Inspection on 31/05/05 for Old Court Barn

This inspection was carried out on 31st May 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Court Barn 10/09/09

Old Court Barn 08/08/07

Old Court Barn 04/05/06

Old Court Barn 31/10/05

Old Court Barn 13/01/05

Old Court Barn 28/05/04

Old Court Barn 22/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Old Court Barn Lumber Lane Lugwardine Hereford HR1 4AQ Lead Inspector Jean Littler Announced 31 May 2005 10:30 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. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Old Court Barn Address Lumber Lane Lugwardine Hereford HR1 4AQ 01432 851260 01432 851260 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) Mr Steven Dodds Mrs Lorraine Maitland Care Home Only. 7 Category(ies) of Learning Disability (7) registration, with number of places Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the information on the previous page a condition of registration allows residents with a physical discorder or a mental disorder in addition to their learning disability to be accommodated. Date of last inspection 13 January 2005 Brief Description of the Service: Old Court Barn is owned and operated as the sole concern of The Barns Partnership. The Home offers a personal care service to seven younger adults with severe learning disabilities/autism. Service users may also have additional physical disorders or mental disorders associated with their learning disability. The Home is situated on a quiet country lane in the village of Lugwardine three miles from the City of Hereford. An unmarked minibus and car are provided for community access and outings. The Home is set in pleasant grounds and the house is divided into two adjoining areas: Little Barn provides accomadation for two residents in single groundfloor bedrooms, with a bathroom, lounge and kitchenette, Big Barn provides accomadation for five residents on the first floor in three single and one double bedrooms, with two bathrooms with self contained showers and three toilet facilities. On the ground floor there is a lounge, dining room, toilet, laundry area, office and main kitchen. No lift is provided and the Home is not registered for residents with mobility difficulties. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out on a weekday between 10.30am and 4.30pm. The inspection was carried out following discussions at a multidisciplinary Vulnerable Adults strategy meeting. The meeting was called when the manager reported that staff had not responded appropriately to an incident where a resident displayed some challenging behaviour. The staff training, guidance and support arrangements for managing complex behaviours were the main focus of the inspection. The residents’ well-being and the progress towards meeting outstanding requirements for improvement were also assessed. Information contained in feedback questionnaires from residents’ representatives and those completed by residents with staff support have been considered as part of this inspection, along with reports from recent Environmental Health and Fire Officer inspections, and communications between the Home and the Commission since the last inspection in January 2005. The inspector had several opportunities to observe staff interacting with the six residents who were at home during the inspection. Only one resident was able to spend a brief amount of time with the inspector in private to answer some questions about the service. What the service does well: What has improved since the last inspection? The arrangements to recruit, support and manage the staff team had been greatly improved. Policies, care plans and care risk assessments had been reviewed and updated to guide staff, and all residents were having review meetings held with their representatives. Staff training opportunities had been increased and planning sessions held with the Community Team psychologist to improve consistency when responding to challenging behaviours. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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 Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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) 1,2,4,5. Detailed information about the service was available, however this needs further development in some area as identified below. Suitable assessment and trial visit arrangements were in place should any new referrals be received. EVIDENCE: A Statement of Purpose and a Service User’s Guide are in place. The Statement of Purpose contains a lot of very useful information. The financial section and sample letters that are included put pressure on representatives to hand over control of the resident’s monies to the Home. A reference is also made about an independent appointee being made available if this is not acceptable. This needs to be changed to indicate that the current financial arrangements could continue after the admission e.g. the family retain control. The Guide had symbols included to assist people with a learning disability to understand the content, however the wording was not in ‘Plain English’. Because the Guide was in a simplified version a copy of the Statement of Purpose needs to be given out to families and representative as well so they have received a full description of the service provided. The Terms and Conditions of Residency document (T&C) and a copy of the most recent CSCI inspection report also need to be provided to them. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 9 A sample T&C document was seen. This did not include the ‘Notice’ arrangements should a resident wish to leave the Home, or information about fees if the resident is away from the Home for a prolonged period e.g. whilst in hospital. This information needs to be added along with the detailed information about additional charges. This was currently only included in the Statement of Purpose. Representatives have not yet been asked to sign up to this document on the residents’ behalf. The same seven residents were living at the Home and there were no vacancies. When a new resident moved into the Home last year his needs were carefully assessed. The transition included several visits and overnight stays as it was appreciated that the compatibility of the group is essential. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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, 10. The care planning and reviewing arrangements had been improved and positive work was continuing. Arrangements for the management of complex and challenging behaviours had been reviewed and made more robust and were being kept under close review. EVIDENCE: All residents had a care plan and staff were making daily reports of events and activities in diaries. The records for three residents were seen as a sample. These showed that the care plans had been recently revised and contained relevant information to guide staff with care and health needs, activity plans, and risk management strategies. A keyworking system was in place and the manager was planning to develop this and the Person Centred approach to care planning over the coming months. Care review meetings had been held recently with families and social workers to confirm that everyone was in agreement with the arrangements and strategies for responding to complex behaviours. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 11 Network planning days have been held recently for some residents with the Community Team psychologist, staff and the resident’s representatives. Clear guidance had been issued following these to promote staff consistency. Some staff had recently attended training in Autism and Positive Approaches to Challenging Behaviour. A recent incident where a resident had shown challenging behaviour was not managed well by the staff on duty or recorded or reported in full. This had led to the manager carrying out a full review of staffs’ skills and arrangements in this area. Clearer guidance had been issued about managing complex situations and on recording and reporting processes. It was positive to observe that one incident that occurred on the day of the inspection at a day centre session was discussed between the staff and the manager and they developed initial ideas about how best to manage any future situations. The manager then planned to update his care plan accordingly. Records were being held securely and a policy was in place to guide staff about confidentiality of information. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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) 12, 15 The residents were being given opportunities to take part in regular planned activities as well as leisure outings. Residents were being supported to maintain in contact and visit their families regularly. EVIDENCE: The sample of care plans seen showed that each resident had an activity timetable in place. The daily records showed that a good variety of outings and activities were being provided including walks, art sessions, college classes, riding and gardening. The manager hopes to increase what is on offer when more college classes become available in September and when a swimming pool at another Care Home is reopened. As person centred planning is further developed consideration should be given to providing new opportunities to residents to widen their life experiences. Residents were being supported to maintain relationships with family by visiting their home one weekend every month. Relatives do not usually visit at other times as this reportedly can unsettle and confuse the residents who benefit from routines. Phone calls are used instead to maintain links. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 13 It is very difficult for residents to develop friendships, however their regular activities give them an opportunity to develop relationships with others outside the Home e.g. with college staff or people at Riding for the Disabled. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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 standard(s) 20. Medication arrangements are suitable in the majority of areas, however key security and staff training need to be improved. EVIDENCE: The medication was being stored correctly, however the arrangements for the security of the key need to be reviewed to ensure only those authorised to give medication can access the cabinet. A sample of records and medication showed doses had been given as prescribed. The controlled drugs were being recorded in the register and a check showed the correct balance was in stock. Some ‘as required’ medication was in stock and records showed this had been administered infrequently and in line with the consultant psychiatrist’s guidance. It was positive that medication regimes were being kept under close review and the effects of recent changes were being closely monitored. All staff who administer medication have received basic training and have been assessed as competent. Some have attended more in-depth training but to meet the Standard all relevant staff should be provided with this. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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. Appropriate arrangements were in place for receiving and responding to complaints. Arrangements for the protection of residents had initially failed when a recent incident was not reported in line with locally agreed multiagency Vulnerable Adult guidelines. Positive action has since been taken to address these shortfalls. EVIDENCE: The Home has a complaints procedure and this had been revised recently and is now in a format suitable for people with a learning disability. No complaints had been received by the Home or the Commission since the last inspection. An Adult Protection and Whistle Blowing policy were in place, which reflects the local multi-agency Vulnerable Adult guidelines. In April 2005 an incident of concern came to light that should have been reported under these procedures. Initially a report was sent to the Commission that misrepresented the events. The manager subsequently forwarded a full report when she became aware of the incident. A Vulnerable Adults referral was then made and an investigation carried out. The findings are due to be reviewed when the strategy meeting reconvenes. Positive steps had been taken since this event to ensure staff were clear about how to respond to challenging behaviours and their duty to maintain clear and accurate records of incidents. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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) 24,25,26,27,28,29,30. The Home is reasonably well suited to its current purpose and provides a comfortable and attractive environment. A review has led to a redecoration plan being developed. The arrangements to maintain cleanliness and deal with repairs are working effectively. EVIDENCE: The gardens were being well maintained and these have been designed and equipped to allow the residents to benefit from them. Both areas of the house were clean, odour free, comfortably furnished and homely. The room sizes are sufficient, however the layout does pose some difficulties when strategies for responding to challenging behaviours are being developed e.g. residents have to go to their rooms when they need quiet time to calm down. Consideration is being given to adding a conservatory to provide additional ground floor space. Currently residents do not need any special environmental aids or adaptations. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 17 The Home was being maintained to a reasonable standard. The dining room and lounge areas were particularly attractive. A shower cubicle had recently been fitted in an upstairs bathroom and new sofas had been provided in Little Barn. The manager had identified areas to be redecorated over coming months. An ‘as required’ maintenance worker is employed and one of the providers also completes repairs. Radiator covers had been added recently to reduce the risk of burns, but because several had already been badly damaged a different design was being considered. The bedrooms were reasonably decorated, some have been nicely personalised. The majority of residents have their belongings and clothes kept in locked storage in their rooms because they have been destructive in the past. The manager should review the need for this regularly and consider positive behavioural strategies to assist them in taking care of their possessions. One resident had a plastic mattress with a thin sheet on top. The manager agreed to review the type and quality of mattresses and bedding to ensure they are suitable and comfortable. On 31st January 2005 an Environmental Health inspection was carried out. Three areas were identified for action. At a subsequent inspection in February 2005 the inspector reported that appropriate action had been taken. Infection control arrangements were in place and night staff were carrying out regular cleaning schedules. Information was supplied to assist the manager in completing a risk assessment for the control of Legionella. The fridge temperature was being recorded daily as required, however some food in the fridge had not been appropriately covered and dated. The manager agreed to ensure standards were maintained on all shifts and would consider providing an alcohol based hand gel for staff to use after assisting residents with personal care throughout the day. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 36. Suitable staffing levels were being maintained and new staff recruited in a robust manner. Staff management structures had been much improved and staff felt they had clear direction and professional support. EVIDENCE: The rotas sampled showed that suitable staffing levels were being maintained. To keep the levels up some cover had been provided by agency staff, however these staff had always worked with the support of a permanent member of staff. The normal staffing level provided had been four or five during the day and at night one waking carer and one sleeping in. It was positive that a pictorial rota that informs residents of the staff who are working with them had been recently introduced. Many members of the staff team had been recruited in the last ten months and some had not worked with this client group before. Shadow shifts, an induction, core and specialised training opportunities were being provided along with regular supervision sessions and staff meetings. These structures were providing clear information, direction and support. There were several examples of staff relating well to residents and dealing positively with their complex and challenging behaviour patterns. A recent incident showed that some lacked experience when they had to respond to a challenging incident that had not previously occurred. Staff supervision and guidance had been increased in response and the manager was aware that this would need to be Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 19 maintained until skills levels increase. The staff spoken with felt well supported and team morale was reportedly good. An enforcement notice for improvement was issued following the last inspection in relation to recruitment practices. Evidence showing compliance had been submitted to the Commission within the timescale. The recruitment records for one new worker were seen. These showed that a clear record was being kept of the application, interview and checks carried out. A CRB check and two written references had been obtained prior to the worker commencing employment. The reason for employment with vulnerable adults coming to an end had not been established with two previous employers, in line with the POVA Guidelines. The manager agreed to ensure this practice was included in the recruitment procedure. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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 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) 37,38, 41, The management arrangements had been made more robust and the new structures were providing good support and guidance for the staff team. The manager had responded positively and openly to recent issues that have arisen and had further developed care plans, policies and recording systems. EVIDENCE: One of the providers Mrs Lorraine Maitland informed the Commission of her resignation on the day of the inspection. Mr Stephen Dodds plans to continue as the sole provider. The recently appointed manager, Mrs Victoria Dodds, had submitted an application to become the Registered Manager. She has relevant qualifications and experience and has been a Registered manager in the recent past. The management structures continue to be improved. Staff meetings were being held regularly and staff were being offered individual supervision Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 21 sessions. Guidance, risk assessments and polices had been reviewed and improved. The staff spoken with reported that the manager was approachable and supportive. She continues to develop her understanding of the residents’ needs and build relationships with them. Feedback from families indicated that they found her approachable and helpful. Appropriate records were being maintained and the quality of the recording had been improved through staff guidance and the introduction of new recording formats. A recent incident of poor recording had been addressed positively. A Fire Officer inspection was carried out on 9th February 2005. Three premises issues were identified for attention and the Fire risk assessment needed up dating. All were reported as actioned by March 2005. Health and Safety was not fully assessed, but the risks associated with hot bath water were being controlled and the manager was planning to review all risk assessments. Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 3 x x 3 x x Standard No 31 32 33 34 35 36 Score x x 2 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Old Court Barn Score x x 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 x x 3 x x E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 23 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 YA1 Regulation 4 Requirement Timescale for action 31/7/05 2. YA5 5 3. YA39 24 The Statement of Purpose and Service User’s Guide must be further developed to cover the areas detailed under Standard 1. The Terms and Conditions of 31/7/05 Residence need to be expanded to cover the areas detailed under Standard 5. (Brought forward, not fully actioned, previous timeframe 31/3/05). A quality assurance system must 31/7/05 be introduced that genuinely reviews the quality of the service and care being provided. The system must lead to continual improvement. A report for each review must be provided to the Commission. (Brought forward, not fully actioned, previous timeframe 31/3/05). 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 YA3 Good Practice Recommendations Develop links with professional organisations specialising E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 24 Old Court Barn 2. YA6 and 8. 3. YA20 in Autism to ensure care planning is in line with recognised current best practice. (Brought forward, not fully actioned). In line with current best practice for people with Autism develop communication systems to facilitate understanding, choice making and participation e.g. meal planning with photographs, sign language, daily pictorial activity timetables, a pictorial staff daily rota etc. (Brought forward, work is continuing). Review who amongst the staff team has access to the medication storage key. Provide in depth training for staff on medication management and administration. In line with POVA Guidance the reason for new recruits leaving employment positions with vulnerable adults should be established from their previous employers. Review the knowledge base and training needs of all staff and develop a training plan to meet these. (not assessed). 4. 5. YA34 YA35 Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 178 Widemarsh Street Hereford HR4 9HN 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 Old Court Barn E52 E02 S24727 Old Court Barn V227509 310505 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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