CARE HOME ADULTS 18-65 Penang Charles Road St Leonards-on-Sea East Sussex TN38 0QX
Lead Inspector Jason Denny Unannounced 14 April 2005 09:30 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. Penang Version 1.10 Page 3 SERVICE INFORMATION
Name of service Penang Address Charles Road St Leonards-on-Sea East Sussex TN38 0QX 01424 420484 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) Communitas Limited Vacant Care Home 6 Category(ies) of Learning disability (LD) 6 registration, with number of places Penang Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of residents to be accommodated is six (6) 2. Residents must be aged between eighteen (18) and sixty-five (65) years on admission 3. Residents with a learning disability only to be accommodated Date of last inspection 6 December 2004 Brief Description of the Service: Penang is a care home registered to provide services for 6 adults with learning disabilities. The home is located in a residential area of St Leonards-on-Sea, close to local transport and amenities. The sea front is approximately 2 miles away. The home is large with mainly spacious rooms. The home has three floors although the registered service user accommodation is set over the ground and first floor only. There is a front and rear garden although there are currently some accessibility difficulties. All bedrooms are single. There are sufficient toilet and bathing facilities, including a walk-in-shower on the ground floor. The activities provided by the organisation consist of a day centre, which some [two of the current five] service users attend. This centre usually provides a choice of 4 activities. The home has its own mini-bus type vehicle. Penang Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [first of two planned before April1st 2006], which took place between 9.30am and 4.30pm. The Inspection found that of the 29 National Minimum Standards inspected, that 13 had been met. The overall focus of the inspection was on residents’ involvement in the home, and reviewing progress with meeting a wide range of long standing requirements. Two inspectors, due to long-term concerns carried out the inspection. The inspection started with speaking to residents [5 in total] in communal areas, along with the 3 staff on duty. The home was toured including all bedrooms. An extended discussion with the operations manager overseeing the home took place around progress since the last inspection. Care and staff records, along with medication arrangements and documentation were inspected. The inspector observed an in-house music activity-taking place for 2 residents before lunch. The inspector observed how staff supported residents with morning routines and preparing for activities. What the service does well: What has improved since the last inspection?
Although there is a lot of work still to do more standards are being met and for the first time in years the home has a realistic and active plan to meet all the areas of weakness with work seen to be ongoing. The management arrangements for the home have changed since the last inspection resulting in more effective management and a more able and involved staff team. The input from the operations manager has led to improvements in the following areas. Routines for residents were seen to be less hurried and based more on residents choices. Attention to Residents personal care needs such as appearance was seen to be good. Residents were observed to have more choice and more things to do. Staff had improved understanding of residents needs. The Staff was more stable and clearer about their roles and responsibilities. The reviewing of residents needs was found to have improved. Record keeping has significantly improved and is better understood and used
Penang Version 1.10 Page 6 by staff. The formal supervision of staff has improved leading to residents having more needs met. Activities were found to have improved with further realistic plans to assist this standard to be fully met. The overall atmosphere of the home was found to be positive with residents more involved in the running of the home. The review of residents health needs was found to have started. Specialist support to residents and staff has improved with the organisations employment of a therapist. The home has a clearer approach to dealing with challenging behaviour. All residents’ bedrooms were found to be personalised and well decorated with a nice range of furniture based on resident’s choice. The overall look of the building was more homely such as the dining room. A range of plans was found to show how a number of standards currently unmet could be met within short timescales. The organisation that own and oversee the home was found to have appointed a suitable permanent manager who starts the week following the inspection. 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. Penang Version 1.10 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 Penang Version 1.10 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) 1,2,3,4 and 5 The home continues to lack a clear Purpose. Information available to visitors lacks accuracy and comprehensiveness. Assessment information on resident’s is confused in some areas which can affect care practice. Residents or their representatives are yet to sign the contract of care, which the home purports to provide which could contribute to confusion about what is on offer. Although improved, the communication needs of residents are not being fully addressed which affects outcomes for them in terms of choice. EVIDENCE: The homes service user guide was found to have been started by a staff person although it lacked resident’s views and the most recent inspection report. The guide also lacks accuracy. The inspector and the operations manager both agreed that no autistic residents lived in the home despite the literature indicating that it was the aim of the home to provide care for this group. Other parts of the guide were confusing. A statement of purpose which accurately reflects the needs of current residents and the future direction of the home will be completed once the organisation are clear about the homes future service provision. This uncertainty has existed for over 2 years and has an affect on all such documentation. Residents had a number of assessments in their file and it was not always clear which assessment information was being followed. The newest resident was found to have made a number of visits to the home before moving in. The resident confirmed to the Inspector that she was pleased with the move. Some residents were found
Penang Version 1.10 Page 9 to lack communication aids, which is especially important for those who lack verbal skills. Staff were not fully able to communicate to Inspectors what residents were seeking to communicate and some lacked understanding of non-verbal communication. One staff person was found to be very fluent in sign/Makaton language and was seen to communicate well with a particular resident. The scoring system in the homes ongoing assessment of service users was found to be inconsistently used and difficult to follow. The operations manager agreed and stated that it was due for replacement Penang Version 1.10 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) 6,7,8 and 9 Care plans were found to have significantly improved in terms of accessibility, clarity and frequency of review. Staff also confirmed that this information was easier to follow. Care-plans still lack full guidance on how assessed needs will be fully met in practice and some specialist information still needs to be transferred over. The scoring system in the care-plans needs to change to avoid confusion. Staff were seen to be more consistent in their approach to residents although not all could confirm that their practice conformed with the care-plan. The home continues to improve its advocacy links. Risk assessments have significantly improved. EVIDENCE: The Inspectors found care planning information to have improved and organised in a way, which was easier to follow as confirmed by staff. Reviewing and updating of care plans was found to be good. The operations manager indicated the way in which these plans will improve further. The physiotherapy, language, and occupational assessments carried out on one resident had not been fully included in his ongoing care-plan. A social care assessment said that one resident should be supported to slow down when eating, due to the risk of choking. The care-plan stated that this resident eats unaided, whilst a staff member said “he needs everything done for him”, whilst another staff person said “you just need to watch him”? The resident
Penang Version 1.10 Page 11 was found to need constant supervision, which was not recorded in the careplan. Overall residents were found to be supported well in practice and the home were continuing to improve care-plans which until recently had been neglected and largely consisted of folders of information. Risk assessments were found to be in good order and regularly reviewed with staff operating with some knowledge of these. The fuller involvement of staff in these careplans has improved their knowledge and practice. The home showed evidence in letter form of how the paid advocate is currently being involved in explaining contracts/agreements to residents before they are eventually signed. Staff were seen to be making a greater effort to seek the views of residents, with one resident indicating that he would like to go shopping after a music session. He was also found to be wearing a particular item, which has been a long-standing wish of the resident in question. Penang Version 1.10 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) 11,12,13,14,15 and 16 Meaningful Activities for all residents have improved but further work is still needed especially for those residents who are less able and who have communication difficulties. Some residents require further educational input to assist with the development of skills such as communication. The home was found to be positively addressing this area with clear and realistic plans to address shortfalls. Routines based on residents needs were seen to have improved. Residents involvement in the home which although still limited, had improved. EVIDENCE: A recent report by an advocate showed continued concerns about activities for a particular resident. The range of activities on offer and being accessed on this inspection visit was found to be greater than on the last 5 visits. Residents themselves had a clearer idea of what was happening next. The organisation’s resource centre was again found to be closed and some staff indicated a high range of leisure outings taking place without clear ideas of what dates they occurred although clearly such activities have increased.
Penang Version 1.10 Page 13 Weekly timetables for residents were shown to be fuller but require further work to fully meet the standard. One resident was found to be regularly involved in food preparation although the items themselves are not eventually cooked due to the residents lacking accurate cutting skills. The home is advised to provide such training to make this activity meaningful. Overall it was positive to see the homes enthusiasm for creating better activity provision. One staff member has been given some responsibilities for monitoring and extending activity provision and outlined a number of realistic plans to the Inspectors. The home indicated that further resources are also needed to ensure that all service users assessed activity needs are met. It was positive that activities for service users who could not attend a day centre were still organised with an extensive long music session conducted by an outside musician who visited the home. Residents were observed to enjoy the music session. Penang Version 1.10 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) 19 and 20 The home was found to be moving towards fully meeting resident’s health needs such as reviewing medication needs and was aware of what additional support it required. Medication arrangements although generally good, were found to need tightening to fully meet the standard. There continues to be a low rate of admittances to Accident and Emergency. EVIDENCE: Medication was overall well managed with only trained staff [by the supplying pharmacy] being allowed to dispense. It was recommended that the home maintains its own medication administration training assessment sheet so all staff can be assessed as competent in the in-house medication system. The home was found to be moving towards organising medication reviews for all residents and developing information sheets to explain the purpose of each medication and why it is being given to individual residents. The home was found to be reviewing resident’s health needs. There was found to be no admittances to accident and emergency over the last year. Penang Version 1.10 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 and 23 The home has not had a formal complaint for several years. Staff continue to demonstrate a sound understanding on how to prevent and report abuse and continue to benefit from adult protection training. Staff were found to be aware of the homes complaints recording policy and procedure. All staff follow a consistent approach when dealing with residents distress. EVIDENCE: All staff working in the home have received formal training in adult protection and prevention of abuse. Staff who have been interviewed across several inspections continue to demonstrate a full and sound understanding of all the issues involved, including whistle blowing and who to report concerns too. The home has a comprehensive complaint policy and form for reporting concerns. There was no record of any complaint made to the home over the last year. The home and organisation have now acted on a long standing recommendation from both the Commission and Social Services that all staff receive the same and appropriate training in dealing with challenging or aggressive behaviour in order to safeguard residents and themselves. The organisation have also been advised to continue to ensure that such training approaches [SCIP] are clearly indicated in the residents care-plan, and the homes statement of purpose to avoid any confusion. Penang Version 1.10 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) 24,27,29 and 30 A homely environment has been achieved since the last inspection with resident’s bedrooms highly personalised with plans to further extend this throughout the home. The garden continues to be unsafe to access for most residents and continues to pose an unnecessary risk to some residents. The home has worked hard to create a clean environment free from offensive odour. An occupational therapist assessment of the building is necessary for those residents with mobility needs. EVIDENCE: The inspector toured the home and found that resident’s bedrooms were or had been personalised with new furniture including comfortable chairs, new wardrobes, with decoration according to resident’s preferences. As one staff member commented there had been an attempt to ensure that “whatever room you should go in you should be able to tell whose bedroom is, as it should be base on their own individual personality”. The home was found to be clean and odour free. A number of carpets had also been replaced with others planned. The front and rear gardens are large but poorly maintained with steep banks and no level access. A newly admitted resident with mobility needs has not had a occupational therapy assessment to ensure that all adaptations are in place. This also applies to another resident who is visually impaired.
Penang Version 1.10 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) 32,33,34,35 and 36 Support given to staff to assist them to do their jobs has improved over the 2 months leading up to the inspection with additional input from the operations manager and changes in the staff team. Staff were found to be clearer about their roles and responsibilities to residents with supervision improving. Staffing ratios was found to be more consistent. Team working has improved and is moving towards being more professional. Staff training was found to be good for new staff although training on communication was again found to be necessary. Recruitment procedures now meet the standard. Staffing performance will improve further once a suitable permanent manager is established. EVIDENCE: Staffing levels included 3 per day shift. Most of the 5 residents were found to have medium to high needs. The inspector observed that all residents’ needs were being promptly met by the available staffing, with routines unhurried. Staffing will need to be reviewed once the remaining vacancy is filled. The home has a comprehensive induction programme. Although the level of NVQ qualification is low, staff confirmed that they will be offered this opportunity. Staff turnover was found to have slowed since the last 2 inspections. Staff were found to have compulsory training such as Moving and Handling, First Aid, food hygiene, health and safety and Fire. The overall planning of training was shown to have improved although staff still require training to
Penang Version 1.10 Page 18 assist them with both communication with residents and understanding their non-verbal behaviour. Staff were unable to fully advocate on behalf of two residents whom the inspectors had difficulty in communicating with. One staff person stated that she found it difficult to understand what a resident liked and enjoyed. Recruitment of staff procedures was now found to be sound with all checks carried out based on those records inspected. The organisation have improved recruitment practice over the last few months. Staff spoken with all confirmed that although the new manager had not yet started they had found it easier to work in the home since some recent changes and further input form the operations manager. The frequency of staff supervisions was found to have slipped over the 3 months before the inspection although in the 2 weeks leading up to the inspection the operations manager had got most pending supervisions done for staff and had the others planned during the same week. Penang Version 1.10 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 and 39 The management of the home both internally and externally by the organisation has been poor for several years as reflected in unmet requirements which span that same timeframe, and in outcomes for both residents and staff. The most recent period has seen some improvement with the intervention from the operations manager and the pending appointment of a new permanent manager who can achieve registration with the Commission. Effective Quality assurance system has been an area of neglect by the organisation over this same period although the most recent 2 months have seen improvements. EVIDENCE: The home has operated with team leaders acting as managers for the last 2 years. There has been a high turnover of staff and a continued range of poor outcomes for residents as evidenced in outstanding requirements. The home has lacked direction and purpose as evidenced in staff interviews, observations of residents, and examining records, and interviewing the various acting managers. Staff interviewed during this inspection indicated that they now felt
Penang Version 1.10 Page 20 better supported and felt the home was “taking realistic steps to make improvements”. The success of the home in meeting unmet requirements by the extended deadline of July 31st will be determined by the effectiveness of the new manager and the support received from the organisation. Section 26 monthly reports of inspections of the home by the organisation continue to suffer from being carried out by different people on each occasion and are not usually sent to the Commission as required. Those reports, which are sent, are not done so in a timely manner. The reports until the most recent one, reflected poor outcomes for residents and staff. This most recent report March 2005 was found not to have been sent to the Commission. The organisation has decided that 1 person will now carry out these visits and it is hoped that this will benefit the process. The home has not yet introduced a quality assurance system based on residents or their representatives views. Resident views should also be published in the home’s service user guide. The external management of the home and support to staff and residents is being aided by the employment of a therapist with relevant skills. Penang Version 1.10 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 1 2 2 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 2 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 x 2 3 Standard No 11 12 13 14 15 16 17 2 2 2 3 3 2 x Standard No 31 32 33 34 35 36 Score x 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x x x x Penang Version 1.10 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 1 Regulation 4 Requirement That the home must introduce an appropriate Satement of Purpose that also clarifies the intended service user group it aims to provides services to. That this statement is completed in line with a clear admittance policy. That the home must introduce a service user guide which is accurate and includes all required information. [Requirement made at the last 5 inspections. Requirement first made October 2003] That the home confirms in writing to the Commission the suitability of the 2 placements [over 65] out of category and how it will meet their needs. That all recommendations from the socials services assessment is carried out for both people. [Requirement made at the last 3 Inspections. Requirement first made December 2004] That service users must have appropriate individualised communciation tools to assist them to get their needs met. That contracts are produced that
Version 1.10 Timescale for action 31.7.2005 2. 1 5 31.7.2005 3. 3 14[1d] [2]&23[2a ] 31.7.2005 4. 3 12[1][a] 31.7.2005 5.
Penang 5 5[1][b][c] 31.7.2005
Page 23 6. 7. 6 11 15[1] 16m 8. 12 16[m&n] 9. 24 16[1&2] [c23[2n] 10. 35 18[1] 11. 39 24 are specific to the service user and homes provision including the individual fees charged. That such contracts are signed by the individual’s representative. [Requirement made at the last 5 inspections. Requirement first made October 2003] That Care-Plans must reflect the assessed needs of service users and be followed by all staff. hat service users are given regular opportunities to develop holistic skills and access educational opportunities. [Requirement made at the last 5 inspections. Requirement first made October 2003]. That all service users have opportunities to take part in fulfilling activities and develop skills. That this forms a timetabled weekly schedule. [Requirement made at the last 5 inspections. Requirement first made October 2003] That all service users have access to all parts of service users communal and private space by the provision of equipment and adaptations to achieving this. That the garden is accessible for all service users. [Requirement made at the last 5 inspections. Requirement first made October 2003] That the home ensures that all staff receive suitable training in communication techniques with adults with learning disabilities and help service users develop their own appropriate communication aids. [Requirement made at the last Inspection December 2004] To establish a quality assurance and monitoring system based on
Version 1.10 31.7.2005 31.7.2005 31.7.2005 31.7.2005 31.7.2005 31.7.2005 Penang Page 24 12. 39 26 service user views [Requirement made at the last 5 inspections. Requirement first made October 2003] That section 26 reports by the responsible person or a representative, are carried out on a monthly basis, and sent to the Commission on a monthly basis. [Requirement made at the last 5 inspections. Requirement first made October 2003] Timescale Extension. 31.5.2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 2 20 20 29 32 36 Good Practice Recommendations That the homes assessment information is organised That the home introduces medication administration assessment sheets for all staff to demonstrate in-house training. That all service users have their medication reviewed on a regular basis. That an Occuaptional Therapist assesses the home in relation to the newest service user That 50 of staff achieve at least NVQ 2 as soon as possible. That Supervisions for all staff are kept on schedule to ensure that they occur at least 6 times a year. Penang Version 1.10 Page 25 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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