Inspection on 03/02/06 for Three Sisters

This inspection was carried out on 3rd February 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 no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Three Sisters 16/08/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Three Sisters Brow Top Road Howarth West Yorkshire Lead Inspector Sughra Nazir Announced Inspection 3rd February 2006 09:30 Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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 Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Three Sisters Address Brow Top Road Howarth West Yorkshire 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) 01302 813100 01302 813101 Voyage Ltd inc. Thelma Turner Homes Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection None Brief Description of the Service: Three Sisters is a home for 10 adults with learning disabilities in Haworth. The premises were converted from bed and breakfast provision and the conversion has been very well-executed with furnishings and fittings of a very high standard. All accommodation is provided in single en-suite bedrooms. Communal spaces include kitchen large dining room and lounges. The home is located in 18 acres and includes on-site farm and go-karting facilities. Haworth is a picturesque village that offers local shops, churches and places of interest. The home is within easy reach of Keighley and Bradford and this allows service users access to a wider range of facilities. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This first inspection was carried out by one inspector over 8 hours. The inspector looked around the house and talked to most of the service users, the manager and 3 members of staff. Care plans, staff files, medication and other records were inspected. Service users in conversations were generally complimentary about the staff including the manager and food and facilities. One service user was dissatisfied with menus and expressed a preference for the company of lively talkative members of staff. The inspector also took account of a pre-inspection questionnaire completed by the manager and comment cards received from service users. The number of requirements and recommendations made reflects the fact that this is a new service. The primary focus of the service has been on establishing itself, accommodating new service users and employing and training staff. The manager is committed to improvement. What the service does well: What has improved since the last inspection? What they could do better: Some revision of the Statement of purpose and Service User guide is required. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 6 Service users plans need to reflect the care provided. Adult protection and complaints policies are in need of revision. Some financial and contractual information is held centrally which should be made available to service users. Policies on handling cashcards, pin numbers need to be clarified to staff. The staff need to improve their awareness of specific needs arising from different racial and cultural backgrounds and as a result of specific conditions. The home has recruited a number of development workers (care staff) without experience of learning disabilities. They must be encouraged to attend LDAF and NVQ training as a priority Supervision of staff must be carried out regularly by staff trained to do so Records policies and procedures must be shared with staff and service users. Systems for monitoring quality need to be established. Health and safety checks must be carried out as required by law and appropriate external agencies (local environmental health agency) consulted. 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. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 4 and 5 The home has good pre-admission procedures that give service users the opportunity to make informed decisions about their future home. EVIDENCE: The home has a Statement of purpose and a document entitled summary of statement of purpose. There is also a DVD that takes prospective users on a tour of this home and two others nearby. Production of the DVD is good practice and could be improved further still with the increased involvement of service users in its production. The Statement of purpose does not contain all the information required by law in Schedule 1 of the Care Standards Act. It does not • Contain the name and address of the registered provider (Voyage) • Specify age range of the service users for whom the home is intended • State arrangements for consultation with service users • State fire procedures and associated emergency procedures • State arrangement for dealing with complaints. Some of this information is in the Service user guide (summary of statement of purpose document). Clearer information is required on the specific techniques used to deal with challenging or difficult behaviour, detailing what training and support staff receive to deliver this aspect of care. The service has access to in-house Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 9 specialists but it is unclear how and when such specialists will inform and advise on care. Neither document sets out the terms and conditions in respect of accommodation to be provided in particular the amount and method of payment of fees. Service users should have information on what is included in fees and what they will have to pay for themselves. Arrangements for holidays for example should be stated. All the information provided to service users should be in an accessible format. The manager was advised to consult regulations and standards whilst revising these documents. Records for the most recent admission were examined and showed good evidence of trial visits, pre-admission assessments and review meetings. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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, 8, 9 and 10 Service users receive a good standard of care but their needs are not documented in full and there should be more opportunities for them to be involved in decisions about their home. EVIDENCE: Service users have detailed plans drawn up from comprehensive assessments. However care plans did not details preferences in all cases for the way assistance is to be provided. Care plans should form an up-to-date record of what the service user needs and detail how care is to be provided covering all areas specified in Standard 2. One service user has specific needs arising from his racial heritage. He is able to make these arrangements himself but no information relating to these needs or support needed to make arrangements was found in the care plans. All service users care plans should record agreed protocols and techniques for handling conflict and dealing with challenging behaviour. A key worker system is in place, and the home should ensure that key workers can communicate with and appreciates racial and cultural heritage of their allocated service user. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 11 Evidence of reviews involving relevant parties was seen on individual files. An example seen of the way staff enable decision-making was that staff provide service users with the information they need to make decisions about their alcohol intake. Restrictions on alcohol over safe limits have been agreed and recorded. Service users have meetings but mechanisms in place for them to contribute to decision-making are limited. Service users do contribute informally to recruitment decisions, as prospective employees are encouraged to visit the home. The manager and staff should give some consideration to how service users can be involved and enabled to influence key decisions within the home. This could be through service user meetings, joining staff meetings representation in management structures and involvement in staff selection. Risk assessments indicating low medium and high risks are in place and could be better placed alongside individual care plans for ease of reference. The home should ensure it has risk assessments in place for all activities including work on the farm. All service user information is kept securely. Staff receive training on confidentiality and sign a declaration. The confidentiality policy does not make clear circumstances under which information may be shared. The arrangements for sharing this and other policies with service users and their families are unclear. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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, 16 and 17 Service users enjoy individualised programmes of social and leisure activities providing a full and varied lifestyle. EVIDENCE: Service users enjoy a wide range of activities. Staffing levels are good and allow service users the support they need to go into town, play football etc. Education programmes are being followed at college and service users also have access to vocational training on the on-site farm. Contact with family and friends is encouraged in the Statement of purpose and in practice however individual arrangements for maintaining such contacts are not detailed in their plans. Service users regularly visit the local pubs and enjoy being part of the local community. One development worker stated that he and a service user play football at a local centre. This provides opportunities for contact with peers who are not disabled. This is good practice Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 13 One service user is enabled to travel to London and to other cities on his own by train. This allows him to take risks and make decisions about his own life. Such arrangements are not documented in full Service users privacy and dignity is respected with personal relationships and the home ensures that service users have the information they need to make decisions about such relationships. A mealtime was observed and staff and service users enjoyed lunch together. The meal was relaxed with a choice of sandwiches, pasta and homemade scones or yoghurt. The meal was unhurried and there was lots of conversation about activities that day. Service users played a full part in presenting the meal and clearing away. Kitchen facilities are well-laid out and give service users free access to prepare snacks and drinks as they choose. One service user was not happy about the choices offered. The manager stated that menu was drawn up taking into account wishes and preferences. There are service users with specific nutritional needs that are being managed within the home. It was suggested that the monitoring of weight and advice on diet might be best obtained from a dietician. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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, 20 and 21 Service users physical health needs are met but medication recording needs improvement. EVIDENCE: Service users receive personal care in the privacy of their own rooms. Care plans provide information about the way in which service users would like to be supported with their personal and healthcare needs. In practice there is a great deal of flexibility around daily routines though such practice is not detailed in individual plans. Specialist adaptations and equipment are provided where required to ensure that service users’ physical needs are met. Service users will only move in once required equipment /adaptations are in place Service users are registered with a GP, dentist and opticians and wherever possible the service tries to secure continuity of care by health professionals such as consultants. Contact is maintained with placing authorities. The home has a medication policy for the receipt administration and disposal of medication. Medication is stored appropriately in locked storage. Some staff have received accredited training. The assistant manager manages the medication administration. During the inspection medication administration records were examined and found to have gaps –this is unsafe practice. All staff responsible for administering medication should have up-to-date training Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 15 on medication in accordance with Royal Pharmaceutical Society of Great Britain guidelines. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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 The policies in place for service users complaints and protection from abuse require some improvement. EVIDENCE: The complaints procedure is detailed in the summary of statement of purpose. The details for the Commission require updating to include telephone number. The policy states that service users can complain to the assistant if the key worker “does not act quickly enough” to sort the problem out. The timescales for response are not specified. The complaints procedure should be revised to make it more accessible in format and displayed in a prominent position in the home. Since the service opened there have been a significant number of incidents involving challenging behaviour from service users to each other and towards staff. In some instances the home has followed sought advice from internal line management and delayed contacting Adult Protection and notifying the Commission. Staff spoken during the inspection showed no awareness of local adult protection services. The manager now has contact details for the Ault Protection unit displayed in her office. Steps must be taken to ensure that all staff receive training on the protection of adults and local protocols for seeking guidance from THE Adult Protection Unit. Accurate and detailed financial records are maintained at the home. Staff are aware that entries are counter-signed however the policy in elation to cash cards pin numbers seems less clear. Some financial records in particular Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 17 documentation relating to fees is held away from the office. Service users should have access to this information. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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, 26, 27, 28, 29 and 30. Service users live in a home that is safe clean and meets their individual needs. EVIDENCE: All areas of the home seen were, clean hygienic and free from odours. A homely environment has been created in all areas of the home with good quality contemporary furnishings Three service user bedrooms were seen accompanied by the manager. The rooms were occupied by the service users at the time so a full appraisal of furniture was not done. The manager should review accommodation provided to ensure that all bedrooms contain the items specified in standard 26. The rooms seen were personalised and contained items to suit each service user such as hifi, personal computer. At least one service user had specialist equipment needed to maintain independent personal care skills. Staff sleeping-in facilities have been designated within the office space. At the moment staff are using one of the spare bedrooms. The office does not provide suitable changing or storage facilities – required for all staff. Alternative secure Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 19 arrangements should be found for medication if the office is used for sleeping in. The laundry in the house has a washing machine with a sluicing facility and staff confirmed that red laundry bags are used for soiled washing. Personal protective clothing is also supplied. Hazardous chemicals are kept locked in cupboards There was evidence in the laundry of independent use of the laundry by service users –this is good practice. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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): 31, 32, 33, 34, 25 and 36 The staff’s understanding of their roles and responsibilities could be improved through training and supervision. EVIDENCE: The home has been operating with some vacancies, but this has not been problematic as the home is under-occupied. Staff without background knowledge of learning disabilities has filled some vacancies. It is important that any training needs are identified and addressed. Staff have received basic training on conditions such as autism as part of their induction. Two staff spoken to did not have any knowledge of the specific condition affecting one service user. All service users should receive care from staff trained to do so. In conversations with staff they said that they had not had the General Social Care Council (GSCC) booklet that underlines the values and skills required for care. A sample of staff files were looked at and were found to contain all the information specified in Schedule 2 except for photographs of staff. Staff have job descriptions and care staff are referred to as development workers. Staff said that they did not receive regular supervision. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 21 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, 40, 41, 42 and 43 Records and procedures are well organised and regularly updated. Monitoring systems should be improved to ensure that health and safety is maintained. EVIDENCE: Observations of staff and service user interaction confirm that service users receive care in a friendly homely atmosphere. The manager has an open door policy for staff and service users. Throughout the inspection service users were seen engaging in conversation with staff including the manager. The manager is developing systems for monitoring of quality. She needs to ensure that the systems developed involve service users, their friends and family and other stakeholders. A report should be produced and shared with service users and the Commission along with an annual development plan. Visits carried out on behalf of the registered provider have not been carried out and reports submitted at the required frequency. This has improved but must be maintained. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 22 It is noted that the testing of fire alarms, emergency lighting is not carried out weekly and that water temperatures are not recorded. The manager must ensure that checks are carried out and documented. No records of environmental health inspections were available, as the home is not registered with the local environmental health authority. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 2 3 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score 2 2 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Three Sisters Score 2 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 2 2 3 DS0000063426.V272191.R01.S.doc Version 5.0 Page 24 No 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 YA1 Regulation 4, 5 Schedule 1 Requirement Timescale for action 30/06/06 2 YA5 17(2) Schedule 4 15 3 YA6 The Statement of purpose must be updated to include all information required by regulation 4 and Schedule 1. Specific information on interventions and techniques used in the home must be stated. Service user guide must include terms and conditions including details of fees and extras such as holidays. All service users must be 30/06/06 provided with a contract that specifies their room number, fees and rights and responsibilities. Individual plans must set out all 30/06/06 aspects of personal and social support set out in Standard 2. This includes planned interventions therapeutic programmes, one-to-one communication support and responses and individualised procedures for challenging behaviour. The plan should consider needs arising from different cultural and religious backgrounds. The plan should be DS0000063426.V272191.R01.S.doc Version 5.0 Three Sisters Page 25 4 YA8 12 5 6 YA15 YA17 24 12 7 YA20 13 8 YA22 22 9 YA23 18(1)(a) (c) 13(6) 17 10 YA28 23 11 YA31 18(4) made available in a language and format the service users can understand. Service users must be enabled to influence decision-making in the home by joining staff meetings being represented in management structures or involvement in staff selection Procedures for maintaining contact with family and friends must be detailed. Specialist advice must be sought where there is an action plan and risk assessment for nutrition needs All medication administration records must be fully completed in accordance with Royal Pharmaceutical society of Great Britain guidelines. The registered manager must ensure that there is a complaints procedure in place and shared with service users that details timescales and correct contact details for Commission. The manager must ensure that the home’s adult protection policies and procedures link in with local authority procedures. Staff must receive training on the protection of vulnerable adults and on managing challenging behaviour. The registered provider must ensure that service users have access to all relevant information relating to their finances. Policies on assisting service users with money must be clarified. Staff must be provided with adequate facilities including a safe place to store personal belongings. All staff must be issued with the GSCC code of practice DS0000063426.V272191.R01.S.doc 30/06/06 30/06/06 30/06/06 30/04/06 30/06/06 31/05/06 31/12/06 30/06/06 Three Sisters Version 5.0 Page 26 12 YA32 18 13 YA34 18 14 15 YA35 YA39 18 24,26 16 YA40 12 17 18 YA41 YA42 12 Staff must receive training to give them the skills to deal with specific conditions of service users and understanding physical and verbal aggression and challenging behaviour. The registered provider must ensure that all information specified in Schedule 2 is held on staff files. Staff must be trained on disability awareness and equal opportunities training The registered manager must develop procedures for reviewing and improving the quality of care and supply a copy of any reports resulting from such reviews to the Commission The registered provider must ensure that visits must be carried out at least once a month, should be unannounced and reports submitted to the Commission. Service users must have access to policies and procedures and they and staff must have opportunities to contribute to their development. Service users must have access to their records and information held about them All required checks to ensure the fitness of premises must be carried out and recorded. The registered manager must consult with the environmental health authority. 30/09/06 31/05/06 31/12/06 31/12/06 30/06/06 30/06/06 31/05/06 23(5) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 27 No. 1 Refer to Standard YA10 Good Practice Recommendations The confidentiality policy and procedures should state circumstances under which information may be shared. The arrangement for sharing such policies with service users and their families should be made clear Staff should have NVQ2 or 3 or equivalent 2 YA32 Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Three Sisters DS0000063426.V272191.R01.S.doc Version 5.0 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. 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