Inspection on 17/08/06 for Grange House

This inspection was carried out on 17th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Grange House 11/05/07

Grange House 17/01/06

Grange House 12/07/05

Grange House 06/12/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Grange House 9 Grange Road Hayes Middlesex UB3 2RP Lead Inspector Robert Bond Key Unannounced Inspection 17th August 2006 10:00 Grange House DS0000048879.V303587.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 Grange House DS0000048879.V303587.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. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grange House Address 9 Grange Road Hayes Middlesex UB3 2RP 0208 813 5264 0208 813 5264 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) londonroad@tiscali.co.uk Milbury Care Services Limited Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Grange House is operated by Milbury who are a nationwide Limited Company who provide residential care to people with learning disabilities. Grange House is registered to provide care to five service users, and the home’s speciality is to provide for people with autism. Grange House is a detached property on a quiet residential street in Hayes. The home is a short drive from the local amenities of Hayes town centre and its public transport links. The property has five single en-suite bedrooms, one of which is on the ground floor. The communal rooms are spacious and include a through lounge, kitchen/diner, conservatory, and a large secure garden with a large activities room at the end. The home has its own vehicle to enable staff to take service users on outings. The fees charged range from £1,662 to £1,893 per week. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a ‘key’ inspection that considered the outcomes of the ‘key’ standards in the Department of Health’s National Minimum Standards (NMS) for care homes for younger adults. On the day of the inspection the home was fully occupied with five service users, and fully staffed but not all the staff are permanent as there are several vacant posts to be filled. Good interactions between staff and service users were observed. The Inspector assessed 24 outcomes in total, and found that 14 were fully met, and 10 were partly met. This led to the Inspector making 8 requirements and 3 recommendations. The Inspector interviewed the Manager Designate, talked to four other staff members, met four service users, toured the premises, and examined a range of records. The care records of two service users were examined in detail (case-tracked). What the service does well: What has improved since the last inspection? Service users terms and conditions have been issued to all service users with a copy placed on the majority of files that has been signed by a Milbury representative and a service user representative. Evidence is placed on the majority of files that service users and/or their representatives have been consulted on the contents of service user plans. Additional staff members have received training in the procedures for the Protection of Vulnerable Adults. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 6 A photograph is held on file for the majority of staff members employed. Training and development assessments and profiles have been formulated for the majority of staff members. The Manager Designate has undertaken his ‘fit person interview’ with the CSCI in order to become in due course the home’s Registered Manager. The home’s printed activity record has been updated. Activities that are available to service users now include swimming trips. What they could do better: Dated and signed assessments by the referring care manager and the accepting member of Milbury’s staff must be kept on file for use and inspection for all service users living in the care home. The content of care plans must be extended so that all care needs are identified together with ways of meeting those needs. Health care needs, stimulation, and how to deal with known challenging behaviours should also be included in care plans. Service user’s parents or representatives should be consulted and should sign their agreement to care plans, and the care plan format should be redesigned to provide a space for such signatures. An advocate should be found for the service user who has no parents to represent her interests. The record of what service users eat should include major snacks, and meals eaten away from the care home. Advice should be sought from a nutritionist or dietician concerning healthy eating options. Good health for service users should be more fully promoted in all its aspects. A deputy manager must be recruited as soon as possible, and vacant support worker posts filled. All staff should be professionally supervised at the required intervals. An updated staff training and development plan is required. Please contact the provider for advice of actions taken in response to this Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 8 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 Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 9 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): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Prospective users’ individual aspirations and needs are adequately assessed in advance of the service user moving in, but the records kept are not always sufficient. EVIDENCE: No new service users have moved into the home since before the previous inspection, indeed not since the home was first opened. The Inspector therefore case-tracked the initial applications and moving in process of two service users. The Inspector found that care managers had undertaken initial assessments and made appropriate referrals, and that staff from the care home had then undertaken their own written assessments to confirm that the home could meet the care needs of the potential service users. Unfortunately one of the original care manager assessments was no longer on file. The Manager Designate was aware of this and reported that he was awaiting a duplicate to be sent by the care manager. See Requirement 1. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 10 One of the assessments that had been done by the Manager Designate had not been signed and dated, and there was no box on the Milbury assessment form for a date and signature. The Manager Designate signed and dated the document in the presence of the Inspector. Individualised care plans had been written that appeared to be based on the initial assessment information. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The existing care plans do not cover a sufficiently large range of care needs. The existing care plans do not sufficiently demonstrate that parents or other service user representatives have been consulted in drawing up the plans. The best interests of service users, who do not have involved parents, are not being sufficiently safeguarded. Service users are sufficiently involved in most aspects of the home. Service users are sufficiently encouraged to take risks as part of a life style that promotes independence. EVIDENCE: Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 12 The Inspector examined in detail the care plans of two service users. He found that the amount of detail was sufficient, the goals and the tasks were appropriate, and the plans were written in a person centred way. The care plans were seen to focus on 3 or 4 elements of personal care only, such as ‘bathing and dressing’, and ‘changing of incontinence pads’. ‘Use of public transport’ was another topic seen. There is therefore substantial scope for widening and extending the topics covered in the care plans to include for example ‘stimulation and activities’, ‘managing challenging behaviour’, and ‘health issues’. See Requirements 2, 5 and 6. The existing care plans do not currently have a designated section within them for parents or representatives to sign their agreement to the plan. See Requirement 3. The Manager Designate reported that whereas four service users have parents who are involved in their care planning, one service user has no parents. Discussions have taken place with the service user’s care manager concerning finding an advocate for this service user. See Recommendation 1. The Manager Designate reported that none of the service users are able to manage their own finances. Milbury is the appointee for three service users, and a relative is the appointee for the other two. The Inspector observed evidence that service users are involved in undertaking practical tasks within the home, and written rotas exist. The Inspector noted that independence is promoted, as evidenced by the care plan that concerned travelling to a day centre on public transport. Appropriate risk assessments are also in place. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 13 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The extent to which service users are able to engage in outside activities within the wider community, is good. Family links are well maintained Service users’ rights and responsibilities are sufficiently recognised. Provision of a healthy diet for service users is not sufficiently promoted. EVIDENCE: The Manager Designate reported that none of the service users have any employment but that two attend Southall College full time, three attend a day centre one day a week and go to the Gateway club, and two go to a Gym Club. The home has an activity programme sheet that verifies this information. Additional activities organised by the home include swimming, walks and trips to the cinema. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 14 One service user is reluctant to join in activities outside of the home but the Inspector observed her receiving one to one stimulation within her bedroom, and the Manager Designate reported that on a recent holiday in Norfolk she did demonstrate for enthusiasm for going out. This care need for stimulating activities, and individual goals and identified ways of meeting the need, should be included in her care plan. The Inspector noted rotas for service users to be involved in setting tables for meals, and for assisting with other household tasks. The Inspector observed a service user assisting a member of staff in the laundry. Four out of five service users have families who attend care reviews and the home’s ‘annual service review day’ that took place on 14th August 2006. The Inspector examined the home’s food menu for the week, and the record of what each service user actually ate. Occasional gaps were seen in the later. For example a service user ate away from the home, but the record does not say what they ate. Sometimes the record named a service user who declined to eat a meal. The Manager Designate said this was because she had a snack between meals, but the record does not show this. Requirement 4. The Inspector saw a meal of fish fingers and chips being prepared at lunchtime. He noted that burger and chips was also on the menu that week. In order to promote healthy eating, it is recommended that advice is sought from a nutritionist or dietician concerning suitable menu items in order to maintain a balanced healthy diet. Recommendation 2. The Manager Designate reported that he hopes to obtain pictorial menus that will assist service users in making informed choices about meals they like. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans are good at describing the ways in which service users would like personal care to be provided. Care plans are poor at considering how service users’ health needs will be met. The home’s procedures for the administration of medication are good and adequately protect service users. EVIDENCE: The Inspector examined in detail the care plans of two service users. He found that the plans were good at describing personal care needs and how best to meet those needs. The Inspector found however that the care plans he saw did not consider any of the service users’ health needs. For example, at least two service users experience epilepsy and are prescribed medication to counter it. The Manager Designate reported that one service user has a fit if she does not get a good night’s sleep and hence a particular routine has been put in place to assist her in sleeping. This routine is not described in her care plan but should be so that Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 16 her representative can sign their agreement to it, and so that new workers at the home can be formally made aware of the routine. See Requirement 6. The Manager Designate described to the Inspector the health services that service users receive, such as GP, six monthly reviews of medication by a consultant psychiatrist, incontinence materials provided via a district nurse, chiropody and dentistry. The Inspector informed the Manager Designate that some care homes for adults with learning disabilities use specific ‘health action plans’ to promote good health for service users in all its aspects. See Recommendation 3. The Inspector examined the home’s medication records. None of the service users are able to administer their own medication. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has satisfactory complaints procedures in place. Service users are adequately protected from abuse, neglect and self-harm. EVIDENCE: The Inspector examined the home’s complaints record. No complaints were recorded since before the previous CSCI inspection. The Inspector examined the home’s complaints leaflet including a pictorial version. The home’s leaflet must be updated to give the contact details for the CSCI’s Hammersmith Office. The Inspector examined the home’s Protection Of Vulnerable Adults policy, which is adequate. The Manager Designate reported that he had received POVA training and had cascaded the training to staff within the home. The Inspector was concerned that in the previous three and a half months he had received from the care home a total of 23 Regulation 37 reports involving ‘critical incidents of challenging behaviour’ by the same service user. Some of these incidents had led to the staff taking action to restrain the service user. The Inspector examined the records of the incidents that had been reported to Milbury’s Regional Office as per the home’s procedure, and noted that a Behavioural Therapist employed by Milbury had reviewed the care needs of the service user in November 2005 and again in June 2006. The Inspector has a Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 18 copy of the ‘crisis management risk assessment form’ completed originally in September 2005. The Inspector saw records that demonstrated that all the current staff at Grange House had been trained in ‘non-violent crisis intervention’. A member of staff the Inspector spoke to confirmed that he had received this training. The Inspector has previously seen Milbury’s policy on ‘restraint’, which includes the ‘child control restraint position’ that is sometimes applied on the service user in question. The Manager Designate described to the Inspector plans in place to reduce and avoid incidents that lead to the service user’s challenging behaviour, particularly at meal times. These plans are not written down anywhere, and hence should be included in the service user’s care plan. This will enable the service user’s representative to be able to sign their agreement to the restraint procedure that is sometimes used, and will provide a formal means of notifying workers in the care home of the issues involved. Requirement 5. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a home that is very homely and comfortable and is sufficiently clean, hygienic and safe. EVIDENCE: The Inspector toured the premises including the activities room and a service user’s bedroom with her permission. The home was seen to be well decorated, well furnished and equipped, and hygienically clean throughout. No health and safety issues were noted by the Inspector. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 20 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, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The staff team is not sufficiently well qualified and not sufficiently effective due to major gaps within it. Staff are not receiving sufficient professional supervision. Training records are not sufficiently up to date. Service users are sufficiently protected by the home’s recruitment procedures. EVIDENCE: The Inspector examined a current staff rota and observed that sufficient staff were on duty on the day of the Inspection. The Manager Designate reported that two new bank staff had recently been taken on, but that 2.5 full time equivalent support worker posts remained unfilled and hence bank staff had to be used. The deputy manager post is still unfilled but interviews are next week, he said. At the present time the home does not have sufficient permanent staff. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 21 As the home still does have a deputy manager, the Manager Designate reported that staff are not receiving formal supervision as frequently as they should. See Requirement 7. The Inspector read the home’s training and development plan but noted that it had not been updated for six months. Requirement 8. The Inspector examined the recruitment records of the most recent person to join the staff team. One reference was initially not available for inspection but this was faxed through from Milbury’s regional office whilst the Inspector was present. Less than 50 of the staff team have NVQ qualifications in care, but the Manager Designate reported that Milbury’s policy is to provide LDAF training to new staff prior to NVQ’s. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 22 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Services users benefit from a home that is managed in a satisfactory manner. Service user views and their parents’ views are ascertained and recorded in a satisfactory manner. The health and safety of service users are promoted and protected to a satisfactory extent. EVIDENCE: The Manager Designate reported that he has applied to the CSCI to be the Registered Manager and that this is expected to be approved once he provides confirmation of his Diploma in Social Work qualification, and of his intention to recommence his Registered Managers Award. He confirmed that he is still Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 23 responsible in addition for the two person supported living scheme known as Ross Cottage. The Manager Designate reported that quality assurance is undertaken at the Annual Review Day as parents are asked for their comments about the service at that event. The outcomes of the review day are then used to create a business plan for the year ahead. The Inspector checked the records of fridge, freezer and hot water temperatures, all of which were satisfactory. The Inspector noted that C.O.S.S.H. cleaning materials were safely locked away. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x 3 x x 3 x Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 25 no 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 YA2 Regulation 14(1) Requirement Timescale for action 01/10/06 2. YA6 3. YA6 4. YA17 5. YA23 The original assessment of each service user admitted to the home must be kept on file. 15(1) The service user care plans must be extended to cover all relevant aspects of how the service user’s needs in respect of health and welfare will be met. 15(1) As the service user or their representative must be consulted over the content of care plans, the care plan format must include somewhere for the representative to sign their agreement to the plan. 17(2)Sch4(13) The record of food eaten must be extended to include meals eaten away from the home, and large snacks eaten at the home. 15(1) The service user care plans must be extended to cover all relevant aspects of how the service user’s needs in respect of health and welfare will be met, including approved restraint DS0000048879.V303587.R01.S.doc 01/01/07 01/10/06 01/09/06 01/10/06 Grange House Version 5.2 Page 26 procedures. 6 YA19 15(1) The service user care plans must be extended to cover all relevant aspects of how the service user’s needs in respect of health will be met. The registered person must ensure that all staff are appropriately supervised. An updated training and development plan is required 01/10/06 7 8 YA36 YA35 18(2) 18(1) 01/11/06 01/11/06 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 3 Refer to Standard YA7 YA17 YA19 Good Practice Recommendations An advocate should be found for the service user who has no parents to represent her interests. Advice should be sought form a nutritionist or dietician so that healthy diets may be more fully promoted. The Manager Designate should enquire whether Milbury support the concept of individual ‘health action plans’ for service users as a means of promoting good health in all its aspects. Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West London Area Office 26-28 Hammersmith Grove Hammersmith London W6 7SE 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 Grange House DS0000048879.V303587.R01.S.doc Version 5.2 Page 28 - 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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