Inspection on 02/11/06 for Tower House [Teignmouth]

This inspection was carried out on 2nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tower House [Teignmouth] 01/09/08

Tower House [Teignmouth] 06/07/07

Tower House [Teignmouth] 12/05/06

Tower House [Teignmouth] 27/09/05

Tower House [Teignmouth] 14/04/05

Tower House [Teignmouth] 04/11/04

Tower House [Teignmouth] 10/06/04

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 Tower House 34 Higher Brimley Road Teignmouth Devon TQ14 8JU Lead Inspector Sam Sly Unannounced Inspection 2nd November 2006 09:30 Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House Address 34 Higher Brimley Road Teignmouth Devon TQ14 8JU 01626 776515 F/P 01626 776515 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) Park Care Homes (No 2) Ltd Vacancy Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2006 Brief Description of the Service: Tower House cares for eight people with learning disabilities and additional autistic spectrum disorder. It is owned by a subsidiary of Craegmoor Healthcare Limited. Tower House is located in Teignmouth, within walking distance of the town centre, bus routes and the train station. The Home is wheelchair accessible, and once inside there is a lift the ground and second floors, and additional stairs. Every bedroom is single, with all but one having an en-suite shower room. There is a relaxation room, dining room, and lounge. The ground floor is used by one specific resident, with their own lounge and dining area. The laundry is also located on the ground floor. The weekly fee at Tower House ranges from £1033.14 - £4297.98, as stated on 11th September 2006. Fees are dependent on the type of facility or care package and needs of the individual person. The fee does not include hairdressing, chiropody, homeopathy, outings, some day services, College courses, some meals out, personal items, public transport, own birthday, Christmas presents and those for friends and family. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place during a weekday in November. Seven hours were spent at Tower House. Residents were spoken with or observed, depending on their communication needs. Staff on duty, two visiting relatives and the acting manager was also spoken with. The acting manager had been in post for only a few months. All types of written records were looked and a tour of all the shared rooms and some of the bedrooms was carried out. To write this report all the records of contact the Commission has had with Tower House since the last inspection were looked at. The acting manager provided information too. Two staff, seven relatives, and two care managers returned comment cards to the Commission. When asked not many relatives or staff said that they had seen the Commission’s last Inspection report, so the acting manager said he would ensure this happened in the future. All the standards that the Commission thinks are most important were looked at during the inspection process. What the service does well: The Home has a thorough assessment and care planning system in place to ensure that resident’s needs are understood and met, including personal and healthcare needs. One social care professional commented that ‘visits are always positive, and care plans and risk assessments have always been available and very thorough.’ Staff at Tower House try hard to enable residents to have interesting, active lives. One relative commented that ‘Tower House is an excellent home and we are more than satisfied with the standard of care there.’ Residents are protected by safe medication handling practices and staff have adequate knowledge about how to protect residents from abuse. Complaints and concerns are dealt with appropriately. The environment at Tower House is clean, hygienic, well decorated and well maintained. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 6 Staff have the competence, skills and training to meet residents needs. One relative commented that the ‘staff are superb.’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed thoroughly before they move in, and then kept under review. EVIDENCE: There have been no new residents admitted to Tower House since the last Inspection. Three resident’s care planning was examined during the visit and held the required information to ensure staff understood and were able to meet their needs. Staff interviewed were involved in the assessment and review of residents needs. The acting manager was developing a new Service User Guide, which would be in a more user-friendly format. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough care plans and risk assessments enable staff to work effectively with residents, however information to enable choice is not accessible to residents. EVIDENCE: Three residents care planning, including their risk assessments where examined and staff were interviewed. The acting manager was in the process of reviewing and improving each residents care plan file and the one so far completed gave clear, easy to read instructions to staff. The acting manager said all plans would be in this format by the end of 2006. Reviews including resident’s family and representatives, and health and social care professionals have been taking place, and one representative who had concerns commented to the Commission that ‘There is a new manager who says he will address all my concerns.’ A care manager commented to the Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 10 Commission that ‘visits are always positive, and care plans and risk assessments have always been available and very thorough.’ There were good quality behavioural plans in place for those residents with behaviours that challenge. The staff member who originally wrote these plans has left Tower House since the last Inspection and the acting manager is in the process of refreshing the positive behavioural training for all staff, and considering training on behavioural management planning for a staff member. Each resident has a key worker who is involved in reviewing his or her plan. Daily records are kept, but vary in quality and do not always consistently show that care plans are followed. It is important for records to show that choices are given, and that activities undertaken are valued as the residents at Tower House have a range of communication difficulties associated with having autistic spectrum disorder and therefore cannot always verbally give views. Full use was not being made of alternative communication systems. There was insufficient use of photos, objects of reference, pictures and symbols to enable residents to access information and make decisions. One resident’s symbolised planner designed to let them know what they were doing next day, still showed the previous days activities and had not been updated. Staff that commented to the Commission said that having a daily activities board would help staff too as they would know what they were doing and what was expected of them. Two residents had their finances managed by the registered provider; the rest had family involvement. Appropriate systems were in place for handling of resident’s money by the acting manager and staff. The acting manager was able to show evidence that a new financial management system had been introduced by the registered provider, and would incorporate the two residents at Tower House in the very near future. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tower House tries hard to ensure residents lead full active, interesting lives and the meals are varied and enjoyed by residents, however at present it cannot be demonstrated that residents make choices about what they do and what they eat. EVIDENCE: Every resident had an activities programme, and residents were in and out of the Home during the day of Inspection helping in the garden and going for short trips. Two residents were going back to their parents that day for a short break. One resident’s representative commented to the Commission that in the past regular structured activities had not been adhered to, which is important for people with autistic spectrum disorder. The acting manager agreed that this had been the case due to staffing issues at times and sometimes due to Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 12 residents choosing not to do what was planned. Due to the lack of communication tools to help residents make choices and the lack of consistent records to show that plans have been followed, options offered, and activities taken up or declined it was hard to evidence that activity programmes were followed, and activities undertaken were valued by residents. However, residents did do a range of activities from trips out, meals out, holidays, walks, shopping, going to clubs for people with learning disabilities and go-karting and having regular contact with family and friends. The home had an activities co-ordinator, but much of his time recently has been spent at another home. The acting manager said that in the near future he would be spending time developing a valued activity programme. Tower House has sufficient transport to get residents out in the community. One resident owns their own car, and another has a free bus pass (an companion pass) so they can access public transport. Staff take residents on the train regularly too. Seven relatives returned comment cards to the Commission and said they were always made welcome at Tower House, they were able to visit at any time and were kept informed of important matters relating to their relative. A meal was shared with residents, and was enjoyed by all. Residents were assisted sensitively with feeding. Residents were offered second helpings. The menu at Tower House had recently been reviewed and reflected the meals staff knew residents liked. However, choices could not be fully made, as the information about meals was written and not in a more accessible format for residents. The deputy manager said they were in the process of photographing meals so that residents could make choices. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and health care needs are well supported and staff administer resident’s medication safely. EVIDENCE: Resident’s personal and healthcare needs were clearly documented in the care plans examined. There were records of regular medical and specialist check ups and appropriate specialist input requested. Resident’s personal care needs were observed to be supported in respectful and dignified ways by staff, and staff spoken with were able to demonstrate clearly how they respect resident’s privacy and dignity. There have been two incidents reported to the Commission regarding the medication procedures at Tower House since the last Inspection. The acting manager has acted appropriately in reviewing the procedures and putting into place measures to ensure incidents do not happen again. The procedures for the receipt, administration, storage, and disposal of medication were observed Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 14 to be safe during the Inspection. All those staff administering medication have received sufficient training. One resident is supported to be involved in partially taking their own medication. For others a risk assessment has taken place, providing evidence that staff should administer medication. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns at Tower House are dealt with appropriately, and staff would be able to protect residents from harm. EVIDENCE: Tower House has a complaints procedure, however of the seven relatives who returned comment cards to the Commission, three were unaware of the procedure. It is important that this information is understood, as resident’s communication needs mean that it would be difficult for them to make a formal complaint. Staff spoken with were aware of the whistle blowing policy and the complaints procedure. Neither Tower House nor the Commission had received any formal complaints since the last Inspection. Staff had received training on adult protection and were able to demonstrate an understanding of what constitutes abuse and that they would immediately contact the manager if they came across an abusive situation. However, they were less clear about where to locate the adult protection policy and procedure at Tower House, and were unfamiliar with the local Authority Alerter’s Guidance. An adult protection issue at Tower House, since the last Inspection was being dealt with, however it was recommended that the registered provider review the process when completed, to improve practice. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is excellent, good. This judgement has been made using available evidence including a visit to this service. The premises are homely, comfortable and safe for residents. EVIDENCE: A tour of all the communal rooms and several bedrooms was made at the visit. The environment was clean, homely and in fairly good repair. The acting manager was making several improvements to the environment at Tower House; the resident on the ground floor now had sole access to all the rooms, except the laundry and had chosen the colour to paint the hallways. Also the sensory room was about to be redesigned and redecorated. Tower House had a dedicated maintenance person to carry out day-to-day repairs and redecoration. The bedrooms entered were bright, cheerful and reflected the personalities of the occupants. The kitchen and laundry required some decoration, and there Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 17 was no record of the kitchen receiving a regular deep clean, although records showed that one of the night staff jobs was to clean it. The flytrap in the kitchen had not been emptied, and contained dead flies. There had been no recent visits from either the environmental health department or the Fire Service. Laundry facilities were clean and hygienic and there were sufficient procedures and training to ensure the control of infection. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from fit, competent, qualified staff and are protected by the recruitment procedure. EVIDENCE: Three staff files were examined and staff were spoken with during the Inspection. Two staff returned comments to the Commission. Staff files demonstrated that correct staff recruitment processes were carried out including criminal record bureau checks. Staff said they received a good range of training, and records confirmed this and showed that nine out of the sixteen staff had NVQ’s (national vocational qualifications) to levels 2 or 3 with another five working towards them. Staff undertake mandatory health & safety training and some specialist training, although the autistic spectrum disorder training available to employee’s of the registered provider has not yet been fully implemented at Tower House. Refresher training on the positive management of behaviour that challenges has been booked for all staff, and the acting manager had a good Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 19 understanding of what other training was required for staff. Staff were also attending Total Communication training. The acting manager had held a number of staff meetings and supervision sessions in the short time he had been in post, and staff said they felt able to voice opinions at these meetings. Staff spoken with had done a multiple choice questionnaire about equal opportunities awareness provided by the registered provider, however this did not equip them to demonstrate a sound understanding, or to give examples of how they promote equality and understand the diverse needs of residents at Tower House. Two relatives said they did not feel there was always enough staff on duty to ensure residents had structured activities. The acting manager, deputy manager, maintenance man and cook were all extra to the care staff numbers each day. The rotas provided showed that care staffing numbers varied each day from 3-7 staff on between 8am-10am, 5-9 staff on between 1pm-4pm, and 3-6 staff on between 6pm-8pm then 1 awake and 1 asleep staff at night. The acting manager has introduced a communication system for staff to call for assistance. One relative commented to the Commission that ‘I am very pleased with the care X receives at Tower House – staff are superb.’ Staff were observed during the Inspection to be interacting at all times with resident, and when spoken with all showed a genuine affection, regard and respect for the residents they cared for. Two relatives, visiting during the Inspection, were spoken with, and said that they were very pleased with the care given, and that staff were kind and helpful. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Tower House does not have a manager who has been assessed and registered by the Commission. The registered provider has systems in place to monitor and improve the service as Tower House, however these systems do not yet reflect the views of residents, their representatives and people with an interest. EVIDENCE: Since the last Inspection an application for the previous acting manager to be registered with the Commission has been withdrawn and the current acting manager has only been in post for a few months. Before joining Tower House the current acting manager was a registered manager for another Home for people with learning disabilities owned by the registered provider. An Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 21 application to register the acting manager had not yet been received by the Commission. The Inspection found that in the short time the acting manager had been at Tower House he had made efforts to improve the Service and support the staff team. Staff said that he was ‘doing a good job’, that he listened and encouraged them to think about new ideas and activities for residents, and that they were ‘able to go to him with any problems’ and he was ‘cheerful and helpful and trying to sort things out.’ The registered provider carried out a range of quality monitoring checks and audits including regular themed self-audits (the latest being on Infection Control at Tower House), and visits by professionals employed by the registered provider to audit care practices, financial systems and health & safety systems. The Responsible Individual also visits monthly to check on the quality of care at Tower House. The views of resident’s relatives have been sort with questionnaires, but ways have not been found to represent resident’s views and to gather the views of other stakeholders. Also there is no system in place to develop an annual development plan or to give feedback to participants. The pre-inspection paperwork returned to the Commission by the acting manager showed that checks on electrics, central heating, water and gas installations were carried out regularly. The fire record book was up to date and accurate, and the acting manager had put together an emergency file, so that staff had one point of access should an emergency arise. Fridge and freezer temperatures were recorded regularly. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 22 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 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 23 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 YA37 Regulation 8 (1) Requirement The registered provider must appoint an individual to manage Tower House. Timescale for action 02/11/06 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. 2. Refer to Standard YA7 YA14 YA13 y YA12 Good Practice Recommendations The registered provider should put into place the banking arrangements for residents that have been proposed. Daily records should indicate whether activities have taken place so that staff are aware whether it is valued by the resident or needs to be changed. Daily records should demonstrate when a choice of activities has been offered. The registered provider should ensure that resident’s representatives are fully aware of the Home’s complaints procedure. Staff should be clear on where the Home’s adult protection policy is kept, and the content of the Local Authority Alerter’s Guidance. The process for investigating the recent adult protection Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 24 3. 4. YA22 YA23 5. 6. 7. YA32 YA7 YA33 YA39 incident should be reviewed by the registered provider to improve practice. Staff should understand the communication needs of residents, and alternative communication systems should be in place at Tower House. Staff should be fully aware, and have received training on equality and diversity issues. The Quality Assurance system should include the views of residents and stakeholders and an annual development plan should be developed with feedback to participants. Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tower House DS0000032607.V310295.R01.S.doc Version 5.2 Page 26 - 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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