Inspection on 30/08/07 for Tarn House

This inspection was carried out on 30th August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tarn House 02/06/09

Tarn House 30/06/08

Tarn House 26/06/06

Tarn House 24/11/05

Tarn House 23/06/05

Tarn House 05/01/05

Tarn House 13/09/04

Similar services:

Ruskin Lodge

Clover House

Dystlegh Grange

The Good Companions

Cuerden Grange Rest Home

Springfield Cottage

Parkside

Park Lodge

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

CARE HOME ADULTS 18-65 Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX Lead Inspector Unannounced Inspection 30 August & 4 September 2007 08:00 th th Tarn House DS0000036626.V346272.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 Tarn House DS0000036626.V346272.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. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tarn House Address Mill Lane Walney Barrow in Furness Cumbria LA14 3XX 01229 471798 01229 470125 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.cumbriacare.org.uk Cumbria Care Mrs Bernadette Eileen Calldine Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (1), Physical disability (3) of places Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 14 service users in the learning Disability (LD) category to include: Up to three service users in the category Physical Disability (PD) 1 service user in the category Learning Disability (Elderly) (LD(E) Maximum number registered 14 One named service user in the category of LD (Learning Disability) may be accommodated within the overall number of registered places. 26th June 2006 2. Date of last inspection Brief Description of the Service: Tarn House is a care home providing personal care and accommodation for fourteen adults with learning and or physical disabilities. The home is owned by Cumbria County Council and managed by Cumbria Care, an independent business unit of the County Council. It is situated in a residential area of Walney Island and is close to local amenities and a local bus route that services the island and the nearby town of Barrow-in-Furness. The Home is on two storeys and is divided into four distinct units. These are called hill view, sea view, Greenland’s and Beachwood. Three of the rooms are used for short-term respite care. Each of the units has a lounge and a separate kitchen with dining area. All the bedrooms are single occupancy, some of which are fully accessible for people with physical disabilities. To the rear of the building are two fenced garden areas with seating. To the front of the building are open plan garden areas and a large car park, which is shared with the adjoining day service. The scale of charges for the home range from £635.56 to £854.11 with additional charges agreed on an individual basis for personal sundry expenses. The home makes relevant information available to residents in an accessible format. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over two days, 30/08/07 and 04/09/07. I arrived early on both days to enable me to see the morning routines in all areas of the home and to meet with people before they left for the day service. I also spent time with them on their return from day services. I received surveys about the quality of care from people who live in the home, their relatives, care staff and other professionals. This provided me with opinions and information about how the home is run. I met with all of the people living in the home, the care staff and supervisors on duty over the two days and the manager. What the service does well: Before someone moves into the home one of the senior staff will meet with them to find out about them and how they like to live their lives and what support they will need. This is written in a care plan so that all the staff know what to do. Some information is recorded in an, ‘easy read format’, using pictures and symbols to make it easier for people to understand. There is lots of information about people that helps staff to understand how they like to live. Staff know people well and support them to do the things they want to do when they want to do them. They get good training so they have the right skills to help people. People are involved in making decisions about their lives and how the home is run. People have busy social lives and enjoy going out in the local community and meeting up with their family and friends. People and their representatives are asked on a regular basis about what they want and if they are happy with the service, so things can be changed if they are not working for them. Tarn House DS0000036626.V346272.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. Tarn House DS0000036626.V346272.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 Tarn House DS0000036626.V346272.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): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place that make sure the home is able to meet people’s needs and that they are aware of their rights and involved in making a decision to move into the home. EVIDENCE: An easy read Service User guide has been developed, which is given to people who are visiting the home or moving into the home. It has relevant information, which enables people to make and informed choice about moving in and what the rules of the home are. The statement of purpose should be kept up to date as changes occur. People are encouraged to have family or their representative supporting them through the admission process. There is an admission policy in place that guides people through the process. All the people living in the home have been referred through a Social Work Care Manager so have a Social Work assessment completed. In addition a member of the senior team will complete a pre-admission assessment. This is completed in liaison with the person, their family or representative and any Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 9 other agencies involved. Based on these assessments and any other specialist assessments a personal support plan is agreed with each individual. Risk assessments are also completed highlighting the severity of the risk and how it will be controlled or managed. One of the staff team will be appointed as a link worker who then takes a lead role in working with the person and significant others, to ensure their “voice is heard” and they get the support and services they need. New placements are reviewed after a six week probationary period so that the suitability of the home can be assessed. Contracts are agreed with Social Workers that are held on file, terms and conditions are agreed and issued to people in the Service User guide. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Informative person centred plans are in place for people who live in the home. They are involved in decision making and participate in all aspects of home life. Some information is not being regularly reviewed and kept up to date for people who have short stays. EVIDENCE: A person centred approach to care planning is being introduced that ensures people’s individual and diverse needs are noted when recording information, this includes personal preferences about lifestyle, cultural needs and beliefs. A good example of this was someone who requested personal care only from staff of the same gender, which has been respected. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 11 Information is recorded in a way that makes sense to the person and they are central to the whole process. There were some excellent examples where photographs had been used to record someone’s life history. Personal relationships and friendships are encouraged with staff providing unobtrusive support to help people keep in touch with and meet partners and friends. All routine and one off appointments with health professionals are recorded including regular reviews of medication. The majority of the people now have an individual health action plan. Some people are supported by the community health team to make sure their complex healthcare needs are responded to appropriately. The service user guide highlights people’s rights and responsibilities but staff are also aware of the need to reinforce this with people on a regular basis to enable them to exercise choice and control in their lives. Information relating to independent advocates is also available, with staff supporting people to access services when required. Through one to one consultation and house meetings people are involved in the day to day decisions about the management of the home. During the pre-admission assessment and on an ongoing basis risk assessments are completed when hazards are identified. This ensures the safety and welfare of people living and working in the home. However the review of risk assessments to make sure they are relevant and up to date is inconsistent particularly for people who are having a short stay. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People continue to enjoy a busy and active social life by pursuing their personal interests and hobbies, with staff encouraging and supporting an independent lifestyle. EVIDENCE: All the people living in the home attend a local day service on either a full or part time basis. Some people also have work placements or are involved with educational activities at the local College. The Day service provides them with a range of educational, vocational or leisure activities of their choosing. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 13 People I spoke to during my visits said how much they enjoyed a range of community activities including, day trips, going out socialising with friends, going for a meal or a drink at the pub or going to town. People were relaxed in the home environment where they could choose to spend time socialising in one of the communal areas or enjoy the privacy of their own rooms. The garden patio area has been extended this year, which was fully accessible. This has enabled people to enjoy relaxing in the garden with friends. Local amenities are within walking distance, which some people are able to go to independently. Staff support people to develop their independence both in the home and in the local community. Some of the people talked to me about how much they had enjoyed their annual holiday, which was very important to them. Staff have shown a high level of commitment to make it possible for people to go on holiday, which is commendable. Feedback from relatives and staff confirmed that people enjoy a good quality of life and can lead an independent lifestyle, which the following quote describes, “the service is flexible and able to adapt to the individual needs of people”. Some people are involved in preparing their own meals such as making a packed lunch or cooking an evening meal. The level or type of support they require is assessed and recorded in their care plan. People are also involved in planning menus for the week and shopping for the food. There was evidence of referrals to the Dietician for specialist advice and support, with healthy eating encouraged with people having a varied and nutritious diet. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Personal and healthcare needs are recorded in detail in a way that people understand. Some medication records are in need of review to make sure medication is administered as prescribed. EVIDENCE: All personal and healthcare needs are recorded in a person centred care plan and a health action plan. This ensures staff are aware of individual needs and how people prefer to be supported. Contact with health professionals is monitored with a record maintained of the outcome and changes to the care plan. Person centred plans are very detailed and record people’s likes, dislikes and preferred routines in a format that they can understand. A good example of this is a person who requested that personal care is provided by someone of the same gender, which is recorded in their care plan and respected by staff. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 15 Based on discussions with staff they have a good understanding and awareness of individual personal and healthcare requirements. Staff also work closely with families and other agencies to make sure they have all relevant information and referrals are made to specialist services as the need is identified. All the people living in the home are registered with a GP of their choice, in addition to people having contact with the Community Health team such as the District Nurse and Community Nurse on a regular basis as needs are identified. A number of medication errors have been reported since the last inspection visit. These were investigated by the manager and a report completed with actions highlighted to improve systems and prevent a reoccurrence. A common error related to missed medication when people were staying in the home on short term care and also when changes to medication had not been noted. This is despite the home having a second person called a “quality checker” supporting the person administering the medication. People staying in the home on short term care now have a specific prompt form completed, which is put on the front of the medication cabinet to act as a reminder for staff to check their medication needs. I checked the medication records against the medication held in the home. There was a clear record of all medication coming into or leaving the home. The medical records (MAR charts) were all signed, up to date and accurate. There was guidance in place for staff relating to all PRN (as and when required) medication. All medication was securely stored at all times. It is recommended all care plans should include information about why medication is required and a record of people or their representative giving their consent for staff to administer their medication. Any hand written alterations to a MAR chart should be checked and signed by two people. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are safeguarded from abuse by the policies and procedures in place. They feel staff listen to them and act upon their concerns. EVIDENCE: The home had received one formal complaint since the last inspection, which was investigated in line with the home’s policy. The policy is displayed in the home in an easy read format using signs and symbols. It is also included in the service user guide and statement of purpose. Based on feed back from the surveys sent out as part of this inspection, people using the service and their relatives are aware of how to complain and who to complain to. People said they felt “safe”, with relatives saying that they felt confident “concerns would be dealt with properly”. There are suitable policies and procedures in place including the local authority policy on the Mistreatment of Vulnerable adults. Staff have received suitable training, based on discussions with them they had a good awareness of what constitutes abuse and their responsibilities in reporting it to safeguard people. Robust financial procedures are also in place that protect people from financial abuse. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27,28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some areas of the home environment have been improved, some aspects of the home are unsightly and not appropriate in a domestic setting. EVIDENCE: All areas of the home were clean and hygienic and there were no malodours. Since the last inspection different areas of the home have been improved with new decoration and furniture. However some aspects of the environment are unsightly and not something you would expect to see in a domestic household. This includes grey insulating foam, held on with black tape, on hot water pipes in both lounge areas and bedrooms and metal radiator guards, which look institutional and are not domestic in style. It is recommended suitable alternatives are found for these items. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 18 Due to the home pre-existing the NMS some of the rooms are undersized, which is recorded in the statement of purpose. Currently the fire escape is being surveyed with a view to replace or repair it depending on the outcome of the report. There are also plans in place to decorate and furnish the upstairs flat, which is in need of refurbishment. The garden area has been improved with the addition of a larger more accessible patio area, which people have enjoyed using in the summer months. People have been involved in tending the garden and making planters for the new patio area, which has created a pleasant outdoor facility. There are plans in place to develop another garden area with a pond feature and some raised garden beds to make them more accessible to people to work on them. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole there is a stable and well trained staff team in place who provide a consistent and reliable service. EVIDENCE: Staff talked about having “good relationships with people” and it was evident from my discussions and observations that they had a good understanding of individual needs and idiosyncrasies. There is a positive atmosphere in the home with the people who live there and the staff working closely together to ensure they were leading fulfilling lives. Staff also talked about “working well as a team” and having good communication, with regular supervision and team meetings”. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 20 Staff are skilled at taking on an enabling role and offering choices to people in all aspects of their lives even with people who have very limited or no verbal communication. The person centred plans are invaluable in providing staff with an insight into how people communicate and what is important to them and how they make their needs known. There is a high level of commitment from staff to ensure people get the support they need in all aspects of their lives. There are robust recruitment procedures in place that ensure all staff are checked and suitably skilled to work in the home. The LDAF (Learning Disability Award Framework) induction and foundation course is completed by new staff as well as an in-house induction to the people who live there and the policies and practices of the home. Staff said training was “good and helped them in their role”. The organisation has a central training unit that produces an annual training plan for all staff. Through regular supervision the manager monitors the training needs of staff, which are recorded in a Continuing Professional Development file. Supervisors pass information onto the manager regarding training activity to inform a monthly report to senior managers. Currently just under 50 of care staff are qualified to NVQ2 or above but plans are in place to increase the assessor support, which will improve this situation. Based on examination of the staff rotas there are sufficient staff on duty and staff absences on the whole are covered by experienced relief staff that have been inducted to the home. However due to the commissioning arrangements around one package of care, there is some pressure, as this has resulted in a small staff team being in place, which has led to staff feeling isolated and having to cover a lot of shifts, in what is an intense environment. Recruitment is taking place, which should resolve this situation. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s views are listened to and respected ensuring the home is run in their best interests. The manager and supervisory team provide sound leadership and support. EVIDENCE: The manager continues to manage the home effectively providing clear leadership and support to staff and the people who live there. People feel “valued” and contribute to all aspects of the running of the home. An annual business plan is produced which incorporates organisational targets as well as Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 22 areas for action, development and improvement specific to the home. Progress is measured against these agreed targets that are developed through consultation with people who live and work in the home. Targets included areas such as staff supervision, training and development as well as targets to improve the quality of life of people living in the home. These included the development of person centred care plans, improving information and communication and completion of health action plans. The home has what they call an annual “service user survey” that is given to all the people living in the home or their representative, to get feedback about different aspects of home life. Parent/carers and other professionals involved with the home are also consulted. The results are then incorporated into a development plan, which was displayed on the notice board as well as people being given their own copy. Consultation also takes place in more informal ways through the role of the link worker and at house meetings and team meetings. This ensures people are able to contribute to the decision making process and their rights and best interests are respected. On the whole the records relating to the running of the home were up to date and accurate including the servicing and maintenance of equipment and the environment, although the manager’s monthly checklist was in need of updating. Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 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 2 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 3 3 3 X Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 2 3 4 Refer to Standard YA1 YA6 YA9 YA20 Good Practice Recommendations The statement of purpose should be reviewed and updated as changes occur. Care plans for people on short-term care should be reviewed and updated on a regular basis. Risk assessments should be regularly reviewed to make sure they are up to date and accurate. All care plans should include information about why medication is required and a record of people or their representative giving their consent for staff to administer their medication. Any hand written alterations to a MAR chart should be checked and signed by two people. 5 YA20 Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 25 6 7 YA24 YA24 It is recommended the metal radiator guards be replaced with a more suitable domestic style alternative. It is recommended that pipes that are protected with grey insulation wrap and black tape should be protected/covered with something more suited to a domestic situation. The staff levels in the upstairs flat should be improved to ensure the safety and welfare of the person living there and the staff. 8 YA33 Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Tarn House DS0000036626.V346272.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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