Inspection on 11/11/08 for Gryphon Place

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gryphon Place 36 Wroxham Road Sprowston Norwich Norfolk NR7 8TY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lella Hudson     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Gryphon Place 36 Wroxham Road Sprowston Norwich Norfolk NR7 8TY 01603406351 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Vhari Macmillian Type of registration: Number of places registered: Swanton Care and Community Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - code PD Date of last inspection Brief description of the care home Gryphon Place is a Home for six clients a physical disability. It is owned and managed by Swanton Care and Community Ltd and specialises in providing a service for people with neurological disorders. It provides nursing and residential care. The Home was newly built and registered in May 2008. It provides accommodation on the ground and first floors and there is a passenger lift. All bedrooms are large singles, with ensuite shower rooms. There are also bathrooms, communal lounge/diner and an attractive Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 Brief description of the care home garden. There is limited parking to the front of the Home. The Home is situated close to the city of Norwich. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the first Inspection of this service since it was registered in May 2008. It is owned and managed by Swanton Care Ltd. This report contains information gathered from a variety of sources. One of the Directors completed the Annual Quality Assurance Assessment (AQAA) and we carried out an unannounced visit to the Home on the 11th November 2008. During our visit to the Home we met one of the clients, spoke to staff and the Manager, were shown around the Home and also looked at some of the records. There has been three Managers since the Home was registered six months ago. The current Manager, Karon Leonard, was appointed approximately three weeks before our visit took place. She has appropriate skills and experience to manage this Home and Care Homes for Adults (18-65 years) Page 6 of 29 has already made several improvements. Ms Leonard is in the process of applying for registration with CSCI. There are currently only two clients living at the Home. Fees are individually negotiated depending on the needs of the clients. Currently there are complex arrangements in place for the provision of staff to support the two clients living at the Home. Both of the clients have their own staff team for part of their care provision. These staff teams are provided through agencies. The rest of the support is provided by staff employed by Gryphon Place. The Manager has already started to make improvements in the way that the different staff teams work and communicate with each other. References to staff in this report only refers to the staff employed by Gryphon Place unless otherwise stated. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 8 of 29 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to give prospective clients information about the service provided. Systems are in place to ensure that effective pre-admission assessments are carried out. Evidence: The Homes Statement of Purpose and Service User Guide were agreed as part of the Homes registration process. The Manager said that she is going to involve the clients in her plan to review the Statement of Purpose and Service User Guide so that they are available in a more user friendly format and also reflect the change in Manager. She also said that the organisation have produced a new format for the pre admission assessment for clients which she is going to start using. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain information and guidance for staff about how the clients like to have their needs met. The views of the clients are sought about a range of issues and their wishes recorded. Risks are recognised and assessed with written guidance available. Evidence: We saw both of the care plans and discussed the process of care planning with the Manager, staff and one of the clients. The care plans that we saw contain detailed guidance about how to meet the clients needs as well as information about the clients preferences about how they receive care. One of the clients told us that he knows what is in his care plan and that he was involved in putting it together. The care plans contain detailed information about the clients preferred form of communication, particularly for the client for whom communication is difficult. Discussions with staff show that they have an understanding of the different Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: communication needs of the clients. One of the clients told us that the staff ask his opinion about a range of issues and that he feels that he has control over the way in which he receives care. The care plans contain evidence of risks having been recognised and assessed. For example, they contain risk assessments relating to mobility, continence, pressure care and choking. There are plans in place to manage the risks appropriately and which also contain the views of the client about how the risks should be managed. Two areas that we identified where a risk assessment was not in place was for the use of bedrails and for a particular dietary issue. However, discussions with the Manager and staff show that the risks have been identified and discussed with a consistent approach being taken to manage the risks. The care plans have been handwritten and some are difficult to read due to the style of the handwriting and poor grammer. The staffing situation at the Home is unusual in that both of the clients have support from different staff teams. For example, one of the clients has been employing their own staff team who has provided the majority of their care with the Homes staff providing care during the evenings and over night. From the week of our visit this client now employs their own staff team for all of their care apart from the administration of medication which is done by the Homes nursing staff. The other client has the majority of their staff supplied by an agency with the Homes staff covering shifts where this cannot be done by the agency. This has led to some confusion in the past but discussions with staff and the Manager show that this has improved and that action is being taken to further improve communication and consistency. There does not appear to have been clear systems in place for ensuring good communication and clarity of roles. Also each staff team has their own care plan and daily recording system. This situation is going to be addressed by the Manager so as to ensure that the care plans are accurate and that consistent care is being provided. The Manager said that she does not look after money for either of the clients but on occasion, she is asked by one of the clients to put their wallet in the safe. A record is kept when this takes place but the Manager intends to introduce a more formal system to ensure that better records are kept of any money and valuables that are being looked after for clients. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The clients are supported to maintain contact with friends and family. They are also supported to take part in activities within the community. Improvements have been made to the provision and quality of meals and the clients now have choice about what is provided to eat and drink. Evidence: The care plans contain information about the arrangements in place to support the clients to maintain contact with family and friends. One of the clients spends two days each week at home with their family and the other client is due to move back to their own home within the next few weeks. One of the clients told us that they are able to use the telephone whenever they wish to. Records show that there has been some concern about whether the other client has been supported to do so appropriately. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Both of the clients have their own vehicle which is used to provide transport to enable them to use community facilities and to maintain contact with family and friends. One of the clients told us that they decide what they will do each day and how they spend their time. The daily notes in the care plans show that the views of the clients are sought about how they wish to spend their time and about what activities they may wish to be involved in. A concern had been raised recently about the quality of the meals provided. One of the clients told us that this has greatly improved since a cook and the new Manager have been appointed. He said that the cook talks to him about planning menus and that he is able to make his own choices about meals. On the day of our visit changes were made to the planned menu due to the client changing their plans for what they were going to do that day. Fresh fruit was available on the side in the lounge. We spoke to the cook and she said that there are no restrictions on her with regard to buying fresh produce and to having flexibility with regard to menu planning. She said that she meets with one of the clients on a weekly basis to plan menus but that these can be changed if she is asked to do so. One of the clients has particular dietary needs and uses a PEG feed system. As previously mentioned in this report the risk assessment relating to the use of this system needs to be in place in the care plan. The daily notes show that clients are able to have drinks and snacks at any time during the day or night. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare needs of the clients are met. Medication is managed safely. Evidence: The care plans contain detailed information about the individual clients health and personal care needs. Both of the clients have very high personal care needs and complex health needs. A nurse is always on duty at the Home. In addition to this one of the clients has their own nurse employed as part of their individual care team. The records within the care plans show that other health professionals are involved in the clients care as required and that action is taken to address any health care issues as they arise. For example it was recorded in one of the clients daily notes as soon as a red pressure area was noticed. An additional care plan was introduced with regard to pressure care and records show that this has now healed. As already mentioned in this report there is a need to ensure that communication is good between the different staff teams involved in the clients care to ensure consistent Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: care is provided. Discussions with staff, both employed by other agencies and the Homes staff, indicate that improvements have been made in this area since the new Manager was appointed. The Manager has already made arrangements for some additional training to be provided to the staff team. This includes training about the specific health issues that the clients have as well as more mandatory training such as moving and handling and food hygiene. The Manager has also made contact with organisations who provide advice and support to people with specific health issues. The nurse who is employed by the Home is responsible for administering medication. We were shown the medication system in use and discussed this with the nurse on duty. The Home has a seperate clinic room in which medication is stored securely. Records are kept of medication received at the Home and that which is returned to the pharmacy. Some medications are being kept in the cupboard which the nurse said are no longer in use. A look at the records show that when the GP has made changes to the medication prescription this has not always been recorded clearly enough on the administration charts. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and dealt with appropriately. There are systems in place to protect the clients from abuse. Evidence: Discussions with staff indicate that they had received training about Safeguarding vulnerable adults and were aware of the whistleblowing procedure. The Manager has also attended appropriate training and is aware of the local procedure for passing on concerns about Safeguarding issues. The training matrix was not up to date so it was not possible to confirm that all of the Homes staff have had updated Safeguarding training. The Manager had contacted the agencies providing care staff for the clients other care teams and asked them for confirmation of the staffs training and that they had an appropriate Criminal Records Bureau disclosure. She had received some information but one of the agencies had refused to provide written confirmation. However, during our visit this situation was rectified and the Manager is waiting for this to arrive. The Home has procedures and policies in place which aim to protect the clients from any form of abuse and a complaints record is kept to record any concerns or complaints. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The Manager said that she was aware of a recent situation in which one of the clients had been unhappy about a situation. This situation occured prior to the Manager starting work at the Home but she has asked those concerned for further information so that she can ensure that the situation does not occur again. The Manager also informed us of a concern/complaint that has been raised with social services but which they have not yet been informed of the detail of or been involved in any investigation as yet. One of the clients spoke to us and said that they are confident that if they spoke to any of the staff, or to the new Manager, then any concerns would be dealt with. They gave an example of an issue about the heating that was raised with the Manager and which was immediately dealt with. Although the outcome did not completely solve the problem for the client they did say that they were satisfied that all that could be done had been done and that they had been kept informed at all times. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a high standard of accommodation which is comfortable and homely. Mobility equipment is provided to meet the clients needs. Evidence: The Home was newly built and registered in 2008. We were shown around the Home by the Manager. The standard of the accommodation is excellent. The bedrooms are all large, single rooms with ensuite shower, toilet and handbasin. The bedrooms have overhead tracking hoists but these do not extend into the bathrooms. The bedrooms do not have electric opening devices and may be difficult for some clients to open independently. The Home has two bathrooms with assisted baths so that clients have a choice of baths or showers. The Home has a lounge/diner which is attractively decorated and furnished. The kitchen is small and designed as an ordinary domestic kitchen. The kitchen does not have a handbasin but the Manager said that she had been told that the Environmental Health department had not required this when the Home was built. The standard of decoration and furnishings throughout the Home is of a high standard. Clients are encouraged to personalise their own rooms and the communal areas. There Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: is a passenger lift to the first floor. In addition to the clients accommodation there is also a laundry, sluice room, clinic room, staff room/kitchen and office. The garden is attractively landscaped and there are paths for wheelchair access. There is limited parking to the front of the Home. The Manager said that the hot water temperatures are regulated. All of the radiators are covered. The Home has a member of staff responsible for maintenance. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of co-ordination of the different staff teams has meant that there have been some times when the clients have not received a consistent service. Appropriate recruitment procedures are followed by the organisation and staff receive training and supervision. Evidence: As previously mentioned in this report the arrangements in place for the provision of staff are not totally clear. Both of the clients have been receiving part of their care by their own staff teams which have been managed by seperate agencies and part of their care provided by Gryphon Place staff who are managed by the Homes Manager. There does not appear to have been much co-ordination of these different systems which, on occasions, has led to confusion and poor communication. The current Manager has already taken steps to address this situation and our discussions with staff and one of the clients provide evidence that the situation has greatly improved. Staff said that communication is much better and there is improved sharing of information about the clients needs. One of the clients said that they are happy with the care that they receive from the Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Gryphon Place staff and that the staff group are more consistent now with the turnover of staff having reduced lately. The staff who spoke to us said that they are now more clear of their own roles and responsiblities within the staff team and of how they link in with the staff from other agencies to provide care to the clients. However, they feel that there are still areas of improvement to ensure that the clients receive care that is consistent and to ensure that effective communication systems between staff teams are in place. We looked at a sample of staff files and these showed that appropriate recruitment procedures have been followed. The staff comfirmed that checks were carried out prior to them starting work. The Manager said that she has asked for confirmation of training and Criminal Records Bureau disclosures from the agencies that support the clients. She said that one of the agencies was not being very co-operative about this but she had insisted that this information be provided. The Manager is currently putting together a record of training that staff have completed as there is not an up to date record available. She said that in her discussions with staff they have all attended mandatory training but that some are due for updates of this shortly. As previously mentioned in this report the Manager has already made contact with organisations who support people with specific disabilities in order to find out what training may be available. The organisation has another Home in the Eastern region which provides a similar service and the Manager said that she is liasing with the Manager of that Home in order to share training if appropriate. The Manager has started to carry out formal one to one supervision sessions and has other sessions booked with staff. Staff confirmed that this has taken place. Staff meetings have also taken place with dates booked for future meetings. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is now being well managed in a way which puts the needs of the clients first. The views of the clients are sought with regard to the running of the Home. The health and safety of the clients and staff is protected. Evidence: The Manager was employed by the organisation at the beginning of November 2008 and has already identified areas for improvement. Discussions with staff and one of the clients provide evidence that improvements have been made in a variety of areas since the new Manager was appointed. For example, the meals have improved, the views of the clients are sought more regularly and communication has improved between the staff teams who are supporting the clients. The Manager has appropriate experience and qualifications in the field of neurological disorders. She has already made contact with other organisations who may be able to provide training and advice with regard to meeting the clients needs. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Staff said that the Manager is approachable and that she makes time to speak to all of them. The staff from one of the clients own staff team said that the Manager is easy to speak to and that she has made improvements in the way that the different teams work together and in the way that information is shared. The Manager has carried out her own, informal, assessment of the service provided in the short time that she has been there but said that the organisation has a formal quality assurance process which will be implemented next year to review the quality of the service provided. We looked at a selection of records relating to health and safety and we could see from these that regular maintenance and servicing takes place for equipment, including the fire safety equipment. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 It is required that risk assessments are carried out for the use of bed rails and for the PEG feeding regime in place for one of the clients This is to ensure that risks are adequately considered and assessed and that consistent care is provided to the clients 05/12/2008 2 20 13 It is required that clear written guidance is available for the use of PRN medication To ensure that the clients receive this as appropriate times and in a consistent manner 05/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 29 1 6 It is recommended that only one care plan and recording system is in use for each of the clients so as to prevent any confusion or inconsistencies. It is recommended that the care plans and daily records are kept in a format which is easier to read with regard to handwriting and grammer. 2 6 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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