Inspection on 26/02/09 for The Gables

This inspection was carried out on 26th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 02/07/07

The Gables 30/03/07

The Gables 24/08/06

The Gables 13/02/06

The Gables 03/03/05

The Gables 03/09/04

The Gables 03/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Mulligan Date: 2 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB 01753890399 01753890399 manager.thegables@fremantletrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Fremantle Trust The registered provider is responsible for running the service care home 7 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) The maximum number of service users who can be accommodated is: 7 Date of last inspection 0 2 0 7 2 0 0 7 A bit about the care home. The Gables is a home for seven adults with learning disabilities and high care needs. The home is situated within close proximity of Gerrards Cross town centre. There is a main bus route from the town centre to nearby towns. The house is in a large cul-de-sac, next to a school. The accommodation is over two floors, however the majority of service users have bedrooms on the ground floor. There are two bedrooms upstairs for the more mobile service users. All bedrooms are individually decorated to personal taste. The home has a large communal lounge, dining room and a separate sensory room. There is a large garden at the back of the home and some parking spaces at the front. Fees for the service: £997.22 per week. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. CSCI surveys were distributed to visiting professionals, service users and staff prior to the inspection. Five of these have been received by the Commission. Feedback from service users and relatives indicate that they are happy with the care provided and feedback was positive. One person using this service requested to speak with the inspector and this took place on the day of the visit. The inspection consisted of examination of some of the homes required records, discussion with the registered manager and the operations manager, observation of practice, discussions with the manager and staff on duty and a tour of the premises. Feedback on the inspection findings and areas needing improvement was given to the carer who assisted during the inspection. All requirements from the last inspection have been complied with and this inspection has resulted in four requirements. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. The manager, staff and service users are thanked for their cooperation and hospitality during this unannounced visit. What the care home does well. The home is a nice and comfortable place to live. Service users are assessed prior to admission to ensure that the home can meet their needs. Prospective service users are given the opportunity to spend time at the home to see how they relate with other service users. Service users are supported to pursue their leisure interests and given opportunities to use community resources. Contact with family and friends is maintained to promote social links. Service users privacy and dignity is promoted and staff were observed to be respectful of service users. A nutritional well-balanced meal is provided. Safe recruitment practices are in place. Staff are approachable, knowledgeable and confident in their roles and they confirm that they feel supported in their role. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has got better from the last inspection. The home has obtained a copy of the Infection Control guidance issued by the Department of Health. On going improvements to the home ensure service users live in a safe and homely environment. What the care home could do better. Risk assessments must be completed for the person newest to the service. Where service users are at risk of weight loss, they must be weighed regularly, or if an individual does not wish to be weighed a risk assessment be put in place to minimise the risks to that person. Written guidelines for as required (PRN) medicines must be recorded for the person newest to the service and the guidance for PRN medicines for the rest of the people using the service needs to be updated. All care staff must receive up to date training in care subjects. This must include moving and handling, SOVA, fire safety and basic food hygiene. Up to date records must be kept of all training completed by the staff. If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact Barbara Mulligan Burgner Ho, 4630 Kingsgate, Cascade Way Oxford Business Park Cowley Oxford OX4 2SU 018 6539 7750 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Service users needs are assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. Evidence: The home has an admissions procedure in place which indicates that all prospective service users are assessed prior to admission, that visits take place and that the home liaises with other professionals and families prior to accepting someone for admission to ensure compatibility with the other service users. There has been one new admission to the service in the past twelve months and the needs assessment for this person was examined. This was found to be comprehensive and the completed assessment was detailed and informative. The assessment tool covers practical and personal support, health care needs, home environment and mobility, cultural needs and personal beliefs, compatibility and views of other service users, day care services, community facilities and amenities and prospective service user views. Information contained within the file shows that the admission took place over a long period that was suited to the needs of the service user. This included visits to the home for meals, day, overnight and weekend visits. Before the service user moved into the home, his room was decorated and personalised with his own furniture and belongings to make stay easier. It is noted that the service users have been asked their preferred name which is indicated throughout any further documentation seen, this is noted as good practice. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. Evidence: Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . All those using the service have an individualised plan of care and support which details their assessed needs and personal goals and documents how these needs will be met. Risk assessments must be completed for the person newest to the service. Evidence: Three care plans were examined during this inspection. These were individualised and person centred and contain information on the users individual health, social and personal care needs. The care plans viewed are detailed and informative and reflect the changing needs of the individual. Care needs are identified with a detailed action plan setting out guidelines detailing how staff will meet those needs. These care plans contain peoples preferred daily routines, likes and dislikes, information about communication, mobility, bathing and washing, continence, mealtimes, relationships and values and finances. There are good protocols in the file for the management of epilepsy and the administration of Diazepam. In addition to these files which are kept in the managers office, there is a working document which is a shorter summary of the main care plan and describes everyday needs and the daily reports written by care staff.These are stored in the lounge and are easily available to care staff. All care plans observed are of a good standard and each file shows that an annual review takes place of the care provided. Daily notes are detailed and informative and record the personal care received and activities that the individual has undertaken Evidence: through out the day. Most of the residents are unable to communicate verbally and there is guidance in the files of peoples non verbal communication behaviours, to help staff understand how residents were feeling. This is recognised as good practice. The home has a key worker system in place although the manager said that not all key workers are able to complete residents support plans appropriately. In this case she will update them. Service users are assessed as having high or moderate levels of dependency and the staff spoken to were knowledgeable about residents as individuals. There are good details in each file of the communication needs of each individual. The registered manager said that the home has recently been having a lot of input from the speech and language therapist and hopes to implement more user friendly formats for several menus and the complaints procedure. The weekly menu is planned with service users and usually one resident may go shopping with a carer. Risk assessments were observed to be in place and these are signed and dated. All of these show that they are reviewed and updated regularly. Examples of risk assessments seen include personal care, traveling;road and car park safety, abuse, epilepsy, using a kettle, medical and health support needs and medication.However the service user new to the home only has two risk assessments in place for epilepsy and eating and choking. The registered manager said the home has been very short staffed and she has not been able to complete all the necessary risk assessments yet. A requirement is issued for improvement in this area. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service have a varied and active lifestyle, which reflects their interests, and are supported to maintain family links and friendships inside and outside the home.Service users receive a balanced diet but nutritional screening needs to be improved. Evidence: There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences. The care plans provides details of what individuals do during the week, social likes and dislikes and information about how they access the community. Family and social contacts were seen recorded in all files. Most people living at The Gables attend a day centre regularly. In each file looked at there is an activities time table which details the activities undertaken at the day centre and at home. Examples seen include jacuzzi, coffee morning, art, sensory communication and cafe/singing. The inspector was able to talk to one person using the service. He said that he likes living in the home and enjoys going to the pub to have a shandy. He told the inspector that he enjoys going to the hairdressers and buying his own clothes. On the day of the visit he went out to lunch with another person using the service and two carers. When they returned he told the inspector he had enjoyed his meal and had fun. The home has its own minibus, which was purchased by families of residents. This is Evidence: used for shopping trips and outings. The inspector noted that individuals dietary intake is recorded and individual likes and dislikes. Residents help with menu planning. The menu is varied and can be presented in picture and widget form. Advice has been provided on managing swallowing difficulties. The dining area provides a pleasant area to enjoy meals and there was a well stocked fruit bowl for people to help themselves to. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service have their needs outlined within their individual plans, ensuring that the manner in which they are supported and cared for by staff is appropriate and promotes their preferences. However nutritional screening and the guidance for as needed medicines needs to be improved. Evidence: Some of the service users in the home are very dependent on staff who attempt, through body language and other forms of non verbal communication to determine when service users would like to go to bed, bath, have their meals and take part in other activities. This is recorded in individual care plans. This extends to supporting service users to choose the clothes they wish to wear, hairstyles, make up and general appearance. The care plans set out in detail the service users preferred routines, their likes and dislikes and partnerships with families, friends and relevant professionals outside of the home. Essential information needed by staff to be able to provide personal and health care support was included in care plans. Staff support people using the service to see their local GP and other community healthcare services when needed, both within the home and in the local community. In each file there are details about how personal care is to be delivered to each person in a way they prefer. There are health screening records that contain information about service users medicines, visiting the doctor,chiropodist, opticians and the dentist. Service users have the necessary disability equipment they require to enable them to maintain their independence as much as they are able. Weights are recorded, but not on a regular basis for all service users. For one individual it is recorded in his file that he has swallowing difficulties and fluid and dietary intake charts are on file indicating that he may be at risk of weight loss. However weights have only been recorded for November 2007, January 2008, October 2008 and February 2009. A requirement has Evidence: been issued for improvement in this area. Medication practices were examined during this visit to the home. Medication was stored safely and medication administration records (MAR) were in good order with staff signatures alongside prescribed dose times. There are very good guidelines in place for the administration of as required rectal Diazepam and other medicines. However this information needs to be put in place for the person newest to the service and updated for other people living in the home. Some of these guidelines have not been updated for four years or more. A requirement is issued for improvement in this area. The registered manager told the inspector that the supplying pharmacy undertakes medication training and a competency based check is carried out in house. Staff are now expected to complete a medication distance learning course. Although training records show that most staff have completed medication training, they were not up to date and it was difficult to assess if all staff had completed training in the safe administration of medicines. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. Evidence: The home has a complaints procedure in place called Fremantle Feedback. This was not available in a suitable format for people using this service. The registered manager said the home had recently had a lot of input from the speech and language therapist and as a result the home were hoping to provide information to service users in a more user friendly format. People who returned the CSCI surveys were aware of how to make a complaint about the service. Some of the service users in the home are very dependent on staff who attempt, through body language and other forms of non verbal communication to determine whether service users are happy or if they may have concerns about the service. The home holds a complaints log and a list of compliments. One complaint had been received by the home since the last inspection and this has been dealt with - and within stated timescales. The Commission for Social Care Inspection has not been notified of any complaints since the last inspection. Procedures are in place for safeguarding vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA policy. Although training records show that most staff have completed SOVA training, they were not up to date and it was difficult to assess if all staff had completed training in the safeguarding of vulnerable adults. This needs to be addressedd and a requirement is issued under standard 30 regarding staff training. The Commission for Social Care Inspection has been notified of one safeguarding issue, which was dealt with by the local authority, which is the lead agency in these matters. Evidence: Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The standard of the environment within this home is good, providing service users with an attractive and homely place to live. Evidence: The Gables is a large detached house, set in a residential street next to a school. The house is clean, well decorated and homely. Thought has been given to the needs of service users throughout the home. For example, there is a sensory room in the home for all to use, and many photographs of service users and their families which are recognised by people using the service. The garden has been made accessible to people using the service and is well maintained. Each bedroom has been personalised to meet the needs of the person and to reflect their likes and preferences. The kitchen is accessible to service users if they wish to assist with meal preparation. The home provides adequate toilets, shower and bathing areas which are spacious and contain grab rails, assisted baths and other aids. The laundry facilities for the home are sited so that soiled washing does not come into contact with the kitchen. Hand washing facilities are sited in the laundry. Policies and procedures were observed by the inspector for the control of infection, which includes the safe handling and disposal of clinical waste. Evidence: Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are looked after by appropriate numbers and skill mix of staff and robust recruitment policy and practices are in place to support and protect the residents. Some training for staff needs to be updated to ensure staff are competent to do their job. Evidence: The staff who were met during the inspection were knowledgeable and presented as good advocates for service users. At the time of the inspection the home had 76 staffing hours vacant. The registere manager said that she had fallen behind with some of the homes required paperwork but the care being provided to service users had not been compromised. On the day of the inspection the registered manager was interviewing two two applicants for care worker posts. The home was not using agency staff to cover the present staff vacancies and the registered manager said they have a reliable team of relief staff. The recruitment files for three care staff were examined,including those new to the service. One file only contaiined one reference and the registered manager provided prooof of this after the inspection. The remaining files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the staff member started work. Some CRB checks are dated 2003 and 2004 and it is recommneded that these are renewed. All newly recruited members of staff receive structured induction training including shadowing more experienced carers until both parties feel confident and comfortable. The induction programme shows that staff are expected to complete all mandatory training in core subjects. Staff training files had not been updated and those looked at showed that there was some updating of mandatory training to be completed. A requirement is issued for improvement in this area. Evidence: Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides a consistent service to people using the service and there are systems in place to protect the health and safety of service users. Evidence: The manager is experienced and is working towards the National Vocational Qualification in management and Care at level 4. She is registered with the Commission for Social Care Inspection. She has updated her skills regularly and further training includes safe handling of medicines, deprivation of libertys and management and leadership training. The Fremantle Trust has a quality assurance programme, which is in place in the home. A senior manager visits the home regularly and reports of these visits are kept in the home. These have been undertaken on the 27/01/2009 and 12/12/2008. A comprehensive audit of care is undertaken annually and residents and relatives views are sought at that time as well as informally throughout the year. The results of the audit are made available to residents and their families and are available in the home for other stakeholders. The registered manager reports to an external line manager who undertakes monitoring visits on behalf of the provider. These were examined by the inspector and follow a detailed format and show that speaking with staff and service users is a regular feature of the visits. A range of health and safety checks are in place at the service, carried out on a daily, weekly or monthly basis. Portable electrical appliances, electrical hardwiring Gas service certificate were available for inspection and found to be up to date. There are service certificates for fire equipment and emergency lighting and records of weekly Evidence: fire alarm testing. The home obtained the control of infection policies issued by the Department of Health.The organisation are i the process of updating their own Infection control policies and procedures. Fire drills are carried out with the full involvement of the service users and these are recorded in the homes fire safety records. There is evidence of water temperature recording, work placement risk assessments, accident and incident reports and health and safety risk assessments. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 9 12 The registered person is required to ensure that risk assessments are completed for the person newest to the service. 30/04/2009 To ensure the risk of harm to service users is minimised. 2 19 12 30/04/2009 The registered person is required to ensure that service users at risk of weight loss are weighed regularly and this is recorded in their care plan; or if an individual does not wish to be weighed a risk assessment in put in place to minimise the risks to that individual. To ensure the nutritional needs of people using the service are regularly monitored and acted upon. 3 20 13 The registered person is required to ensure that 30/04/2009 written guidelines for as required (PRN) medicines are put in place for the person newest to the service and the guidance for PRN medicines for the rest of the people using the service are updated. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. To ensure people using the service receive their medicines safely and as prescribed. 4 35 18 30/06/2009 The registered person is required to ensure that all care staff receive up to date training in core subjects. This must include moving and handling, SOVA, fire safety and basic food hygiene. Up to date records must be kept of all training completed by staff. To ensure that care stfaf are trained and competent to carry out their job. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 34 It is recommneded that all Criminal Records Bureau checks dated 2003 and 2004 are renewed. 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