Inspection on 16/05/06 for St Andrews, Paignton

This inspection was carried out on 16th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Andrews, Paignton 24/12/09

St Andrews, Paignton 29/06/09

St Andrews, Paignton 13/01/09

St Andrews, Paignton 28/01/08

St Andrews, Paignton 08/08/07

St Andrews, Paignton 01/03/07

St Andrews, Paignton 10/10/06

St Andrews, Paignton 13/12/05

St Andrews, Paignton 20/06/05

St Andrews, Paignton 13/10/04

St Andrews, Paignton 19/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 St Andrews 24 St. Andrews Road Paignton Devon TQ4 6HA Lead Inspector James Rose Unannounced Inspection 16th May 2006 10:00 St Andrews DS0000018429.V289566.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 St Andrews DS0000018429.V289566.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. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Andrews Address 24 St. Andrews Road Paignton Devon TQ4 6HA 01803 559545 01803 391582 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) Mr John Davies Mrs Paulette Davies Vacant Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (21) St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A Manager to be registered by 15th June 2004 Date of last inspection 13th December 2005 Brief Description of the Service: St Andrews is a care home for up to 21 younger or older adults with mental health needs. The building is situated in a residential area of Paignton, within walking distance of the sea-front, shops and amenities. There is level access through a small front garden, with one step inside the lobby area to access the house. There is also a concreted area and lawn to the back of the home. The home has a lower ground, ground, first and second floor with stairs throughout. This may cause difficulties for residents with mobility problems as there are no bathing/shower facilities on the ground floor. An external fire escape connects all floors. On the lower ground floor there is a laundry, store room, bedroom, shower/bathroom, and lounge/staff sleep-in room. On the ground floor there are bedrooms, a kitchen, toilet, office, dining room and lounge. The first floor has a shower room, bathroom, and bedrooms, and on the second floor there are bedrooms and a toilet. Two of the bedrooms are shared by two residents. One bedroom currently being used by a resident is under 10sqm, when this resident leaves the home the use of this room must be reviewed. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during May 2006; three visits were made to the home 12.5 hours in all. Evidence was also obtained from three healthcare professionals from psychiatric services, one of the doctors that provide service to the home and the district nursing service. Residents at the home were asked to complete a questionnaire about the quality of the service at the home in a way that was anonymous and four residents were consulted individually in private during the inspection process. A sample of the care records was examined and the way the home delivered care to the residents was observed. What the service does well: What has improved since the last inspection? Maintenance issues are addressed quickly at the home and the need for fire doors had been addressed. The requirements made by the environmental health department had also been satisfied. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 6 What they could do better: 11 requirements are repeated in this report that were called for at the time of the last inspection in December 2005. Of this 11, 8 were raised at the inspection undertaken before that on 20 June 2005. Little progress has been forthcoming concerning these very serious matters. Social care assessments of residents needs were still missing, it is acknowledged that many health assessments had been completed, however, these were not signed at the time of the inspection. Comprehensive service user plans were not available. No programme was available of residents’ social activities; it was understood from the proposed registered manager that a picnic trip is in the planning stage that will take place when the weather improves. Substantial gaps were found in the recording and the processes employed during the administration of medication at the time of the inspection. No controlled drugs book was available and a recommendation is raised as a matter of good practice that Tamazepam is stored and recorded a medication subject to the controlled process. These matters are very serious and have the potential to put residents at risk. Staff employed at the home still have substantial gaps in their personnel files, appropriate fitness checks must be completed and all references must be followed up. There is a clear risk to residents until this is achieved. No formal supervision of the staff team or the proposed registered manager is undertaken at the home. The recording of the induction training undertaken was incomplete and no ongoing training programme was in place, few staff had any experience of the care of persons with mental health issues. No quality assurance system was in place in the home to promote good practice. The conduct and management of the home continues to fall below the national minimum standards. The new proposed registered manager advised that she has a weekly meeting with Mr and Mrs Davis, this is unrecorded and has not contributed to any discernable improvement in the provision of records or the safe administration of medication. All the healthcare professionals consulted expressed concerns about the quality of the service provided at St Andrews. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 7 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. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 8 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 St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 9 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): 2 The homes performance in this group is poor. No assessment had been undertaken of resident’s individual aspirations and social needs. EVIDENCE: The recording undertaken by the home for five residents was examined in detail. Health assessments were in place for these residents but they were not signed and did not demonstrate that they had been discussed with the person concerned. No assessments had been undertaken of the social needs of these persons and no discussion had been recorded of their individual aspirations. New comprehensive social assessments should be undertaken without delay and a requirement has been repeated in this report to ensure this is achieved. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The homes performance in this group is poor. There are no comprehensive care plans available in the home for any of the residents. No recording was apparent of the way decisions are undertaken. Few risk assessments were in place and those that were available were of poor quality. EVIDENCE: Although most of the health assessments had been undertaken there were no comprehensive care plans available for residents. The health assessments that were available at the time of the inspection were not signed and did not demonstrate that they had been discussed with the person concerned. No social needs were recorded and the home does not have a social programme running. It was understood that the proposed registered manager is in the planning process of taking residents out on a picnic when the weather improves but no other activities were apparent. No recording was available to demonstrate how decisions are reached about residents’ lives. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 11 Few risk assessments were in place at the time of the inspection to assist residents to take responsible risks, those that were available were of poor quality and therefore of little value. No evidence was available of risk being assessed prior to admission according to health and social services protocols and in discussion with the service user and relevant specialist; and risk management strategies agreed and integrated into an individual care plan. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. The performance in this group is poor. The residents are not assisted to take part in age, peer and culturally appropriate activities. No planning is available to demonstrate that residents are part of the local community. No recording was apparent to demonstrate that residents have appropriate personal, family and sexual relationships. No planning was undertaken to promote independence, choice and freedom of movement for residents. Residents advised that they enjoyed the meals at the home. EVIDENCE: The lack of a meaningful care plan demonstrated that no planning has been undertaken to ensure that community links and social inclusion were seen as important issues by the home. No leisure or activities programme was in place for residents. No recording was undertaken about residents’ relationships. No planning or recording was available to demonstrate how the home would promote independence, individual choice and freedom of movement. From observations made during the inspection it was clear that the residents were respected by the staff team, and were helped in sensitive way when St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 13 required. One resident had been informed that her father had died and was being actively supported by staff and was clearly relieved that a member of staff was going to accompany her to the funeral. Four residents were consulted individually in private and they all advised that the staff now available in the home were helpful and assisted them the way that they preferred. A two-week menu system was used in the home and the menu for the day was on display in the dining room, all the residents that were consulted during the inspection advised that they liked the meals provided. The home was well stocked with food products and fresh vegetables were delivered every three days. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The performance in this group is poor. A single assessment and an agreed approach to a resident’s physical and emotional health needs is missing. The administration of medication in the home is poor and a cause for concern. EVIDENCE: In general terms residents advised that they did receive personal support in a way that they preferred. However, as there was no care plan where an agreed approach was recorded no consistency would be possible across the staff team. The same is true of residents physical and emotional needs for although health assessments had in the main been undertaken these had not then been used to form part of an active agreed care-planning process. The recordings of the administration of medication in the home were examined. Substantial gaps were found in the medication administration sheets that recorded the issue of medication to residents. It had been decided by the home to enable some residents to self medicate, however, the decision process undertaken was not recorded and no risk assessment was in place and no locked storage facility had been provided in residents bedrooms. With such poor methodology the norm residents are at risk. A new requirement has been St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 15 raised to ensure that all staff adheres to the policy and procedure for the correct administration of medication in the home. The home did not have a controlled medication-recording book available and the proposed manager has been asked to ensure one is provided; an additional requirement has been raised for this purpose. A recommendation has also been raised for Tamazepam to be stored and recorded in the same way as medication subject to the controlled process as a matter of good practice. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The performance in this group is poor. Residents felt that their views were listened to and acted on. The clear lack of planning and training has the potential to put residents at risk. EVIDENCE: Residents were consulted individually and in private during the inspection process and advised that they felt their concerns were listened to by the staff and acted on. The lack of planning and of any comprehensive risk assessment process coupled together with a fundamental lack of training concerning mental health issues for staff and the proposed registered manager puts residents in a position of being at risk. The home did have a complaints procedure in place and it was understood that a weekly meeting is undertaken with Mr and Mrs Davis although this was unrecorded. It is acknowledged that Mr and Mrs Davis have attended adult protection training as required in the last reports. St Andrews DS0000018429.V289566.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 The performance in this group is adequate. The outstanding required work has been completed in the home. The home is safe and an adequate environment is provided for residents. Some modification to the laundry procedures is required to ensure infection control. EVIDENCE: The requirement called for by the local fire authority for fire doors to be fitted has been achieved and restrictors have been fitted to the opening windows to ensure residents were safe. The home has a redecoration programme in place and work was being undertaken by the handyman during the inspection. An external store has been provided for safe storage of all the paint and redecoration materials thus avoiding an unnecessary fire risk. At the time of the inspection one resident was unable to get to a bath or shower, however this matter has now been resolved as this person is about to leave the home. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 18 The laundry room of the home needs the floor resealing and a protocol should be produced to ensure that dirty washing does not contaminate clean laundry. The current practice for clean laundry to be stored in an open situation whilst dirty washing is brought in and put into the washing machine is not appropriate. St Andrews DS0000018429.V289566.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 The performance in the group is poor. Many carers at the home are not qualified to deal with mental health issues although some sensitive care delivery was observed. The home’s recruitment policy and practices continue to be incomplete. EVIDENCE: The new proposed registered manager has been able to recruit new staff and the home currently does not have any vacancies. The recruitment process was flawed however as checks had not been completed on some carers and some references were not in place and I was advised by the proposed manager that job descriptions were not provided. Some night carers were working unsupervised without the appropriate checks being completed and an immediate requirement was raised to end this practice. Four carers were interviewed during the inspection process they demonstrated sound values and respect for residents privacy and dignity. The recording of the induction completed by the home for new carers was examined and found to be confused, some elements of the induction were ticked only, some were ticked and had one signature and some were ticked and had two signatures. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 20 This was pointed out to the proposed manager who advised that this was an error. No training programme was available for carers to make them familiar with mental health issues; this was particularly disappointing given the needy residents group. The staff were not being given any formal supervision by either the proposed manager or Mr and Mrs Davis. St Andrews DS0000018429.V289566.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 and 42 The performance in this group is poor. Residents do not benefit from a well run home. No recording was available to demonstrate that residents’ views contribute to the development of the service provided. The health safety and welfare of residents is in question. EVIDENCE: The homes recording available at the time of the inspection was particularly poor. Residents had not had their social needs assessed and no meaningful risk assessment was in place. The recording of the administration of medication was incomplete and decisions had been made to enable some residents to self medicate without risk assessment being undertaken and an appropriate secure facility being provided for storage. The staff team is in general inexperienced in dealing with mental health issues and does not have formal supervision. There appear to be deficits in any of recording areas that are inspected. Given this position it is difficult to conclude that residents are safe. St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 22 It is acknowledged that all harmful cleaning chemicals are held in appropriate secure storage. Fire requirements have been met and environmental health issues resolved. St Andrews DS0000018429.V289566.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 X 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 1 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 2 X X 1 X St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 24 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 YA2 Regulation 14 Requirement Residents must have comprehensive assessments (Previous timescale 26/09/05 – 20/01/06 not met) Residents must have suitable contracts, signed and agreed by them (Previous timescale 19/02/05 & 26/09/05 – 20/02/06 not met) Timescale for action 27/06/06 2. YA5 5 (c) 13/06/06 3. YA6 15 Residents must have 25/07/06 comprehensive care plans, signed and agreed by them. Care plans must be reviewed and amended (Previous timescale 26/09/05 – 20/01/06 not met). Residents must have comprehensive risk assessments, signed and agreed by them and reviewed regularly (Previous timescale 26/09/05 – 20/01/06 not met) Residents educational, work and leisure needs must be met. (Previous timescale 20/03/06 – not met) 04/07/06 4. YA9 13 (4) 5. YA14 12 (1) 25/07/06 St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 25 6. YA13 12 (1) Residents educational, work and leisure needs must be met.(Previous timescale 20/02/06 – not met) Residents educational, work and leisure needs must be met. (Previous timescale 20/02/06 – not met) The registered providers must ensure that all staff adheres to the policy and procedure for the correct administration of medication. Mr and Mrs Davies must risk assess and put into place strategies to ensure residents are not at risk. (Previous timescale 13/12/05 not met) All staff employed in the home must have the appropriate fitness checks carried out before employment such as Criminal Record Bureau and Protection of Vulnerable Adult checks (Previous timescale 22/06/05 & 26/08/05 – 20/01/06 not met) All references must be followed up before employment and interview records kept. 25/07/06 7. YA12 12 (1) 25/07/06 8. YA20 13 (2) 23/05/06 9. YA42 13(4) 27/06/06 10. YA34 19 16/05/06 11. YA36 19 Supervision discussion with staff about poor practice must be recorded. (Previous timescale 20/01/06 – not met) The Owners must give the acting manager the support, assistance and resources she requires to manage the home. The Commission must receive an application for a registered manager at St Andrews (Previous timescale 26/08/05 – 30/06/06 12. YA37 18(1) 25/07/06 St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 26 20/01/06 not met). 13. YA39 24 The quality assurance system at St. Andrews must be fully implemented. The Commission must receive a report of the findings with a time specific action plan for meeting deficits. Audited results must be available and must reflect the views of residents. Residents and stakeholders must receive feedback with regard to their contribution to the quality assurance system (Previous timescale - 22/06/05 & 12/10/05 – 20/02/06 not met). 14. YA43 18(2) Mr and Mrs Davies must formally and appropriately supervise the acting manager. (Previous timescale 20/01/06 not met) 13/06/06 27/06/06 15. YA43 25 Mr and Mrs Davies must provide 27/06/06 the Commission with evidence that they are running St Andrews in a manner to ensure it is financially viable. (Previous timescale 20/01/06 – not met) The registered persons must ensure that the laundry floor is resealed. 27/06/06 16. YA30 13 (3) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Andrews DS0000018429.V289566.R01.S.doc Version 5.1 Page 27 1. 2. YA30 YA12 The registered providers should provide a protocol to ensure that soiled washing does not contaminate clean laundry. Residents should have information on opportunities for further education, distance learning, vocational, numeric and literacy training and education, employment and personal development should be reviewed as part of their next planning meeting. There needs to be a separate fridge or lockable storage in the current fridge for storing eye drops etc and the pharmacy report must be maintained in the home. 50 of care staff should have at least NVQ 2 by the end of December 2005. A staff training and development plan should be developed from staff supervision and appraisals. There should be a training budget in the home. There should be a business and financial plan open for Inspection in the home. The registered providers should treat Tamazepam in the same way a medication subject to the controlled process as a matter of good practise. 3. YA20 4. 5. YA32 YA35 6. 7. 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