Inspection on 02/08/05 for The Cedars (8)

This inspection was carried out on 2nd August 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

The Cedars (8) 09/10/07

The Cedars (8) 17/10/06

The Cedars (8) 13/01/06

The Cedars (8) 03/02/05

The Cedars (8) 25/08/04

The Cedars (8) 18/03/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 8 The Cedars Ashbrooke Sunderland Tyne and Wear SR2 7TW Lead Inspector Katie Tucker Unannounced 2 August 2005 1:00pm 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 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 Stationary 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. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 8 The Cedars Address Ashbrooke Sunderland SR2 7TW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 567 9753 European Services for People with Autism Limited Mr Francis Damian Evans Care home only 8 Category(ies) of LD Learning disability (8) registration, with number of places 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3.02.05 Brief Description of the Service: 8 the Cedars is a detached five-floor house that has been adapted to provide a care service. The home provides personal care for 8 adults who fall within the Autism Spectrum. This house has eight bedrooms and is divided into two units of four. In the downstairs unit the cellar has been converted to provide a bedroom, shower and office. A mezzanine landing contains the dining room and steps, which lead to the kitchen. Both units have their own entrance. Steps lead up to the main entrance for the first unit. The second unit’s separate entrance has a level access but internally stairs lead up to the unit. Neither unit would be suitable for some one with a physical disability. The home is located in Ashbrooke and is walking distance from Villette Road shopping area. There is a range of shops on this busy parade, which include a post office, greengrocer, supermarket, chemist and newsagents. A pleasant park is easy to access. Bus stops can be found on the main road and have routes that go to the city centre and Durham. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The majority of people who use services dislike the term service users therefore in this report people will be referred to as residents. This was an unannounced inspection of 8 The Cedars and was conducted as part of the routine yearly programme. An inspector visted and spent half a day at the home talking with residents and staff. A sample of risk assessments were examined. The staff were asked about the care plans, the complaints procedure, access to training and any changes to working practices. The residents were asked about life at 8 The Cedars and the activities that they joined in. The general maintenance of the building was checked. 8 The Cedars provides a service for younger adults with an Autism Spectrum Disorder. People at the home have difficulty understanding abstract thoughts and emotional context. Also people find changes in routine very difficult to deal with and other people’s needs and feelings difficult to understand. A number of the residents find meeting strangers extremely challenging and if given the option would not like to spend time talking to new people. These people’s wishes were respected. A part of the inspection however does look at staff practice and attitude. This type of observation did form a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by residents and the staff. During this inspection key standards were focused on but not all were checked. What the service does well: The manager and staff have consistently shown that they are able to work well with people who have an Autism Spectrum Disorder. Staff constantly challenge the boundaries of residents’ experiences and provide people with the new and different opportunities. They are adept at working with people in a manner that will assist people to remain comfortable and willing to try something new. Thus some residents have joined in a rowing competition, others enjoy horse riding and join in conservation projects, performing arts as well as assist in completing wood work projects. Some of the people have extremely complex needs and previously have experienced a great level of anxiety, which has led to people risking hurting themselves or others. Over the years since the people have lived at 8 The Cedars this behaviour has markedly reduced and disappeared for some people. This type of change has not been achieved within the other care settings people have lived. Although it has taken time the approaches staff have developed and used contributed to the reduction. Staff have not stopped 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 6 working towards changing behaviour and tried a range of approaches to find ones that work for each person. ESPA employs and has access to a range of specialists such as psychiatrists and psychologists. These specialists regularly visit residents and provide support in all aspects of people’s lives including sex education, managing anxiety, and social skills. They also provide support and advice to staff. Staff’s in depth knowledge of the difficulties that people with autism spectrum disorders experience allows them to actively promote people’s wellbeing. ESPA has a range of services, which includes day service (the Croft Centre) that has been specifically designed to meet the needs of this client group. It features a café were people can serve and provide meals, performing art facilities as well as craft and aromatherapy facilities. A dedicated and appropriately qualified staff team work at the Croft Centre. Residents from 8 the Cedars regularly use these facilities and staff accompany people to offer support if it is needed. 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. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 The way in which the assessment material is collected and recorded means residents’ needs can be met at 8 the Cedars. The various styles of service user guide makes it useful to all but lack of information about fees flaws this record. EVIDENCE: An assessment panel (which consists of experts in the field of understanding the autism spectrum) determine whether people’s needs can be met by ESPA and the service that will be the most appropriate for that individual. This process ensures that when people move to 8 the Cedars the manager can be confident that all of the information has been obtained and that the service is appropriate for that particular individual. ESPA has also developed a full and comprehensive assessment tool (the living plan) for the home. Information from the initial assessment via the panel is included, which ensures full background information is available to the staff working with the individual. Staff have completed the assessments for all of the residents and have involved them if possible or their relatives within this process. The assessments are extremely detailed, well written in plain English and outline all aspects of the individual needs and aspirations. Staff ensure information on past behaviour is kept but say whether it is current or not. Thus anybody working with a person would know what works well and what does not. If a new behaviour develops whether this has happened before, if so how it was extinguished or if it is cyclic behaviour that disappears of its own accord. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 9 The service user guide clearly outlines the service provided at 8 the Cedars and is provided in a range of formats. It also contains a summary of the items listed in Schedule 1 of the Care Home Regulations 2001. Thus people have the full information needed to make a decision about whether they like the sound of the service. A generic the terms and conditions of residence is included in the service user guide for specific individuals, which does provide space for the inclusion of the amount of fee however individual agreements do include this information. Also copies of the local authority placing agreement are not provided. These are not only required by regulation 5 of the Care Home Regulations 2001 but without them people cannot make informed decisions about whether the feel that the service they are getting is value for their money. ESPA has stated that relatives have copies of their terms and conditions, which includes the fees and at present they are working with local authorities to ensure agreements are provided. The evidence that representatives have signed the terms and conditions and know the fee levels is not provided at the home so this cannot be verified. Also the local authority placing agreements often stipulate specific conditions such as the number of staff that needed to be provided for an individual. By not having a copy at the home the manager, residents or relative cannot check that contractual agreements are being met. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9 The format used for risk assessments is very comprehensive but at times staff do not use it to demonstrate how they are working with people around the risks that they encounter. EVIDENCE: The risk assessment format allows staff to record full and detailed information about the presenting risk and actions staff have to take to reduce or work with the risk. The plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. Staff have ensured that they step out clearly each action that needs to be taken. However some of the strategies that have been put in place need to be reviewed, as they do not accurately reflect staff and resident practice. Also staff at times are not evaluating them in line with the timescales they have set. Also when they have evaluated them they at times have not up dated the action although the evaluations so that practice has changed. The service users have the potential to challenge staff in many ways including passive challenge. The plans are under review and were not available for inspection. They will be checked at the next inspection to confirm that that they are complete and identify primary and secondary actions to be taken prior to the use of physical interventions. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The skilled work of staff and the range of experiences offered both by ESPA and 8 the Cedars have allowed residents to greatly widen their life and expectations. EVIDENCE: Over the years residents have been encouraged to widen the range and types of activities they join in. People regularly go to the pictures, shops, and local pubs as well as joining in a range of more challenging activities such as canoeing, rambling and horse riding. The staff have not become entrenched in common assumptions about people within the Autism Spectrum Disorder not liking or being able to change routines. They have skilfully worked with people to work with their preferred routine and gradually introduce different activities. This skilled approached has allowed people to find out if they do like different activities. ESPA also runs the Croft Centre, which provides a range of courses and opportunities for people. The difference in the range of skills people have and how they positively deal with the stresses and strains of everyday living is extremely marked. Residents also go on various holidays and staff have tailored these trips to meet people’s specific needs. Thus some people have been on short camping 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 12 trips because they find they are able to cope well with this type of holiday whilst others have stopped in hotels. Family are constantly involved in the care of residents and are aware of how staff are working with people. The residents regularly write and visit their relatives. The staff accompany people on the home and return trips when relatives cannot pick people up. The way staff and ESPA promote the full involvement of relatives helps to ensure residents and relatives fell valued by the service. People with Autism Spectrum Disorders find it difficult to form meaningful relationships and understand other people’s needs. However staff have worked within the boundaries of each person’s social and emotional skills so that they can live with the other people in the home. Also ESPA employs a psychologist who works with people around sex education and forming relationships. This is specifically targeted to the needs of each person so is very helpful for all concerned. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 ESPA and staff have demonstrated an in depth knowledge of the difficulty that people within the autism spectrum experience and this means they can actively promote people’s wellbeing. EVIDENCE: ESPA employs and has access to a range of specialists such as psychiatrists and psychologists. These specialists regularly visit the residents at 8 the Cedars and provide support in all aspects of people’s lives including sex education, managing anxiety, and social skills and also provide support and advice to staff. The staff have acted upon the interventions the specialists have suggested and asked for further support when necessary. They also have shown the confidence to assess and identify when a strategy is not working as well as hoped and made specialists aware of this. Thus they have kept an open mind and worked hard as advocates for residents to ensure people can reach their potential. Also staff have worked closely with GP, community nursing services and hospital staff when someone is physically unwell. The staff work with service users in a sensitive and skilled manner. The staff have repeatedly demonstrated that they are able to communicate will people and identify when a particular behaviour may indicate that the person does not feel well. Then they have always ensured that appropriate medical help is sought. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The complaints procedure is available in various formats and all using the service can understand it. EVIDENCE: ESPA developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. They have considered all of the communication needs of the residents who use their services and developed a comprehensive range of formats. These formats include tape, pictorial and written styles. The speech and language therapist employed by ESPA has been involved in developing these accessible formats. Thus staff can be confident that people with a range of needs can understand the complaints procedure. This is reproduced in the service user guide and made available to all the residents and their representative. The manager and staff recognises the importance of dealing with minor concerns in a proactive manner. The staff and ESPA actively encourage residents and relatives make their views known. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 On the whole the building meets the needs of the residents and visitors with a disability. However because of recent unforeseen events some of the parts of the home are not in good repair. EVIDENCE: The design and location of the home is a positive feature as it blends in well with the community. The home exceeds the current space requirements of the national minimum standards in all areas. However not all of the bedrooms offer an en suite facility. 8 the Cedars is usually maintained to a high standard but recent issues with the maintenance team has meant delays in agreed refurbishment have been seen. Thus one bathroom and kitchen need, as a matter of urgency, works completed to bring them up to a good standard of decorative repair and meet infection control requirements. 8 The Cedars is not suitable for someone who has a physical disability because of the access to and throughout the home is via stairs. But ESPA has considered what has to be done should someone visit who has a disability. When the environmental standard changed the Government set certain requirements. One of these being the service user guide had to reflect where the home does not meet the requirements of the standards for new registrations. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 36 Staffing levels meet the needs of the residents. The staff team are effective and are in the process of completing appropriate NVQ Awards to demonstrate their competency. The physical interventions training, at present leaves ESPA vulnerable, as it prevents them from being fully insured. EVIDENCE: At all times during the day at least 4 care staff inclusive of a senior care are at work during the day but often 5 staff are on duty. Currently additional staff are at the home being trained so they can work in new services that are being developed so more staff are around. At night 1 waking staff member plus a sleep-in senior staff member are on duty. Without the placing contracts being available it is uncertain whether 8 the Cedars is complying with any specific contractual arrangements that have been made. A cook/domestic is employed for 40 hours per week. Care staff with service users also complete domestic and catering tasks. ESPA provides an in depth training programme, which is specific to autism specific disorders and newly appointed staff receive induction and foundation training. All mandatory training is covered in the first six months. Training is delivered centrally and in-house and most trainers have completed qualifications to make sure they are the appropriate person to teach a particular course. However the person who completes physical intervention 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 17 training had not received accredited training in this area for some years. This means staff using these techniques cannot be confident that they are following current good practice also they do are not insured. Thus should any injury occur when staff are using an intervention ESPA is not covered by their public liability insurance and cannot demonstrate they meet the requirements of Health and Safety legislation. The manager has been to a training course on physical intervention, which was provided by an accredited trainer as have a couple of the senior staff. However the staff involved in most interventions have not been on accredited training. The numbers of physical interventions that have been needed is fairly limited but in recent months have increased. Some incidents have been quite severe such as a staff member being pulled around by their hair. These has incidents have been successfully resolved and appropriately recorded plus the staff members have been debriefed. On the whole staff have been able to use a range of primary and secondary interventions to ensure incidents have not escalated to the point where a physical intervention has needed to be used. Also staff explore any underlying reason why such incident might be occurring and taking action to reduce triggers. This type of proactive approach reduces levels of stress for all concerned. 25 of staff now hold a NVQ Award and the remaining staff are either on their way to completing a course or about to start one. Thus it is expected that by the date required by government for 50 of staff to hold this type of award, December this year, 8 the Cedars will have more than 50 of staff with this award. The manager has nearly completed the Registered Managers Award. The assistant unit manager and a senior support worker are working toward the Joseph Rowntree Award. This is a degree level course, which includes the Registered Managers Award. The manager is also ensuring that all of the staff receive appropriate supervision. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Action is being taken to make sure the health and safety needs of residents and staff will be met. EVIDENCE: The manager is now ensuring that all of the fire instruction and training is completed at the specified times and recorded. Residents are included in this training so know what to do in the event of a fire. The lack of accredited physical interventions training poses potential health and safety risks for the residents and staff. This was discussed at length with the deputy manager who said he was aware that it was something that ESPA had acknowledged and were in the process of resolving. It was felt that there was potential for ESPA to become an accredited trainer because on the whole the content of the courses offered would meet the requirements of BILD. The government has identified BILD as the only organisation responsible for verifying and determining which providers are accredited trainers. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x 4 x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 4 x x 3 x x Standard No 31 32 33 34 35 36 Score x 2 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 8 The Cedars Score x 4 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 20 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 1 Regulation 5 (3) Requirement Timescale for action 8.11.05 2. 24 13 (4) (a) The owners must ensure a copy of the local authority placing contract is provided to each service user guide and available in the home. (Requirement made at previous inspections – timescale for action 23.02.05) The toilet must be repaired and 11.02.06 recommissioned. The downstairs kitchen must be refurshbished and fixtures such as the fridge renewed. All staff who use physical interventions must have accredited training and this must be refreshed on a yearly basis. 3. 35 18 (1) (c) 24.01.06 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 35 Good Practice Recommendations Consideration should be given as to how 50 of care staff will achieve a NVQ Level II by 2005. 8 The Cedars B52 B02 S15774 8 The Cedars V219529 2 Aug 2005 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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