Inspection on 01/03/06 for Springfield House

This inspection was carried out on 1st March 2006.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springfield House 07/11/07

Springfield House 26/09/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Springfield House 255d Stroud Road Gloucester Gloucestershire GL1 5JZ Lead Inspector Ms Tanya Harding Announced Inspection 1st March 2006 09:30 Springfield House DS0000063470.V283700.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 Springfield House DS0000063470.V283700.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. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Springfield House Address 255d Stroud Road Gloucester Gloucestershire GL1 5JZ 01189 581950 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) www.orchardendltd.co.uk Orchard End Limited Lisa Maria Cassidy Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Springfield is a newly registered home which is part of Orchard End Group Limited. The home is located on a main road close to Gloucester city centre and within walking distance of local amenities and pubic transport routes. The house has been refurbished and decorated and is furnished in a comfortable and stylish way. Springfield offers accommodation for up to six service users with learning disabilities who may also have additional mental health needs. Five of the bedrooms, all with en-suite facilities and on the first floor and one bedroom along with communal lounge, dining area, large kitchen and offices are on the ground floor. The garden is simple and well maintained. There is car parking at the front of the house. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the home and was carried out by Tanya Harding, regulation Inspector and supported by Iain Macgregor, business services administrator from the Commission. The registered manager has left and the acting manager and the project manager facilitated the inspection. The quality assurance co-ordinator and the operations manager were also present for part of the visit. The main purpose of the visit was to assess the quality of the service against the key National Minimum Standards. There was an assessment of the systems by which care and support is delivered to the service users and examination of the procedures for staff recruitment. All of the service users who moved into the home since it opened in August 2005 were met and greeted. There were discussions with some service users, the psychology assistant and with support staff. A return visit was made on the 14th March 2006 to look at medication administration procedures in the home and to interview staff. A complaint has been received about the home prior to the inspection and this too was followed up at this visit. Findings of the investigation are presented in this report under Standard 22. What the service does well: What has improved since the last inspection? What they could do better: There should be better monitoring of medication administration to ensure greater robustness of the process and better clarity of records. Recording of incidents needs to be more detailed to provide a clear trail of events. Guidance needs to be compiled about identified risks to the service users and how these need to be managed. A formal record of complaints made about the home must be maintained. Springfield House DS0000063470.V283700.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. Springfield House DS0000063470.V283700.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 Springfield House DS0000063470.V283700.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, 2, 3 and 4 Systems for admission of new service users centre on good practice in collating the necessary information and involving the service users in the process in order to enable them to make an informed choice about the move. EVIDENCE: The home has developed a Statement of Purpose and a Service Users Guide. At the time of the inspection five of the six vacancies were filled. Each of the admissions was overseen by the project manager and involved the registered manager and later the acting manager. Some concerns were raised about the suitability of the admission for the service user who moved in shortly before the inspection. The Commission is satisfied that the home has made a thorough assessment of the person’s needs and has put in support systems which involve outside professionals to enable the service settle in and to monitor their additional needs. Additional training is provided for staff about the assessed needs of each service user before they move in, including a detailed overview of care plans and potential risks. The admissions process is holistic and demonstrates the involvement of the service users and their family in visiting and ‘test driving’ the home. The service users spoken with communicated mixed views about living in the home, but were observed to be settled and comfortable in their environment. One service user said that they preferred Springfield to their last placement. Springfield House DS0000063470.V283700.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 and 9 Care guidance is detailed and provides a good point of reference to staff, although recordings of daily events and other observations could be improved to provide a better evidence trail of whether service users’ individual needs are being met and identified risks are being managed. Better guidance on taking risks would promote greater awareness of safety amongst staff and safeguard the service users. EVIDENCE: A number of care files were seen. These contained a variety of information about all aspects of the individual care package. There were personal information sheets and pen pictures about each service user as well as photographs. There was evidence that service users are encouraged to have involvement in managing their own money. Incident records for one person showed that on occasion the person has attempted to leave the house and on some occasions has left the house. Records did not provide sufficient detail about these events by which an evaluation of staff response could be made. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 10 Staff spoken with were clear that the service users are free to leave the house if they wish to and made reference to procedures which are in place to ensure that the risks to safety are minimised if a person chooses to leave the house. There was lack of assessed risks to service users and this needs to be addressed. The individuals who live at Springfield have complex behaviours and this would need to be incorporated into the guidance on what support may be necessary to keep people safe whilst going out into the community or taking part in activities around the home. Staff spoken with had a good understanding of the missing person procedure. Springfield House DS0000063470.V283700.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): 12, 13, 15, 16 and 17 Service users benefit from flexible and individual programmes of activities with opportunities to develop their skills and pursue interests. People are supported to be as independent as possible and to make informed choices about their daily routines. EVIDENCE: The home has identified a comprehensive list of community venues which offer opportunities for leisure, education and relaxation. Individual plans of care refer to service user’s preferences and individuals are encouraged to put forward ideas about what they would like to do. One service user went to a cookery course at the local college and upon return said that she had enjoyed this. Another service user has continued their attendance to the Adult Opportunity centre after moving into the home. This is because it was recognised that the person had established networks there which were important to them. Staff handovers are used to direct staff support to the activities chosen by the service users. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 12 The service users were observed to have free access to all areas of the home and were seen involved in preparation of drinks. Daily routines in the home were observed to be very flexible and with service users being consulted about planned and adhoc activities, preferences for meals and who would provide the necessary support. Mealtime was observed and this was relaxed and unrushed, with some service users choosing to eat at different times to others. One person went out to a cafe. One service user said they wanted to buy a delicacy, which they enjoyed and which was part of their culture. Plans were already in place to enable the person to do this. Springfield House DS0000063470.V283700.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 and 20 Systems are in place for monitoring and responding to healthcare needs of the service users. Better monitoring of medication administration would ensure greater robustness of the process and better clarity of records. EVIDENCE: There were care plans in place about support with personal care, but some where generic and did not provide information about how a particular service would prefer to receive this support. Feedback was received from staff that tasks around intimate personal care should be covered in greater detail during the induction. Including the necessary detail in care plans could also help this. All of the service users are registered with local health services as necessary and some receive regular visits from Community Psychiatric Nurses as part of the ongoing support. One person receives regular input from the Occupational Therapist and the Speech and Language Therapist. There is ongoing monitoring of health issues which the service users have. For one person records are being collated about identified behaviour when this is witnessed by staff. This is to help the GP establish whether the person has a health condition which can be treated. Staff have received awareness training in epilepsy. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 14 All of the current service users are female. Records seen provided evidence that personal care is always supported by female staff. Examination of the medication records showed that there are numerous occasions when the service users refuse to take prescribed medication. This is documented as necessary and GP is contacted for advice. The home needs to develop written protocols around this. The manager advised that she has started to put together protocols for ‘as required’ medication. Some confusion could arise in cases where medication is not administered because the service user is asleep at the time of administration. The manager acknowledged that these matters may need further follow up. She advised that stock control is carried out regularly and any surplus medication is returned to the pharmacy. A returns book is kept. There were also on occasion gaps in signatures, where it was not clear whether the staff had administered medication or not. Medication administration records must be accurate. Staff receive training in safe handling of medicines. At the time of the visit two staff returned from a medication course. They said that the course was useful and helped their understanding in this area. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 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 the following standard(s): 22 and 23 Service users are given opportunities to voice their views about the care they receive. Systems which are in place to protect people from abuse could be further improved to ensure the set procedures are robust and are followed consistently. EVIDENCE: The service users were observed to voice their opinions about the way they receive care and support. Those spoken with were confidently expressing whether they like or dislike aspects of their life at Springfield and said they would talk to the manager or key staff if necessary. There was no formal log of concerns or complaints in the home and this needs to be put in place. The Commission has received an anonymous concern about supervision and safety of the service users following an incident during which one service user went to lie in the middle of a busy road and another person was seen wondering outside in their nightwear. The investigation into these concerns showed that the home had taken steps to protect the service user when the person was putting themselves at risk and had provided notification of the incident to the Commission as required. A full explanation has been provided of the circumstances surrounding the incident and actions taken as a result to prevent future occurrence. However, it was found that the records completed on the day of the incident may not have been as comprehensive as necessary and this must be addressed by the home with the relevant staff. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 16 The home accommodates service users with complex behaviour needs and there is a need for close monitoring and robust procedures to be in place for responding to critical events and to ensure that service users are protected from harm. There is care guidance in place about managing behaviour challenges and staff are trained in de-escalation and use of physical intervention. Guidance for one service user who presents particular challenges was examined in detail. This has been compiled by the assistant psychologist who also provides weekly support sessions to the service user. The acting manager has provided additional interim guidance about responding to the service user. This stated a number of limitations which may have to be imposed in order to prevent the service user and others around them from harm. A number of serious incidents have taken place during which the service user and other people have sustained injuries. Whilst it is seen that the home is trying to manage the behaviours in line with agreed plans of care, the significance of risk cannot be ignored. The home has been required to make an adult protection referral. To date there have been a number of incidents during which physical intervention was used. Staff spoken with confirmed that they have received the required training and would only use restraint as a last resort. Restraint techniques which are seen as high risk (as detailed in the Department of Health Guidance) are not used or taught to staff. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 17 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 and 30 Service users live in a comfortable and homely environment. EVIDENCE: The home was opened in July 2005 when it was refurbished and updated in line with the National Minimum Standards. On the days of the inspection the home was warm, bright and clean. The service users were observed using the comfortably furnished dining room and lounge areas. The kitchen is spacious and well equipped and all of the bedrooms have en-suite facilities. The manager advised that service users are being consulted about the use of a spare room on the first floor and that it was likely to be furnished as an additional quiet lounge. Some aids and adaptations have been provided to support the service users with mobility difficulties. This includes the handrails on the stairs and a bath hoist. There is also a call bell in the upstairs bathroom. The garden is enclosed and landscaped with easily accessible patio area. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 18 The proximity of the main road is being monitored and additional security measures are being considered. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 19 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): 32, 34 and 35 There are good systems in place for training and developing staff and this should ensure that the service users are supported by a skilled team, once the team is well established. EVIDENCE: The home has been in operation since July 2005 and there have been a number of changes to the staff team and the management team since opening. The current team is relatively new and some staff have not worked in care before. All new recruits receive in-house induction as well as formal meetings to monitor their progress and development. With the recent management changes some of these monitoring meetings have been missed, but overall these additional supervisory arrangements are seen as good practice. There was evidence of staff meetings taking place and these incorporated discussions about good working practices. Minutes of monitoring meetings provided evidence of discussions between staff and supervisors about good values and progress with induction. There appeared to be sufficient numbers of staff on duty during the inspection, although some feedback was received from staff suggesting that this is not always the case. This should be monitored by the manager and staffing levels should be reviewed again once the home is full. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 20 Files for several current staff were examined and on the whole were in order. CRB disclosures and other pre-employment checks have been obtained as necessary. Some shortfalls were noted and highlighted to the manager. This included the need to obtain an additional reference for one staff member from their last employment in care. For two other members of staff to obtain a reference from their more recent care positions. Full employment history is being obtained as necessary, although for one staff member there was a gap in employment from October 2004 to January 2005 for which no explanation was provided. This should be followed up. The Organisation has a dedicated training personnel and NVQ assessors. Staff are required to complete a variety of mandatory training around health and safety, fire safety, manual handling, first aid and food hygiene. Training in responding to aggression and use of physical intervention is also compulsory. New staff are signed onto the Induction and Foundation courses including LDAF. There is also access to NVQ training and additional specialist training where necessary. This includes epilepsy awareness, awareness of Autism and mental health, supervision of staff, value base awareness training, in-house and external safe handling of medication courses. With each new service user being admitted, the home has ensured that staff receive a full day training about the assessed needs of each person and on agreed care plans. This is good practice. However, it was identified that some newer staff may have missed out on this awareness training for some of the service users and could benefit from additional input. The acting manager has been identifying shortfalls in staff practice and is looking at areas for further training and development. This includes further training in effective recording, infection control, risk assessment and COSHH. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 21 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, 39, 40 and 42 Consistency of management support should ensure greater stability to the home for the benefit of service users and staff. Quality assurance systems are well developed and are inclusive of service users’ views. This should help the home to be responsive to the needs and wishes of the residents and to safeguard their best interests. EVIDENCE: The registered manager has left and an acting manager has been appointed. She is currently going through the registration process with the Commission. The acting manager is receiving ongoing support from the operations manager, the project manager and the quality assurance co-ordinator to ensure that the transition does not compromise the quality of care delivered to the service users. This report comments about a number of shortfalls which likely to have resulted because of the management changes and the acting manager expressed her commitment to addressing these as quickly as possible. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 22 Feedback received from staff suggests that staff would benefit from a period of management stability, improved communication in the home and time to gel together as an effective team. The Organisation has an establish process for monitoring quality assurance and regular unannounced visits are carried out in line with Regulation 26. Reports of these are comprehensive and are forwarded to the Commission regularly. There are formal systems by which the service users are consulted, in addition to the informal daily communication and support offered by staff to help service users to express their views and opinions. Feedback from families and involved professionals is also being obtained. The home has a comprehensive list of procedures as required under the Regulations. Consideration should be given for obtaining guidance about emergency admission and detention under the Mental Health Act 1983 and subsequent legislation. Health and safety procedures in the home were assessed to be satisfactory as part of the registration process. This included checks on electrical systems, fire protection systems, gas installations and water systems in the home. Information supplied by the acting manager in the pre-inspection questionnaire provides evidence of regular Fire Safety checks being undertaken, a recent fire drill being carried out and arrangements for servicing of equipment and adaptations. Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 3 X 3 X Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 24 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 YA9 YA20 Regulation 13(4) 13(2) Requirement Risks to service users need to be identified and recorded. The home needs to develop written protocols for when medication is refused by the service users. Medication administration records must be accurate. 3 4 YA22 YA23 22 13(6) and 17 There must be a formal log / record of concerns / complaints. Records of critical events and incidents which may adversely affect the well being of the service users must be comprehensive. Staff must be given guidance on how to write such records to ensure all factual information is recorded. An adult protection referral must be made for a specific individual as detailed in the text. Additional information relating to staff employment needs to be obtained as detailed in the text. 31/05/06 31/05/06 Timescale for action 31/07/06 31/05/06 5 YA23 13(6) 30/04/06 6 YA34 19 31/05/06 Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 25 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 YA18 Good Practice Recommendations Guidance about support with personal care should provide detailed information about how a particular service user would prefer to receive this support. Better guidance could be given to staff during induction about how to provide support with intimate care in a way which is accepted by a specific service user. Staff should receive additional awareness training about individual plans of care and assessed needs of the service users, with particular reference to newer staff. The manager should identify and monitor the reasons for staff shortages (where these arise). Consideration should be given for obtaining guidance about emergency admission and detention under the Mental Health Act 1983 and subsequent legislation. 2 YA32 3 4 YA33 YA40 Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Springfield House DS0000063470.V283700.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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