Inspection on 14/02/06 for St Michael's

This inspection was carried out on 14th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael's 13/10/09

St Michael's 31/07/09

St Michael's 19/06/09

St Michael's 20/04/09

St Michael's 31/10/07

St Michael's 15/12/06

St Michael's 14/06/05

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

CARE HOME ADULTS 18-65 Priory Gate 129-131 Wingfield Road Stoke Plymouth Devon PL3 4ER Lead Inspector Brendan Hannon Unannounced Inspection 14th February 2006 10:00 Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Priory Gate Address 129-131 Wingfield Road Stoke Plymouth Devon PL3 4ER 01752 564944 01752 563400 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) Stoke HealthCare Ltd Vacancy Care Home 37 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (37) of places Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home is registered for 37 service users. 8 staff who provide care must be on duty from 8am to 2pm; 7 care staff from 2pm to 8pm and at least 2 waking night staff from 8pm to 8am. One named Service User out of category over the age of 65 years Date of last inspection 14th June 2005 Brief Description of the Service: Stoke Healthcare Ltd purchased the home on the 24/03/05 and a wholly new service for adults with mental health needs was established. The service is located in a large detached building, approximately 150 years old, on a residential road close to Stoke village in central Plymouth. A full range of amenities and facilities are within walking distance of the building. The service will be able to accommodate up to thirty-seven residents over three floors when building work has been completed. The building is being redeveloped and only one half is open to residency at the present time. All the necessary facilities are available to residents in the occupied half of the building. There is a large non-smoking lounge/dining room next to the front entrance of the building on the ground floor. Opposite this room is a smoking lounge. To the side of the building is a large area of enclosed garden surrounded by mature trees. Only single room accommodation is provided in the home. Due to the age of the building many of the rooms have high ceilings, which help the rooms and the home in general to feel spacious. The service offered by the home is for people with long standing mental health issues of various types. Some residents have mobility difficulties but mostly the residents are fully mobile. There is no shaft lift in the building. The residents group has a mixed range of abilities from highly independent to more significantly disabled. The home allows smoking in designated areas either in the specified smoking room or outside the home. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. Preparation for the inspection included analysis of communication with Priory Gate since the Announced Inspection 14/06/05, and a follow up inspection 03/08/05. An inspection plan was developed from this information. There were 12 residents living at the home at the time of this inspection. The inspector was in the home for 5.5 hours from 10.00am till 3.30pm. The inspector looked closely at the care of two of the residents. The whole of the occupied building was inspected. The regional manager, the acting manager, a senior carer and the managing company director Mr A. Patel were spoken with during the inspection. Care plans, risk assessments, care records, medication records, and health and safety records were inspected. Some policy and procedure was also inspected. What the service does well: What has improved since the last inspection? This service began at the end of March 2005. The last follow up inspection visit was on 03/08/05. Management of front door locks and window lock systems has been changed so that residents are not now inappropriately restricted within the home. The gender balance of the care staff team has changed so that female residents who wish to have their needs met by mainly female staff can do so. A manager for the home has been consistently in post since the 1st November 2005. The regional manager is providing additional support. Consistent management arrangements will improve the delivery of support to the residents. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 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. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not inspected on this occasion. EVIDENCE: This section was not inspected on this occasion as core standard 2 was inspected at the announced inspection in June 2005, at which time this standard was met. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The delivery of resident’s care is affected by generalised care planning and resident risk assessment. Improvements in these areas will support the delivery of good quality support to the residents. EVIDENCE: Resident’s care plans were sampled. There is an adequate care plan format and risk assessment format available to use. All the residents’ files had a care plan and individual risk assessments. Though care plans were adequate aspects of care planning could be improved. The information held in the care plan document should be comprehensive to cover all the issues affecting the resident and the information should be more detailed. There was little information in the care plan on the leisure and/or valued activities participated in by the residents. Some residents have behaviours that challenge the service. In these circumstances there should be a clear behaviour management plan section within the individuals care plan to ensure that staff always intervene in a consistent planned manner. A consistent approach will keep residents safe, may help residents to adapt their behaviours, and will enable residents to enjoy a better quality of life. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 10 Some charts were in use recording, for example, behaviours and fluid intake. These charts were being poorly maintained making them of little use in the monitoring of a residents condition. If charts are to be used they should be properly established and comprehensively completed by staff. There were individual risk assessments in resident’s care plans. They did not identify all the risks and agreed restrictions affecting the resident and they did not address the resident’s identified risks in enough detail. Individual residents risk assessments must be comprehensive and detailed to identify all the risks and agreed restrictions affecting the resident and the measures in place to reduce these risks to an acceptable level. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Residents do not have enough appropriate activity to ensure a good quality of life while living at the home. EVIDENCE: An individual daily record is maintained for each resident. This record provides evidence of the amount and quality of activity which the residents have been enabled to participate in. It was stated that the present staffing level was not adequate to enable residents to participate in the social, leisure and skills development activity that they needed. There was little reflection of this area of residents’ needs in either the residents’ assessments of need or their care plans. There is a record and plan of residents’ meals. The management stated that residents are choosing their meals. At the present time care staff are cooking for the residents. They have not been training to either provide a wide variety of food or on how to cater for 12 to 14 people at one mealtime. There is a vehicle for the use of the home but only two members of the staff and management team are licensed to drive. This has limited its use by residents. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 12 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): 18,20 The administration of residents’ medication by the home must be improved. The residents physical and mental health needs are being supported by the home within their personal care registration. EVIDENCE: The management described some of the personal care issues that the staff were supporting residents to manage. The residents care plans and information given by the management showed the considerable health support being received by the residents. The input of Community Psychiatric Nurses, Psychiatric consultants, district nursing and GPs was noted. This professional input and the homes support for health service intervention, helps to keep the residents mentally and physically well. During the follow up inspection on the night of 03/08/05 various issues were identified in the administration of the homes medication. Therefore this area was a focus of this unannounced inspection. The manager and senior care staff, present during this part of the inspection, were aware of how the medication administration system should work. Medication was generally kept safe but was not well stored. The home continues to use the business safe used by the previous owners. This store was not designed to contain medication. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 13 Two administration points of a Controlled Drug (CD) medication had not been delivered to a resident. This was due to a failure in the reordering system and therefore no stock was available in the home at the administration point. Another delivery of CD stock was not entered into the CD register. The recording of Controlled Drugs is made more difficult as the home is still using the CD book that was used by the home under its previous ownership. The homes pharmacy was said to be having difficulty with the necessary changes of prescription for the residents. This is partly due to a poor system of communication between the home and the pharmacy. The medication repeat ordering system and the new prescription ordering system were not working adequately. The home administers the majority of medication through a blister pack monitored dosage system. A number of instances of tablets being taped back into the blisters were noted. This practice should be ended as medication is likely to fall out of the resealed blisters and tablets may be contaminated. Recording on the Medication Administration Record was generally adequate. However there were occasional instances when medication had not been signed for by administering staff even though the medication was stated to have been given. The homes pharmacy has offered to train staff in medication administration. All staff that administer medication must undertake medication administration training. A recommendation made to amend the medication procedure to include reporting of medication errors and the decision making process used to decide to administer PRN medication had been carried out. The residents must receive their medication consistently from a robust effective and efficient medication administration system. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 14 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 Complaints are properly managed by the home, which protects the welfare of the residents. EVIDENCE: There is an adequate complaints procedure and this is clearly displayed in the home and is also contained within the Service Users Guide. There have been two complaints made to the CSCI since the Announced Inspection in June 2005. In the first complaint a number of allegations were upheld. These were as follows; (1) Un due restriction of a resident to inside the building – upheld. (2) Invasive monitoring of a resident during a private conversation – upheld (3) Inappropriate language used by a staff member towards a resident – upheld. Management agreed to change staff practice through training. In order to inspect on the issues contained in the second complaint a night follow up inspection was carried out on the 03/08/05. The upheld issues were as follows (1) Undue restriction of residents to inside the building at night – upheld. Response - Practice and door/ window lock systems in the home have been changed. (2) Female residents wished to have their needs met by mainly female staff. Response – there is now an appropriate balance of male and female care staff. (3) Accident records were not available for inspection. Response – accident records were available during this inspection. (4) Inadequate toilet facilities available for residents on the ground floor. This inspection found that this issue had not been resolved. A requirement has been made to make available an additional communal toilet on the ground floor for resident use. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 15 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): 24,27,28,30 The residents have a good quality of life within the home because the environment in the building is maintained to an adequate standard. EVIDENCE: One half of the building is being completely redeveloped and this is not available for use by the residents. The half of the building presently available for resident occupancy is generally appropriate to meet the residents needs. The occupied half of the building is only an interim facility till the other half of the building is complete, and then the presently used half of the building will also be redeveloped. The management stated that residents on permanent contracts are made aware before moving into the home that they will need to transfer within the building during the redevelopment process. The communal areas presently in use have an adequate standard of décor. The smoking lounge and main lounge are generally pleasant rooms for residents to use. However neither had window coverings. Appropriate window coverings must be fitted in both rooms. Resident’s bedrooms had been personalised and decorated to different degrees but all were of an acceptable standard. Some necessary repairs were identified to the regional manager. All the bedrooms had a good quality of furniture. Residents commented on how happy they were with the furnishings and facilities in their rooms. Toilets and bathrooms were adequately decorated. At the follow up inspection of 3/08/05 it was Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 16 recommended that additional toilet facilities be made available on the ground floor specifically to meet the needs of the residents accommodated on this floor. No action had been taken to resolve this issue and a requirement was issued. The occupied part of the building was adequately clean and the existing laundry facility had appropriate equipment and met infection control requirements. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 The present staffing level meets residents’ personal care and heath care needs. The present staffing level does not facilitate enough leisure and valued activity for the residents. Staff training should be improved to provide a more skilled workforce that will be able to provide good quality support to the residents. EVIDENCE: The staff were seen throughout the inspection to be relaxed and helpful when supporting the residents. The management and staff records showed that training for NVQ is at an early stage of development at the home. 15 of the care staff are qualified to NVQ2 or above. The management stated that a number of other staff would be beginning NVQ2 courses soon. There is a staffing level condition in place on the certificate of registration. However this will only apply when the home is occupied at its maximum level. At the time of the inspection there were 12 residents but this was planned to rise to 14 in the near future. The present care staffing level is 3 staff between 8.00am and 8.00pm. There are two waking staff at night. The home has no cook or cleaning staff at present though the management stated they are attempting to recruit to these positions. In the meantime care staff are carrying out these roles as necessary. Therefore there are large parts of the day when the actual care staffing level available to provide ordinary support falls to 2. At this staffing level, to maintain the safety of the residents in the building, no care staff can leave the building to support residents externally. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 18 Therefore the acting manager is often needed to assist the care staff to carry out basic functions such as support residents to attend the GP or hospital appointments. The management stated that this staffing arrangement could meet the personal and health care needs of the residents within the building. During the inspection various instances were noted that showed that the existing staffing arrangements made it very difficult for the home to meet the National Minimum Standards for social, leisure, skills development and valued life activity. The home has a vehicle available for activities but only two members of the staff team can drive. An appropriate structured induction is available to use. Some members of staff have completed this induction programme. The management were advised to backdate it to other members of existing staff who might benefit from this learning. The staff team is lacking formal training in the provision of care and support to people with mental health. It is recommended that the staff team’s skills be increased through formal mental health training. Appropriate staff training will help the staff meet the residents’ care needs. The staff personnel files were not available for inspection. The managing company director stated that all employees in contact with vulnerable adults have had a POVA check and a CRB which have shown no criminal convictions. The required staff records must be kept available for inspection at the home at all times unless a formal arrangement is agreed with the CSCI that they may be held elsewhere to be inspected by arrangement. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 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 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): 38,39,42 The management of the service is meeting most of the residents’ basic needs. EVIDENCE: There is no registered manager for the home. There is an acting manager in post and the regional manager visits three days per week to provide additional support to oversee the home. The acting manager has only been in post since November 2005. The acting manager and staff were seen to be working well together. Good working relationships amongst the staff will promote better quality support for the residents. Some areas of management systems were not operating effectively. A regulation 37 report regarding a recent serious incident, that should have been written and sent, has not been returned to the CSCI. Communication in the home was inconsistent. Information needed by following shifts had not always been recorded in individual resident records and in residents’ charts by previous shifts. As a result action had not been taken immediately to address specific issues. As previously noted management oversight of the medication administration system had not been effective. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 20 A quality assurance system designed with a focus on residents’ interests is in place but has not been used. The quality assurance process should be implemented. The planned system will be practical to use and is likely to produce useful results. The following section relates to health and Safety issues. Though there is a general building risk assessment individual risk assessments for hot water outlets and radiators, that have not been physically adapted to reduce risk, have not been written for each specific tap and radiator to identify that they are safe. It was noted that radiators were hot to the touch and that one resident uses the walls and furniture to balance when walking. This resident’s individual risk assessment should address the issue of hot surfaces. The home has large open spaces and radiators were kept at a high temperature to maintain an adequate temperature in the building. The record of fire protection checks and fire training is thorough. A record of accidents is maintained. Safety checks are being carried out appropriately. Not all of the fridges and freezers had consistent temperature records. Fridge and freezer temperature records showed that appropriate food storage temperatures are being maintained. Though electrical safety testing had been carried out on dommestic items in the home a certificate verifying the safety of the mains wiring in the occupied part of the building was not available. A safe environment benefits both the residents and the staff. Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 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. 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 2 3 4 5 CONCERNS AND COMPLAINTS Standard No Score 22 23 X X X X X 3 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000062825.V286956.R01.S.doc LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 2 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Priory Gate Score 3 X 1 X X 2 3 X X 1 X Version 5.1 Page 22 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 YA9 Regulation 13 Requirement Each resident must have a comprehensive and detailed individual risk assessment. This must include all the restrictions of choice, or personal freedom, agreed to be in the residents best interests to maintain their safety. Medication must be adequately managed, stored and administered by the home. All staff administering medication must receive appropriate medication administration training. Additional toilet facilities for residents use must be provided on the ground floor of the existing accommodation. Curtains must be fitted in the main lounge and an appropriate window covering must be fitted in the smoking room for the comfort privacy and dignity of the residents. Personnel files must be kept available for inspection in the home. An individual risk assessment must be in place for each hot DS0000062825.V286956.R01.S.doc Timescale for action 01/06/06 2 YA20 13 14/05/06 3 YA27 23 01/05/06 4 YA28 23 01/05/06 5 6. YA34 YA42 23 13 01/05/06 01/05/06 Priory Gate Version 5.1 Page 23 water outlet and radiator that has not been physically adapted to limit hot water, or surface temperature. 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 YA6 Good Practice Recommendations Each residents care plan should comprehensively identify the resident’s needs and direct staff in how to meet these needs. All management of challenging behaviours should be planned separately and in detail. Charts should be used effectively. The service should formally train care staff to meet mental health needs. The service should have a training programme in place to achieve 50 of care staff NVQ2 or above qualified. The minimum care staffing level should be reviewed to ensure that the staff have enough time to support clients in valued activities, skills development programmes and leisure activities. Regulation 37 incident reports should be sent to the CSCI as necessary. The management should establish and maintain effective communication and shift records. The management of the home should implement the quality assurance system. A mains wiring certificate should be obtained for the part of the building presently in use. 2 YA32 3 YA33 4 5 6. YA38 YA39 YA42 Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Priory Gate DS0000062825.V286956.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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