Inspection on 20/04/06 for Prema House

This inspection was carried out on 20th April 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 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Prema House 12/10/05

Prema House 04/05/05

Prema House 28/10/04

Prema House 27/05/04

Prema House 03/12/03

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

CARE HOME ADULTS 18-65 Prema House 45-47 Gleneagle Road Streatham London SW16 6AY Lead Inspector Lynne Field Unannounced Inspection 20 April & 11th May 2006 10:00 th DS0000022749.V289244.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000022749.V289244.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000022749.V289244.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Prema House Address 45-47 Gleneagle Road Streatham London SW16 6AY 0208-677-2302 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) Ludmilia.iyavoo@deepdenecare.org Mr Sam Vindalon Mrs C Vindalon Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) DS0000022749.V289244.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. up to five persons only aged 65 years and above Date of last inspection 12th October 2005 Brief Description of the Service: Prema House is a 24-bedded private home for adults with mental health needs. It is one of two homes in the Streatham area owned by the same proprietors. The home provides long-stay accommodation and support for people over the age of 45 and for up to five service users over the age of 65, all of who have enduring mental health problems. It is situated within easy walking distance of transport links, and all amenities offered in Streatham High Street. The building is made up of two large Victorian houses, converted to interconnect internally. There are 16 single and four double bedrooms, two of which are almost completely divided by a wall providing a high level of privacy. The registered providers plan to phase out the double rooms as service users vacate them, and convert them into single rooms with en-suite facilities. The home has a range of communal areas that includes two main sitting rooms, a small kitchen for residents to make drinks, and a number of small smoking rooms. The home employs a cook and a cleaner, as well as care staff who prompt and support residents in personal care and activities of daily living. There is a large and attractive paved rear garden. There are a number of internal stairs, and the home is not suitable for people with mobility problems. Prospective service users can get information about the service provided from the statement of purpose and service users guide. DS0000022749.V289244.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place over two days covering the early morning of a weekday, and lasted nearly ten hours. There were 23 service users living at the home at the time of the inspection and there have been three new admissions in the last 12 months. The inspection methods included a tour of the building on both days of the inspection. The new manager gave her views of how she planned to develop the service. The inspector was given a tour of the home. The inspector met and spoke to ten service users and five members of staff over the two days of the inspection. A number of records held at the home were inspected. Both the proprietor and the Director of Operations came to meet the inspector to discuss the plans and the development of the organisation. What the service does well: 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 DS0000022749.V289244.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. DS0000022749.V289244.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022749.V289244.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have information about the home before they move, and can visit. Their needs are assessed at referral stage and they are given a contract when they move in. EVIDENCE: The inspector was told three service users had moved into the home since the previous inspection in October 2005. The inspector spoke to two of the service users who said they had information about the home before they visited and made the decision to move in. The manager told the inspector she goes to meet them to complete the homes assessment and if they are thought to be suitable they are invited to visit the home and if they choose, to stay for one or two days. The manager told the inspector they encouraged prospective service users to bring relatives to look at the home. Records that were inspected showed that appropriate assessments had been done before admission. This includes assessing service users aspirations and needs, with risk assessments and care plans in place. Licence agreements were in place that had been signed by the service user, their Social Worker, and a representative from the home. DS0000022749.V289244.R01.S.doc Version 5.2 Page 9 The home’s Statement of Purpose and Operational Policy has been sent to the Commission and has been updated to reflect changes in registered person, number of rooms, and facilities. DS0000022749.V289244.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have individual care plans and are involved in making decisions about their lives. Service users, relevant care professionals and their family (where appropriate) are consulted in planning and reviewing care. There are good risk assessments in place, and records are kept securely in the home. EVIDENCE: The inspector examined four services user files, which are kept in a locked cupboard in the main office. Care Plans are agreed between staff and service users, with specific ‘Agreements’ being drawn up that are signed by both, which set out how problems will be addressed by them together. Risk assessments and management plans are in place. Care plans and risk assessments have been reviewed and updated. There are records of social workers meeting with service users on file and copies of placement reviews are held in the service users files that were inspected. DS0000022749.V289244.R01.S.doc Version 5.2 Page 11 The manager told the inspector that sometimes during a review issues are discussed where it was not possible to make a decision because the social worker needed to go away and ask for an agreement to an issue. Records of meeting and medical appointments are all recorded in the service users files. The inspector was shown records of key worker meetings that are held and recorded, which showed how staff consult with service users about progress in their care and issues relating to the home. At the present time the home has not been able to access any advocacy support for the service users but will continue to try to find a service that can meet this requirement. This requirement has been re-stated. One service user is not able to manager their own money. The money is kept in the safe. All financial transactions are recorded and signed by the service user and two members of staff each time. This has been reviewed with the service user and signed by them and other professionals involved. Other files showed that regular reviews were held, attended by the user and the multidisciplinary team involved in their care. One service user controls their medication. The service user was supported to do this and this was risk assessed over a number of months. It continues to be monitored at key worker meetings the service user has each month. The inspector spoke to eight service users and one relative during the course of the inspection. They confirmed that they were able to make choices about their life, with support from staff. The service user’s relative told the inspector she was impressed by how the staff have supported her relative to be able to make choices and how much he has developed since he came to live at the home. Each service user has a key to the front room as well as their bedroom, and can enter and leave the home freely. DS0000022749.V289244.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have individual programmes of activities that reflect their interests and wishes. They are offered some opportunities to participate in routines in the home as well as in activities outside, although many choose not to take up these options. Rights and responsibilities are respected. Meals at the home are of a very high standard. EVIDENCE: Service users told the inspector they had their own accounts and money. The service users said they were registered to vote and three told the inspector they had voted during the recent elections. They were well aware of their rights and benefit entitlements and said if they needed help to access any of these they could ask the staff to help them. DS0000022749.V289244.R01.S.doc Version 5.2 Page 13 All the service users that the inspector spoke to were positive and warm in their comments about the home, and had said they had no complaints or criticisms. Interaction between service users and staff was warm and friendly, and there was a relaxed and sociable atmosphere in the home. Some service users had activity programmes that included attending college or Day Centres. At the time of this inspection, approximately ten service users were spending the morning at home, watching television, doing their laundry or cleaning their rooms. Service users said they were supported to maintain contact with family and friends and showed photographs and letters to the inspector. The inspector met one service users’ relative who said she visited the home twice weekly and was always made to feel welcome. They said their relative had let himself go and had given up but since moving to the home he “had come alive” and they said the home was “a brilliant place”. Service users are able to come and go at the home freely and have keys to the front door as well as their own bedrooms. Records of meals are kept in the kitchen. The home is set up to provide long-term support rather than rehabilitation. Service users have individual programmes of activities that reflect their interests and wishes. They are offered some opportunities to participate in routines in the home as well as in activities outside, although many choose not to take up these options. Rights and responsibilities are respected. Meals at the home are of a very high standard. Service users told the inspector that they were encouraged to take part in some food preparation and communal cleaning chores as well as their bedrooms. The home employs a cleaner who cleans all communal areas and a cook/catering manager, who prepares a communal cooked lunch and dinner daily. Meals continue to be served, ready plated, by staff although the manager says they have are considered other options but have found this was the best way to ensure all service users had enough food. Service users told the inspector they liked the food at the home and had a choice of what to eat. The record of menus indicated that a choice of two main courses were on offer each mealtime. Service users said they are able to make special requests. The inspector was asked to join the service users for a meal and observed this happening when two service users did not want what was on the menu but had not told the cook before hand. Service users’ said they discussed the menu at service user meetings and decided what would be on the menu. DS0000022749.V289244.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way that they prefer and require, and this is undertaken in a respectful and professional manner. There were several discrepancies in recording and administration of the service users medication. EVIDENCE: The inspector observed interaction between staff and service users, which was respectful and appropriate. Each service user is registered with the GP of their choice and Community Psychiatric Nurses visit regularly to work with the service users and support the staff. The inspector noted that the manager and staff conveyed a clear sense of commitment to the delivery of a flexible service. Service users’ medication is stored securely in a locked medication cabinet in the staff office. The inspector inspected three of the service users medication at random. There were several discrepancies in recording and administration of the service users medication. An immediate requirement was left that all the DS0000022749.V289244.R01.S.doc Version 5.2 Page 15 homes medication is audited and review how the medication is logged into the home. Since the inspection the inspector was notified that this immediate requirement has been met. The homes operations director has written to confirm she and the home manager had audited all the homes medication and verified as accurate. To avoid future errors each service user is to have only one months supply, which will have a stock record recorded on the medication chart. The operations manager says they are considering going over to the Boots monitoring system. A system has been put in place to monitor the medication weekly and monthly. The inspector was told that no member of staff is allowed to administer medication until they have completed the homes medication training. This is followed up each year with refresher training given by the local pharmacist who comes in twice a year to check the homes medication. One service user is self-medicating which was agreed at a meeting with the community psychiatric nurse. The service user was assessed and monitored in a program over eight weeks and there was a full risk assessment, which is reviewed as part of the monitoring process. After the eight weeks the service user is monitored weekly by checking the medication kept in the service users room and observing their behaviour as part of the risk assessment. There is medication agreement form on the service users file that has been signed by the service user, the manager or key worker. DS0000022749.V289244.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users know their views are listened to and acted on. EVIDENCE: There is a complaints policy. The home has a complaints box, which is checked daily. The manager reported that no complaints have been made since the one that was from a next-door neighbour about a service users coughing during the night. This was dealt with following the home’s policies and procedures. The manager of the home said she would deal with complaints as they arose by following the home’s complaint policy and procedure. Service users spoken to during the course of the inspection told the inspector that they had no complaints or concerns but if they did they would tell the manager of the proprietor and “they would sort it out”. Service users meetings are held monthly and all service users are invited to attend. Service users told the inspector they felt their views were listened to and acted upon. The manager told the inspector the organisation has sent out a service user questionnaire. The results from that were in the process of being collated by the provider. The manager told by the inspector that there were no adult protection issues but if there were, the home would follow its adult protection policy and contact all the appropriate people. The manager said that the registered provider had DS0000022749.V289244.R01.S.doc Version 5.2 Page 17 provided training for staff in adult protection. This included different types of abuse, signs and signals of abuse as well as how to deal with it and what to do if staff suspected abuse was taking place. This was followed up and discussed in staff meetings and at supervision. DS0000022749.V289244.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that they find comfortable. Bedrooms are personalised. There are numerous communal areas for service users to use, including lounges that are either smoking or non-smoking. EVIDENCE: The inspector had a tour of the home and saw all the communal areas. Six service users who showed the inspector their bedrooms said that they were happy with them and that they had everything that they needed and wanted. Each was personalised to reflect their own tastes and interests. The lower ground floor consists entirely of communal areas. There is a large dining room, the manager told the inspector the home has ordered round dining tables with the view to making the dining room area more homely and domestic in appearance. Off the dining room is the main kitchen. Next to this is a smoking and non-smoking lounge with a small kitchenette for making snacks. Lounge areas were refurbished recently making the rooms bright and clean. There is access through the lounges to a large and attractive paved garden area. There is a large shed in the garden that houses the laundry. DS0000022749.V289244.R01.S.doc Version 5.2 Page 19 Access to the lower ground floor and upper floors is via flights of stairs. There are toilets and bathrooms on all floors, which have locks on the doors. The manager told the inspector she was planning to consult with the service users about making the bathrooms and toilets more homely. All the bathrooms and toilets were clean and fresh looking and the stair carpet replaced since the previous inspection. This requirement has been met. The registered provider discussed with the inspector of his plans to convert two double rooms into single en-suite bedrooms. At the last inspection in October 2005 a requirement was made that the registered person was to submit a written plan for refurbishing the home, in respect of converting double rooms into single en-suite and to indicate the time scales for this. This requirement has been re stated. DS0000022749.V289244.R01.S.doc Version 5.2 Page 20 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): 31,32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective staff team, who have access to training that supports the service users. Policy relating to the recruitment of staff is good. EVIDENCE: Copies of the job descriptions have been sent to the CSCI and contain all the information specified in Schedule 4(6). This requirement has been met. Four staff files were inspected. All files checked had satisfactory CRBs and POVA checks on all the staff. The requirement from the last inspection has been met. Staff told the inspector they had access to a range of training and are encouraged to attend training courses. The inspector saw from the files inspected a record of training the staff has undertaken is kept on their personal file in the home. The team leader told the inspector another copy of the all the training staff has undertaken is kept at the home’s head office. Five staff have NVQ level two or above. The organisation has employed a member of staff to be the clinical lead who is working with the manager to improve care plans and documentation relating to DS0000022749.V289244.R01.S.doc Version 5.2 Page 21 how service users are supported and what strategies will help service users achieve goals. Staff had recently had training in challenging behaviour to help staff support service users to comply with agreements and other actions that could be taken to help service users who had histories of non-compliance with such agreements, which had contributed to previous placements failing. Staff have also had training in “General welfare and well being of clients: Physical, Spiritual and Psychological” and Rehabilitation and Activates of ADL skills. DS0000022749.V289244.R01.S.doc Version 5.2 Page 22 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): 37,38,39,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. Senior management roles in the organisation promote clarity, accountability and promote the best interests of users. EVIDENCE: The home has a new manager who was appointed in February 2006 and has had experience managing a staff team before joining the organisation. The manager has started the process of applying to be the registered manager. The manager told the inspector of her plans for the home, which involved working with service users and staff to make improvements in the home by motivating them. She wants the service users to live more fulfilled lives, to give service users more choices and motivate them. One service user told the inspector “the new manager is good” and “there are lots of good changes”. DS0000022749.V289244.R01.S.doc Version 5.2 Page 23 They said when they had their key worker sessions and service user meetings where they were able to say what they felt and it was acted on as well as listened to. The home is in the process of monitoring the on-call system of the organisation. Times and the issue are recorded and will be collated to look at how staff could deal with arising issues without calling the manager. At the present time the team leader is the one to make any decision and is on call. The home needs to ensure the team leaders have knowledge, training and skills to make any decisions that may be the responsibility of the manager. This requirement has been re-stated until this has been fully completed. Records indicated that all fire and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. DS0000022749.V289244.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 2 3 x x 3 2 DS0000022749.V289244.R01.S.doc Version 5.2 Page 25 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 YA7 Regulation 12(2)(3) Requirement Timescale for action 31/07/06 2 YA27 23(2)j 3 YA38 10(1) 12(1) 18(1)(2) The registered person must ensure that service users are offered advocacy support, particularly when making decisions that may effect their future placement, and that this is recorded on their files. Previous requirement of 10/11/05 not met. The registered person must 31/07/06 submit a written plan for refurbishment of the home, in respect of converting double rooms into en-suite single rooms. This is to indicate timescales for action. Previous requirement of 01/02/06 not met. The registered person must 31/07/06 review and monitor the on-call rota, and out-of-hours support to the home, to ensure that this is adequate, appropriate, and avoids staff fatigue. The outcome of the review, with timescales for any action agreed, to be notified to the Commission in writing. Previous requirement of 10/11/05 not met. DS0000022749.V289244.R01.S.doc Version 5.2 Page 26 4 YA43 10, 24 The registered person must submit revised Business Plans to the CSCI, with information relating to any changes in organisation or operation. This is to include details of the organisational structure and roles of the senior management team and Directors. Previous requirement of 10/01/06 not met. 31/07/06 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 YA39 Good Practice Recommendations The Registered Person should ensure that quality assurance monitoring, based on service users views, and are included in the updated Business Plans being developed. Previous recommendation not met. DS0000022749.V289244.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000022749.V289244.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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