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Inspection on 22/06/05 for The Trio House

Also see our care home review for The Trio House for more information

This inspection was carried out on 22nd June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Trio House is a very homely and comfortable place for the residents to live. It is an ordinary family house and so helps the home and residents to be accepted as part of the local community. The residents have lived together as a group for years and this must help to give them security in their lives. It felt very pleasant and relaxed in the home. Staff were kind and caring to the residents and had a good attitude to their job. They knew the residents` likes and dislikes well and the help they all needed. Residents` needs are written in care plans that inform staff what to do to help meet them. Good daily reports are also made by staff including such as the activities residents have taken part in and where they have been that day and how they are. The care records showed residents` personal and health care needs are given priority and that staff support them when they may feel upset or frustrated. The house is furnished well and kept in a very good state of repair and decoration. Residents` bedrooms had been made very personal and are decorated in a colour residents like with their own pictures, photographs and other things. This means that as well having two sitting rooms and a kitchen diner they have their own space.

What has improved since the last inspection?

More care staff had been employed and there was better staffing cover for the home. Two new staff had relevant experience and training from previous jobs. Some other training had also been arranged to ensure staff have the skills and knowledge to do their job properly and more safely. Half of the staff now had an NVQ qualification and two planned to do a higher level NVQ. Some of the things that needed action following the last inspection had been done. This included medicines training for staff and some changes to the information documents about the home and to records kept.

What the care home could do better:

Residents should have a contract that includes actual details of all the extra costs they have to pay, and what these are for. This must be agreed by their family or a person that can do so for them. This is to ensure their money is used for their benefit and that the home provides what it is supposed to. The weekly menu of meals provided should give a true picture of what residents have eaten and show they receive a healthy and varied diet. The senior did not have access to staff and some financial records. These records must be kept by the home and need to be inspected. Thought should be given to how these records could be made available for future inspections.

CARE HOME ADULTS 18-65 The Trio House 15 Abbotsmead Road Belmont Hereford HR2 7SH Lead Inspector Christina Lavelle Announced inspection 22 June 2005:16.15 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. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Trio House Address 15 Abbotsmead Road Belmont Hereford HR2 7SH 01432 342416 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) Miss M C Stevenson Miss M C Stevenson Care Home only 3 (3) Category(ies) of Learning Disability registration, with number of places The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: In addition to the category of registration detailed on the previous page there is an additional condition of registration that residents may also have a physical disability associated with a learning disability. Date of last inspection 19 February 2005 Brief Description of the Service: The Trio House is home to three adults with severe learning disabilities. The home was set up for the current residents (who are all men) in 2001 when the care home they were living in was closing. The provider and manager of this home was also the manager of their former home and so has known the residents well for years. The property is quite a large house that is in a modern housing estate on the outskirts of the city of Hereford. It is an ordinary family house and so fits in well with the local community. There are local shops and facilities nearby. The residents all have single bedrooms. One of the bedrooms has an en-suite bath and one other a shower. The home has a fairly small, secure garden that you can reach through the conservatory. There is a large sitting room and because the conservatory is a proper building it can be used as another sitting area. The accomodation also has a kitchen diner and a utility room. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over two and a half hours in the late afternoon on a very hot Wednesday in the summer. The three residents were at home with two care staff (one a senior) on duty. Time was spent talking to the staff about the residents’ and their care. These two staffs training and how they find working in the home were also discussed. The residents are not able to give their views of the home and the care they receive. However time was spent in their company to gain an impression of how “at home” they seemed and how well they and staff got on together. The evening meal was seen, the house was looked at and the residents’ care records and some other records were checked. Questionnaires about the home were left for all the staff team to complete, of which three were sent back. The two staff on duty were very helpful during the inspection. What the service does well: The Trio House is a very homely and comfortable place for the residents to live. It is an ordinary family house and so helps the home and residents to be accepted as part of the local community. The residents have lived together as a group for years and this must help to give them security in their lives. It felt very pleasant and relaxed in the home. Staff were kind and caring to the residents and had a good attitude to their job. They knew the residents’ likes and dislikes well and the help they all needed. Residents’ needs are written in care plans that inform staff what to do to help meet them. Good daily reports are also made by staff including such as the activities residents have taken part in and where they have been that day and how they are. The care records showed residents’ personal and health care needs are given priority and that staff support them when they may feel upset or frustrated. The house is furnished well and kept in a very good state of repair and decoration. Residents’ bedrooms had been made very personal and are decorated in a colour residents like with their own pictures, photographs and other things. This means that as well having two sitting rooms and a kitchen diner they have their own space. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 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 Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 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 The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 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) EVIDENCE: Standards 1 and 5 were not fully assessed in this inspection. However a revised statement of purpose and terms & conditions of residence/contract documents had been sent to the Commission following the last inspection, as they needed to more information. This included details of the cost of anything residents have to pay extra to the charge to live at the home. Although the new contract format does state what these extras are it was not confirmed by the provider that the actual cost of extras had been included in a contract and signed as agreed on behalf of each resident by their relative or representative. The other Standards in respect of the assessment and admission of prospective residents are not applicable as the service was set up for the three men living there. Therefore there had not been any vacancies since the home opened and there are no plans to admit new residents for the foreseeable future. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 9 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) 6, 7 & 9 Each resident had a care plan drawn up and risk assessments carried out so staff are aware of all their needs and how to meet them. Risk management plans were also in place to help staff safeguard residents from harm. Residents are not able to make informed choices or decisions. However it would help to ensure their preferences and best interests are taken into account if their families and/or representatives were more involved in care planning. Including these other people in care plan reviews and recording their input and agreement to each resident’s plan would achieve this better. EVIDENCE: All the residents’ care records and plans were looked at. Plans include relevant areas of care needs, any goals, communication and behaviour issues and how staff should deal with them. Appropriate risk assessments had been carried out and risk checklists completed to ensure residents safety. The plans and risk assessments had been reviewed and updated at an appropriate interval. There was no recorded evidence that residents’ relatives or representatives had been involved in the care planning and review process as would be expected. Plans should also reflect the extent to which residents are able to make decisions and who has helped them to do so if they are not and why. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 10 Each resident’s care record contained his photograph and a personal profile. This provided helpful information about their individual needs; likes and dislikes and described how they may react to situations and how staff should respond. Comprehensive daily reports were also made covering each person’s mood, activities, wellbeing, family visits and any other events in their lives. There were instructions for staff about how to deal with one resident’s selfabusive behaviour, which was referred to as restraint. Whilst staff were advised to simply obstruct this behaviour or distract the person the term restraint implies the use of physical force. It would be more appropriate to refer to this as positive intervention rather than as restraint. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 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) 12,14,15 & 17 Staff arranged activities and outings so that residents can occupy themselves in an interesting way and go out and mix with other people in the community. It will help to show better that their individual wishes and needs are being met when the plan to develop individual activities programmes is implemented. Residents’ are supported by staff to maintain close links with their families. If the weekly menu reflected an accurate record of meals it would ensure it could be confirmed whether residents receive a wholesome and varied diet. EVIDENCE: Currently staff record where residents have been such as day services, leisure activities, walks and other outings in the daily reports. However staff said they planned to draw up an activities programme for each resident. This should be a positive development by showing individuals’ wishes and interests more clearly and how this informs how they are supported to spend their time. As the residents have severe learning disabilities they are not able to develop work related skills or take up work placements. Until fairly recently they had all attended day services at least three times a week but this had been cut to The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 12 one day and staff continued to seek other opportunities. They now had around three and a half days a week when they pursued particular activities. These included a farm project, spa pool, horse riding for the disabled, trampolining, and music therapy. Outings, such as bowling and to local events are also arranged and the home has a vehicle to facilitate this (although only the manager and one staff can drive it) and taxis are used. Today there had not been any planned activities and residents had been out for walks to the park and to the local large supermarket for a coffee with staff. Staff said that the residents had recently returned from a nine day holiday in Spain. Two residents go home to their families every weekend and the other has regular contact. Staff report that the home has a very good and open relationship with residents’ families and they are always made welcome. Although Standard 17 on food provision was not fully assessed staff said they try to ensure residents receive a balanced diet. They also monitor the food intake of one resident who can have a health problem that is affected by his diet. A weekly menu is drawn up and staff are all aware of residents’ likes and dislikes, which are listed. The menu indicated that varied and balanced meals are provided, although this evening’s meal of tinned hamburgers in gravy, frozen potato croquettes and sweet corn is not considered very wholesome and was not the meal stated in the menu. Whilst staff apparently do record meals actually provided each day in their shift handover it is important that an accurate record of food is kept to ensure, and so that it can be checked, residents receive a healthy diet. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 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) 18,19 & 20 Appropriate arrangements are in place to ensure the personal and health care needs of residents are identified and met and their good health promoted. Plans also show how they can be supported with any upset or frustration affecting their mood and behaviour. Medicines are managed safely by staff in the home. EVIDENCE: Residents are very dependant on staff for all their personal care and daily hygiene records were completed by staff, and in respect of continence management, which showed their needs were met. All the residents were well presented and appropriately dressed for the very hot weather. Care records showed that residents’ health care is closely monitored. A diary of health care checks and routine appointments (e.g. Dentist) was kept and individuals’ records showed GP and other input from health care professionals such as a Psychiatrist, Occupational Therapist and Continence advisor. Records were also kept of relevant physicals checks, such as their weight. Residents’ moods and behaviour were monitored and recorded and their plans describe the signs when they are upset in any way or frustrated and how staff can manage this and help them feel better. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 14 Medication was stored securely and medication records had been maintained appropriately. Four staff had attended a training course on the safe handling of medicines recently and the senior on duty had received training previously. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 15 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) It would be very difficult to assess if residents’ views and concerns are listened to because of their disabilities and limited communication although staff were seen to focus on their needs and preferences. The home provides a complaints procedure to enable people acting on residents’ behalf to raise any concerns. From the evidence obtained in this inspection residents’ safety and protection is safeguarded through good care planning, risk assessments and providing appropriate staff support and a safe environment. EVIDENCE: These 2 Standards were not fully assessed however there is an appropriate written complaints procedure provided by the home. The provider had also confirmed following the last inspection that staff had received in-house training relating to adult protection. This training should have included procedures to follow if staff suspect abuse/neglect of residents and the local multi-agency procedures for the Protection of Vulnerable Adults. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 16 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) 24,25,27 & 28 The Trio House provides suitable accommodation to meet the needs of residents. The home offers a secure, homely and comfortable place for them to live and being an ordinary family house fits in well with the local community. The premises; furnishings, equipment and décor are of a very good quality and appropriate arrangements are clearly in place so that a good state of repair and cleanliness is maintained. EVIDENCE: The Trio House is in a convenient location for some local services and facilities and the city centre can be easily accessed by a vehicle. The house was very clean and tidy throughout and is very well maintained, furnished and decorated. The small enclosed garden is a pleasant area for residents to enjoy and provides a safe place for them. Residents have single bedrooms reflecting their individual personalities in respect of colour, décor and their own pictures and possessions. There are sufficient bathroom and shower facilities (including two en-suite) and the kitchen diner and two sitting rooms provide ample space to be used flexibly. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 17 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) 32, 33, & 35 Staffing arrangements are appropriate overall to meet the needs of residents. When one aspect of staff deployment is reviewed this should be confirmed. Progress has been made for the staff team to receive relevant training and support. This should help them to understand residents ‘ needs and how to meet them better. Also how to deal with and promote their safety and welfare EVIDENCE: Staff on duty had a caring attitude and approach towards the residents and residents clearly responded positively to this. There are six care staff employed in addition to the provider. Whilst this team is small some staff are part time and staff report they are able to provide extra cover for leave. The feedback from staff questionnaires indicated there are enough staff for residents’ care and to do the cleaning and cooking. Staff discussed that they are sometimes woken up from about 4.00am to assist one resident. This person’s daily report showed this had occurred six times this month so far. The Commissioning Authority is reviewing this situation currently and may decide to increase funding so the home can provide waking night staff. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 18 Most staff had undertaken core health and safety training or it was planned they attend a course or session soon. Three had an NVQ level 2 qualification and it was planned for two to progress to level 3. This meets with the Standard specifying half of care staff in homes should have achieved NVQ. Staff on duty had a lot of previous experience working with people with learning disabilities and who can also have challenging behaviour. They had attended training on epilepsy and positive interventions for challenging behaviour. A training opportunity relating to dementia was being sought for staff and should be of benefit. Both staff on duty were fairly new and said when first appointed they had completed an induction checklist including confidentiality. They were also informed about fire safety precautions and took part in a fire drill and looked at all the care records. They spent time at the home with the manager and doing shadow shifts before working as part of the rota. Staff said they now each had a personal development plan that included their training needs. They also confirmed they had individual supervision sessions with the manager and that staff meetings were held monthly with records kept Staff records could not be checked as the manager was on holiday and they were locked up. However both staff confirmed that CRB/POVA Checks had been taken up and two references obtained before they were able to start working with residents. Consideration should be given to how these records could be accessed in future inspections. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 19 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) From the evidence obtained the home is operating safely and residents are enable to have appropriate lifestyles with the care and support they need. EVIDENCE: Although none of these Standards were fully assessed staff said they felt well supported by the manager and were given enough information to do their job properly. Also they feel able to express their views of the home and about residents’ care. The home was currently working on updating all their risk assessments using a new format to include such as electrical safety, clinical waste, bathing procedures, radiators etc. A gas inspection had been carried out recently and the electrical system was to be serviced the following week Overall there were no hazards that could pose a risk to residents identified during this inspection and the environment provided was safe. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 20 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 x N/A N/A N/A x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 x x Standard No 11 12 13 14 15 16 17 x 2 x 3 3 x 1 Standard No 31 32 33 34 35 36 Score x 2 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Trio House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 21 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 YA 5 Regulation 5 Requirement The service users guide and terms and conditions/contract must include the actual cost of any extra charges made to the residents for any facilities and services not covered by fees. This to be agreed with each resident or their relative and/or representative on their behalf. Timescale for action By the 31st of August 2005 2. YA 17 16 & 17(2) Schedule 4, para 14 (This was required in previous inspections and although a revised contract format had been produced it was not confirmed it had been ratified and agreed) The record of food provided must By the 30th reflect the meals actually July 2005 provided so that it can be determined whether residents recieve a satisfactory diet. (This was required following the last inspection and is repeated) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 22 No. 1. 2. Refer to Standard YA 6 YA 6 Good Practice Recommendations Residents plans should be drawn up, reviewed and agreed with the involvement of families and appropriate other people and their input should be recorded. Any interventions needed from staff to deal with behaviour that could cause self harm should be positive and be described as such. Therefore consideration should be given to the use of the term restraint in one residents plan Residents plans should reflect the extent that each person can make decisions in their lives. If they are not able to do so other relevant people should be involved in making decisions on their behalf and this input should be recorded and in what circumstances. Consideration should be given to how required records can be made available for inspection in the absence of the manager; whilst at the same time maintaining confidentiality and other statutory requirements such as Data Protection 3. YA 7 4. YA 41 The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN 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. Extracts may not be used or reproduced without the express permission of CSCI The Trio House E52 - E02 S24794 The Trio House V234465 220605 Stage 4.doc Version 1.30 Page 24 - 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. 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