Inspection on 20/07/07 for Summerlands

This inspection was carried out on 20th July 2007.

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

Other inspections for this house

Summerlands 17/07/08

Summerlands 29/06/06

Summerlands 01/02/06

Summerlands 08/07/05

Summerlands 06/01/05

Summerlands 12/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Summerlands 9 Villiers Road Southsea Portsmouth Hampshire PO5 2HG Lead Inspector John Vaughan Unannounced Inspection 20th July 2007 10:55 Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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 Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerlands Address 9 Villiers Road Southsea Portsmouth Hampshire PO5 2HG 023 9283 0682 023 9283 0682 francescabilsland@yahoo.co.uk 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) Mrs Francesca Bilsland Miss Joy Michelle Tremayne Care Home 23 Category(ies) of Learning disability (23) registration, with number of places Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users in the category LD must be at least 40 years of age One service user over 65 years of age can be accommodated. One current, named, service user in the category MD can be accommodated. 29th June 2006 Date of last inspection Brief Description of the Service: Summerlands is a Grade 2 listed building designed by the architect Thomas Owen and built in the 19th century. The interior and exterior of the home have numerous features of architectural interest. The building was converted to provide care/support and accommodation for up to 23 people with a learning disability some time ago and is in need of significant improvement. The home is located close to, and between, Southsea shopping centre and the sea front, promenade and beach. Accommodation is set over four floors and consists of five single and nine double rooms. There is a stair lift between two floors. However, it does not extend to the lounge and dining room level. Therefore, rooms on the upper levels are not suitable for people with mobility difficulties. There is a pleasant walled garden with seating, accessible from the lounge and available for residents’ use. The weekly charge for this service ranges from £325 to £400 and is dependant on the needs of the individual and if they have a single or a shared room Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector met with people using the service, staff members and the manager of the home during the visit to the service, which took place over one day. During the visit the inspector spoke to people about their experiences of the home, observed people and staff, sampled records, talked to staff and looked and the facilities and environment provided for people who live in the home. The inspector also reviewed information held by the commission including previous reports, incident reports and the Annual Quality Assurance Assessment (AQAA) provided by the manager of the service. As part of the assessment of the service surveys were circulated and the inspector received six responses from people who use the service, two responses from care managers and two responses from healthcare professionals. The comments were positive and supportive of the service. The only area highlighted for improvement was the environment, which has been raised as a concern for some time. What the service does well: People benefit from a activity programme that has been put together based on their individual needs and interests which includes trips out, walks, shopping, arts and crafts, trips to the theatre and holidays. Detailed care plans support the people with their assessed needs and these are reviewed with the individual on a regular basis. The home has a very comfortable and relaxed atmosphere and people who use the service and staff talked openly together. The inspector saw positive contact between the staff and people who live in the home. People are supported and encouraged to keep in contact with families and friends. The home is generally clean and tidy and free from any unpleasant smells. People who use the service told the inspector that they were happy with their private rooms. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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 Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are only admitted following a full assessment of their needs and can visit and try out the service before they make a decision to move in. EVIDENCE: Since the last inspection of the service two people have moved into the home. The inspector looked at the files for these individuals and had the opportunity to meet with them both during the visit. Both files contained complete assessments carried out by the manager and one had a care manager’s assessment. The manager explained that the information is obtained from visits to meet the individual, discussions with people who support the person and the care manager. Records seen by the inspector provided evidence of consultation with an occupational therapist on additional adaptations to the home for one of the people who moved in. People have the opportunity to visit the home, meet other people who use the service and stay for a meal as part of the admission process. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are supported by an established care planning and risk management system that responds to their assessed needs however this needs some work to improve the healthcare guidelines for one person using the service. EVIDENCE: The inspector was provided with files that contained the care plan for all of the people who use the service. Statements are recorded on the needs of each person and how staff to respond to these needs. Areas covered include supporting people with personal care, important daily routines, likes and dislikes, healthcare and activities. These plans are supported with a risk assessment and specific assessments on epilepsy and moving and handling. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 10 One person requires help and support to maintain a colostomy however the person’s plan did not contain any information or procedure for the support required. The manager stated that prior to the admission the staff went to the person’s previous placement were they were provided with training from the staff at that service. The inspector advised that they place clear instructions in place to support their practice and look at training for staff in this area. People who use the service told the inspector that they feel supported by staff to make choices about daily activities, routines and meals. The plan of one individual documented how they have been consulted about increasing activities and they said that they do not wish to engage in any other structured activities. The inspector spoke to this person and they confirmed that they have been asked and encouraged to take part in other activities but they do not wish to do so and this has been respected. The inspector noted that the person, their key worker and the manager have signed plans. People using the service were able to tell the inspector who their key worker was. The home has key worker sessions to review the care plan and any actions or goals in place however on the plans seen by the inspector had only one recorded session each. The manager agreed that these sessions have not been as consistent or effective as planned and they would discuss the regular use of these sessions with the staff team. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are supported to have varied and individualised activities based on their needs and wishes. The meals provided meet the likes and dislikes of people who use the service. EVIDENCE: The majority of people have lived in the home for some time and have wellestablished routines and interests and the manager stated that they find it difficult to persuade people to try new things. The records of one person confirmed that they have been encouraged to try new activities and have refused. The inspector spoke to this individual who said that they are very happy with going to their club three times a week and do not wish to do anything else when at home. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 12 An activity plan is in place and staff confirmed that these activities do take place. A number of people attend various clubs and centres throughout the week. One person told the inspector that they are able to organise their day, visit friends and go on holiday. Another person spoke of holidays each year with family members, going to art and craft groups and shopping. Regular trips are organised for people including trips on steam trains, ferry rides, shopping and the day before the visit a group went to see a musical in Southampton. Individual hobbies, interests and activities are recorded in each persons plan. The second lounge is set aside at times for activities including the use of a computer. The activity timetable provided by the manager had varied activities including cinema trips, art and crafts, music and movement, bingo and watching videos and DVD’s. Feedback was positive about lifestyle, activities and the food provided in the home from all people who spoke to the inspector. One person told the inspector that they have meals that they like and if there is something on the menu they don’t like this can be changed. Care plans reflected the likes and dislikes of people who use the service. The inspector observed a meal and this was a relaxed and unhurried experience for people who use the service, throughout the day people had drinks and accessed the kitchen to return their cups, plates and cutlery. The inspector noted that the dining room does not have any natural light and this takes away from the mealtime experience, as the room is gloomy. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical and healthcare needs of service users are well met and improvements to the medication practices demonstrate that people using this service are kept safe. EVIDENCE: The inspector saw evidence of contact with General Practitioners, dentists and specialist consultants and a record is maintained of contact with health professionals. In most cases care plans are in place to support people with their healthcare needs. One person who has a colostomy needs further support strategies put in place and input for the staff team from healthcare professionals such as the district nursing team to update them on care and support of the individual. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 14 The medication is stored in a secure cabinet. Medication records were checked and found to be up to date and accurately completed. The inspector spoke to a staff member who dispenses medication and discussed the use of over the counter remedies. The member of staff was clear that they would not give any un-prescribed medication to an individual without reference to the manager. The manager stated that they have homely remedy agreements in place but they had been filed away. The manager found these documents and arranged for them to be put back into the medication administration records to inform staff what each person can have without a prescription. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service has systems in place to record and respond to any concerns, complaints and allegations to keep people who use the service safe from abuse. EVIDENCE: The manager stated that there have been no complaints since the last visit. A record is maintained in the home to document any concerns and the response to these concerns. The inspector noted that the home has policies and procedures on the protection of vulnerable adults and a copy of the multi agency strategy is also available in the home. People who use the service said that they know who to speak to if they are worried or concerned about anything and could name key workers and their care manager as people they would speak to as well as the manager of the home. The manager stated that up to this point they have provided training in protection people from abuse for her staff team however they are looking to secure additional external training for staff. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The environment provided for people who use this service is homely and comfortable in parts improved by the completion of repairs required at the last visit however the building is old, very dated and in need of major investment and improvement to meet the needs of people. EVIDENCE: The inspector looked at the facilities and environment provided to people who use this service. The previous inspections of this home have raised significant concerns about the suitability and safety of the premises. At this visit the inspector looked at all areas of the home accompanied by the manager. The requirements to replace a cracked sink in one of the attic bedrooms, replace a headboard, replace a old worn out armchair and improve the small lounge has been met. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 17 The manager stated in the annual quality assurance assessment and in her face-to-face discussions with the inspector that maintenance is reactive at present. The carpet in one of the shared bedrooms on the lower ground floor is badly stained; the manager has raised this in a staff meeting and advised the inspector that it may not be replaced due to the plans for refurbishment. With the exception of the issue with the carpet no new environmental issues have been highlighted at this inspection however there continue to be concerns about to poor environment on the lower ground floor which includes the old and poorly maintained toilet cubicles that do not promote the well being or self esteem of people who use this service, the lack of limited light in the dinning room and the obscured glass in the bedrooms on this floor that restrict light and view for people who use these rooms. As a result of the last inspection of this service a requirement was made that the provider submit a timescale for the commencement of the redevelopment work of the service. This has not been submitted. The manager stated that planning consent has not been obtained yet and there had been delays with suitable architectural input into the design, as they have had to change architects. The manager did not have any information on the timescales and the provider was away at the time of the visit. Two new people moved in since the last visit and share a room at their and their care manager’s request. Input from the occupational therapist was sought on the provision of additional rails to the stairway leading to the attic rooms. The inspector noted hazard tape and padding on roof beams on the stairway and in the attic to draw people’s attention to the lower ceiling heights. People’s bedrooms had lots of personal belongings, ornaments pictures and personal equipment making these spaces homely and personal to the individual. The large number of shared room’s mean that it is difficult for people who express a wish to move into a single room to be offered such a choice. The toilet and bathroom facilities are provided on each floor. These are decorated in a uniform colour scheme and do not feel homely or comfortable. The manager agreed stating that they are fully aware of how these areas feel. The inspector noted that the home was free from any unpleasant smells at the time of his visit. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. A trained and supervised staff team support people who use this service. The recruitment practices do not demonstrate that a thorough recruitment procedure is followed to keep people safe. EVIDENCE: The inspector looked at the records for three of the staff who work in the home who have been recruited since the last inspection and spoke to the manager about recruitment practices. The records available in the home were very well organised and the all information was is place for each person except one CRB. The inspector saw evidence of two written references, application forms and proof of identity. The information on Criminal records bureau Checks (CRB) was not available for one of these records and an old CRB from a previous provider was on file. The manager acknowledged this serious shortfall and stated that they would make arrangements for an application to be submitted and a Protection of Vulnerable Adults (Povafirst) check to be completed as soon as possible. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 19 The manager also stated that this person only works at weekends and would be supervised at all times until the outcome of the CRB was known. There is a good mix of staff skills and experience in the home and the manager stated that all staff are encouraged and supported to undertake NVQ training, currently On the day of the visit the staff on duty had been working in the home for a significant number of years and demonstrated a good understanding of the needs of the people who use the service. Staff said that they are encouraged to keep their training up to date and feel well supported by the manager. Mandatory training is carried out in; moving and handling, fire safety, medication, first aid, health and safety, food hygiene and safe handling of medication. The manager stated that the three new staff are currently undertaking their induction and foundation training and completing a skills for care workbook. These booklets were not available for inspection as staff had them at home however the inspector saw the home’s induction record in each of the files. Staff confirmed that they receive regular supervision from the manager and staff meetings take place regularly. The inspector saw supervision contracts on each of the staff files he examined. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service is managed in an open manner by an experienced and skilled manager however improvement is required in some areas to demonstrate that this is effective. The home does not have a system is in place to develop the service with views from service users and their families included in this process. EVIDENCE: Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 21 The manager is experienced in the management of residential services for vulnerable people, has completed a NVQ level 4 in care and the registered manager’s award. Staff and people who use the service spoke highly of her. Areas have been identified in this report, namely the recruitment of a staff member without a valid CRB check that will need to be addressed to demonstrate that the service is being effectively managed. The home has not developed the quality assurance system as outlined at the last visit. The manager had started by sending out questionnaires to people who use the service and their families in March of this year however they have not collated this information yet. The manager stated that they are still to survey staff and other stakeholders but need to develop a survey for this. During the discussion with the manager it was noted that the service does not have its own quality assessment process or policy. The manager agreed that this is required. The inspector confirmed by examining the homes servicing records and in formation supplied by the manager in the AQAA that the alarm system has been serviced regularly. Weekly alarms tests are completed, a fire drills and staff training in fire safety take place regularly. A weekly inspection of all fire fighting equipment takes place. The manager took advice fro the infection control nurse following the last inspection who advised that the use of towels in bathrooms and toilets would be acceptable if they are regularly checked, laundered and replaced. The manager stated that these are replaced regularly throughout the day. The inspector note a stretch of exposed heating pipe work in a bedroom that could be a potential risk to the individual should they fall. The manager said that this has not been covered in the person’s risk assessment and they are not at risk of falling. The inspector advised that this included in the person’s risk assessment and if required remedial action taken to keep the person safe. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 22 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 23 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 YA24 Regulation 23 Requirement Provide people who use this service with better facilities on the lower ground floor including the refurbishment of the toilets. The carpet in the bedroom identified on the lower ground floor must be replaced. The outlook and light must be improved by the replacement of the obscured glass in the shared bedroom on the lower ground floor. Staff employed by the provider must have a CRB check and protection of vulnerable Adults list check. Timescale for action 19/10/07 2. 3. YA24 YA24 23 23 17/08/07 17/08/07 4. YA34 19 17/08/07 5. YA39 24 A quality assurance system must 14/09/07 be put in place to develop and improve the service based on the views of people who use the service and their representatives. Summerlands DS0000011856.V338740.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The key-worker meetings should be restarted to enhance the good care planning system in place and promote people’s involvement in the planning for their support needs. 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