Inspection on 01/05/07 for The Firs, Paignton

This inspection was carried out on 1st May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Firs, Paignton 24/10/08

The Firs, Paignton 04/01/06

The Firs, Paignton 16/06/05

The Firs, Paignton 03/12/04

The Firs, Paignton 13/07/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Firs, Preston 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ Lead Inspector Michelle Finniear Unannounced Inspection 1st May 2007 09:00 The Firs, Preston DS0000018442.V335009.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 Firs, Preston DS0000018442.V335009.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 Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs, Preston Address 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ 01803 523191 01803 523191 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) Havencare (Plymouth) Mrs Patricia Clare Cronin Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: The Firs provides care for up to four adults with learning disabilities and/or additional physical disabilities. The Home is a detached property with level access to local shops, amenities and public transport. Each resident has a separate flatlet with it’s own bedroom, lounge and en-suite bathroom facilities for maximum privacy. There is a large communal lounge/dining room, which has level access into an attractive enclosed garden. Also on the ground floor are an office, laundry and large kitchen. The Firs comprises a ground and first floor with stairs leading to the first floor which could be a problem for a resident with mobility problems. Fee levels were not available for this inspection. Copies of the most recent inspection report are available in the home. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is a summary of a cycle of Inspection activity at The Firs since the last inspection visit in January 2006. To help CSCI make decisions about what it is like to live at The Firs the owner gave us information in writing about how the home is run; documents sent to us since the last inspection were looked at along with what we found when we last visited; a site visit of 8 hours was carried out without saying when we were coming; we talked to the manager and staff on duty; we looked at some of the records the manager keeps, such as accident and medication records; and we looked at the house to see if it was clean and in a good condition. We also looked at the diaries of the people who lived at the home and their experience of care was ‘tracked’ looking at how well the home understands and meets their needs, and the opportunities and lifestyle they experience. We spent some time with the people who lived at the home, and sent them questionnaires to fill in about living there. This is so that we could get as many peoples views as possible about how the home was run. Two people living at the home, two relatives and seven members of staff completed and returned questionnaires. What the service does well: Each person who lives at the home has a small flatlet of their own, with a living area, bedroom and private bathroom. This means that even though they can use the lounge and garden when they want, they all have private space in which they can spend time away from other people if they wish. Staff are aware of the needs of the people who live at the home, including their specialised communication. This helps to ensure that staff can understand what people are saying and can have a conversation with them in a way they can understand. People who live at the home live in a domestic environment and have opportunities to develop life skills such as domestic chores in a meaningful way. This helps them to feel involved in running their home The home has good staffing levels and staff training which should mean that staff can support people living there well with a thorough understanding of their needs. The Firs, Preston DS0000018442.V335009.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. The Firs, Preston DS0000018442.V335009.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 The Firs, Preston DS0000018442.V335009.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, 5. Quality in this outcome area is adequate. Information about the home is available for people who are thinking about living there and systems are in place to make sure a full assessment is completed before any one is offered a place to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Firs has information available about the home which is only available in a written text format at present. Staff spoken to felt that the people who live at the home at the moment would not benefit from this being made available in other formats, for example video or pictorial/symbols. This may need to be considered at a future date. Of the two service users who completed questionnaires, one said they had and one said they hadn’t received enough information about the home before they moved in. There are four people living at the home, and there have been no vacancies for over five years. This means that no admissions have been carried out under current legislation to enable a full judgement to be made on this outcome group. However there are policies and procedures in place to support any future admissions, and staff spoken to were clear about what would need to The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 9 happen before someone else came to live at the home. A full assessment before someone is admitted to the home means that the home can be clear that they can meet that persons needs and that the person can be confident that the home will be able to support them in the way that they wish. Each person who lives at The Firs has a contract with the home, which explains what is paid for their room, what they can expect to receive in return for the fees and what responsibilities they have. Copies seen were not in a format that service users would understand, but text copies have been given to people who support them. The Firs, Preston DS0000018442.V335009.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 Quality in this outcome area is good. Care is well planned; people who live at the home are supported to make decisions and take risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home each have an individual plan, which shows what support they need to lead a full life, and explains how that support is to be given. Plans for all four people were seen, and these were then discussed with staff, compared to what was seen during the day, and in discussions with people who live there where possible, about how they were spending their day. The plans and diaries seen reflected well the care given and activities undertaken. Plans are written with input from the person whose plan it is wherever possible, and included pictures, symbols and photographs of importance to The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 11 them. This makes it easier to understand by the person concerned than text would, and helps them to communicate more clearly. One room seen also had a chart where the person whose room it was indicated what they wanted to do, drink etc. This worked as a communication and planning tool and helped this person make sense of their day. Some of the people living at The Firs have communication difficulties, and individual discussions with staff demonstrated they were very clear as to the interpretation of body language, facial gesture and vocalisation and what they meant. They were also able to physically demonstrate how the people who live at the home communicate, and this could later be seen while spending time with residents, and in care records. Plans were being regularly reviewed, and in some input could be seen from relatives and people at the home in these reviews. This helps in ensuring that service users and their supporters have a say in the way their care is managed. Files also contained information on risk assessments and risk taking. Risk assessments are a way of evaluating and reducing as far as possible any risks, whilst still allowing people opportunities to develop new skills and lead a full life. The Firs, Preston DS0000018442.V335009.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): 12, 13, 15, 16, 17 Quality in this outcome area is adequate People who live at the home are able to influence the way the home is run and have opportunities to develop. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence was seen and heard at the home of the activities, opportunities and lifestyle available to the service users at The Firs. Activities undertaken are recorded in personal diaries, one of which is written by the person themselves. On the day of the site visit one person was away staying with their family. Other people living at the home were spending time in their rooms or the garden and one went shopping with a member of staff to buy groceries for the lunch and evening meal. Time was also spent involved in household tasks, The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 13 including taking clothes to the laundry, shopping and observing the preparation of food and drinks. This demonstrates that the people living at The Firs have opportunities to develop their skills. This was also supported in discussions with the staff on duty, who outlined the work put in to motivate service users to participate further. One person who lives at the home commented that they “like to help around the house and garden”. However one relative commented that the home did not provide a structured enough environment for their relative, and expressed concerns that their relatives interests and hobbies were heavily influenced by the staff. Some staff commented that activities could be improved by additional funding being available. The two service users who completed questionnaires indicated they always or sometimes chose what they did each day. Risk assessments were seen for activities, and discussion was held with staff on opportunities available for people living at The Firs and on how they chose to spend their lives. All have very different needs, but staff commented that despite this they blended well. Staff were also aware of the problems associated with those service users with more complex needs taking up staff time and dominating the way the home operates, and discussion was held on how this was managed. The Firs has a vehicle available which is funded by Havencare. People who live at the home pay a small charge per mile to use this vehicle. Involvement is had with the local community wherever possible, including use of local shops and facilities. A person who lives at the home also spoke about a local club they attended for people with learning difficulties and what they did there. Discussions were held with staff on holidays that had been enjoyed and on further ones planned for this year. Write-ups of these were seen in peoples files. Discussion was held with staff about the menu planning and food served. Menus demonstrated a good variety of food served and staff also eat with service users. Lists were seen of individual preferences and meal choices. On the day of the visit the menu had indicated liver for tea, but service users had chosen to have sausages instead, which demonstrates that menus are flexible and that people who live at the home can affect the way the home runs. The Firs, Preston DS0000018442.V335009.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 good. People who live at the home have the support they need to maintain their health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Files for four people living at the home were looked at and discussions were held about service users healthcare needs. Questionnaires were sent to supporting general practitioners, community learning disability staff and relatives to get an overall view about how the home promotes the healthcare of the people who live there. Staff confirmed that no people living at the home would be able to fully coordinate or manage their own health care needs. They are therefore dependent upon staff to arrange this for them. Files contained information about pre-emptive healthcare such as screening for cancer, and another file contained information on healthcare assessments that had been carried out, hospital appointments etc. Files also contained evidence of staff The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 15 acknowledgement of peoples views and wishes on their healthcare needs. This demonstrates that appropriate healthcare is being accessed. Evidence could be seen in files and through discussion with staff of a high level of support for some people living at the home, which is reflected in the documented need for physical intervention to stop one person in particular hurting themselves or others. Staff were also able to explain through discussion and modelling how this intervention takes place, and the training they have received to ensure that the person is protected until they have calmed. Further information is being sought in this area. Staff had an understanding that sometimes difficult to manage behaviours are a form of communication, and information in files was written in a way that underlined this. During the site visit an OT visited the home to support staff in working closely with someone at the home to understand and help support a with a recent increase in challenging behaviours. The Firs medication systems were also seen. The home uses a series of blister packs, pre-prepared by the pharmacist, which helps to avoid errors in administration and makes it easier for staff to see what medication has been given out. Staff who give out medication are trained in how to use the system, Controlled drugs, which are those that require special storage and handling measures due to their potential to be misused are being managed appropriately and records kept of the stock balances. The Firs, Preston DS0000018442.V335009.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. Procedures are in place to protect service users from abuse and abusive practice and to address any concerns or complaints that may be raised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Firs has a corporate complaints procedure on display in the homes hallway, but it is however acknowledged that the some of the people living at the home would not be able to make a formal complaint no matter how this information was presented to them. In this instance the home would have to rely on the interpretation of gesture, behaviour, and vocalisation to determine their dissatisfaction. The people at the home who completed questionnaires indicated that they were clear about who they would talk to if they were unhappy about something. One commented “I am happy. I don’t need to talk to anyone”. The complaints procedure contains information on people outside of the home to whom complaints may be addressed. This is to ensure that if people are concerned about raising issues directly with the home they would know who to go to. No complaints have been received by the home or by The Commission for Social Care Inspection in the last year. One historical allegation had been made The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 17 anonymously to the local adult protection team, however this was investigated and found to be unsubstantiated. Staff receive training in adult protection and the home has a policy and procedure which complied with local guidance and protocols. A member of staff spoken to could outline the action they would take if an allegation had been made. This showed a good understanding of the system and should therefore help protect people living at The Firs from abusive practices. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. The Firs provides an attractive and homely environment for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at The Firs have access to good inside accommodation and a secure, enclosed and attractive garden, with seating and attractive planting. Good parking is available to the front of the home. The rear garden also contains a garden building, owned by one person, and used as a sensory room by that person. The house itself is a converted residential property, close to local shops and services, and a level walk to the sea front. Each person who lives at the home has a separate lounge, bedroom and bathroom facility of their own, as well as access to the lounge/diner and other communal facilities. Rooms were The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 19 individually furnished and well decorated in accordance with interests or needs. Accounts indicate that a person living at The Firs recently purchased a new mattress for their room, and this was discussed with the manager as it was not clear why this had not been obtained through the homes budgets. All areas seen on the site visit were clean and service areas were clear from a build up of laundry. The environmental health officer has visited in the last year, and confirmed that a good standard of food hygiene was in place. The manager confirmed that regular environmental audits are carried out, and could demonstrate a planned list of refurbishments and repairs to be completed over the coming year. The laundry was clean, and has suitable washing machines, although the dryer was being repaired on the day of the visit. In this area is also the sluice and medication cupboard, which is not ideal in terms of infection control or maintaining a stable temperature. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. Staffing arrangements are satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the site visit files for four members of staff were seen, along with training records and appraisals. Discussion was also held with staff in groups or individually looking at aspects of their role and work with people living there. Questionnaires were sent to the staff at the home and seven were returned completed. These questionnaires were complimentary about the amount of training available to them. Comments such as “Excellent training opportunities” and “plenty of training courses, flexibility of hours” were seen as things the home did really well. Personnel files contained evidence of what checks the home had done before employing that person, including taking up two references, criminal records bureau checks, and evidence of qualifications. All of the files seen contained the required information. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 21 Discussions held with the members of staff on duty during this site visit demonstrated they had a clear knowledge and understanding of the service users they were caring for. Evidence was seen of individual staff training including induction and supervision systems. Supervision is a process that combines staff development and performance management, and is regularly carried out with each member of staff and the manager or deputy. Files for four staff members were selected at random, which indicated that these supervision sessions are being carried out regularly, and actions identified during the course of supervision could be seen to have been implemented. The home also has a training and development plan for the staff group as a whole which identified the training needed and when it is to be provided. Discussion was held on training for staff about the specific needs of people at the home, including specialist input related to mental health needs. This helps to ensure that mental health problems are not missed when caring for a learning disability. The staffing rota was flexible and discussion with staff confirmed that they worked a variety of shifts dependant on the needs of the service users they were caring for. There were sufficient staff on duty to care for the people who live at the home and ensure they could follow the activities they wished to do, especially as staff also have to cook, clean and support people while on shift. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. The home is being well run. Work is required to provide a quality assurance system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has completed her registered managers award and isan experienced manager. This means that service users should benefit from a consistent and well managed service, with a management who really understand their needs and goals. Staff confirmed “the management always endeavour to accommodate when you need any help or assistance with work” The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 23 A formal quality assurance system for the home has not yet been provided. This helps homes to identify what is working well, and where they can improve things, to make life better for the people who live there. There are comprehensive systems for the management of health and safety at the home. Some policies and procedures were sampled, along with evidence of environmental risk assessments such as the fire precautions risk assessment. This identifies where there are risks of fire at the home and what needs to be done to minimise these risks. Policies and procedures seen were all satisfactory and up to date. The home has been inspected for asbestos and legionella. Staff receive training in health and safety practices. Water temperatures are restricted, and hot surfaces seen were protected. Window openings above the first floor are restricted. This should all mean that service users are living in a safe and well maintained environment. Discussion was held on risk assessments for safe working practices, some of which could be seen. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 24 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 3 2 3 3 x 4 x 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 3 25 4 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 25 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 YA39 Regulation 24 Requirement The responsible individual must develop a system for reviewing and improving the quality of care at the home. Timescale for action 19/08/07 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 YA38 YA5 YA7 2 YA20 Good Practice Recommendations Clear information about what service users might be expected to pay for should be available. Where large purchases of items such as furniture, usually provided by care homes are made on behalf of service users there should a clear evidence trail of the reasons for the purchase, evidence of discussions with the service user or their supporters and multi agency agreements. Medication would be better stored in an area where there are not high variations in temperature and humidity such as there are in the inside the laundry and sluice room. The Firs, Preston DS0000018442.V335009.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Firs, Preston DS0000018442.V335009.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!