Inspection on 19/04/06 for Tramways

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tramways 16/09/08

Tramways 12/10/07

Tramways 17/01/06

Tramways 03/08/05

Tramways 19/01/05

Tramways 26/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Tramways Tramway Road Brislington Bristol BS4 3DS Lead Inspector Sandra Jones Key Inspection 19 & 25 April 2006 09:30 th th Tramways DS0000026641.V290381.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 Tramways DS0000026641.V290381.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. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tramways Address Tramway Road Brislington Bristol BS4 3DS 0117 3009637 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust To be appointed Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (14) of places Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 14 persons aged 65 years and over with Learning Disibilities for personal care only May accommodate up to 14 persons aged 40 to 65 years with Learning Disibilities for personal care only 12th January 2006 Date of last inspection Brief Description of the Service: Tramways is registered to accommodate up to fourteen adults with learning disabilities. The care home is operated by Aspects and Milestones Trust and at present there are two acting managers. The property was purpose built and arranged on one level, designed into two separate units accommodating seven people, linked by a passage, with a shared kitchen. It is situated in an industrial estate close to the Bath Road and within walking distance of shops, amenities and bus routes. Each unit has their own staffing with a manager, senior and home support workers. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. It is the Trust’s intention to change the current purpose of the home. Residents in house 1 will move as a group to a more suitable environment and the residents in house 2 will move separately. This inspection was conducted in house 2 because the residents are moving to separate care homes. The methodology of this inspection was based on the assessments of key standards. Records were examined and a tour of the premises took place to make judgements on the standards of care. Relatives comment cards were sent to next of kin to seek their comments on the standards of care at the home. Residents and staff were consulted on the daily routines and interests. What the service does well: What has improved since the last inspection? Clearer assessments have identified the potential of each person and have provided the platform to empower individuals. It is evident from this inspection that significant steps were taken to ensure Essential Life Plans were meaningful. The plans will assist in the smooth transition and personal development of the person’s future placement. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 6 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. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 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 Tramways DS0000026641.V290381.R01.S.doc Version 5.1 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): These standards were not examined at this inspection. EVIDENCE: It is the intention for the residents in house 1 to move as a group to a more suitable property within twelve months. The residents in house 2 will move separately in a shorter time span. For this reason the information to enable choice about the home was not examined. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 This Quality outcome is adequate. Essential Life Plans (ELP) are adequate and place the individual at the centre of their care. Links between running reports and Elp’s must be developed to evidence choice and establish the progress of the plans. Risks identified are assessed and measures introduced to minimise the risks. EVIDENCE: Essential Life Plans (ELP) have been developed with residents, staff and external facilitator. As the residents in house 2 are moving from Tramways their placing authority reviewed their needs. Elp’s are linked to the core assessments and guide staff to meet their identified need. Likes, dislikes and preferred routines are incorporated. There are elements of the key principles of Valuing People within the ELP, which are essential for their future placements. Overall the Elp’s are specific and clearly place the individual at the centre of their care. In house 1 Elp’s were further developed to incorporate additional information to safeguard residents from abuse. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 10 For residents that use other means of communication “Listen to me” plans are used to describe the gestures used by the person, the perceived meaning and the actions that staff must take. Handover sheets are used to ensure checks are undertaken and assist staff to plan the day for the residents. Individual plans for each person are listed with essential communication to be handed to oncoming staff. From the handover sheets, diaries are used to record the day’s events. Generally, staff record activities undertaken. A better link between the individuals Elp and running reports must be developed to evidence choices and to assess the progress of the Elp. One resident is diagnosed with PICA, which is an eating disorder, and risk assessments are in place to prevent choking. Although there are no reasons for having keypads installed in the front door and link between the two houses, the residents are moving and therefore these keypads will not be removed. There are residents currently accommodated that at times present with aggressive, violent and inappropriate behaviours. Risk assessments are completed for behaviours that challenge. Triggers of agitation are listed with the actions to be taken to diffuse and divert potentially aggressive and violent incidents. For inappropriate behaviours, action plans specify the actions to be taken to establish positive behaviour. Through examination of the accident records, two residents can become aggressive towards each other. Reactive strategies must be developed to ensure that where possible violent incidents are reduced. The manager developed reactive strategies for one of these individuals for the second inspection visit. Risk assessments are also completed for activities that may involve an element of risk. Risk assessments are based on accessing the community, bathing and getting in and out vehicles. Risks are identified and actions to reduce the level of risks are developed. The number of recorded accidents evidenced that risk assessments are effective. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 &16 The quality outcome in this area is good. Members of staff take steps to enable residents to experience meaningful activities. Members of staff recognise that social inclusion into the community must be promoted for residents. Relatives are welcome and staff ensure links with relatives and friends are strengthened. Residents routines for daily living are incorporated into the person’s ELP, their preferred mode of address must be included. EVIDENCE: The residents currently accommodated in house 2 are entitled to 3 hours of day service per week, provided by day care staff. Essential Life Plans (ELP) describes the things that are essential to the individual. Within the essential information are the activities that the person enjoys. Pinned to the notice board is the list of activities that each person may undertake. These are known as “taster” activities, which residents can sample, with the support of the staff, to experience a wide range of meaningful activities. At present three residents attend college courses and pursue other interests that include visiting shops, aromatherapy and train spotting. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 12 Residents in both houses visit local pubs, restaurants and shops. The members of staff must accompany residents outside the home and it is evident from observations and records that social inclusion is promoted at the home. Residents are registered onto the electoral roll. Relatives comment cards were sent to twelve next of kin and five responses were received. One person declined to complete the cards and four were returned completed. There were positive responses regarding the welcome received from staff during visits and that bedrooms can be used for additional privacy. Relatives made supplementary comments that members of staff keep them informed about all aspects of their family members’ well being. Where maintaining links with family and friends is important, ELP specify the actions to strengthen these links. Residents routine for daily living are incorporated into the person’s ELP. It was noted during the evaluation of the records that shortened versions of persons name are used within ELP’s. However, there is no reference to this being a preferred mode of address. Residents have little understanding of the concept of privacy. In terms of keys to bedrooms and receiving mail unopened, one resident has keys to their bedroom and mail is read with residents. One resident’s ELP indicates wishes for privacy. It was understood that this individual was provided with a key to their bedroom. Regarding handing mail to residents the manager in house 2 reported that the support with mail depends on the individuals interest. During the inspection, members of staff were observed engaging with residents and using positive interaction. There is specific designated 1:1 time with individual residents and ELP’s specify the gestures used by residents whenever their attention is needed. To seek staff’s attention, residents were observed leading staff. Two residents prefer not to socialise with other residents and have the freedom to seek company in public areas or to be alone in their bedrooms. Two residents will sit away from the other residents during mealtimes. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19&20 The Quality in this area is good. Essential Life Plans detail residents personal support needs which must define the individuals privacy needs. Health action plans, will be introduced for each person in advance of their move, and address health care needs. Safe systems of medication administration, recording and disposal exist at the home. EVIDENCE: Residents personal hygiene needs are specified in their ELP’s and detail their preferences on the manner in which staff provide personal care. For example, their preference for a shower or bath, the assistance needed and the individuals capabilities. While it is acknowledged that members of staff are aware of their responsibilities towards respecting residents rights, ELP’s must specify privacy needs. Daily routines about times to raise and retire, meals and activities are listed within the ELP. Within the individual’s ElP, essential information about their appearance is recorded. The residents in house 2 require some level of support with moving and handling. Generally based on getting in and out of vehicles, support outside the home and using the bath hoist. Risk assessments are in place for supporting residents that require assistance. Where additional clarity is needed to use equipment, photographs are used to emphasise the techniques Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 14 to be used. Risk assessments are reviewed by the staff and overseen by the Health and Safety facilitator. Health action plans are to be introduced for each residents in house 2 before their move. Plans were prepared for one person and the format used follows Valuing People guidelines. The health care services involved with medications prescribed are specified in the content page of the plan. The need, action to be taken and by whom are listed within the action plans. Advice from the professional and the date of the visit is recorded in separate contact sheets to monitor health care needs. It is evident that residents health care needs are assessed and procedure through the health care action plans are in place to address them. One female resident is accommodated in house 2 and because of a lack of cooperation, routine screening is not undertaken. Medications are administered through a monitored dosage system and records examined indicated that immediately after administration staff sign the records. A record of medications no longer required at the home is maintained and signed by the pharmacist to evidence receipt of the medication for disposal. Currently the staff are going through medication needs with one person as this individual has the abilities to understand the information being conveyed. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 &23 The Quality in this outcome area is adequate. Comments from relatives suggest that concerns they raise, on behalf of their family member are taken seriously by the staff. Strategies are in place to safeguard residents from abuse. EVIDENCE: Comment cards were sent to twelve relatives in advance of the inspection and at the time of the inspection five had responded. Two relatives indicated their awareness of the complaints procedure and three had made a complaint. Additional comments made by relatives indicated that complaints raised with staff are taken seriously and acted upon. There were no complaints received in house 2 for investigation since the last inspection. One resident has psychologist involvement with input from a psychiatrist to ensure strategies are in place to safeguard other residents from abuse. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 The Quality in this outcome group is adequate. The property is maintained to an adequate standard. The home is clean and free from unpleasant smells. House 1 must have access to its own laundry once the residents in house 2 move out. EVIDENCE: Tramways is purpose built for fourteen people with learning disabilities. The accommodation is arranged into two houses with separate entrances with a link between the two houses. Each house has seven bedrooms and its own toilets, bathroom and lounge and share the kitchen and laundry. The property is sited within an industrial estate with close access to residential community. Shops, restaurants, bus routes and amenities are within a short walking distance. While there is level access into the home the local environment is undulating. Generally the property is maintained to an adequate standard. The maintenance of the property was the focus of this assessment, as the use of the property will change in the near future. One member of staff has the responsibility for Health and Safety checks, which includes identifying repairs. The Trust employs contractors to visit homes weekly to undertake repairs. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 17 The premises are accessible to all service users. There is level access, wide corridors and doorways to maintain residents independence with moving around the home. Bedrooms are single with furniture and fittings that are suitable for the individual. There is a combination of the home’s furniture and personal belongings, which reflect the person’s personality and interest. The laundry is sited away from the laundry in house 2 and facilities are shared with house1. The wall finishes and floor covering ensure that they can be cleaned easily. However, the air vent needs cleaning. There are two industrial washing machines with specific cycles for foul linen. Three dryers are installed to assist with drying the clothes of fourteen individuals. The residents in house 2 are moving to different homes and while a suitable property is found for the residents in house 1, will remain for a 12-month period. The intention is to use house 2 for short-term care, which has an impact on house 1 by having to intrude into the residents of house 2. House 1 must have access into their own laundry. . Tramways DS0000026641.V290381.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 &36 This Quality outcome area is poor. Individual personnel files must include a current photograph. Identification cards for agency staff must be checked on arrival by the staff at the home. Where CRB serial numbers are not included in their id’s, agency staff must be able to produce a copy of their crb if asked. The training programme is well established, members of staff undertake induction, statutory training and vocational qualification. Other training specific to the needs of the residents must be considered. Staff in house 2 are supervised regularly and individual supervision of staff in house 1 is not regular. EVIDENCE: Three members of staff were recruited since the last inspection and are currently undergoing the probationary period. Staff personnel files were recently transferred from the Trust office to the individual homes. Personal details, role, contractual hours with the terms and conditions of employment are held in files. Photographs are not currently included within the files. In terms of bank and agency staff, managers’ are not provided with any information on the suitability of the person to work with vulnerable adults. It was understood from the manager that every effort is made not to use agency staff. Where CRB serial numbers are not included in their id’s, agency staff must be able to produce a copy of their crb if asked. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 19 The competence of two staff to fulfil the expectation of their role is being discussed with personnel. Their capabilities to undertake specific tasks have raised concerns and written confirmation of the actions to be taken were sent to these individuals. Supervision in house 2 takes place regularly at 4-6 week intervals it follows a specific agenda. Job descriptions, performance, personal development and allocated tasks are discussed during supervision. It was understood that in house 1, supervision has lapsed. Stringent efforts towards individual supervision must be made to ensure all staff have regular supervision. The external manager visits the monthly to assess the conduct of the home. A report is then prepared and sent to the home and CSCI. Training was discussed with the manager in house 2 and the assistant home manager in house 2. It was understood that it is an expectation of employment that support workers must be competent to be left in charge of the home. For this reason once staff complete the probationary period, they are registered onto the NVQ level 3. In house 1 four staff are registered onto the NVQ level 3 and in house 2 one person has completed NVQ level 3. Two staff are registered onto the NVQ level 3 and two are undertaking Empowering practice training. Two members of staff were employed at the home since the last inspection and are currently on their probationary period and undertaking the induction programme. The training records for staff in house 1 were examined and it is evident that inductions for new staff take place. Statutory training is provided and vocational qualification. It was understood from the manager that training needs are discussed during Personal Development Reviews. Personal Development Plans reviews are annual with staff and focus on the role, responsibilities and training needs. From the review an action plan is prepared and monitored during supervision. It is acknowledged that vocational qualifications and statutory training is accessible. Other training specific to the needs of the residents must be considered. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 &42 The Quality in this outcome area is adequate. The manager must provide a satisfactory crb to complete the “Fit” person process for registration. Health and Safety checks promote the residents safety and welfare. EVIDENCE: The manager has recently undergone the “Fit” persons process to register as manager of the home. The process will be complete once a satisfactory CRB disclosure is obtained. The manager is in the process of completing the RMA. Arrangements are in place to maintain a safe environment for the residents and staff. One member of staff is responsible for checking the premises and for reporting repairs. A contractor appointed by the Trust visits monthly to undertake reported repairs. Certificates are available for gas safety checks, portable appliance and the removal of clinical waste. Gas safety and electrical appliance checks occur annually by a competent person. A company registered to manage the collection of waste is appointed to remove clinical waste from the home. A contractor services hoists and Hydrobaths annually. The records that relate to fire safety checks and practices were examined and it is evident from the log that checks take place at the stipulated frequencies. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 21 In terms of fire drills and training, members of staff have participated in fire drills. Fire training will be arranged once the Trust has provided the manager with material for the training. Tramways DS0000026641.V290381.R01.S.doc Version 5.1 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 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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 x x x x 3 x Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 23 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. 2. Standard YA6 YA6 Regulation 13 (4) 13(4) Requirement Links between ELP’s and running reports must be developed to evidence choice and progress. ELP’s must include the individuals preferred mode of address. The individual’s privacy needs must also be included within their ELP Residents in house 1 must have access to their own laundry. A current photograph of the person must be included in their personnel files The staff on duty must check identification cards whenever agency staff are used at the home. Where crb serial numbers are not included in the id card, copies of the crb must be produced if requested. Other training specific to the needs of the residents must be considered for staff. Members of staff must be adequately supervised. The manager must obtain a crb to complete the registration process DS0000026641.V290381.R01.S.doc Timescale for action 30/06/06 30/06/06 3. 4. 5. YA30 YA34 YA34 16 7,9,19 Sch.2.1 19(9i2) 30/07/06 30/06/06 30/05/06 6. YA35 18 (i) 30/08/06 7. 8. YA36 YA37 18(2) 9 30/06/06 30/06/06 Tramways Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tramways DS0000026641.V290381.R01.S.doc Version 5.1 Page 25 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. 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