Inspection on 13/09/06 for Larchwood Grove

This inspection was carried out on 13th September 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Larchwood Grove 10/06/08

Larchwood Grove 01/08/07

Larchwood Grove 11/05/06

Larchwood Grove 01/09/05

Larchwood Grove 17/08/04

Larchwood Grove 20/05/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Larchwood Grove 60 Parrock Road Gravesend Kent DA12 1QH Lead Inspector Jo Griffiths Key Unannounced Inspection 13th September 2006 09:00 Larchwood Grove DS0000023972.V305799.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 Larchwood Grove DS0000023972.V305799.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. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larchwood Grove Address 60 Parrock Road Gravesend Kent DA12 1QH 01474 352722 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) Larchwood Court Limited Janet Zimba Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users with a learning disability may also have a physical disability. 11th May 2006 Date of last inspection Brief Description of the Service: Larchwood Grove is situated in a residential area in the town of Gravesend. The home has a large rear garden and accommodation is provided over 2 floors. The building has recently been extended and refurbished to provide modern accommodation and single bedrooms. There are 4 single wheelchair accessible bedrooms on the ground floor and 6 single bedrooms upstairs. The home is currently only registered for 8 people, but has applied to increase this to 10 once the new bedrooms are fully complete. The home offers some respite care. The home is staffed 24 hours a day with 1 waking night staff and 1 sleep over staff member. Public transport is available to access the town centre and there are a range of pubs, shops and cafes within walking distance. The fees charged by the service range from £500 to £1660 per week depending on service users’ levels of dependency. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a full key inspection and took place between 9.00am and 4.00pm on 13th September 2006. The newly registered Manager, Janet Zimba, was present throughout the inspection. A tour of the premises was given by one of the service users and some service users gave their views on the home. Records and documents were inspected. There were 4 service users living at the home at the time of the inspection. What the service does well: What has improved since the last inspection? Most of the things that we asked the Manager to do after our last visit have been done. This is very positive. The Service User Guide has been updated to give service users better information about the home. There are new assessments that are being completed with service users to make sure their needs can be properly met. The care plans have greatly improved. Service users’ meetings have started to happen again and they have more opportunity to do the activities they want to. Service users money is being kept safe and their medication is being handled in a safe way now by trained staff. Service users know how to make a complaint now if they need to. The building work has finished and the home is now very modern with lots of space. All service users can now have their own bedroom. Lots of equipment has been bought to help people with physical disabilities. For example, special baths, hoists and beds. Staff are no longer working really long hours and the recruitment of staff has got better to protect service users. There is now a registered Manager who is at the home 5 days a week. The owner has started visiting the home each month to check that everything is going ok. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 Service users are provided with the information they need about the home. Most service users needs have been properly assessed and reviewed. Some service users still need to have their assessment of need reviewed. Service users said they felt the home met their needs. Service users do not yet have an individual contract with the home. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The Statement of Purpose and Service User Guide have been updated and these are now available for service users and their relatives in the entrance hall. There is a minor amendment needed to the Statement of Purpose and this was discussed with the Manager. Some service users have had their needs reassessed using new assessment forms. The new forms cover all areas of need. The rest of the service users in the home should have a review of their needs. Any new service users to the home must have a full new assessment before they move in to make sure the home can meet their needs. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 9 Service users spoken with said they were happy at the home. One service user used to stay for periods of respite but has now moved in permanently. The home is better equipped to meet the needs of the service users now that the modernisation work has been completed. A letter was seen from a health professional stating that staff were very skilled in meeting the health needs of one particular service user. This has also been noted under standard 19. The Service User Guide includes a draft copy of the contract that is to be provided to service users. The Manager said that she was not aware that these had been signed yet and would check this with the owner. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Service users have a plan of care to meet their individual needs. They would benefit from these plans being expanded to include guidance for staff on the actual support they need. Service users are supported to make decisions and choices but would benefit from this being addressed within their care plan. Service users are encouraged to be involved in the running of some aspects of the home. Risks to service users have been assessed but require review. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Each service user has a new care plan in place that covers all areas of their individual need. The new care plans need some further work to expand them and include more detail of the actual support the person needs. This should Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 11 include how to support service users to make decisions and choices. The new care plans are clear and easy for staff to follow. One service users records show that staff do not check on him at night. This should be assessed and recorded within the care plan. The service users’ meetings have been happening most months. The Manager will ensure that these start to take place weekly when respite service users start to visit the home again. One service user confirmed that a meeting was planned for later that week. Service users are supported to manage their money where they can. Some service users have an appointee for their finances and this is an arrangement with their Care Manager. The home holds money for service users where they have asked for this to happen. The records and security of money held were checked and found to be satisfactory. Some risk assessments for service users have been reviewed. The Manager must ensure that all risk assessments are reviewed regularly and that all areas of risk to the service user are assessed. This should include any activities they do either in the home or outside. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 17 Service users have the opportunity to participate in activities of their choice. Service users are supported to maintain contact with their local community, friends and family. Service users enjoy a balanced menu with healthy choices. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users each have a plan of activities that they participate in each week, although this is flexible to their wishes. Records show that service users do lots of different activities, both at home and out within the local community. On the day of the inspection service users were going out for a trip to the zoo. One service user who recently moved to the home changed the day centre that he was attending but later decided that he missed his friends and wanted to Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 13 return to the previous one. He was supported by the staff team and his care Manager to arrange this. The Manager said that they intend to purchase a computer for service users to use at home. Service users can have visitors when they wish to. There are now 2 separate lounges so they can choose to see their visitors in private or they can use their own bedrooms if they wish. There is a balanced 4 week menu available that offers healthy choices for each meal. At present service users are choosing what they would like from the menu on a daily basis. Records show that service users generally make the same choices and the Manager must ensure that these are genuine choices and that they know they can have something different to other service users if they wish. One service user showed me the kitchen and said he liked to help with the cooking. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users personal care needs are met, but they would benefit further if these needs were clear in the care plan to ensure all staff know the level of support the person needs. Service users can be confident that their health needs are well met. Service users are protected by the home’s procedures for administering medication. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users would benefit from their care plans being more detailed about the actual support they require to meet their personal care needs. Service users spoken with said that the staff are very nice and help them with lots of things. Records show that service users personal care needs are met each day. Service users health needs are generally well met. Opticians appointments had been booked for all service users and records showed there is regular contact with the GP where needed. A recent letter from a dietician was seen. She is Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 15 involved in the care of one service user who is fed via a gastrostomy tube. The letter states, “I have rarely seen better care of a person with a feeding Gastrostomy. The Staff have become experts in this”. Medication storage was seen. This is being stored safely and stock records kept. The Manager checks and audits the medication weekly. Medication records were signed and accurate. The Manager was advised that for any medications that are prescribed as PRN or “as needed” there should be guidance for staff as to when this should be given. The guidance for one service user to have rectal diazepam administered was out of date. The Manager said she would review this with the epilepsy nurse. Senior staff are responsible for giving medication and have received training. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users and their relatives know how to make a complaint if they need to. Service users would benefit from the remainder of staff receiving training in Adult Protection. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: There have been no complaints received by the home. The complaints procedure is now placed in the entrance foyer for visitors and service users to see. Most staff have received training in safeguarding vulnerable adults and the Manager agreed to arrange training for those who had not received this. The Manager should also attend an update in this training. There is one adult protection alert that has been raised since the last inspection and the Multi agency team is currently investigating this. The outcome of this will be reported upon in the next inspection report. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Service users live in a homely and safe environment. Service users bedrooms suit their needs. Service users bedrooms promote their independence. Service users have sufficient bathroom facilities to meet their needs. Service users have access to sufficient communal space. Service users have the specialist equipment they need. Service users benefit from a clean and hygienic home. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The provider has made an application to increase the number of beds in the home from 8 to 10. There has been major building works going on to extend Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 18 and modernise the property this year in preparation for this increase. CSCI are currently processing the application and will report on the outcome of this in the next inspection report. The improvements made to the environment have greatly improved the standard of living and the service provided to the people in the home. All the bedrooms are now single and most have ensuite facilities or a bathroom nearby. The new bedrooms are well equipped for service users with physical disabilities and have tracking hoists and high/low beds. The new bedrooms have been fully furnished. It was agreed with the Manager that an occupational therapist would be asked to assess the needs of the current service users in relation to the new bedrooms to ensure they have the correct equipment and layout before moving into these new rooms. There are now two lounges and a large dining room. The kitchen has been relocated and modernised. The separate laundry room is well equipped and hygienic. There are a number of bathrooms with varying types of adapted equipment to meet a range of physical needs. The home has been redecorated throughout and work is ongoing to make the garden more accessible to service users ready for next summer. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Service users benefit from being supported byqualified staff. Service users are supported by an effective team but would benefit from confirmation of the 1-1 support for one service user. Service users are protected from abuse by the home’s recruitment procedure. Service users would benefit from staff receiving further training. Service users would benefit from staff receiving more regular formal supervision. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Five members of the care staff team have completed or are working toward their NVQ award. The Manager said it is planned for three more staff to register this year. The staff have completed much training this year and most statutory training is now up to date. The Manager must ensure that all staff have a basic food Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 20 hygiene certificate and complete the appointed persons 1st Aid training. Some staff require an update in their Adult Protection training. Most staff have started a 12 week course in medication. It was discussed with the Manager the benefits of starting to explore other training for staff that will help them to better support service users. The recommended courses that would be of benefit are Person centred planning, communication and sexuality. It is recommended that the Manager develop a training plan for the home with identified courses for the coming year. Recruitment records were checked and these showed that staff are recruited safely and following company policy. Staff supervision has not taken place regularly. The Manager was advised this should happen approximately every 2 months as a minimum. The rota shows that staff are no longer working unsafe hours. At present there are only 4 service users living at the home and there are 2 members of staff on duty. One of these staff members is allocated as a 1-1 for a service user and this is funded separately. The Manager must ensure that, if a service user wants to go out to an activity with a member of staff, there are sufficient staff left at the home to support the other service users without having to use the 1-1 staff member. The Manager was advised to confirm with the care Manager exactly how many hours are funded as additional support and to review the rota with this in mind. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Service users now benefit from a Manager that is registered solely for this home. They will benefit further once the Manager has completed the recommended qualifications. Service users are asked their views on the home and know that the owner will regularly check the quality of the service. Service users’ health and welfare are promoted and protected. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The Manager of the home has now been successfully registered with CSCI. She has made a number of improvements to the home and has ensured that the majority of the requirements made at the last inspection have been met. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 22 The Manager is working toward the Registered Manager Award and said that it is planned that she will complete this in October 2006. The Manager was advised that she would then need to complete a care qualification to the standard of NVQ 4 in Care. The provider has started to complete quality visits to the home each month under regulation 26. The Manager must have these available for inspection in the home. Questionnaires sent to service users and their relatives to ask their views of the home were seen at the last inspection. The Manager is advised to repeat this exercise each year. The environment has greatly improved and no longer presents the risks to service users that were a concern at the last inspection. The Manager has reviewed most individual risk assessments for service users. She must ensure that the general risk assessment for the home is reviewed to reflect the changes to the building. Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 3 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 4 30 3 STAFFING Standard No Score 31 x 32 4 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 2 x 2 x 3 x x 2 x Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 YA23 YA42 Regulation Requirement Timescale for action 30/11/06 13(4)(5)23(4)(d)16(2j) The registered person shall make arrangements for staff training. In particular relation to Moving and Handling, fire safety, food hygiene and 1st Aid. This requirement has not been fully met since made at the inspection on 04/11/02. From this inspection staff still require updates in Basic Food Hygiene and 1st Aid. There are also staff that require an update in adult protection. 2. YA5 5(1c) The registered person shall produce a written guide to the care home which shall include a standard form of contract for the DS0000023972.V305799.R01.S.doc 30/11/06 Larchwood Grove Version 5.2 Page 25 provision of services and facilities by the registered provider to service users. In that all service users must be provided with a copy of the contract for their care in the home. This requirement was made at the last visit. The contracts could not be found in the home on this visit. The Manager must ensure a copy is held for each service user. 3. YA20 13(2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, Where medication is prescribed as “As needed” clear guidance must be written for staff so they know when they should administer this. The guidance for when rectal diazepam must be reviewed and updated for one service user. 31/10/06 Larchwood Grove DS0000023972.V305799.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is recommended that the sentence in the Statement of Purpose (page 2) that states service users can be cared for from the age of 18 until they pass away be removed. This could be misleading for service users as the home is registered for people up to the age of 65. Anyone wishes to remain in the home longer would be considered on an individual basis. It is recommended that the assessment of need be reviewed for all service users and the new form completed. It is recommended that the care plans be further expanded to include more detail of the persons needs. This should include the support they need with personal care, support throughout the night and support to make choices. It is recommended that the remainder of the service users risk assessments be reviewed. It is recommended that the provision of the 1-1 support for one service user be reviewed with the care Manager to ensure it is effective and not being used to support other service users. It is recommended that a training plan for the home be devised and that other training that would benefit service users be explored. This could include Person centred planning, sexuality and communication. It is recommended that formal supervision sessions for staff take place every 2 months. It is recommended that the Manager begin the NVQ 4 in care once she has completed the RMA. It is recommended that the general risk assessment for the environment be reviewed to reflect the changes to the building. 2. 3. YA2 YA6 YA18 4. 5. YA9 YA33 6. YA35 7. 8. 9. YA36 YA37 YA42 Larchwood Grove DS0000023972.V305799.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: 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 Larchwood Grove DS0000023972.V305799.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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