Inspection on 13/04/05 for Radnor House

This inspection was carried out on 13th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Radnor House 04/11/08

Radnor House 13/11/07

Radnor House 21/08/07

Radnor House 05/07/06

Radnor House 14/11/05

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

CARE HOME ADULTS 18-65 Radnor House 139 Canterbury Road Hawkinge Folkestone CT18 7AX Lead Inspector Lois Tozer Unannounced 13 April 2005 10.00 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. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Radnor House Address 139 Canterbury Road, Hawkinge, Folkestone, Kent CT18 7AX 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) 01303 894693 01303 894092 Caretech Community Services Limited Toni Frances Zinzan Care Home 6 Category(ies) of Learning Disability (6) registration, with number of places Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th December 2004 Brief Description of the Service: Radnor House is owned and operated by CareTech Community Services Ltd and is registered to provide accomodation and personal care to a maximum of 6 persons within the age range 18 to 65 who have learning disabilities. It was first registered in October 2004 under the Care Standards Act 2000. At the time of inspection, there were 4 residents living at the home. It is a detached propertey situated in the centre of the village of Hawkinge, Kent. The layout of the home is not suitable for persons using wheelchairs for internal mobility. The home comprises of four single bedrooms situated in the main house and two semi-independent flatletts that are accessed via the main front door. The flatletts have individual front doors within the main building that are fittled with a key code panel. All bedrooms have ensuite facilities and the flats have full bathing facilities plus kitchenette. There are two bathrooms with wc facilities and one separate wc. Residents benefit from a large ‘L’ shaped lounge / diner that opens onto the secluded rear garden. A small room off the lounge is available, this is used as a quiet area but can be used as a separate dining room if required. There is a central kitchen for the preperation of all main meals. A shingle covered carpark to the front of the premises allows parking for aproximatly 8 vehicles. There is an administration office for the secure storage of information and a dedicated medication room. A cellar is available for storage, however is not in day to day use. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Radnor House is a relatively new service and has experienced significant changes in its short life. The manager, Mrs Toni Zinzan, returned to work in late December 2004, however lost the experienced deputy manager to another home in the organisation. As such, the manager has had an intensive workload and is just starting to get a handle on the management of the home. The inspector, Lois Tozer, made this unannounced statutory visit on 13/04/05 between 10.00 and 15.45 – 5.75 hours. The focus of the inspection was to gather as many service user views as possible and was able to speak at length with two residents, who made the following positive comments about the home ‘I like visits from my family, we see each other every week; I like being with other people, but its good to have my own flat. Everything is going fine [for me] at the moment.’ ‘The centre we go to is great fun; there is a ball pool and art stuff. Some of the staff are sweet and kind, I met X before I moved here, it was good to get to know him before I moved in’. Residents were happy with activities taking place away from the home and were keen to say that a Thursday night disco was great fun. Due to insufficient numbers of staff having adequate communication training using signs, conversing with the remaining residents was not possible. The two residents who were able, indicated that they would like greater involvement in some activities, such as cooking, looking into college and knowing what was going on during the shift. One resident, when asked what was different between the previous placement commented ‘I knew what would happen each day’, indicating that this was a reassuring, positive thing. The following methods were used during this inspection; Direct and indirect contact with residents, observation of activities, reading individuals care and support plans / risk assessments, medication charts, training records and talking to staff and management. What the service does well: What has improved since the last inspection? Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 6 Although the last inspection was an ‘additional visit’ stemming from an adult protection investigation (the protection aspect of the complaint being unproved), requirements were made for greater clarity in the duty rota and the improvement of the range and quantity of foods available. These requirements had been fully met. A further requirement to obtain needs assessment information in sufficient detail has also been met, however the information has not been used appropriately to form the basis of a really effective care plan. 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. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 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 Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 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) 2 The service has used an effective assessment process in the past, with successful results. Two residents living at the home had received a needs assessment and had been admitted to the home, but the infrastructure to support their specific needs was not in place. EVIDENCE: Two assessments were seen, these had taken place well in advance of residency being taken up, however staff skills and training were not in place to meet the individuals needs on the point of admission and remain in need of improvement. The pre-admissions information clearly outlined the challenges the service would have to meet to offer the residents a quality life, including the management of challenging behaviour, engagement in activities, specialist communication skills (Makaton and British Sign Language). Staff forming the current team had not received sufficient training to appreciate using signing communication at all times to ensure the full inclusion of signing individuals in everyday life, having received a one-off 4 hour training session. One resident had their support requirements / support plan drawn up after moving to the home, but this was not descriptive of support needs, being written in a ‘fuzzy’ manner, in the 1st person. Requirements to improve the service user plan and to have staff adequately trained to meet the residents needs have been made. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 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 standard(s) 6, 7, 8 & 9 The home has made good efforts to produce individual service user plans that cover all aspects of the individual’s lives. The quality of information however does not support the complexity of the individuals living at the home and as such, residents cannot be assured of a consistent approach that is both supportive yet developmental. Residents were not actively engaged to maximise the skills they already have. EVIDENCE: Each resident has a completed individual support requirement form in their file. The depth of information was not sufficient to enable a staff member to support a resident with consistency as it had been written in a 1st person manner outlining wishes and desires more than strengths and needs and there were no documented plans to develop personal involvement in the running of the home. Specific support requirements had not been expanded in any greater detail. Staff advised the majority of activities that were not taking place at the company resource centre took place ‘spontaneously’. A resident became distressed when there was confusion as to where and when an activity would take place. The shift planning system does not specify which staff should be doing what with whom during the shift time, leading to loss of quality time to work with individuals. Several residents have been assessed as having autistic behaviour, with clear indications from pre admissions Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 10 assessment that structure is fundamental to their wellbeing. The inspector has therefore made requirements that the support plans are much more descriptive, link to the risk assessments and offer a level of development opportunities within the home each day when working alongside staff. Residents were happy with activities taking place away from the home and were keen to say that a Thursday night disco was great fun. One resident felt that they could be more involved in cooking. Residents have been risk assessed in respect of using facilities safely. Staff training to address skills shortfalls in engaging people in meaningful activities is required. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 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 standard(s) 11, 12, 13, 14, 15, 16 & 17 Personal development is not sufficiently promoted within the home, staff were observed catering to residents rather than supporting them to be more independent. Some residents are reliant on the use of sign language, but are inadequately supported. The importance of consistent signing was not understood; therefore the individuals using this communication were excluded from group conversations or idea sharing and staff miss out on practicing their skills. Outings to the wider community are taking place regularly. A lack of clarity existed regarding the required diet for one resident, but the range and quantity of food now available to the residents has improved. EVIDENCE: Training supplied to staff for signing communication consisted of 1 x 4 hour ‘taster’ session. Staff advised that only 2 team members are really competent at communication in this manner. Staff were not comfortable or confident to use signs ‘naturally’ and were therefore unable to engage signing residents to their fullest potential. The level of consultation and involvement in decisionmaking and the running of the home offered to signing residents is lower than that of the verbally able. Signing residents did not have communication books Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 12 or clear communication assessments to aid staff increase the level of communication. Information in a service user plan indicated that a specialist diet was advised, but did not clarify its importance; this must be confirmed with the residents GP or dietician. Requirements to address these shortfalls have been made. Two residents told the inspector that they get out and about in the wider community quite a lot and enjoy things like shopping, disco & pub. Families can visit and residents say that they like to have visitors. A resident said that college would be a good idea and would ask a key worker to help nearer enrolment time. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Healthcare is well managed, the manager ensures that residents have access to all health care professionals as required; this is supported with well documented outcomes. Personal support requirements, as documented in the individual plan need improvement to ensure the staff can offer a consistent approach that is in line with residents wishes and feelings. Some serious issues regarding medication management were observed and must be rectified through the provision of appropriate training for staff. EVIDENCE: Personal support is outlined in the individual support plan but does not specify the individual’s strengths and needs and if there is any goal to work towards greater autonomy in this area. The shift planner is drawn up at the start of the shift, however this is not in consultation with residents, therefore they are unaware who will support them with personal care until the time comes. The ‘fuzzy’ descriptions of personal care needs are required to be more factual and state what support a person requires maximising their independence; these must be kept under regular review. Standard YA20, Medication; none of the staff, including the manager, have received training from a qualified source to manage this important area. The manager was open with the inspector in highlighting the known shortfalls, these being; lack of staff training; confusion in re-ordering from the correct pharmacy, resulting in all medication being received in generic packaging, not Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 14 the administration system the home has agreed to use; how medication is logged for returns and where it should be stored (currently stored in the staff office, not the medication room); handwritten directions were not accurate and a double check for accuracy had not taken place; medication records have been signed in advance of staff offering residents their medication, therefore records have been overwritten when the medication is refused, confusing the clarity of what has actually taken place. Requirements have been made to address these issues. The current protocol is that two staff administer all medication as a safeguard, however this results in two staff being taken away from service user contact up to 3 times per day, this may not be necessary when staff have been trained to meet the requirements of the service, but remains a decision for the manager of the home. The home were making clear efforts to monitor medication that is delivered in generic packaging or is regarded informally as a controlled drug and have a dedicated medication administration room. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 These areas were inspected briefly, there is a complaints system in place, but there was no obvious pictorial complaints system for residents Three staff have received certified Adult Protection training, a further two are awaiting their certificates. EVIDENCE: One complaint has been received by the home in December 2004, resulting in an adult protection investigation with the Police Special Investigation Unit taking a lead role. Adult protection issues were unproven; the home followed the local authority procedures and protocols diligently. This complaint was not logged per the homes procedure, the inspector notes that this occurred prior to the return of the present manager, who advised that this information will be sought and stored appropriately. The manager had identified in advance of the inspection that a pictorial or alternative complaints procedure is required by some of the residents and has applied for assistance from head office, therefore no requirement has been made as this is being addressed. Three areas of improvement were identified; two being met which were; the improvement of the duty rota to accurately reflect what staff were on duty and the quality and quantity of food. The third requirement to improve needs assessment information has also been met, but this, as identified above, has not been effectively translated into an initial support plan to enable the manager to fully assess if the staff skills can meet the service user needs. No further requirements were made for these standards. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 & 30 The home was converted for registered residential use from a domestic dwelling. Each resident has a personal en-suite of a toilet and a hand washbasin and both flats have full en-suite bathing facilities. Bedrooms are spacious and have natural ventilation and lighting. Some bedrooms seen were quite bare; others were well furnished and homely. The communal areas of the home are well furnished, bright, clean and homely. Each flat has a sitting / dining area, the main communal areas are a large lounge / diner with a separate room that can be closed off for quiet or private use. A safe and secluded garden to the rear offers free access to fresh air and barbeque in the summer. The kitchen is situated next to the dining room. The laundry is situated on the 1st floor and is kept locked when not in use. EVIDENCE: The home was clean and tidy; there were no unpleasant odours. Three bedrooms were seen, one was furnished to a high standard, and the other two were fairly bare in response to the needs of the service users. A maintenance representative was on site to mend broken furniture and rectify fitting Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 17 problems. Records were not examined in relation to limitations on furniture, but the residents spoken with agreed that they had what they wanted in their rooms. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 35 The home has sufficient staff and has sufficient vehicles to offer access into the wider community. There are insufficient numbers of staff adequately trained in signed communication methods to meet resident needs. Inadequate organisation of staff through the shift was seen to cause service user confusion and engagement opportunities were being missed. Staff were friendly and appeared to have good relationships with service users, but have not received the type of training required to offer a full and active life in within the home. EVIDENCE: Residents were seen waiting for something to happen, rather than be supported and involved in preparation. The majority of shift planners demonstrated that the tasks the shift leaders set out were of domestic orientation but did not include the resident’s participation. A more effective shift planning system that offers all service users a level of supported participation in the everyday running of the home is required. Staff are provided in adequate numbers to offer a highly individualised service to all residents (a minimum of 4 staff are available between 07.30-22.00; day care support is provided 5 days a week from 09.00-16.30 and the manager remains supernumerary to this figure). Staff training records indicated that inadequate signing training had been provided and the manager had not received any to date. Staff had received non-violent crisis intervention training, however no certificates were available. Service user needs led Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 19 training had not been analysed, therefore a requirement to audit needs and identify suitable training has been made. The manager advised that the LDAF (learning disabilities award framework) inductions had not been completed and this was a matter that was currently being dealt with. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 42 The home is a new service and has had little consistency since registration in October 2004. The registered manager returned to post late December 2004, however lost the experienced deputy manager who was acting up in her absence. The manager has significant experience in the care sector and holds the Diploma in Welfare Studies as well as currently undertaking the NVQ level 4 registered managers award. EVIDENCE: The manager must take a proactive role in the organisation of shift leaders and ensure that the staff left in charge of the shift have sufficient training and support to guide staff appropriately and meet the promises made in the statement of purpose and the service user guide / contract. Records showed that a high proportion of the staff team had received health and safety training and a rolling programme of updates was available. Shift leading and skills training to meet service user is inadequate and requires improvement, this is addressed earlier in the report. Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 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 x 2 x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 Radnor House 2 2 2 x 3 Standard No 31 32 33 34 35 36 Score x x 2 x 2 x Version 1.20 Page 22 H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc 16 17 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 23 NO 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. 2. Standard YA2 YA6 YA9 & YA18 Regulation 14 Requirement Timescale for action 01/06/05 01/07/05 3. YA7, YA12, YA13 4. YA17 5. YA20 & YA35 6. 7. 8. YA20 YA20 YA20 Needs assessment form a supportive, informative initial service user plan. 15 (1; Support plan to describe 2,b) individual strenths & needs, detailing specific areas as required. Must be accessable and easy for staff to use to offer developmental support and link to relevant risk assessments. 12 (2 & Greater focus and improvement 3); 16 to involve service users at the (2,h, heart of shift planning, m,n); 24 involvement and decision (3) making. 12 (1 & b) Seek clarification to confirm 16 (2; i) status of individuals specialist diet, taking remedial action as required. 13 (2) 18 Staff who administer medication (1, a, c must have training from a [i]; 2, a, b qualified source that will give them the skills to meet the [i]) needs of the service. 13 (2) Medication policy to include instructions for re-ordering, checking in and returns. 13 (2) 17 Handwritten entries on MAR (1,a) sheet must be accurate and be countersigned for accuracy. 13 (2), 17 Revise staff practice of signing H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc 01/06/05 01/06/05 01/07/05 01/06/05 15/05/05 15/05/05 Page 24 Radnor House Version 1.20 (1,a) 9. YA 33 & YA35 YA35 10. 17 (1,a) Schedule 3 (3, l) 18 (1, a, c) 18 (1 to 2, b [iii]) for medication prior to its consumption by service users. All records must be clear and legiable. A staff member must be available during the waking day to communicate effectivly with signing service users. Audit the service users needs against staff training & skills, provide action plan to address shortfalls by 25/05/05 and supply all training to address shortfalls by 01/12/05. 01/07/05 01/12/05 11. 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 Good Practice Recommendations Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent, TN23 1HU 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 Radnor House H56-H05 S61367 Radnor House V220938 130405 Stage 4.doc Version 1.20 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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