Inspection on 12/01/06 for Millstream

This inspection was carried out on 12th January 2006.

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

Other inspections for this house

Millstream 31/07/09

Millstream 31/07/08

Millstream 31/07/07

Millstream 09/01/07

Millstream 05/07/06

Millstream 06/09/05

Millstream 23/11/04

Millstream 28/04/04

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

CARE HOME ADULTS 18-65 Millstream Mill Road Frindsbury Kent ME2 3BT Lead Inspector Anne Butts Announced Inspection 12th January 2006 09:30 Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Millstream Address Mill Road Frindsbury Kent ME2 3BT 01634 299970 01634 299971 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) Opus Living Vacant Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service User with Huntingtons Disease whose date of birth is 03.12.1940. To accommodate one person whose date of birth is 14 November 1937 Date of last inspection 5th September 2005 Brief Description of the Service: Millstream is a large care home situated on the outskirts of Strood. Local services are approximately 1½ miles away downhill. It is in keeping with the local area. The home caters specifically for adults with a diagnosis of Huntington’s Disease, and has been designed with their needs in mind. The home is set over three floors. All bedrooms are en-suite and there is a range of shared spaces. There is a large rear garden which has terraced, paved and lawned areas and has good access for service users. There is some parking space to the front of the building. The home also has three vehicles which are used for the service users benefit. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that was carried out by one inspector. The manager was present during the course of the visit. Due to the nature of Huntington’s Disease many of the service users have limited communication abilities. However, part of the process for an announced inspection includes the Commission for Social Care Inspection sending out short questionnaires to service users, relatives and appropriate health care professionals and this enables feedback to be gained from people who may not be available at the time of inspection and comments from this have been included within this report. The focus of the inspection was to look at outcomes for service users and this included: Speaking to staff and looking at how the home supports their staff in ensuring that they can provide quality care to the service users living within the home. Looking at care plans and how they set out the care and support that is required in order to meet the individual needs of the service users. Observing the day-to-day activities of the home and inspecting policies and procedures. Millstream was part of the Opus Living Group, which has recently joined with a larger organisation. Alongside this there have also been some internal staff changes within the home itself, and this has led to a period of change. The manager, who has been in post since September 2005, demonstrated a commitment to supporting staff and service users through this and is aware of the concerns which may arise from these changes. Discussions held with staff during the inspection process also confirmed that they felt largely supported and that generally conditions within the home for both staff and service users were improving. One member of staff stated “I’ve worked here for a number of years and have seen some changes, but I now feel well supported and that I can spend quality time with the service users”. Any requirements and recommendations that were made at the previous inspection had either been addressed or are in the process of being dealt with and overall this was a positive inspection and it is the opinion of the inspector that the home is in the process of moving forward and will be supported by the larger organisation. What the service does well: The pre-assessment process is aimed at ensuring that the home is able to meet the needs of the individual. Risk assessments support service users in their daily lives. Any complaints are dealt with in an effective manner. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 6 The home’s recruitment procedures and structure for interviewing and employing new members of staff are very thorough and records demonstrated that the home carries out all relevant checks with regards to new staff. The managers and staff maintain a clean, pleasant and largely safe environment for service users living within the home. 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. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Prospective service users are fully assessed prior to moving into the home to ensure assessed needs can be met. EVIDENCE: There is a thorough pre-admission assessment in place, which is specifically aimed at assessing the needs of people with Huntington’s disease, and takes into account the assessment process as identified within the National Minimum Standards. Family carers’ input is taken into account and the home is becoming more pro-active in ensuring that they are fully involved in the assessment process and ongoing needs of the service user. The home was able to evidence that they had recently admitted a new service user as a matter of urgency, and had effectively managed this transition in the best interests of the service user. The home is continuing to develop close links with the local hospice, specialist services and the Huntington’s Disease Society in order to ensure that they can meet the ongoing and changing needs of the service users living within the home. These assessments are now part of an ongoing process that are aimed at supporting and enhancing the care plans. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 and 10. Whilst service users benefited from improved care plans some areas of the plans need to be expanded upon in order to further support staff in meeting their needs. Service users are protected by risk assessments that support them in maintaining an independent lifestyle as possible. EVIDENCE: Care plans and service users files are now more streamlined and much of the irrelevant information has been ‘archived’ – in that it is still accessible but the key information and guidance that staff need to support the service users with their current needs is now more readily available in a current working file. The actual care plans are in working progress and the home is looking at an appropriate model or format. There is an improvement in the general information provided for care staff, but the actual care plans are still in need of improvement in that they identify the assessed needs of the service users and good practice would be to incorporate the outcomes of reducing risks as identified within the risk assessment process. Regular monthly reviews are held with service users and their key workers and changing needs are reflected into updated care plans. The home is still aiming towards ensuring that care Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 10 plans are person centred and reflect the individual’s personal wishes and capabilities. Two members of staff have been trained in person centred planning and the aim is that this is cascaded through the whole care planning process. Risk assessments are detailed and on the whole well written and identify how to support the individual in their daily lives. Confidential service user files are stored securely and the staff only have access to the information that they need to support the individual. Daily records were seen to be concise and well written and are usually completed by the key worker. There were gaps still being left between recordings and good practice is that this should not happen and this was discussed at the time. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, 15 and 16. Service users opportunities for development of skills are not a primary need, but staff promote independent living as far as is practicably possible. Leisure activities need to be promoted in order for service users to benefit from appropriate and more fulfilling lifestyles. EVIDENCE: Huntington’s Disease is a condition that is degenerative by nature, and therefore many of the service users within the home are severely disabled – the home however promotes an independent lifestyle as possible. Regular reviews of care plans include how key workers can promote the daily living of the service users and staff are being encouraged to include service users in daily living activities. Feedback obtained through the questionnaire process identified that there are concerns held by some relatives with regards to activities, as there is no longer an activities co-ordinator. The manager is aware of these concerns and is promoting the development of key workers which is aimed at ensuring that these members of staff can spend quality time with the service users and Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 12 develop a knowledge of the individuals preferences and choices and then promote these – this process is now being fed back into the monthly reviews and are aimed at maintaining and improving quality of life. This is currently an ongoing process and the home needs to continue to ensure that they work with the service users, their relatives and other interested parties in promoting, developing and maintaining the lifestyle of the service users living within the home and a requirement is being made to this effect. The home was able to evidence that families are involved in the care of their relatives and is maintaining close links with family members. Over the Christmas period the home organised a get together for service users, families, friends and healthcare professionals and the manager confirmed that this had been a success. Staff were observed to be supportive of service users and interaction between them was positive. Service users are able to access all parts of the home and there are several communal areas, some quieter than others, where service users can spend their time. There is a smoking lounge on the lower floor that can be used as required. Many of the service users are dependent upon staff for all their needs and this must be taken into account by the home in the promotion of individual choice and preferences. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 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 the following standard(s): 18,19,20 and 21 Health needs are met and service users have full access to all professional health care services as required. The service users’ welfare is largely protected by the home’s structure and systems for the handling of medication, but awareness by staff of up to date policies and procedures would further safeguard service users. Service users and families are well supported with regards to their wishes in respect of end of life issues. EVIDENCE: Care plans and personal files showed evidence that service users are supported with their personal care in a manner that promotes their privacy and dignity. Members of staff spoken to also confirmed that service users can choose to get up and go to bed when they prefer. Records viewed showed that there is a high input from relevant healthcare professionals. The home has now organised regular monthly meetings with the speech and language therapist and other healthcare professionals and is maintaining close links with The Huntington’s Disease Society. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 14 At the last inspection the pharmacy inspector for the Commission carried out a through inspection on medication and all requirements and recommendations made at that time have largely been addressed. The home now has two trolleys so that large quantities of medication do not have to be transported around the home and a member of staff confirmed that this made it a lot easier as the trolley was now not too heavy. Set staff administer medication and sample signatures were in place. The monitoring of drug administration times has improved – and there is communication book that is used at staff handover. There is also a new policy and procedure in place for medication – although a member of staff was not aware of it and a recommendation is being made that staff responsible for medication should be made aware of the new policy and procedure. As Huntington’s is a degenerative disease, the home aims to ensure that if chosen this is a home for life, and has developed close links with the local hospice so that they can meet and support both the service user and their families with any end of life issues. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 The home has a robust complaints system and service users and relatives can be confident that their concerns will be listened to and acted upon. Service users are potentially at risk from abuse due to lack of staff training in Adult Protection issues. EVIDENCE: The home takes any complaints or concerns seriously, and these were seen to be acted upon and responded to within appropriate timescales. Records are kept with details of any outcomes fully recorded. There is a full complaints procedure in place and the home has a copy of the Kent and Medway Joint Adult Protection Protocols, and this is supported by their own Adult Protection procedures. Staff have received some training with regards to physical and verbal aggression, although all staff would benefit from this. The majority of staff has, however, attended a training course specifically about Huntington’s. Adult protection training remains outstanding for the majority of staff and this needs to be addressed as a matter of urgency. The home implements full checks prior to any new members of staff starting including CRB and POVA checks. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users benefit from living in a safe, clean and comfortable environment that suits their needs. EVIDENCE: A brief tour of the environment was undertaken, although a full inspection of these standards was not carried out as the home had largely met these at the last inspection. The home has carried out some redecoration in one of the communal areas and in a few bedrooms. The home continues to be well maintained and clean throughout. The home was designed with the needs of a more dependent service user and the majority of rooms have good natural light and a good outlook. The laundry has been moved and ventilation is being improved so as to make a better working environment for staff. There is a smoking room on the lower level for service users, and a new extractor fan has been fitted. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 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 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): 31, 32, 33, 34, 35 and 36 Service users are protected by the home’s thorough and robust recruitment procedures, though staffing levels have resulted in service users not always receiving consistent care. The service users benefit from being cared for by staff, who are well supervised, and have a good basic understanding of their needs, however their care may be compromised as staff have not received adequate training. EVIDENCE: As previously stated in the introduction to this report there have been some staff changes in recent months, and this has resulted in a high staff turnover. The home has the support of regular bank staff, and also a group of regular agency staff and there is an ongoing recruitment programme in place. The home needs to ensure that the staffing complement is at a level that will meet the needs of the service users, and a recommendation is being concerning this. One member of staff did advise that they had concerns with regards to the staffing levels at different times, but also felt that they could now speak to the manager and were able to voice any concerns, and felt supported by the manager and other members of staff within the home. Practice with regards to the administrative procedures of the home is also undergoing a period of change and development and the administration management is in the process of being reorganised and records for staff are Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 18 now kept within the home as opposed to a head office and the manager is now responsible for staff recruitment. These changes have been a positive step forward in the development of supporting staff within the home. Several staff files were viewed and members of staff talked to the inspector. There are fully defined clear job descriptions in place and staff are aware of the General Social Care Council code of conduct standards and these are now given out to staff. Key workers are in place and they are becoming more involved in the care planning procedures for the service users. The manager is in the process of organising regular key worker meetings that will enable staff to share and develop further knowledge of the service users with whom they are working with. One member of staff stated that “As I am now a key worker I am getting know my resident better, and am able to support them more and I have a better understanding of their needs”. As the home is currently recruiting staff they are aiming for people who are able to demonstrate that they are motivated and committed to providing care and support to this service user group. Current members of staff spoken to all demonstrated a commitment to the people living in the home and it was evident that they are keen to support the service users. Part of the homes training programme includes ‘service specific’ training and a high proportion of staff have attended a course on Huntingtons. A proportion of staff have either completed an NVQ or are in the process – the home still needs to further develop their workforce with regards to this and a recommendation has been made to this effect. The recruitment procedures are thorough with full information gained from prospective applicants and as part of the interview process staff are given a tour of the home and see the service users. Staff files viewed evidenced that a minimum of two written references are obtained, and the home now follows up written references with a phone call to at least one of the reference providers – this is recognised as good practice. Staff are employed on a probationary period and no new members of staff are confirmed in post until satisfactory CRB checks and POVA information has been obtained. New members of staff are given terms and conditions and a ‘buddy’ system has been introduced which is where the new member of staff is supported by a more experienced team member. All new members of staff undertake an induction programme, and one new member of staff stated, “I have found the buddy system good and have felt well supported”. The training and development programmed has recently been reviewed and a training needs assessment for the staff has been developed, which identifies the areas where staff need training. The larger organisation has recently employed a trainer and she will be able to support the individual home in ensuring that their staff’s training needs are up to date. However, although some training needs have been met, there are some shortages with regards to mandatory training needs and these need to be addressed as a matter of Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 19 urgency. There is a training programme in place for the forthcoming year that includes training sessions in those areas that are needed and the home must ensure that the appropriate staff attend this training and those who are most in need must be prioritised – a requirement is being made to this effect. Staff supervision is now occurring and senior members of staff have been trained in supervision. Supervision guidelines are in place and key worker meetings and group supervision are also taking place. A member of staff confirmed that she found the group supervision very beneficial and it enabled staff to share ideas and feedback to each other any concerns. The manager stated that supervision is a priority for the coming year. Overall staff moral has improved through the better relationships that have developed between the service users, staff and management. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40 and 42 The home is run in the best interests of the service user, although service users’ rights would further be promoted by a full consultation period prior to any changes. The health, safety and welfare of service users are protected by the homes environmental maintenance schedule. EVIDENCE: As previously stated at the beginning of this report there have been some organisational changes in recent months. This has led to some concerns by staff, but the manager was able to demonstrate that she is aware of these issues and committed to supporting staff through this period of change. Most members of staff spoken to confirmed that they were confident in the management of the home and now felt supported and that they worked as part of a team. On this occasion formal quality assurance outcomes were not viewed, but other evidence showed that through the complaints and incident records, and Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 21 regular monthly reviews with service users that the home is keen to listen to the needs of the service users and their relatives. There had been some previous concerns where it had been felt that service users preferences with regards to changes to a communal area had not been fully taken into account, although it appeared that this has now been resolved. The home must make sure that there is evidence of full consultation for any future changes to service users lifestyle. Previous requirements and recommendations are acted upon. There are policies and procedures in place to protect service users and staff, but these are soon to be updated and will be in line with the larger corporation. The home must ensure that as these take place staff and service users are made aware of any changes in procedures especially with regards to the ones that will affect the daily living and practices within the home. The home ensures that all regular maintenance checks are kept up to date, and equipment that is used for moving and handling purposes is regularly checked and serviced. Risk assessments are in place to protect service users and promote their daily living and the home informs all relevant parties if there are any untoward incidents and is committed to working with The Commission in promoting the care of the service users. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 2 3 X 3 X Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA14 Regulation 16 (2) (m) (n) Requirement Timescale for action 31/03/06 2 YA35 18 (1) (c) The home must ensure that service users are consulted about their interests and preferred activities and that reasonable steps are taken to ensure that these needs are met. An action plan stating of how the home aims to continue to address these needs and how they will be reflected into the care plans must be forwarded to the Commission within the timescale stated. The registered person must 09/03/06 ensure that staff are trained in meeting the needs of the service users within the home especially with regards to Adult Protection training. An action plan aimed at prioritising staff training to be provided to the Commission within the timescales stated. Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 24 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 YA20 Good Practice Recommendations It is strongly recommended that staff are made aware of updated policies and procedures with regards to medication and good practice is for staff to sign and agree that they are aware of the guidelines within the policy and procedure. It is strongly recommended that the home ensures that the percentage of staff who hold an NVQ are in line with the guidelines set out in the National Minimum Standards. It is strongly recommended that the home ensures that there are sufficient staff on duty to meet the needs of the service users. It is a good practice recommendation that service users and staff are made aware of any changes in policies and procedures in the light of the new organisational structure. 2 3 4 YA32 YA33 YA40 Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 25 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 Millstream DS0000057566.V267184.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!