Inspection on 12/11/07 for Holly Cottage

This inspection was carried out on 12th November 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly Cottage 08/06/06

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Southfields

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

CARE HOME ADULTS 18-65 Holly Cottage Highlands Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Mrs Sally Gill Key Unannounced Inspection 12th November 2007 09:00 Holly Cottage DS0000066932.V352441.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 Holly Cottage DS0000066932.V352441.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. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Cottage Address Highlands Farm Woodchurch Ashford Kent TN26 3RJ 01233 861493 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Canterbury Oast Trust Mrs Ann Kathleen Combes Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2006 Brief Description of the Service: Holly Cottage is registered to provide accommodation for up to five adults with a learning disability and admits people with low to medium dependencies. The Canterbury Oast Trust (COT) owns the business and the Registered Manager, Ann Combes has day-to-day control. Holly Cottage is a purpose built bungalow with all accommodation on one level. There are five single rooms, a shower/toilet, bath/toilet, toilet, laundry, kitchen and lounge/diner. Service users have access to garden areas. Holly Cottage is situated on Highlands Farm, which is a well-known tourist attraction in a rural area on the outskirts of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs. The Cottage has transport, which can be used for the service users and a local bus service passes the farm entrance. The staff compliment consists of a registered manager, team leader and support workers. Support workers work a rota that includes a minimum of one staff on duty. Addition support is in place as needed. At night one member of staff is on the premises sleeping in but can be called if needed. Currently charges are £818.66 per week. Additional charges are made for some activities, newspaper and magazines, hairdressing and toiletries. Previous inspection reports are available from the provider or can be viewed and downloaded from www.csci.org.uk. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over a period of time and concluded with an unannounced visit to the home between 9.00am and 2.40pm. The registered manager assisted throughout. We spoke to two service users and staff during the visit and met two other service users briefly. Interactions were observed. Five people were living at the home on the day of the visit with no vacancies. Surveys were sent to the home to distribute to service users, relatives and health and social care professionals. Feedback received from service users, relatives and professionals was very positive. Everyone is happy with the care and support received. The care of two service users was tracked to gain evidence. Various records were viewed during the inspection and parts of the home viewed including two bedrooms by invitation, toilet, office and communal areas. The manager had completed the Annual Quality Assurance Assessment (AQAA). Information contained was adequate but could be enhanced to reflect better the service and this was discussed with the manager. What the service does well: Service users gave positive feedback both during the visit and through their surveys. Comments included ‘I like living here, I like my room, everything’s fine’, ‘I don’t want to move from Holly I like all the staff and the residents make me laugh’, ‘I like living at Holly it lovely and quiet’ and ‘I’m fine here’. Service users feel they are able to make decisions regarding their own lives as well as the day-to-day running of the home. Service users confirmed they have opportunities to get out and about into the local community; they have a wide range of leisure activities and plan their holidays to places they want to go. Relatives feel they are kept informed and communication links are very good. They feel the atmosphere in the home is more relaxed than previously and feel service users have all benefited from this. Relative’s comments included ‘the house manager and care staff work very much as a team and are readily available’, ‘they are always friendly, helpful and sound as if they have all the time in the world for me even though they must be very busy’, ‘X leads a fulfilling life’, ‘the home works to give a full and satisfying life to their residents regardless of the level of disability’, ‘COT and Holly provides an excellent safe environment for X and most importantly a full programme of day services to Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 6 stimulate them and help them achieve their fullest potential’, ‘communication is excellent’, ‘Holly provides a homely environment and all the staff that we have come into contact with have been uniformly excellent’, ‘we cannot fault COT or Holly Cottage, COT is a model for the rest of the care community’, and ‘its lived up to all our hopes and expectations’. The home is clean, safe, homely and well maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Holly Cottage DS0000066932.V352441.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 Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need and their needs assessed in order to make a choice as to whether this home is right for them and can meet their needs. EVIDENCE: The homes service user guide is displayed within the home. The home has had one departure and one new admission since the last inspection. The new admission was a transfer from another COT establishment. An assessment was completed by the manager prior to the transfer, which is held on file. The home also obtained a copy of the service users care mangers assessment. The manager advised that the admission was not as well planned, as she would have liked due to timescales out of her control. However the service user was able to make two visits to test drive the home with their original key worker. The home also met with the family and care manager. To ensure the transfer went as smoothly as possible the services users day services have not been changed. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 10 Contracts are in place, which are agreed with service users. The manager advised these had been updated when fees have increased. Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives and play a role in planning the care and support they receive. Strategies for dealing with aggression/behaviours should be better documented in care plans. EVIDENCE: A care plan is in place for each service user. The manager advised that she is working to improved the set up of care plan folders in order to make them easier to use. One had already been completed. Care plans are informative, describe the support a person needs and state any the individual goals. Service users confirm that their care plan had been developed with them. Care plans were seen to be reviewed and up to date. A relative confirmed that they are also involved in any reviews as are care managers. The goals and aspirations of service users are always discussed at reviews. It is recommended that the consistent approach adopted by staff in consultation with professionals for handling the behaviours or aggression of one service user is documented in the care plan. A key worker system is in place although Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 12 the manager advised that due to staff turnover this had not been as well organised as it could have been. Service users have regular meetings where they are able to discuss what leisure activities they would like to do and any concerns they may have. The home has introduced several visual aids to improve participation and communication including one activity programme, today’s menu, who’s in the house and who’s on duty this week. The service users keep these up to date. Service users have also increased their responsibilities within the home with more involvement in household tasks. It is hoped this involvement will be developed further. A suggestion to involve service users further in recruitment was discussed. The home should be sure that any limitations on choice, which are agreed with service users, are recorded in the care plan. This would include where food is stored purposely on the top shelf of a cupboard. Risks are assessed and documented which were seen to be reviewed and up to date. Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style, and are being supported to develop their life skills. They have a wide range of social, educational and recreational activities opportunities. EVIDENCE: Staff have worked hard to achieve personal development for service users since the last inspection. One service user was obviously more confident within the home. The manager felt that this was the case for other service users whose confidence and self-esteem has increased. Communication books/aids have been introduced with good results. One service user has had input from the Community Learning Disability Team (CLDT) in relation to handling their aggression. As previously mentioned the involvement in house hold chores has increased. Service users have responsibility for cleaning their own rooms, are part of a Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 14 rota for communal areas as well as doing their own laundry. Service users will be undertaking a new programme in skills training. It is hoped this will commence in January although some service users have already chosen the units they want to undertake. Service users continue to have a varied programme of educational/training opportunities mainly from within COT day services activities such as craft, horticulture, computers and working in the Highlands Farm restaurant. It was apparent that service users enjoy and are happy with their programmes. The manager advised that these are regularly reviewed and discussed with service users. The home was successful in setting a volunteer work opportunity outside of COT for one service user unfortunately the placement could not be proceed long term. It is hoped that other opportunities will be sourced. Service users have access to the local community including events at the Rare Breeds, shops, pub and swimming pool etc. An ideas folder has been developed of places to visit. A new 7-seat car has been purchased since the last inspection. Holidays have been tailored to suit individuals rather than the whole home going on the same holiday. As a result service users have been on a variety of holidays and/or days out this year. Service users talked happily of visits and holidays with families and also friends. Relationships are supported. Very positive feedback was received from all relatives that responded. Service users confirmed that they plan the menus monthly with encouragement from staff towards a healthy diet. They are involved in the shopping and preparation of the main meal. Lunch and breakfast is free choice and independent where possible. A written menu and pictures of today’s main meal are displayed. Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. Minor improvements are needed to the medication system to fully protect service users. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care plans evidenced service users preferred routines around personal care where assistance is required. Discussions evidenced independence is promoted where possible. Service users confirmed that bedtimes are flexible. Staff have worked hard to improve consistency and ensure continuity for service users in the light of staff turnover. Service users have access to regularly health care checks including doctors, opticians, dentist and chiropodist. They are supported with appointments when necessary. Any concerns are monitored and referred as appropriate. A holistic therapist visits the home once a fortnight. Staff have accessed professional support and guidance which has been followed through into practice. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 16 Medication management has improved. The pharmacy supplying the medication has changed. One service user talked proudly about the fact that they are responsible for part of their administration. There are plans to develop this further and also to look at other service users skills for possible develop in this area. Risk assessments are in place for self-administration. Service users confirmed that they have completed their own medication workbook that is kept in the care plan. Medication Administration Records (MAR) charts appeared satisfactory. The forms are being used, as designed, for all medication related purposes. Internal/external medication is now stored separately. The written PRN instructions for staff need further detail such as trigger to flag other action i.e. maximum dose and authorisation needed. Medication is logged in and out and now includes home visits. A list of homely remedies has been signed by the GP for each service user. The home need to ensure the list are kept up to date and do not double up on prescribed medication. Homely remedies need a system to audit stock control. Staff that administer medication have receive training. Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service feel able to express their concerns and have access to an effective complaints procedure. Service users are protected from abuse. Strategies to handle aggression need to be recorded to ensure risks are minimised. EVIDENCE: The complaints procedure is displayed within the home and each service users bedroom. This is pictorial and also includes photographs to ensure that service users know who to complain to. Service users confirmed that they did know who to talk to about any concerns. Relatives felt any grumbles are always addressed immediately. A log of complaints is kept but to date no complaints have been received. The blank complaint forms are now kept in the hall for easy access. There has been one adult protection alert since the last inspection following an incident of aggression. Management followed their procedures and worked with professionals and families to put strategies in place to reduce the risk of reoccurrence. A professional also attended a staff meeting to speak to staff about working with one service user and managing their behaviour. One of the recommendations from the alert has not yet been met. However the manager spoke of the reasons for the delay and hopes to resolve this shortly. Staff are trained in adult protection, NAPPI and challenging behaviour. See previous comments regarding the consistent approach adopted by staff to be documented in the care plan. The handling of aggression was discussed with Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 18 the manager in relation to the use of restraint as a last resort, the homes policy that is no restraint and staff training, which must be uniformed. The manager has reviewed the training and has booked staff onto courses. However these are not that frequent and it is strongly suggested this should be reviewed by COT. Holly Cottage DS0000066932.V352441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26,27, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, hygienic, safe and very homely. EVIDENCE: The home is purpose built with sufficient space and facilities. It is attractive, well maintained and has a comfortable and homely feel. It is apparent that service users have full and unrestricted access to all parts of their home. Since the last inspection there have been some improvements to the home including new hall furniture and pictures have been purchased, a wash hand basin has been fitted to one bedroom and another has been decorated by relatives and also has a new easy chair. Bedrooms are individual; reflect personal taste and service users say they are happy with their rooms. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 20 The gardens have been pruned for the winter, which also allows more light in service users bedrooms. The gardens are safe and accessible although not totally private. The manager advised there are plans to erect a summerhouse in the garden with electricity to provide addition space for service users. The homes development plan also contains other improvements to the environment. Staff advised that maintenance jobs could be delayed by large projects undertaken by the maintenance department, which can be frustrating. The home was clean and hygienic. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a sufficient number of staff that is qualified, experienced and skilled who support the smooth running of the home. EVIDENCE: The manager advised that 75 of permanent staff is qualified to National Vocational Qualification (NVQ) level 2 or above, the final member of the team is currently undertaking NVQ. The home has used approximately six flexi bank staff over recent times five of which are NVQ qualified. There is small team of staff which are obviously very committed and work well as a team to the benefit of service users. Turnover of staff has been quite high for a variety of reasons which has resulted in high use of the COT flexi bank staff. A relative confirmed that staff changes have been handled better than in the past and that their X gets on well with the flexi staff. Staff files were examined. Files evidenced a robust recruitment process is followed. However the manager needs to be able to satisfy herself that a Protection of Vulnerable Adults (POVA) check has been carried out as part of Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 22 the Criminal Records Bureau (CRB) check. There was some discussion to the extent of service users involvement in the recruitment of staff. The Trust now has a programme in place for staff induction, which is to Skills for Care specification, mandatory and some specialist training. This is in conjunction with an outside training provider. A professional specialising in autism has attended a staff meeting. Staff confirmed that they felt very well supported. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home where their views underpin the day-to-day running and any development. EVIDENCE: The manager is currently undertaking her Registered Manager Award NVQ level 4. She has been the manager at the home for just over a year although has worked for COT previously. Annie has a wealth of experience within learning disability services. Relatives and staff confirmed that manager is supportive and works hard to ensure the team pull together as one. A relative said that Annie has helped us to understand autism, she is a very good manager, her eyes and ears are everywhere and she works well with higher management. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 24 As previous mentioned the atmosphere in home was more relaxed and one service user appeared more confident. The levels of responsibility and involvement of service users has improved and it is hoped this development will continue. Relatives were very positive about the staff and management of the home and the excellent communication. Service users, relatives and professionals complete quality assurance questionnaires annually usually about the time of a residents review. If these are not positive the manager responds individually. Feeding back to all participants who complete surveys was discussed. A development plan is in place for the home. Regulation 26 visits take place regularly where again service users are asked their views of the home. Information received indicated that some of the home policies have not been reviewed for several years this needs to be addressed. Health and safety checks are carried out regularly. The home and equipment is well maintained. Staff are trained in core subjects. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 4 3 X X 3 X Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 YA6 YA20 YA20 Good Practice Recommendations The consistent approach adopted by staff in consultation with professionals for handling the behaviours or aggression is documented in the care plan Written PRN medication instructions for staff need further detail such as trigger to flag other action i.e. maximum dose and authorisation needed. Homely remedies need a system to audit stock control. Holly Cottage DS0000066932.V352441.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holly Cottage DS0000066932.V352441.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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