Inspection on 21/02/06 for Sahara Lodge

This inspection was carried out on 21st February 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sahara Lodge 28/01/09

Sahara Lodge 28/01/08

Sahara Lodge 25/09/06

Sahara Lodge 13/10/05

Sahara Lodge 05/07/04

Sahara Lodge 17/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Sahara Lodge 143 Earlham Grove Forest Gate London E7 9AP Lead Inspector Announced Inspection 21st February 2006 09:45 Sahara Lodge DS0000022847.V271926.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 Sahara Lodge DS0000022847.V271926.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. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sahara Lodge Address 143 Earlham Grove Forest Gate London E7 9AP 0208 555 3735 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) Sahara Homes (UK) Limited Ms Sharon Kaur Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registration inclusive of basement flat at 141a Earlham Grove The home can accommodate one (1) named service user over the age of 65 years. 13th October 2005 Date of last inspection Brief Description of the Service: Sahara Lodge is run by Sahara Homes (UK) Limited and is registered to provide accommodation, care and support for nine people with learning difficulties. It consists of two separate units, a semi-detached care home for eight service users and an adjacent basement flat accommodating one service user. Sahara Lodge is aimed at service users with learning disabilities who may also have challenging behaviours. It provides twenty-four hour supervision and support in a secure and safe environment. This includes one wake in and one sleep-in member of staff. The basement flat is also provided with twenty-four hour support by staff from the care home. At present this includes one sleep-in staff member at night. Sahara Lodge is close to local amenities including a park, shops and leisure services. Forest Gate station is close by and there are good bus routes to Stratford. The Provider, Sahara Homes (UK) Limited, also owns two other homes in East London for people with learning disabilities, Shrewsbury Road and Cranbrook House. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day on 21st February 2006. The newly appointed manager was present to assist with the inspection, as well as the Senior Support Worker and the manager from another home who has given management support to the home in the absence of the current Registered Manager. The inspector toured the premises, spoke with four service users, inspected four service user files, four staff files and examined a range of records and documentation. In addition, the inspector spoke with four service users, four staff members as well as the managers. The inspector reviewed all 12 requirements given at the last inspection for compliance. What the service does well: What has improved since the last inspection? What they could do better: There are five restated requirements concerning the need to ensure all information required is in the Statement of Purpose and service users’ contracts; the need to further improve care plans and risk assessments and for documentation required concerning staff files. A further five new requirements are given during this inspection predominantly concerning records about staffing. The inspector was concerned that a member of staff had been employed without a satisfactory POVA check. Good employment practises must be observed to ensure the protection of vulnerable service users. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 6 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. Sahara Lodge DS0000022847.V271926.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 Sahara Lodge DS0000022847.V271926.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): 1, 3, 4, 5, Prospective service users’ needs are assessed. The home demonstrates its capacity to meet assessed service users’ needs. Information for Service users concerning the home’s services and facilities has improved. Each service user has been made aware of the home’s terms and conditions. EVIDENCE: The requirement to revise the Statement of Purpose(S.O.P) as given at the last three inspections, to include all information required by regulation, was examined. It is now revised and contains most required information. However it must be updated again to accurately reflect the current staff shift patterns which vary from the information written in the S.O.P. A previous requirement to revise the Service Users’ Guide as according to regulations has also been met. Service users contracts were much improved and available in each service user file. However they must now specify the method of payment. Contracts were signed by the service or their representative or recorded entry given where consultation with the representative concerning the contract was ongoing. Service users’ assessments were inspected at the last inspection and the inspector was satisfied that service users’ needs are assessed prior to placement. Prospective service users are able to visit the home prior to admission. The home showed its capacity to meet assessed needs through records kept in service users’ files, the knowledge, skills and commitment shown by staff and in the ongoing development of service users in the home. Sahara Lodge DS0000022847.V271926.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, 9 Service users are supported to take risks as part of an independent lifestyle. Care plans have generally improved however care plans and risk assessment documents still require more work. Care plans must still comprehensively include all needs and actions identified in other assessments. There must also be an improved system of risk assessment for an effective assessment of risk to service users. EVIDENCE: The inspector was satisfied with evidence seen at the last inspection that the home consults with service users on personal matters and matters affecting living in the home. Staff also support them with decision making and with their personal development. The inspector reviewed requirements given at the last inspection concerning improve care plans to include all needs identified through other assessments such as the risk assessment. The requirement for the risk assessments to identify all key risks associated with individual service users was also reviewed. Four service users’ care plans and risk assessments were examined. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 10 The format of the care plans had been revised. They contain details of a broad range of needs including: personal care and daily living skills; communication needs; community living; cultural/spiritual; personal relationships; educational/leisure; financial; behavioural and other safety issues. Care plans were detailed. However despite a general improvement in the quality of care plans, the home still needs to ensure that actions specified in risk assessments to meet identified needs are also specified in the service user care plans. For example, one service users’ risk assessment gave detailed guidance on seating arrangements and actions required by staff when taking one service user out on public transport, in order to better manage his behaviour. This information was not included in the care plan. The care plan of the service user in the basement flat must also specify whether they require wake-in or sleep-in staff supervision and to adjust the care plan accordingly to reflect any further change in need. The Senior Support Worker informed that the needs of the service user in the basement flat had changed in respect of his night time supervision needs, which had changed from wake-in to sleep-in staff supervision, as a result of a change in his medication. The care plan must also be updated accordingly. Evidence was seen of a positive approach to service users and risk taking to promote independence in service users’ as part of their assessed needs. Care plans now have an added column of Risk Category at the end with some freehand text at the bottom of care plans detailing actions required to minimise risks. The inspector acknowledges the home’s attempt to integrate risk assessments with care plans. However, this method is inadequate compared with the old method of risk assessment used by the home. Its inadequacy is based on a failure to have a proper system of assessment and it fails to identify the actual risk. Whilst needs are identified in the care plan, the risk classification, for example, may be stated as high, medium or low without identifying the actual risk. This format could also encourage a lack of consistency among staff in completing assessments in terms of how risks are identified without a formal system of risk assessment. A requirement is given for the system of risk assessments to improve. Sahara Lodge DS0000022847.V271926.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): 14, 15, 16 Service users have opportunities for their emotional and personal development through appropriate individual and social activities. Staff are committed to meeting the individual and collective needs of service users and uphold their rights to privacy, dignity and respect. EVIDENCE: Records of activities examined in service users’ files evidenced that service users are supported to exercise their independent living skills where capable, as in their participation in cooking; shopping; laundry; washing up and in their personal care. Service users are encouraged to develop their social and communication skills, with support for the particularly vulnerable from the Community Team for people with Learning Difficulties. Service users attend different day centres and a club for people with learning difficulties, according to their assessed needs. Other service users who have declined such activities are encouraged to engage in other social and community and activities inside and outside of the home. These include golf, going to the cinema, meals and drinks out to a restaurant or pub; trips in the minibus and visits to church. Inside the home there are various activities such as arts and crafts. Contact and visits with family and friends is encouraged. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 12 Risk assessments were viewed in relation to key holding. Staff show sensitivity and respect to service users who require privacy within their rooms. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 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 the following standard(s): 18, 19, 20, 21 Service users are supported to maximise their personal development with dignity and respect. Their physical, mental and emotional health needs are met. Medication practises are safe. EVIDENCE: Service users interviewed confirmed that they are treated well and with respect. Staff were knowledgeable in the support needs of individual service users and demonstrated appropriate interaction showing sensitivity and respect to service users. Files contained correspondence and reports from multi-disciplinary professionals through the local health services and Local Authority, including professional assessments and health appointments. The consultant psychiatrist reviews service users with behavioural or emotional needs. Medication administration and records were checked and deemed to be correct at the time of inspection. A restated requirement from the last two inspections for an updated medication policy was met. A requirement is given to obtain signed statements from each service user concerning their views and preferred arrangements in the events of ageing, illness or death. Sahara Lodge DS0000022847.V271926.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 Service users know how to complain and feel their views are listened to and taken seriously. (Standard 23 was not assessed. However at the last inspection, it was concluded that service users benefited from staff who were knowledgeable in Adult Protection matter). EVIDENCE: There were no recorded complaints since the last inspection. The staff informed that service users were satisfied with the home and that no complaints had been expressed. This view was supported by documents and minutes of meetings seen by the inspector and by positive statements provided by service users directly. The complaints policy is satisfactory and also produced in pictorial form. An anonymous worker within the organisation expressed some concerns to the CSCI. This regarded insufficient staff cover on some occasions of the adjacent basement flat, which accommodates a service user with learning difficulties who requires 24 hour supervision. There was also concern about the effect of insufficient staffing on his behaviour. The inspector examined a range of records including the service users’ file and spoke with staff and all the managers. The inspector could find no evidence to substantiate this concern. All persons interviewed by the inspector were firm in their belief that the flat is always supervised. The inspector could not find evidence to substantiate a deterioration in the service users’ behaviour as a result of insufficient staffing. However the inspector was dissatisfied that 24 hour staff cover was not evidenced on the staff rota. For this reason, a requirement is given to ensure that 24 hour supervision is maintained as recorded in the service users’ care plan and that the home can provide records to evidence this, including the Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 15 staff rota. Concern was also expressed by the same staff member regarding inadequate induction. The inspector found no evidence to substantiate that induction or ongoing staff supervision or support was inadequate. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27, 28, 29, 30 Service users benefit from living in a homely, comfortable and safe environment, which is suitable to meet their needs. EVIDENCE: Service users live in a comfortable, clean and homely environment. Service users’ rooms are furnished with personal items such as photographs, pictures, furniture. There are sufficient toilet and bathroom facilities. There is a combined lounge and dining room with a large television and 3 sofas. There is a kitchen and laundry room sufficient to meet service users’ needs and a garden, which is well designed with a patio, table and chairs. A requirement given for decoration to the walls in the hallway requiring repair was met. The home is clean and hygienic. The home is unable to cater for service users with physical disabilities who require adaptations. Sahara Lodge DS0000022847.V271926.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, 36 Service users benefit from staff who are clear on their roles and responsibilities and who receive ongoing training and are knowledgeable in responding to their needs. Service users benefit from staff who are provided with management support and training to assist in their service delivery. However requirements are issued concerning recruitment procedures and the staff rota. EVIDENCE: The inspector had discussions with four staff members. Staff interviewed confirmed that they receive good supervision and support from their manager and regular training. The inspector was satisfied that staff were knowledgeable about their roles and responsibilities and the individual needs of the service users. There are thirteen permanent staff members in all. The inspector viewed that there are sufficient staff numbers to meet the needs of the service users (see also concern about staffing in Concerns, Complaints and Protection). Staff work on a flexible shift system. There were four staff members working on the day of inspection. There is one wakeful and one sleep-in staff member in the main home and additional sleep-in staff overnight in the adjacent flat. Staff files examined contained all necessary information, with the exception of one staff member. The inspector was concerned that that a member of staff had been employed without an immediate application for a CRB and without a POVA check. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 18 This staff member is also working with the service user who lives in the basement flat. Assurances were given that this staff member is always supervised. However, this was not always reflected in the staff rota. The Registered Manager must not employ a person to work at the care home without a satisfactory POVA check. Persons employed pending a full CRB check must be supervised at all times. Good employment practises must be observed to meet regulations and to ensure the protection of vulnerable service users. Staff receive induction and most staff have or are doing an NVQ Level 2 or 3. One staff member spoken to informed that he had received a long period of induction. The senior confirmed this had lasted for two months. Staff receive regular supervision. The staff rota was unclear and confusing. It lacked clarity of whether shifts were am or pm; not all shifts in the flat were coded with an ‘F’ as used by the home; a code ‘C’ was used without definition; shifts did not correspond with set shift patterns identified to the inspector, ie staff working 7-10 rather than 7-11 or 12, the normal shift pattern; variations to the rota were not always noted and the rota did not reflect whether staff were on sleep-in or wake-in duty either in the flat or in the main home. This is a document open to inspection in order for the home to give an accurate reflection of staffing. A requirement is given to improve the rota. Sahara Lodge DS0000022847.V271926.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): 37, 38, 39, 40, 41, 42 Service users benefit from good health and safety practises within the home and their rights and best interests are safeguarded by the homes’ policies and procedures. EVIDENCE: Prior to this inspection, the Registered Manager acknowledged to the inspector that her lack of presence in the home due to personal difficulties had until now affected her ability to meet National Minimum Standards in running the home. The newly appointed manager has a background of relevant experience in management within the care industry and with service users with learning difficulties. Staff informed that good management support has always been available. In the period between this and the last inspection, the senior care worker acted as a Deputy Manager in the absence of the Registered Manager with good support available from the Registered Manager as required. A recent water safety certificate was available as required from the last inspection. Water temperatures in basins were also adjusted close to 43 degrees. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 20 Other health and safety certificates such as gas and electricity were examined at the last inspection and were stlll valid and general health and safety practices were found to be observed at the last inspection. The home was observed to have a range of policies and procedures relevant to the service users and practises in the home. Staff spoken to informed that they were familiar with policies and procedures. However the home must now have in place a system of quality assurance, including monitoring, review and improvement of the service provision, as according to regulations and National Minimum Standards. Sahara Lodge DS0000022847.V271926.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 2 x 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 3 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 1 2 3 1 3 3 3 x Sahara Lodge DS0000022847.V271926.R01.S.doc 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 YA1 Regulation 4, Sch 1 Requirement The Statement of Purpose must be updated to contain accurate information about staffing. The service users’ contracts must specify the method of payment. The Manager must ensure that actions specified in risk assessments to meet service users’ needs are also specified in service user care plans. The care plan for the service user living in the adjacent basement flat must specify whether he requires wake-in or sleep-in staff supervision. The Manager must ensure that the system of risk assessments is and improved. The Manager must ensure that signed statements are obtained from each service user or their representative concerning their views and requested arrangements in the events of DS0000022847.V271926.R01.S.doc Timescale for action 05/04/06 2. YA5 17 (2), Sch 4 (8) 15 05/04/06 3 YA6 05/05/06 4 YA6 15 08/03/06 5 YA9 13 (4) 05/05/06 6 YA21 12(1) 05/05/06 Sahara Lodge Version 5.1 Page 23 ageing, illness or death. 7 YA33 18 The Manager must ensure that the service user in the adjacent basement flat always receives 24 hour supervision as according to the need stated in the service users’ care plan. The home must provide written records to evidence this, including the staff rota. The staff rota must be revised to provide clear information concerning staff on shift as follows: • • • • Have a separate staff rota for the basement flat Specification of am and pm shifts on the rota Define any codes used in the rota (ie the letter ‘C’) Identify any variations to the rota concerning staffing Specify whether staff are on sleep-in or wake-in duty at the flat and the main home respectively. 08/03/06 08/03/06 8 YA33 18 08/03/06 • 9 YA34 19 (1) (4) The Registered Manager must not employ a person to work at the care home without a satisfactory POVA check. Persons employed pending a full CRB check must be supervised at all times. The home must now have in place a system of quality assurance, including monitoring, review and improvement of the service provision. This must also DS0000022847.V271926.R01.S.doc 10 YA39 24, 26 05/04/06 Sahara Lodge Version 5.1 Page 24 include monthly unannounced visits to the home. 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 YA9 Good Practice Recommendations Old risk assessments available in service users’ files are potentially confusing. The inspector recommends only the current risk assessments to be stored in service users’ files, or for a clearer filing system of assessments. Sahara Lodge DS0000022847.V271926.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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. 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