Inspection on 13/03/06 for The Turrets

This inspection was carried out on 13th March 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Turrets 18/01/07

The Turrets 08/09/05

The Turrets 21/03/05

The Turrets 11/10/04

The Turrets 12/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Turrets 7 - 9 Glebe Road St George Bristol BS5 8JJ Lead Inspector David Smith Unannounced Inspection 13th March 2006 09:45 The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Turrets Address 7 - 9 Glebe Road St George Bristol BS5 8JJ 0117 9554058 0117 9554058 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) Mrs Lorna A Arnold Mrs Lorna A Arnold Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 10 persons aged 18 - 64 years with learning disabilities 8th September 2005 Date of last inspection Brief Description of the Service: The Turrets is a 10-bed care home for males and females with mild learning disabilities, aged between 18 and 64. Mrs Arnold is the registered provider and manager who is actively assisted by her husband and eldest daughter. The philosophy is that of an extended family offering support and guidance within a secure framework and structured home life. Local shopping and other public amenities are within walking distance. The home is near a bus route accessing Bristol, Hanham, and Kingswood. Respite and Nursing accommodation are not provided. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over one day. The inspector gathered information for this report from discussions with the Registered Manager and staff members, inspection of care plans and associated records, health and safety records and a tour of the home. The inspector also met privately with four of the people who live in the home. The people who live in the home wish to be described as “people” or “individuals” rather than residents or service users. This has been reflected in this report. What the service does well: Each person who lives in the home told the inspector they were very happy living at the Turrets and that they felt well cared for. The service is focused on the people who live in the home. The long-standing staff team demonstrate an extremely good knowledge of each individuals care and support needs. The service provides a comfortable and structured home life for each person who lives at The Turrets. The illness and sad death of an individual living in the home was handled with the greatest care, respect and understanding. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home should review its progress in providing information in a format which is accessible to each person who lives in the home. Reactive strategies for individuals who display challenging behaviour should be regularly reviewed. This will ensure each person is supported in accordance with his or her current needs. Develop personal plans for staff based on appraisal outcomes and ensure appropriate training and updating takes place. This will ensure staff training and development compliments individuals’ new or changing support needs. The home should conduct a review of quality care at least every twelve months. The outcomes of this review should inform the development plan for the home to ensure the best outcomes for each person who lives in the home. The home should review its recording procedures. This should focus on the level of information recorded and the best methods of recording. This will ensure clear evidence in relation to individuals, family, friends or other professionals’ views of the quality of the service provided. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 7 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 Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. Each individual and their families are provided with relevant information about the home, to enable them to make a choice. EVIDENCE: The Statement of Purpose and Service User Guide remain as previously submitted to the Commission and meet the regulatory requirements. There have been no admissions since the last inspection. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Care plans are detailed and written in a person centred way. The review process has now been improved to ensure that each person’s support is consistent with their current support needs. The home should review the accessibility of information for each individual. Staff have a good knowledge of the support needs and communication abilities of each person as relationships between those living at the home and the staff team staff are very well established. The risk assessment process supports each person to take risks as part of their lifestyle. EVIDENCE: The inspector examined five care plans. These all provided good levels of information relating to the support needs of each individual. Each person has the opportunity to enter his or her comments throughout their care plan. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 11 A care plan template is in use, which covers the following areas. Residential Care, Personal Care, Living Skills, Risks, Mobility, Reading and Writing, Shopping and Money, Personal Safety, Emotional Needs, Social Needs, Employment, Health and Privacy. Care plans and daily records for each individual are not in a format which is accessible to them. The inspector had a lengthy discussion with the manager regarding the issue of developing accessible information and the responsibility for providing this to people who live in the home. The accessibility of information remains a key element in the provision of person centred services. Each care plan had been recently reviewed. The date and attendees of the last review meeting are added to the care plan. No formal record or minutes of the review meetings are currently maintained. The home should consider maintaining a clear record of each review meeting and agreed outcomes. Several reviews are not attended by any representative of the relevant Funding Agency, although the home ensures they are invited to attend. The four people who live in the home told the inspector they attended the meeting to review their care plans. They all also commented that they could speak to “Lorna or Paul” (Mr. and Mrs.Arnold) at any time if they had a problem or wanted to change something. Staff consulted and observed during the inspection demonstrated a very good knowledge of the support needs and communication methods of each person who lives in the home. Each person is encouraged by staff to make informed choices. The Risk Assessment process supports individuals to take risks as part of an independent lifestyle and ensure their welfare and safety. One individual has had the water supply disconnected in their room following repeated flooding and the danger of water ingress into electrical fittings. This is now supported by a Risk Assessment, which is regularly updated. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 16. Each person who lives in the home has opportunities to take part in a range of community and leisure activities. Each person is seen as an individual. Their recreational and occupational arrangements are well organised and varied. Individuals are supported to maintain friendships, relationships and links with their family. EVIDENCE: Each person who lives in the home is supported by staff to engage in a variety of work and leisure activities. Two people who live in the home are currently in paid employment. Other individuals attend a variety of drop-in centres, day services, Disabled Christian Fellowship services, college or educational courses. The manager has been The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 13 instrumental in accessing relevant courses for individuals, especially when day services have declined or closed. One person told the inspector that he currently works five days per week at Bristol Trade Centre. He really liked his job. Lorna and Paul helped him find this job and supported him when he started work. Another person told the inspector that she works in a charity shop. She likes working there. She is also attending a college course, which she hopes will lead to a part time job of working in a café. Many people who live in the home are able to access the community independently. People enjoy going shopping, the cinema, swimming, bowling, to the pub and out for meals amongst other activities. The household are involved with planning holidays or day trips. The inspector was told of holidays to Turkey, Blackpool and Butlins, which individuals had attended. One individual said he had been to see Cliff Richard in concert and had stayed overnight in London. Many people have well-established links with their families and see them often, sometimes staying overnight or going on holiday with them. Several individuals have friendships outside of the home and can entertain visitors if they wish. Two of the people who live in the home are engaged to each other. An engagement party was held on the home’s patio in July, which their friends and family attended. Both individuals told the inspector they really enjoyed their party. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 21. Individuals are supported in their preferred manner and individual’s physical, emotional and healthcare needs are generally well met. Experienced staff have a good knowledge of each person who lives in the home and how to provide appropriate levels of support. The illness and recent death of an individual was handled with the greatest care, respect and understanding. EVIDENCE: Each person who lives in the home is registered with a local GP, Dentist and other relevant professionals such as an optician. The home does ensure each person accesses other relevant health care professionals where necessary such as the Community Nurse. The care documentation in place for individuals provided clear guidance for staff on how they should support those living at the home with their personal The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 15 care. Individuals had recorded their preferences and the assistance required with personal hygiene and personal support. In general each person is independent with their personal care although varying degrees of prompting or help is required by some. Each individual is able to speak with doctors, dentists and other health care professionals and give their consent for treatment. Staff normally accompany individuals to attend appointments. The staff team have a good knowledge of each person’s support needs and they ensure that appropriate support is offered/provided. There has been a recent death of one of the individuals who lived in the home. The Commission had been informed of this in accordance with the regulations. Through discussions with the manager it was evident that staff had provided sensitive ongoing care and support both within the home and at the hospital. Family members had been kept informed of their relative’s condition. When her condition deteriorated in hospital, the manager ensured that a hospice service was not used and strongly advocated that either this young lady should remain in hospital or return to her home at the Turrets, where people she knew well could continue to spend time with her and care for her. She passed away peacefully in hospital. The staff team and several of the people who live in the home attended the funeral. Each person who lives in or works at the home has supported each other through a very difficult and distressing time. The inspector was shown a copy of the Notices posted by the family and the Turrets in the Bristol Evening Post. The family’s notice described staff at the Turrets as “extended family” and that their relative “loved them all”. The family thanked the home for giving their relative a “wonderful life and exceptional care”. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who live in the home are able to express their views and feel these are acted upon. There are satisfactory arrangements in place to manage complaints or any allegations of abuse. Reactive strategies are in place to support individuals who display challenging behaviour. These should be reviewed and updated in line with care plans. EVIDENCE: A complaint procedure including CSCI contact details is available and is given to each individual who signs to acknowledge receipt and understanding of this procedure. There have been no complaints recorded or any allegations of abuse. The four individuals spoken with all confirmed to the inspector that they could express their views. They each stated if they were unhappy about any issue they would talk to Lorna or Paul. Each person said they would be happy to do this and felt sure that they would be helped to solve the problem. The current group of individuals living in the home display little physical or verbal aggression. Physical intervention is not required. The home has limited reactive strategies in place for individuals who display behaviour which can be interpreted as challenging. One strategy examined by The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 17 the inspector however was out of date. This still made reference to Regulation 14s for notifiable incidents, the Registration Unit not CSCI and had the incorrect contact telephone number for the commission. There was no evidence to show when this had last been reviewed. All reactive strategies should be reviewed as part of each individuals care plan review to ensure the information contained in each is up to date and subject to regular scrutiny and updating. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. The Turrets provides a homely, comfortable and safe environment for each person who lives in the home. Each person is supported to individualise his or her bedroom. The home was clean, tidy and hygienic on the day of inspection. EVIDENCE: There have been no changes in the services and facilities provided at the home since the previous inspection. The location and layout of the home is suitable for its intended purpose. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 19 The home comprises of two large linked properties. This provides one spacious home for the individuals to live in. There is a communal lounge and a separate activities room which can be used for table games and playing music. There is also a patio area at the rear of the home. The communal areas are well furnished and in good decorative order. Each person’s bedroom is decorated to reflect individual likes/tastes. Each person has photographs, pictures, books and other items evident, which help to personalise their rooms. Individuals have a key and can lock their bedrooms if they wish. Three people told the inspector they always lock their bedroom door when out of the house. The kitchen is appropriate for the nature of the home. All individuals are encouraged to use the dining room for meals and snacks. The laundry facilities comprise of an industrial washing machine and dryer. Each person who lives in the home needs to sort their laundry and the staff washes it for them. The standard of cleaning in the house was good throughout on the day of inspection. . The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 and 36. The relationships between staff and those living at the Turrets are well established. This provides a supportive environment for each individual who lives in the home. Staff have been provided with appropriate training to ensure they can meet the support needs of each person who currently lives in the home. No additional/updated staff training has been provided since the last inspection. Staff appraisals have been introduced, however these remain inconsistent. EVIDENCE: The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 21 There is a small, longstanding group of staff that have worked at the Turrets since it first opened in 1995. Three members of the family are regularly working in the home. Two other family members work in the home when it is possible for them to do so. There have been no changes in the staff team since the last inspection. All staff carry out various roles in care/support work, catering and general housekeeping duties. Discussions with staff members and observation of their work practice demonstrated that they were approachable, good communicators and were comfortable with individuals living at the Turrets who were at ease with them. There is always at least two staff on duty when the individuals are at home. Mr & Mrs Arnold are very often in the home when not officially on duty. They have a flat on the premises and with their daughter cover the sleep in duties. There are no staff vacancies at present. Sickness rates are very low. The home’s staff team covers any vacant hours due to holidays. The home has never used agency staff to cover shifts within the home. All four individuals spoken with liked living in the home and thought highly of the staff team. They know the staff team well. Two individuals said of all the different places they had lived in, this home was the best. Another told the inspector she never wanted to leave the Turrets, as she was so happy here. Due to the size of the home and the small group of staff no formal supervision sessions are carried out. Such supervision as there is, is informal. Ms Arnold has created an appraisal/performance review document. The inspector viewed one which had been successfully completed. The intention was that all staff would be appraised annually: this has still not been achieved and it is recommended the home reviews this procedure as this will help to identify training or development needs for each staff member. Staff have had training which they feel equips them with information and skills to support the individuals who currently live in the home. No formal additional/update training has been provided to staff since the last inspection. One staff member is currently awaiting registration to commence NVQ Level 2. The home currently has a vacancy, which they are marketing. The assessment process for any prospective individual entering the service must also focus/identify additional training needs for the staff team. This will ensure a good quality service can be provided and staff are supported in their professional development. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. The management arrangements are simple and there are clear lines of accountability. The ethos of the service is evident and is clearly communicated. The views of the people who live in the home are sought and acted upon. A review of quality care must be conducted annually. The home has sound Health and Safety arrangements in place. Hot water and fridge/freezer temperatures are still not recorded. EVIDENCE: The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 23 The manager Mrs Arnold has been the registered manager since 1995 and has a Bachelor of Education for people with special needs qualification. The deputy manager Ms Arnold has an NVQ Level 3 and has completed the NVQ Level 4 care manager’s award and is currently undertaking a degree in social work. Ms Arnold developed and updated policies and procedures as part of course work toward the care managers award. There have been no changes in the policies since the last inspection. These were not examined by the inspector and will therfore be focused upon during the next inspection process. The ethos of the service is clear. The philosophy of the home is that of an extended family, offering support and guidance within a secure framework and structured home life. Whilst the outcomes for the people who live in the home remain positive, the home should review its decision only to record limited amounts of information. The home could adapt its existing recording systems to offer clearer/improved evidence of how outcomes are achieved and how the service is perceived by other stakeholders. This should be acheivable wihout materially altering the amount of time available to directly support the people living in the home. A review of quality care was carried out and completed in January 2004. The inspector was shown several questionniares, completed by each person who lives in the home, family members, other health care professionals, funding agencies and day services. Most of the comments were very positive or complimentary. Some negative comments were clearly acted upon. For example, one individual wanted to be more involved in the choice of meals. Staff had supported him to develop a list of foods which he either liked or disliked and ensured he could be offered favoured foods. Whilst the method of review is appropriate, this process must be carried out each year. The outcomes of each review should then form a development plan for the service, which can be shared with all stakeholders. The home’s central heating system has now been serviced and a copy of the certificate was examined during this inspection. The fire log was examined. This showed the fire alarm system is tested on a weekly basis. Other equipment is tested monthly. There are regular fire drills involving both the people who live in the home and staff members. The home does not record the temperature of hot water outlets or fridge/freezer temperatures. The rationale appears to be that all individuals The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 24 who live in the home can accurately check the temperature of hot water prior to its use and that the ethos is to promote a homely/extended family support. It is reccommended that the home supports these practices with Risk Assessments if current practice is to continue. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 3 3 X 3 X 3 3 X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 STAFFING Standard No Score 31 X 32 2 33 3 34 X 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000026618.V286175.R01.S.doc X Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Turrets Score 3 3 X 4 3 3 2 X 2 3 X Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA23 Regulation 13(6) Requirement All reactive strategies for individuals who exhibit challenging behaviour must be subject to regular review. Timescale for action 13/03/06 2. YA35 18(1) Ensure that staff training and updating takes place to meet current, new and changing needs of each individual 13/03/06 accommodated. An annual Quality Assurance review must be conducted and form a development plan for the service. 3. YA39 24 12(3) 13/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The home should review its progress in providing information to each individual in a format which is DS0000026618.V286175.R01.S.doc Version 5.1 Page 27 The Turrets 2. 3. YA41 YA42 accessible to them. Review record keeping procedures to improve records and ensure transparency within the service. Review the use of Risk Assessments to help ensure the welfare and safety of each individual who lives in the home and the staff team. The Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Turrets DS0000026618.V286175.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!