Inspection on 16/02/06 for Heightlea

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heightlea 17/10/06

Heightlea 25/08/05

Heightlea 10/03/05

Heightlea 13/04/04

Heightlea 09/10/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Heightlea Old Falmouth Road Truro Cornwall TR1 2HN Lead Inspector Richard Coates Announced Inspection 16th February 2006 09:15 Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 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 Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 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. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heightlea Address Old Falmouth Road Truro Cornwall TR1 2HN 01326 371000 01326 371099 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) Spectrum Mr Giles Reynolds Docking Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th August 2005 Brief Description of the Service: The registered provider for Heightlea is Spectrum. Spectrum is an organisation which provides services for people with autistic spectrum disorders. The home is registered to provide accommodation and care to up to three service users. There are four single bedrooms, two on the ground floor and two on the first floor. The shared space comprises two sitting rooms, a conservatory, a spacious hallway and a kitchen-diner on the ground floor, and a large communal room on the first floor. There are two bathrooms, one on each floor. The home also offers a respite care and day care service. One service user currently has regular respite stays when one of the other residents spends time with his family. Heightlea is a detached property situated on the edge of Truro and has pleasant rural views. The approach to the home is a fairly steep drive and the main access has a moderate threshold through the double glazed door and a substantial (approximately 9 inch) step at the inner door. The garden can be accessed down a step from the conservatory on to a patio. A path leads to a large sloping grassed area. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned announced inspection and the aim was to review compliance with the requirements and recommendations set at the last inspection report, dated 25 August 2005, and to focus on key standards in the areas of care planning, personal and healthcare support, protection, staffing and management. The key standards in the other areas were included in the previous inspection. The registered manager had provided follow up information about the actions taken to comply with the requirements and recommendations since the last inspection. The inspector was at the home for over seven hours and spent time, including lunch, with staff and service users. The registered manager was absent at the time of the inspection and an acting manager was in charge of the home. The inspection involved discussions with the acting manager and staff, touring the premises, and examining policies and procedures, records and care plans. The inspector is grateful to the acting manager, staff and residents for their assistance in completing the inspection. What the service does well: What has improved since the last inspection? The staff have drawn up risk assessments for the range of activities undertaken by each resident. These risk assessments provide clear directions and information for staff about the management of risk and facilitate the involvement of the residents in the community. Paper towels are now provided Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 6 at hand washing facilities. This is a better hygiene practice than shared cotton towels. 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. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 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 Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 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): EVIDENCE: No new residents have been admitted to the home since the last inspection, so there were no examples to inspect of new or prospective residents being introduced to the home. The records for one of the current residents were case tracked and included a service users guide which had been personalised to the resident. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Service users have detailed written care plans, which inform and direct staff in meeting their assessed needs. More attention to detail is needed in dating and signing records. The care plans include detailed risk assessments which specify the interventions required to protect service users. EVIDENCE: Care plans are made up of a care plan summary document, guidelines on support for personal care, the risk assessment and safe working practice document, further risk assessments for specific activities and support needs, and the individual plan. The summary care plan directs and informs staff about the resident’s care needs, preferences and strengths. The example case tracked was not signed or dated. The guidelines for personal care set out the support needed by the resident to complete their self care. This is person centred and informs the support staff clearly how to support the resident to be as independent as possible. The example case tracked was not signed or dated. The individual plan was drawn up at a meeting in October 2005. The next meeting is planned for April 2006. The plan was a detailed document that reviewed all areas of the resident’s life, included the resident’s views and set goals for the future. The care plan record and the individual plan do not Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 10 evidence involvement of the resident or their representative, for example by a signature. The most recent individual plan did not set out specific measurable and realistic goals, but made rather general statements. The risk assessment and safe working practice document inspected was dated October 2005. The risk assessments for specific activities and needs are currently being re-written on a revised format. They are all dated recently and signed. Risk assessments are comprehensive and inform and direct staff about the interventions required to reduce risk and protect the resident. Risk assessments also set out where restrictions of choice have been agreed to prevent self-harm and certain identified risks. Residents have a key worker who records a monthly profile summarising the activities, achievements and issues of the last month. Staff complete a daily diary. The content of these records appears to have improved in their references to the individual care plan. The care plans, daily records, observation during the inspection and discussion with staff and residents, provided evidence that staff provide information and support to residents to make decisions about their daily lives. Spectrum acts as appointee for benefits for three residents and this was notified in the pre-inspection questionnaire. There is no current contact with independent advocates. The minutes of the residents’ meeting record this forum for making decisions. The agenda for the next meeting was on the notice board for residents to add their agenda items. The records demonstrate that these meetings encourage residents to express their views. One specific inappropriate piece of recording in these meeting minutes was drawn to the attention of the acting manager. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were included in the last unannounced inspection report. EVIDENCE: Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 12 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 The personal support provided to service users meets their needs as identified in the care plan. The service users’ physical and emotional health needs are met. Arrangements for the handling of medicines do not completely protect service users. EVIDENCE: Care plans show that residents here manage most of their personal care independently. The plans detail the limited support required, for example minimum interventions with bathing, and identify residents’ preferences and areas of independence. Residents were positive about the support they received and the routines of the home. They felt that they were safe and their privacy was respected. Residents wear contemporary fashionable and age appropriate clothing. No residents require assistance with transfers or moving and handling. Relatives expressed satisfaction with the care provided at the home and the arrangements for keeping them involved and informed. All residents are registered with local GPs. Records detail contact details for GPs, dentists and opticians and record details of medical conditions. Visits to GPs, opticians and dentists were previously recorded in the daily diary. This has been recently changed to a specific record sheet which sets out the history Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 13 of visits and contacts in a more accessible single format. The care plan case tracked for one resident provided staff with information and directions about his healthcare needs. The revised policy and procedure on medicines was available to staff, but there was no signature list to confirm that each worker had read it. The acting manager stated that the Boots monitored dosage system would be introduced to the home very soon. The introduction of the monitored dosage system will resolve most of the following issues. The medication is currently stored in individual locked boxes in a locked filing cabinet. This facility is not fit for purpose. The acting manager stated that the new system would provide a suitable medicines cabinet. No residents have been assessed as being able to manage their own medication, but they or their representatives have not signed consents to the administration of medicines. The current medicine administration records are handwritten each week. It would have been good practice for a second person to have checked and signed these. There is a system for the recording the receipt and auditing stocks of medicines; this is rather elaborate on initial inspection. The administration of medicines is always signed by two persons. Staff have not entered codes in administration records to denote absence from the home in order account for gaps in the record. Residents appeared to have a range of ‘as required’ medication. The guidelines for staff as to the indicators for the administration of this medication were not sufficiently detailed and consistent. There were records of regular reviews of residents’ medication. It is recommended that the requirement for ‘as required’ medication is reviewed again. There were no controlled drugs in use. Staff receive basic training to establish their competence to administer medicines; this does not meet the intention of the standard. The new Spectrum training plan provides more robust training for staff in the safe handling of medicines. Patient information leaflets were on file. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 14 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 There are basic systems in place. The revised adult protection procedure should improve the arrangements for the protection of service users when it becomes operational. Training for staff requires development to ensure that vulnerable adults are completely protected. EVIDENCE: Spectrum’s corporate complaints procedure is provided to service users and their representatives through the home’s service users’ guide. Service users stated that they were satisfied with the care and support provided, and had not made any complaints. The acting manager reported in the pre-inspection questionnaire that there have been no formal complaints since the last inspection. Service users are supported to maintain contact with relatives so that there is an external overview of their care. The provider invites relatives and commissioning authorities to attend their six-monthly care plan reviews. Spectrum’s policy and procedure for the protection of vulnerable adults from abuse has been reviewed and updated to comply with the standard and to be more informative to staff. The commission’s understanding is that the new policy and procedure will be issued to staff soon. Staff complete in-house training in the protection of vulnerable adults. The commission recommends that managers and staff should attend the local multi-agency training on the protection of vulnerable adults. The Spectrum training manager had reported the difficulties experienced in accessing this training at an earlier meeting. The provider intends to develop further its own training in this area. The commission will continue to review this at future inspections. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 15 Care plans and risk assessments provide staff with detailed guidance about how they should understand and deal with physical and verbal aggression. Staff receive specific training in physical interventions. The home holds personal allowances as cash in individual locked boxes for each resident. Monthly cheques are sent out from Spectrum head office and paid into individual bank accounts. The home maintains a record of transactions which is sent monthly to head office for checking. One resident’s cash balance was checked against the record and found to be accurate. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 16 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 The premises need prompt attention in some areas in order to continue to provide a safe, comfortable and homely environment. EVIDENCE: These standards were included in more detail in the last unannounced inspection. The premises require redecoration in some areas to provide a reasonable standard of environment. The wallpaper, for example, in the large upstairs sitting room is peeling from the walls. In other areas the walls and woodwork require repainting. There is a problem with damp in the bay window of the ground floor lounge, and in one ground floor bedroom where the plaster behind the radiator has come away from the wall. The vinyl floor covering in the sun lounge inside the patio door is rucked and forms a trip hazard. The home requires a general spring clean – to include for example laundering curtains and cleaning light shades. Responses to maintenance needs do not always appear to be timely. The acting manager reported that a request has been made to head office for the redecoration of the premises. A representative of the maintenance team visited the home on the day of the inspection to examine the damp areas and Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 17 this will be referred to the landlord. The carpet in the main lounge is due to be replaced as part of fixing a loose floorboard. The worktop in the kitchen is worn in one area and, with the hob, will be replaced. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 18 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 Spectrum employs sufficient qualified staff to support service users. A recruitment record showed that service users are supported and protected by the home’s recruitment policy and practices. Arrangements for induction and core training appear satisfactory. Staff are up to date with most training as provided by the previous training programme. Staff are well supervised and supported, but the provider is not carrying out annual appraisals. EVIDENCE: Staff have a range of experience and qualification. Five staff have NVQ level 2 in care, and this exceeds the 50 level set in the standard. Staff were accessible to and comfortable with service users, and engaged in appropriate interactions during the inspection. The staff roster shows that three staff, including the manager are generally on duty during the day and two staff during the evening. There is one worker sleeping in on call from 10 pm to 8 am with the back up of the Spectrum on call system. There are currently more male than female staff and this reflects the gender composition of the residents. Staff accompany residents when they attend college and other daytime placements. The roster evidences the use of bank and temporary staff to cover gaps and absence. There are occasions when one member of staff is on duty during evenings when there are two residents in the home. Staff did not consider this to be unsafe. This arrangement did, however, restrict the choices of the two residents in activities and outings, and should be Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 19 reviewed. The home’s staffing had, owing to personal circumstances, recently reduced by two, and this was causing some problems in covering shifts. The home is not currently using its full staffing capacity. However, the acting manager is reviewing the current deployment of staff to address this. Staff reported that there are regular staff meetings with good attendance. There are no staff aged under 21. Spectrum has corporate policies and procedures for recruitment of staff. Home managers and staff from human resources conduct interviews and retain a record of the interview. The records for a member of staff, inspected through the provider’s computer system, showed that the provider had obtained all the required checks, documents and information. Staff stated that they receive statements of the terms and conditions of their employment. Spectrum has a training manager who plans, budgets for and arranges the delivery of training. Individual homes nominate staff to attend a structured programme of courses. The training programme has been developed recently to meet the needs of the staff and organisation. The revised induction training complies with the Skills for Care specification, and provides staff with a significant amount of their core training. There were no recently appointed staff to provide evidence for this at Heightlea. The home’s training plan summary sets out the training completed and the training planned in required areas for each staff member. These areas include, for example, food hygiene, health and safety and first aid. Staff are mostly up to date with their required training as previously provided. The commission’s understanding is that training in the safe handling of medicines and in adult protection has been improved and is planned for delivery over this year. Staff supervision records were locked away and, in the absence of the registered manager, could not be inspected in detail. Staff reported that they receive regular recorded supervision. A separate log of sessions confirmed that staff had received regular supervision in recent months. Staff felt well supported to do their jobs. The provider does not currently carry out annual staff appraisals. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 20 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): 39, 41 and 42 The registered manager is competent and experienced, and is working on his NVQ 4 award. Spectrum have introduced quality assurance strategies, but no summaries of outcomes have been made available. The records in the home complied with regulations and protected the rights and best interests of service users. Systems in place in the home protected the safety and wellbeing of service users and staff. EVIDENCE: Standard 37 was not inspected in detail, as the registered manager was absent from the home at the time of the inspection. He is currently working on his NVQ4 award. It was not possible to inspect the progress made in implementing effective quality assurance systems as the acting manager, who had been at the home for just a few days, was not able to locate the relevant material. Staff reported that the views of residents, their representatives and other stakeholders had been sought by questionnaire at the time of individual Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 21 reviews. The commission will review compliance with this standard at future inspections. Service user records comply with the contents specified in Schedule 3 to the regulations. They are in good order. Other required records, for example the roster, visitors’ book, menus, residents’ money, and accident reports, were inspected and satisfactory. Spectrum provides corporate policies and procedures to meet its responsibility as an employer. Staff training in health and safety was covered in the standard for training. The standard ‘Health and Safety Law’ information poster was displayed in the office. The detailed risk assessments relating to the care of residents were discussed in an earlier standard. A list of required maintenance and safety records was provided in the pre- inspection questionnaire. A sample of these were checked against the originals and found to be accurate. This is a home for three residents and the fire service is not required to make regulatory visits. The provider has completed a risk assessment and has a contract with a specialist company for equipment and advice. The record of maintenance of equipment is displayed in the office. Records detail weekly checks of the fire systems, for example smoke alarms, extinguishers and emergency lighting. Fire procedures are displayed conspicuously and fire drills are recorded as taking place every two months. The Control of Substances Hazardous to Health cupboard is in the office and locked. Data sheets are on file. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 22 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 X 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 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 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 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X X X X X 3 3 X Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 23 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 2 3 Standard A20 YA20 YA24 Regulation 13 13 and 18 23 Requirement The registered person must provide storage for medicines which is fit for purpose. Staff must receive training in the safe handling of medicines which complies with the standard. The registered person must take action to deal with the damp penetration in the ground floor lounge and ground floor bedroom. The registered person must replace or repair the rucked vinyl floor covering in the sun lounge. Timescale for action 31/05/06 30/09/06 30/09/06 4 YA24 23 16/03/06 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 Heightlea Refer to Standard YA6 YA6 YA6 Good Practice Recommendations All care plan records should be signed and dated by the responsible worker. Care planning records should show evidence of the involvement of the service user or their representative. Individual plans should set specific, measurable realistic DS0000009113.V278611.R01.S.doc Version 5.1 Page 24 4 5 6 7 8 9 YA20 YA20 YA20 YA23 YA24 YA33 10 YA36 goals with time scales. When hand written medicine administration records are in use, they should be checked and countersigned by a second person. Staff should use appropriate codes on medicine administration records to record absence from the home. The registered person should provide clear written guidance for staff on the use of ‘as required’ medication. Staff should attend regular refresher training in adult protection that is in accordance with local multi-agency procedures. The registered person should review the state of internal decoration of the premises and redecorate where this is required. The registered person should review whether one worker being on duty with two service users meets the stated aims of the home, allows uninterrupted work with individuals, and provides person centred care. Staff should receive an annual appraisal to review performance and agree personal development plans. Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Heightlea DS0000009113.V278611.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!