Inspection on 19/04/05 for Lowdon House

This inspection was carried out on 19th April 2005.

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 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

Lowdon House 17/05/06

Lowdon House 21/09/05

Lowdon House 14/01/05

Lowdon House 15/09/04

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

CARE HOME ADULTS 18-65 Lowdon House 12 Bairstow Street Preston Lancashire PR1 3TN Lead Inspector Denise Upton Announced 19 April 2005 th 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 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 Stationary 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. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Lowdon House Address 12 Bairstow Street Preston Lancashire PR1 3TN 01772 258313 01772 258313 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Joan Smith Mrs Joan Smith Care Home only 6 Category(ies) of Mental Disorder (6) registration, with number of places Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th January 2005 Brief Description of the Service: Lowdon House is a terraced property situated close to the centre of the city and within easy reach of community resources and facilities. These can be accessed independently or with the assistance of staff. The home is registered to accommodate up to six service users with a history of mental illness that do not require nursing care. Lowdon House provides accommodation over two floors and all service users are accommodated in individual bedroom accommodation that was recently refurbished. Although bedroom accommodation is not provided with an en-suite facility, bathing and toilet facilities are sufficient in number and located close to communal areas of the home and bedroom accommodation. Although the majority of service users smoke, the home has attempted to provide a none smoking environment in the dining room and conservatory although this is dependent on the cooperation of service users. Lowdon House is a smaller family type establishment with the proprietor providing care and support supplemented by a small nucleus of staff. In consequence, service users needs and preferences are well known and therefore more easily addressed. Social activity is determined in accordance with the collective and individual wishes of service users accommodated. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a 7 hours period and started at 10.00am.The inspector spoke with the registered person and the two senior care staff that were on duty. In addition, two people who live at the home were spoken with individually and brief general discussion also took place with two other residents who were at ‘home’. A number of records and policies and procedures were also examined and a partial tour of the building took place. At this inspection, the Commission For Social Care Inspection pharmacist inspector also visited and assessed the medication standard. The findings of this are also included in the summary report. One additional unannounced visit had been made since the last announced inspection. The letter sent to the registered person following this visit can be obtained from the Commission For Social Care Inspection office on request. What the service does well: What has improved since the last inspection? The staff team have made some improvements to the written information held in respect of a resident that is looked at on a regular basis to make sure that the information remains correct. Any changes that may be required are discussed and agreed with the individual person. The registered person was able to show how they have improved some of the policies and procedures so that staff have clear information on how they should be working. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 6 Since the last inspection, the registered person has gained a professional qualification and other members of staff are also undertaken nationally recognised training. All residents spoken with said they got on well with the other people who lived the home and liked the support of the staff group to talk to or to help them with shopping or other domestic tasks. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 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 standard(s) 1,2 & 5 The home’s Statement of Purpose and Service User Guide are good in providing service users and prospective service users with details of services the home provides enabling an informed decision about admission to the home. The care planning and risk assessment process has been developed and improved that provides a holistic account of current strengths and needs. EVIDENCE: The Service User Guide was reviewed and amended in February 2005 and now incorporates the service user’s views of the home as recommended at the last inspection. However, the revised copy of the Service User Guide provided to each individual service user only contains the views of that particular service user rather than the collated views of all service users. It is understood that a collated response will be developed that ensures confidentially and a copy of this will be provided to all existing service users for inclusion in the revised Service Users Guide and also made available to prospective service users. The Statement of Purpose is compliant with requirements and recommendations but is about to also be reviewed and updated. Significant improvement was noted in respect of information documented with regard to service users current strengths and needs. Although admissions to Lowdon House are infrequent, as part of the ‘case tracking’ process, records in Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 9 respect of the most recently admitted service user were inspected. The pre admission assessment document has been updated to good effect and now incorporates the manager’s assessment along with an overview of the prospective service users requirements. This document covers a variety of topics including daily living, communication, social needs, personal relationships, work, health, medication and finance. Relevant risk assessments have also now been developed with outcomes incorporated into the individual care plan. Each individual service user contributes to their care plan and risk assessment process that is reviewed on at least a six monthly basis with the documents signed by the service user to acknowledge their understand of and agreement to the outcome. This process was confirmed by a service user spoken with who also stated that his Social Worker had also being involved when discussing the proposed care plan. However it is recommended that any written pre admission information provided by the Community Psychiatric Nurse, Social Worker or other professional involved is kept on the service user’s file. If no written information has been provided, this should be recorded along with details of the verbal information provided prior to admission. Each service users is provided with a contract/statement of terms and conditions of residency, which is signed by the service user and proprietor. However as identified in previous inspection reports, not all of the recommendations in respect of this Standard had been fulfilled. A revised contract/statement of terms and conditions is currently under development. It is understood that this document will incorporate all recommendations and a copy will be provided to each service user in addition to the master copy held on the individual service user’s file. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 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 standard(s) 6,7 & 9 The home regularly reviews individual care plans and risk assessments to ensure the information in respect of strengths and needs remains up to date with service users determining their own lifestyle where ever possible. EVIDENCE: Since the last inspection, the care-planning document has been reviewed, revised and extended to good effect and now identifies the actual assistance required. In addition, outcomes of the individual risk assessments are now incorporated. The individual care plan is reflective of the service user’s current strengths, needs, wants and wishes and includes any restriction with regard to choice or freedom that is agreed with the service user. It was evidenced that all care plans are routinely reviewed on a monthly basis with outcomes identified in the six monthly reviews. However if the monthly review has indicated change, the existing care plan is immediately updated. Care plans are devised in consultation with the individual service user and signed by the service user. A resident confirmed that staff had read to him his proposed care plan and explained what it meant prior to him signing the document. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 11 Service users at Lowdon House are encouraged to make their own life style decisions and that right is only limited by individual assessment findings. Service users are enabled to manage their own finances however where this is not a viable option, the service user signs a document agreeing to the management team holding personal monies in safe keeping and the Department of Social Security benefit book. When necessary, staff assists the individual service user with budgeting and shopping that was identified on the care plan and confirmed by a service user spoken with. However if an individual’s mental health improves and independent ability increases, the service user can reclaim these task with the support of the staff team. The multi disciplinary Care Programme Approach care planning documentation identifies risk and any risk management strategies that had been agreed prior to admission to the home. This is reviewed on a regular basis and supplements the ‘in-house’ risk assessment process to ensure the information remains current. Service users are provided with verbal information on how to maximise their own personal safety to avoid limiting the service user’s choice. Through observation of policy documents, it was evident there are formal procedures to follow should a service user not return to the home when expected. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 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 standard(s) None of the 7 Standards were assessed at this inspection. EVIDENCE: None of the seven Standards were assessed at this inspection. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 13 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 standard(s) 18,19 & 20 The systems for assisting residents maintain they’re chosen lifestyle are good however the system for recording medication and medication administration is poor that potentially place service users at risk. EVIDENCE: Current service users at Lowdon House are self caring in respect of physical care tasks but are routinely assisted with lifestyle support that is identified on an individual basis and dependent on the strengths, needs, wants and wishes of the individual. Routines within the home are flexible to accommodate individual requirements and service users spoken with stated that they were comfortable with all members of staff with one resident describing the staff group as ‘great’. The home maintains links with the local psychiatric services including community psychiatric nurses and mental health social workers that provide staff with advice as required. Residents are supported to manage their own healthcare requirements and have access to a range of health care professionals that includes a medication review on a regular basis. At this inspection, the Commission For Social Care Inspection Pharmacist Inspector assessed the medication standard. (Standard 20). Because the current Nomad system supplied by a community pharmacist used by the home was not of a good standard, the proprietor at Lowdon House was advised that Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 14 other community pharmacies are better placed to provide monitored dosage systems and computer-generated records. With the current system, it was difficult to maintain accurate record keeping. This would be improved by the facility of a computer-generated administration recording system. Poor practice was evidenced in respect of medication administration recording and that, along with less than accurate handwritten recording in respect of drugs received into the home and of drugs destroyed or returned to the pharmacist for disposal, made it difficult for an accurate audit trail of medication to be maintained. In turn this could place residents at risk and should be addressed as soon as possible. It is understood that consideration is being given to arranging for an alternative Pharmacist to supply medication to the home. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 15 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 standard(s) 22 & 23 The home has developed a satisfactory complaints system and adult abuse policy and procedures for protection of service users. EVIDENCE: No complaint has been made in respect of Lowdon House for some considerable period of time. The home’s complaint procedure is compliant with requirements and incorporated in the Statement of Purpose and Service User Guide. All service users are encouraged to voice any concerns and complaints immediately so that issues can be discussed and addressed. Residents accommodated are vocal in their approach to resolving issues and prefer this option to raising any formal complaint. Documentation has been developed to record any future complaint that details the investigation, action taken and outcome. At the time of this inspection, the home’s adult abuse policy and procedures could not be located. However these documents were evidenced at previous inspections and found to be compliant with requirements and recommendations. Various other policies and procedures were also evidenced in respect of the protection of residents that included the home’s policies and practices with regard to service users monies and valuables. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 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 standard(s) 30 The standard of the environment within this home is, in the main, satisfactory. However further physical risk assessments are required particularly in relation to the laundry area in order to minimise risk to service users and staff. EVIDENCE: At the time of inspection the home was maintained to an acceptable standard. Since the last inspection a number of risk assessments have been developed in respect of the physical environment. It was suggested that the generic physical risk assessments that have recently been undertaken could be further developed and extended to identify any potential risk for each individual room accessed by service users and action taken to minimise that risk. This is particularly relevant to the laundry area located in the basement of the home that is access by residents when they attend to their own washing with staff supervision. Although some improvement was noted in respect of this area that includes a lock to the door when not in use to ensure service users are safe from cleaning materials and hazardous substances, this area is still cluttered that could cause a potential safety risk and requires further attention in order to fulfil all the recommendations of this Standard. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34 and 36 Recruitment policies have not been consistently followed resulting in service users receiving care from a staff member who has not been properly vetted. This potentially leaves people who use the service at risk. Staff training is now seen as a priority to ensure staff have the skills and knowledge to provide a good quality service. EVIDENCE: Lowden House enjoys a small stable staff group who support the registered proprietor to address the strengths and needs of service users accommodated. The relationship observed between staff and service users is positive with current residents wants, wishes and requirements well known and addressed on an individual basis. Staff training has been a priority and currently one member of the care staff team holds an NVQ Level 3 in care, one member of staff has almost completed Level 2 of this award, another member of staff is currently undertaking this course of study and a further member of staff is waiting for a commencement date to undertake this award. In addition further short course training has undertaken by the majority of staff that includes infection control, moving and handling and first aid training. Although the majority of staff have worked at the home for an extended period of time, a new member of staff recently took up employment at Lowdon Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 18 House. Evidence was available of a Criminal Records Bureau clearance having being secured in respect of this person, however there was no evidence of an application form being completed, references being sought or a satisfactory medical declaration being obtained. As part of a robust recruitment process required by regulation, these documents and clearances should have been obtained and deemed to be satisfactory prior to the applicant taking up post. An immediate requirement notice was issued for the proprietor to ensure that these checks are taken up retrospectively and prior to any new members of staff starting work. At present staff supervision is informal and conducted as part of the routine day-to-day management role. However, all staff received a formal appraisal in November 2004 and it is understood that this process will take place on an annual basis. In order to supplement the formal appraisal process it is recommended that formal supervision be introduced on a regular basis in order to support staff and provide an opportunity for individual discussion. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39 & 42 EVIDENCE: The proprietor/manager at Lowdon House has extensive experience in running the care home, has recently completed the Registered Managers Award and is waiting for the certificate to be issued. Evidence of the manager`s commitment to ensuring that the aims and objectives of the home are achieved was gathered through discussion both service users ‘case tracked’ who stated the service was what they had been led to expect and was fulfilling their needs. In addition, the proprietor has also undertaking further periodic training in addition to the Registered Managers Award to increase her skills, knowledge and competence while running the home. Although appropriate policies and procedures are in place, it was evident they they are not always followed and this issue should be addressed by the manager to ensure compliance. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 20 Formal and informal systems are in place to ensure service users views are known that includes service users questionnaires and informal daily dialogue with staff. This allows service users to have some say into how the home is run. Service users can also influence change through bi-monthly service user meetings. Staff meetings also take place on a bi-monthly basis to enable staff to formally voice their views and opinions. In addition, the home has achieved the ‘Investor In People’ award that provides an external quality monitoring system on how the home is achieving aims for service users. It was recommended that other stakeholder questionnaires could be developed to enable other people to comment on how the home was meeting service users needs. The majority of staff have sucessfully completed health and safety training that included a fire safety awareness course, health and safety in the work place course, moving and handling training and it is understood that a qualified first aider is now on duty at all times. A number of staff have also recently attended updated first aid training and it is understood that this will be arranged for all remaining staff in the near future. Although a policy document in respect of COSHH requirements has been developed, as yet risk assessments in respect of all safe working practices have yet to be introduced and it is again recommended that risk assessments be undertaken for all safe working practice topics covered in Standards 42.2. Although there was evidence that induction training was provided, it is recommended that this be evidenced against the TOPSS induction programme to ensure compliance and foundation training to TOPSS specification should be introduced. Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 2 Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x 2 x 1 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lowdon House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x x 2 F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 22 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 34 Regulation 19 Requirement Timescale for action Immediate 2. 20 3. 20 4. 20 5. 20 Newly appointed staff must only take up employment at the home when all requirements in respect of recruitment processes are fulfilled. 13(2) The manager to ensure an accurate record of receipt of medication into the home is made. Schedule The manager to ensure an 3 17(1)(a) accurate record is made of 3(i) medicines administered to service users, a newer design MAR supplied by the community pharmacist would facilitate this. 13(2) The manager to ensure an accurate record is made of all medicines returned to the pharmacist or distroyed. 13(2) The manager to ensure all medication kept in the home is labelled and fully identifiable, a new monitired dosage system would help faciliate this. 16/05/05 16/05/05 16/05/05 16/05/05 Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 23 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. Refer to Standard 1 2 Good Practice Recommendations The Service User Guide should contain the collated views of all service users. Written information provided prior to admission by any professionals involved should be included in the individual servicer user file. If written information is not provided this should be recorded along with the verbal information obtained prior to admission. The contract of residency that is about to be revised should contain all recommendations if what should be included. Please provide a copy of the Adult Abuse Policy and Procedure that was not available at the time of inspection. A physical risk assessment specific to the laundry area should be undertaken and outcomes actioned. At least 50 of the care staff team should have achieved at minimum, NVQ Level 2 by 2005. t is recommended that formal one-to-one supervision be developed and introduced. All policies and procedures shouild be implementated. Consideration could be given to developing a qualityu assurance questionnaire in respect of all stakeholders. It is recommended that current induction training be evidenced against TOPSS specifications to ensure compliance and foundation training to TOPSS specifications be developed. Current staff traininmg in rewspect of first aid and updated food hygiene should be continued until all staff have received this training. Risk assessments should be undertaken for all safe working practices. it is recommended that the names of all staff and residents who take part in fire practices be recorded. 3. 4. 5. 6. 7. 8. 9. 10. 11. 5 23 30 32 36 37 39 43 Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Area Office, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Lowdon House F57 F09 S9837 Lowdon House V215707 190405 Stage 4.doc Version 1.20 Page 25 - 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!