Inspection on 16/03/07 for The Beeches

This inspection was carried out on 16th March 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 13/02/09

The Beeches 22/02/08

The Beeches 15/11/05

The Beeches 16/05/05

The Beeches 31/08/04

The Beeches 19/04/04

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

CARE HOME ADULTS 18-65 The Beeches 35 Ethelbert Road Canterbury Kent CT1 3NF Lead Inspector Kim Rogers Key Unannounced Inspection 16th & 19th March 2007 11:00 The Beeches DS0000023597.V318674.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 The Beeches DS0000023597.V318674.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. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 35 Ethelbert Road Canterbury Kent CT1 3NF 01227 769654 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 David John Barzotelli Care Home 18 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (4) of places The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 15th November 2005 Brief Description of the Service: Beeches is a care home providing personal care, support and accommodation to 18 people with learning disabilities. Service users at this home should all be over 18 years of age. The home is located in a residential part of Canterbury, not far from the city centre and close to public transport. The home consists of a large detached building with an extension to the rear. All bedrooms are single. There is parking space at the front of the house and also some on road parking. At the rear of the house is a garden area, with seating, greenhouse and shed, which is well maintained and accessible. The owner is Mr David John Barzotelli. Mr Barzotelli also owns another home in the area. The fee for this home is about £600 per week. For more information about the home, fee etc please contact the Provider. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and carried out over two days, four hours on a Friday and two and a half hours on a Monday. Staff and service users assisted the inspector. The manager has changed since the last inspection. The manager was not at the home on either day of this inspection so the ‘temporary manager’ assisted the inspector. Following this visit the CSCI was informed that the manager had left and the temporary manager will oversee the home until a permanent manager is recruited. Some work was carried out prior to the site visit including surveying some service users and care managers. A pre inspection questionnaire was supplied, which was analysed. During the site visits the inspector spoke to service users and staff, made observations, had a look around and sampled some records. Service users said ‘I look after the garden. I go out there every day if I want’ Comments cards from service users indicated that service users feel safe and well cared for and have enough to do. Surveys completed by relatives sent to them by the home indicated that 100 are happy with the service provided. What the service does well: What has improved since the last inspection? The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 6 A competency assessment for staff has been developed since the last inspection. This checks staff knowledge and competency in several areas including adult protection and medication. The one double room has been divided into two single rooms. 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 The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 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 The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users know their needs will be assessed. This assessment should also include aspirations. Information about the home is available but not in suitable formats for service users. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before a person moves in the home carries out an assessment of needs. This was evident in service user plans. Service users and their representatives are involved in this assessment process. Sometimes care management assessments are received. Some assessments were sampled and none had an assessment of aspirations or personal goals for the future. Aspirations and personal goals must be assessed and supported. Prospective service users are given information about the home. Current service users do not have individual copies but have access to this information from the office. The home now offers a respite service and supports some service users who are over 65 years of age. The Statement of Purpose and service user guide should be reviewed to include this information. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 10 Service user plans sampled had contracts detailing terms and conditions of residency and service users or their representatives had signed them. Some information is not included and should be, for example the procedure of service users paying for their own and staff food and drink when out. Information about the home is written and therefore not in a suitable format for all service users to understand. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 11 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): 6,7,9 The lack of person centred plans means service users may not have the support they need to lead the life they want. Review must be more meaningful to ensure the support provided is effective. Communication could be better supported with the development of communication aids and systems. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a service user plan, which were sampled. Plans detail individual needs including mobility, communication, health and relationships and action needed by staff to support these needs. Plans should also include support needed to achieve personal goals. After reading a plan you do not a feel for who the person is, where they are from and what life they want. For example there was no mention of a person’s significant life events or aspirations. Plans should be person centred to ensure The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 12 service users get the support they need to lead the life they want. Plans are not in formats understandable to individuals. Risks assessments are included in service users plans and relate to assessed needs. Staff sign and date a review sheet regularly and note no changes or some changes. There is some evidence that service users are involved in this review process. This review appears ineffective, for example a ‘plan of care’ to prompt a person to use the WC every hour dated 11/4/06 showed the results of review as ‘no change’. Yet the daily record showed the person is regularly incontinent. No action had been taken in response although the plan appears to be ineffective. It was unclear if staff are still following the plan. Some plans and risk assessments need more detail for example one plan stated ‘X can grab staff and fall down’ with action by staff to address this recorded as ‘ X needs to understand the dangers of this ‘ There was no mention of how X will be supported to understand this and what support is necessary to ensure the safety of X and staff. Daily reports by staff do not reflect the support being delivered for example one report from 5/3/07 to 12/3/07 showed ‘has appeared happy’ for the majority of the entries. There are some aids, which promote communication for example a board shows the day and date and the names of staff on duty. This could be further developed to increase choice and decision-making and was discussed with staff. Staff are trained to level 4 in Makaton. Communication needs are assessed in individual plans, but the lack of effective review means it is unclear if interventions are successful in improving communication. For example one plan dated 4/4/06 stated the plan was to ‘introduce Makaton (signing) gradually, point, pronounce words..’ The review sheet to date showed ‘no change’ Staff said introducing Makaton was not successful so had ceased but there were no changes or updates to the plan. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16,17 Service users have opportunities to join in activities and most access community facilities. Existing relationships are maintained but more could be done to support new relationships and friendships. Service users rights and responsibilities are recognised. Service users have a balanced diet and there is potential for service users to be more involved in planning and preparing meals and packed lunches. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Generally staff are aware of the need to support people to develop their skills including social, emotional and independent living skills. This could be more reflected in individual plans by identifying personal goals and the support needed to achieve these goals. For example, one service user told the inspector about wanting to clear out the greenhouse and grow tomatoes and vegetables. This should be planned and supported. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 14 There are no individual activity planners. Activities are offered in house daily by support workers. Service users are only aware of what’s on offer if staff tell them as there is no visual activity information. Shift planning is not used therefore activities can be ad hoc. Daily reports do not show the support being delivered to increase opportunities to take part in meaningful activities. On the first day of the inspection there was a treasure hunt in the garden and on the second day some members of a local church sang songs with service users in the lounge. Service users have opportunities to access community facilities including day centres, shops etc. No one currently has a job. Current relationships are detailed and supported in individual plans. However there is no mention of how service users will be supported to develop new friendships and relationships to increase their social circles. Not all service users have a key to their room and the front door. An assessment relating to this decision was seen in an individual plan. Staff knock on service users doors before entering. Access to the home and grounds is not restricted. Rules about pets, smoking, alcohol etc are detailed in contracts of residency. As mentioned this information is currently in written format. The kitchen is accessible to service users and there is also a separate training kitchen. There is a menu and a record kept of meals and alternatives taken. Service users only know what’s for dinner of staff tell them. This was discussed with staff who suggested a picture board might be useful. The home has a cook who is aware of service users likes and dislikes. Fresh fruit and vegetables for snacks are available and the cook promotes the benefits of healthy eating and exercise. Increased exercise has been promoted following feedback from relatives. Special diets are catered for. A mealtime was observed. This was relaxed with service users given the time they need. Service users are supported discreetly and respectfully. Service users are encouraged to take part in the clearing up after dinner. Service users can help themselves to drinks and there is a water cooler in the dining room. There is a rota showing service users share the cooking and household tasks. Waking night staff prepare packed lunches for service users. There could be potential for staff to make packed lunches with service users rather than for them. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 15 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 Unrealistic expectations means service users do not control their own medication although some could. Health needs are assessed and service users are supported to access a range of healthcare support. Personal care needs are met but more detailed records would ensure that service users get the support they need and prefer. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some service users need support with their personal care. The lack of detail in individual plans means that service users may not be supported in the way they prefer. Each room has a wash hand basin and bathrooms and toilets are sited near to bedrooms. General health needs are assessed and recorded in individual plans with a record of health appointments attend. This should be developed into individual health action plans. All service users are registered with a GP and have support to access specialist support when necessary. Weight is monitored and exercise promoted following feedback from relatives. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 16 Due to the lack of effective review of individual plans it is difficult to establish if current support is adequate. No service user currently controls their own medication although staff agreed this should be reviewed as some people could have more control. The current homes requirements for service users who wish to self medicate are unrealistic, for example the guidelines state that service users must be able to read, tell the time and understand what they are taking the medication for. Storage of medication, records of receipt, administration and disposal of medication are good. The medication procedure needs amending and this was discussed with staff. Some people have ‘when needed’ medication and need individual protocols for these. The general ‘when needed’ protocol is detailed. The deputy manager is responsible for ordering and checking medication into the home and has awareness of policy and procedures. Staff have training before administering medication then competency is checked regularly by observations and questioning. The deputy manager audits the administration records regularly to monitor compliance. Consent to medication should be established and recorded. Issues relating to consent need review in light of new legislation. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 17 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 Improved communication systems will ensure that all service users can complain and make disclosures. Service users are protected from abuse. Guidelines for problem behaviours should be more detailed and regularly reviewed. There is potential for some service users to have more control over their money. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure. This is produced in a pictorial format displayed on a notice board in the dining room although service users do not have their own copy. Improved individualised communication systems will ensure that all service users have the support they need to make complaints and express their views about the service. A record of complaints is kept. The service has received one complaint since the last inspection, which was partly substantiated. The home has polices for safeguarding vulnerable adults and whistle blowing. Staff attend safeguarding vulnerable adults training and most have recently completed a competency assessment consisting of watching a film and answering written questions. Some staff have attended ‘understanding challenging behaviour’ training and ‘Non aggressive physical and psychological intervention’ training. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 18 Guidelines to support problem behaviours need more detail for example one plan says ‘X can be loving and demanding’ with no explanation of what this means and what the behaviour might look like. Staff reported some reduction in a person’s behaviours although the review sheet showed ‘no change’ The home looks after service users’ monies and keeps individual records and receipts. After discussion staff agreed that there is potential for some service users to have more control over their money and this should be reviewed. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 19 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): 24,30 The home is clean, safe and comfortable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector had a look around the home, which is clean and comfortable. All bedrooms are now single and have wash hand basins. One room is now allocated to respite care. Rooms are personalised and individual. Service users said (on comment cards) they are happy with their rooms. Rooms are fitted with locks and service users are offered keys. Not everyone has somewhere secure in their room to keep their valuables. The temporary manager said the office safe could be used. Quality assurance results showed that relatives are happy with the environment. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 20 Bathrooms and toilets are sufficient for service users needs and have suitable aids and adaptations. The physical environment is appropriate to needs of the people who live at the Beeches. The garden can be accessed from the lounge and has chairs and patio area. A service user said they would like the greenhouse cleared so they can grow vegetables again. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 21 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 Service users are supported by sufficient trained staff who have their competency checked regularly. Service users are protected by the homes recruitment procedures and could be more involved in the recruitment of staff. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff work early and late shifts. At night there is one waking staff and one sleep in staff. There is also a cook and cleaner. A manager and deputy manager supervise staff. There is diversity on the staff team and staff have clear job descriptions with defined roles. About 30 of staff are qualified to the National Minimum Standard of NVQ level 2. The majority of staff have attended mandatory courses but there are some shortfalls that need addressing. Training relating to service users needs is limited for example person centred planning and person centred active support. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 22 Since the last inspection competency assessments have been introduced. This checks staff ongoing competency by asking them questions, oral and written. This could be developed to include other topics and was discussed with staff. A staff file was sampled. The necessary records were present relating to recruitment for example, application form, references and checks. The temporary manager said that service users have the opportunity to meet prospective staff when they visit the home for their interview otherwise they are not involved in short listing, interviewing and appointing staff. There is potential for service users to be more involved in the recruitment of staff. One staff in charge at night is under 21 years of age. There is no risk assessment relating to this breach of the standard. New staff complete a n induction in line with the minimum standard. Staff were observed interacting and supporting service users positively and respectfully. Staff spoken to have a good understanding of service users needs. 100 of relatives who responded to the homes quality assurance surveys said they feel staff are trained, friendly and helpful. Supervision for staff needs to increase to meet the minimum standard. In a staff file sampled there was only one record of supervision for each year 2005, 2006 and 2007. Staff meetings are held regularly and records are kept. Records show that polices are discussed and reinforced and service user issues are discussed. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 23 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): 37,39,42 The home is adequately run with good quality assurance systems in place based on service users and their representative’s views. Service users health and safety is protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has changed since the last inspection. A permanent manager was in post for a few months and was not present at this inspection. The manager has now resigned. The temporary manager (previously acting manager for six months) is now in charge and assisted the inspector. The Provider said that a permanent manager would be recruited. The manager supplied a pre inspection questionnaire, which showed details of the health and safety checks of equipment carried out since the last inspection. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 24 The pre inspection questionnaire shows that the home has the required policies and procedures, which have all been reviewed regularly. These can be produced in widget (symbol) and large print if necessary. Polices are discussed and reinforced at staff meetings. Some policies and procedures need reviewing for example the medication administration and self-medicating polices. The Registered Provider monitors the home regularly and compiles a report. Part of this monitoring includes talking to service users and staff. The home sends out questionnaires to service users, their representatives and staff. Service users are also supported to air their views at review meetings although improved communication systems will ensure that all service users can give their views. Results of this consultation have been complied into a report, a copy of which was sent to the Commission. Result should also be published in a format understandable by all service users. The results show that all service users who responded are happy and feel safe. When service users said they are not happy action has been taken to improve the service. The majority of staff said they feel valued and enjoy working at the Beeches. All of the relatives who were surveyed said they are happy with the service provided. Staff are aware of health and safety issues and most have the necessary training related to health and safety. Some shortfalls in staff training and competency need addressing. Accidents and incidents are recorded, reported and monitored, as they should be. The home’s fire risk assessment needs reviewing in light of changes to legislation. The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 25 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 2 3 X 4 X 5 2 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 26 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Personal goals and aspirations must be identified, recorded and supported in individual plans that are person centred. Monitoring and review of individual support plans must be effective to ensure service users have the right support and changing needs are identified. Individual and general communication systems must be developed to ensure all service users have support to air their views and communicate their wishes and choices. The homes fire risk assessment must be updated ad reviewed. The medication administration policy and self-medicating policy must be reviewed and improved. Individual PRN (when needed) medication guidelines must be developed and recorded. Timescale for action 30/09/07 2. YA6 15 30/06/07 3. YA7 17 30/09/07 4. 5. YA42 YA20 23 13 31/05/07 31/05/07 The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 27 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 YA1 Good Practice Recommendations The statement of purpose, service users guide, contract and other information should be produced in formats accessible to service users and contain up to date information. Service users should be supported to find and keep jobs, continue training and take part in fulfilling activities. Individual activity plans and shift planning should be considered. Service user would benefit from the development of individual health action plans. Assessments should be reviewed to ensure that service users take as much control as possible over their lives for example, money and medication. Staff would benefit from more supervision and training relating to service users needs, for example person centred planning and alternative communication. 2. YA12 3. 4. 5. YA19 YA23 YA32 The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Beeches DS0000023597.V318674.R01.S.doc Version 5.2 Page 29 - 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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