now that they are older and also from a health and safety perspective to prevent injury to staff. It is concerning that previous timescales made by CSCI for the home to address this of 1st September 2004, 1st August 2005 & 1st June 2006 have not been met. Further, to ensure that the home is competently managed and accountable, annual development, business and financial plans for the establishment should be prepared and be available for inspection on the premises. DS0000021746.V308263.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 4 2 X 3 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 X DS0000021746.V308263.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 YA27 Regulation 23 Requirement Timescale for action 01/05/07 2. YA30 23 As highlighted in the previous inspection report, bathroom / shower facilities must be redesigned to meet the needs of the people accommodated and to allow staff sufficient access to provide assistance. (Previous CSCI timescales of 1st September 2004, 1st August 2005 & 1st June 2006 were not met). The carpet in the main lounge 01/05/07 needs to be cleaned or replaced 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. Refer to Standard YA5 Good Practice Recommendations ‘Service Agreement’ / ‘Contract’ forms should be amended to include any other additional payments required. For example, additional charges made for use of the home’s transport - £8 per week for people on Lower Rate Disability Living Allowance (DLA) and £25 per week for those on the Higher Rate of DLA. DS0000021746.V308263.R01.S.doc Version 5.2 Page 25 2. 3. YA20 YA23 4. YA24 The home should obtain a refrigerator to separately store any medicines that need to be kept below a certain minimum temperature. The home’s policies and procedures on the protection of vulnerable adults should be reviewed to reflect local protocols, contact information etc. Senior staff should also receive additional training regarding the action to be taken, things to do / things not to do, if an allegation of abuse is received. From time to time the homes living environment should be reviewed to consider any adaptations required to meet the changing needs of the service users accommodated. Staffing levels may also need to be reviewed. The financial implications associated with this need to be considered within any business plans and budgetary arrangements for the continued running of the home. DS0000021746.V308263.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 DS0000021746.V308263.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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