Inspection on 14/11/06 for West Dean

This inspection was carried out on 14th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Dean 30/11/05

West Dean 09/08/05

West Dean 23/02/05

West Dean 01/09/04

West Dean 25/02/04

Similar services:

Hillside

Applegarth

Trevayler Residential Care Home

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 West Dean 77/79 Yarborough Road Lincoln Lincs LN1 1HS Lead Inspector Mr Doug Tunmore Key Unannounced Inspection 14th November 2006 09:15 West Dean DS0000002396.V319673.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 West Dean DS0000002396.V319673.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. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Dean Address 77/79 Yarborough Road Lincoln Lincs LN1 1HS 01522 568248 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) westdean@unitedheath.co.uk United Health Limited Mr John Warriner Care Home 16 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (10) of places West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: West Dean is a care home providing personal care for 16 residents who have a learning disability or mental health need. West Dean is not registered to provide Nursing care. The home is a large detached property located on a steep hill on one of the key routes within the City of Lincoln. The home is set back from the main road, within its own grounds and garden. There is access to the front of the home through the main entrance, which has a number of steps. There is also access to the rear of the home by way of the parking area, which is set on a steep slope. The property has four floors. There are two selfcontained flats on the ground floor. These are used as pre-discharge facilities, which support residents who are choosing to move into the community. The home is one of a group of homes owned by United Health PLC. The home has a flat rate of current charges, which is £348.00. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and took into account any previous information held by the Commission for Social Care Inspection (commission) including the homes previous inspection reports, their service history, the homes pre-inspection questionnaire sent to the home by the commission prior to this inspection. The site inspection consisted of case tracking a sample of two residents records and assessing their care. The inspector spoke with two of the residents other than those who were being case tracked and joined two other residents for lunch. The inspector also spent time with the manager and a carer. A partial tour of the home and a review of a sample of the records were also included. What the service does well: What has improved since the last inspection? What they could do better: Issues raised in this inspection were as follows; 1. Resident’s files did not contain a letter confirming that the provider could meet their needs. 2. Residents did not have the provider’s terms and conditions on file, which would give details of the conditions and fees for individual placements. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 6 3. Care plans need to be updated to so that they provide clear, detailed information regarding the needs of residents. These plans would benefit from addressing objectives and outcomes, which can be reviewed in order to evidence the good practice observed, and to support residents in fully meeting their personal goals. This requirement was made in the homes last report dated 30/11/05. 4. Residents should be encouraged to take part in their plan or care and sign it to confirm that they agree with the care provided. If residents are reluctant to sign any documentation then the manager must acknowledge this in writing. 5. Residents self medication risk assessments were seen and found not to have been signed by residents confirming that they are aware of the risks. 6. Resident’s requests for the home to be decorated have not been addressed. 7. Parts of the home are not clean or tidy. 8. The home has not informed the commission of an incident relating to the welfare of a resident. 9. Staff at this home have not had training specific for this client group. 10. One care workers personnel file did not contain all the documentation required to ensure the safety of residents. 11. The providers have not established a system for ensuring that there is a quality assurance process in which residents are informed of the outcomes. 12. Residents files did not evidence that risk assessments are drawn up with residents, detailing those risk relating to not having window restrictors on those floors occupied by residents. 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. West Dean DS0000002396.V319673.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 West Dean DS0000002396.V319673.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, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a comprehensive care needs admission assessment, which helps to ensure that a residents needs would be met. Residents do not have a copy of the providers’ terms and conditions. The home does not write to prospective residents confirming whether they can meet their care needs. EVIDENCE: A previous inspection carried out on the 30/11/05 evidenced that the home had a prospective residents care needs admission form. It was also found that ‘visits made to the home before admission for some new residents and, where this was not possible a visit made by staff from the home to the individual before admission to undertake an assessment of needs’. The manager stated that residents would have been visited prior to admission and assessments of their care needs would also be undertaken. Two resident’s file seen did not contain a letter confirming that the provider home could meet prospective residents needs. The manager stated that he visits all prospective residents prior to admission. He also said that there have been four admissions since the last inspection to this home and all had been successful. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 9 Two files of residents were seen and did not contain a written document of their terms of conditions of occupancy with the provider. During this inspection the operations manager brought to the home service users guides for named residents and contracts for those residents who did not have them on file. One resident stated that he had been given a service users guide some time ago. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have care plans in place, which could be improved further, to fully reflect individual goals and aspirations. EVIDENCE: A review of all information available prior to this inspection and a previous key inspection carried out in August 05 and November 05 at this home evidenced that residents had an individual care plan. However, the November 05 inspection also found that; care plans would benefit from being updated further to provide evidence of action plans, with outcomes, which fully promote residents aspirations. This inspection found that care plans require further work in relation to preparing residents for independent living in the community. This inspection also found that some residents need support in maintaining their independence within the home, which needs to be documented in care plans to ensure that this support is delivered. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 11 One resident seen confirmed that he was aware of his care plan and thought that he had signed it. He also said that he had attended reviews relating to his care. Other residents files seen, did not evidence that residents are actively involved in their care plans, which had not been signed by them. The manager needs to make a file note indication that residents had declined to sign their care plan. All residents were also found to have a risk assessment separate to, but linked to their individual care plan. A resident confirmed that regular house meetings are held in which residents are empowered to raise any issues and discuss the running of the home. This inspection showed that the last house meeting was undertaken on the 28/07/06 and issues discussed related to outings and holidays. One resident also stated that he had meetings on occasion with his key worker ‘if I want her’. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in appropriate activities within the home and local/wider community. Residents are also encouraged to maintain family relationships and to develop relationships with other residents with support as they wish. The home provides a varied and balanced nutritious diet for residents. EVIDENCE: A previous key inspection carried out in November 05 at this home evidenced that residents are encouraged to develop practical life skills as part of their overall care plan. Additional care staffing hours had been provided for staffing to support residents with social activities linked to care plans. Residents files showed that residents are given opportunities for personal development and engage in leisure activities of their choice. One resident commented that he is West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 13 independent and retains links with his brother and sister with whom he meets for weekend lunches. A second resident said that she has a boy friend who she visits regularly and hopes to move out into the community and be independent in the future. Residents care plans evidenced that one resident attends the Shaw trust, another attends cookery lessons, another does voluntary work for Strut and another attends to the garden at the home. Evidence was also seen in files that residents social workers are involved in finding suitable activities or voluntary work for their clients. The manager stated that residents are encouraged to be independent, and clean their own rooms and go shopping. However, two residents showed the regulator their rooms and it was found that support was required for these residents in order to maintain their independence and in one instance prepare for living on her own. Care plans must be updated to ensure that care staff are aware of the needs of individual residents. Residents were observed throughout the inspection, coming and going freely and undertaking activities of their choice, as they wished. Residents confirmed that they felt well supported. The regulator joined two residents for lunch and engaged a number of others who said that the meals are good at this home and they have their main meal at teatime. Residents also confirmed that if they want an alternative to the menu of the day, it is provided for them. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 18,19 & 20 The health care needs of residents are met. Residents have not signed their medication risk assessments. EVIDENCE: A previous key inspection and the homes pre-inspection questionnaire evidenced that each resident has a named key worker. This system helps to ensure consistency in care provided, whilst promoting good working relationships between a named member of staff and a resident. Care plans seen at this inspection evidenced that all health related needs are recorded and staff support residents to attend GP and other health care appointments within the community. One resident stated that he had been to the dentist on the day of the inspection and also attends the opticians and his GP when he requires theses services. One resident commented that he West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 15 administers his own medication and showed the regulator the lockable facility in his room where medication is stored. Self medication risk assessments were seen and found not to have been signed by residents confirming that they are aware of the risks and are prepared to self medicate. Some residents at the home also require support with medication. There are policies and procedures for recording all aspects of administering medicines. Records of medication given were seen and found to be up to date at the time of this inspection. The manager and trained care staff administer medication to residents. The homes training record showed that training in the administration of medication was undertaken on the 07/11/05. Since the last inspection the home has developed its main storage facility for medication. The last pharmacist inspection was undertaken on the 26/04/04. It would be advisable if the provider arranged for annual inspections of the home medication to offer advice and ensure that appropriate administration of medication is undertaken. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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. 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. Residents are empowered by the homes complaints procedure The home takes the protection of residents seriously, and acts to support and protect residents. EVIDENCE: Previous key inspections found that the manager encourages residents to talk about any concerns they may have and has set up residents meetings to enable greater opportunities for those living at the home to air their views. Information received prior to this inspection showed that the last residents meeting was held on the 13/09/06. Issues relating to the running of the home were discussed and concerns that residents had addressed by the manager. The homes pre-inspection questionnaire evidenced that there have been no complaints made at this home since the last inspection. The home has an up to date copy of the policy, procedure and guidance relating to the protection of adults. The last key inspection found that Staff files evidenced that team members had received training in safeguarding vulnerable adults. The homes training record showed that this training was carried out in 2004 and in 2006. A staff member described appropriate action that should be taken if a resident raises concerns regarding abuse. A resident stated that ‘he feels safe, the people (residents) are good and pretty well all staff are approachable’. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Externally improvements have been made to the home. Internally the home is not reasonably well maintained. Parts of the home are not clean or tidy. There are no unpleasant odours. EVIDENCE: A partial tour of the home found it to be in need of redecorating. Those residents who showed the regulator their rooms felt that they needed redecorating. One of the residents commented that he had asked for a new carpet but no action had been taken. It was observed his room had not been vacuumed for some time, as around the skirting board of his room there was a substantial layer of dust. One resident needs some support with managing the contents of her room. This needs to be a part of her care plan and agreed with the resident as to how this is to be addressed. Since the last inspection the West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 18 kitchen has been partly refurbished and a new dining room carpet has been fitted. The minutes of the last residents meeting were seen and comments made by residents were when would they be getting their rooms decorated and carpets fitted. The manager stated that no action has been taken regarding residents requests. The home currently employs an agency cleaner who works twenty hours a week. One resident stated that the home is clean and there are no unpleasant odours. All rooms are numbered for each resident and residents have their own keys for rooms and from observation made at this inspection can come and go to their rooms as they so wish. The last inspection of this home found that rubbish accumulates outside the home each week. The manager said that a storage container facility is now in place to store rubbish more hygienically. This inspection noted that the front garden has been grassed over and shrubbery planted giving an attractive aspect to the front of the home. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 19 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, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Robust recruitment practices are not in place. Staffing levels meets the needs of residents. EVIDENCE: The last key inspection dated November 05 found that the home was adequately staffed, with staff, who demonstrated experience and competence to care for the current group of residents. Through the checking of staff files and discussion with the manager, it was confirmed that a recruitment policy and procedure is in place to ensure that the team is balanced and provides appropriate physical, and social support for all residents safely. This inspection found that adequate checks are not undertaken in that one care workers personnel file did not contain identification or a current photograph. One carer said that she had undertaken the homes recruitment process and confirmed that references and criminal record bureau checks were acquired prior to starting work at this home. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 20 The manager commented that each worker in the home has been given the General Social Care councils pack relating to the registration of care workers and the philosophy of the Care Council for all social care homes. A carer stated that she had undertaken the homes induction training, which included fire procedures. The providers training plan was seen and found to be up to date. The training record identified that the manager and care workers who had undertaken statutory training undertaken in 2006 and planned training in 2007. Information received from the home in their pre-inspection questionnaire evidence that the home has 28 of staff trained to National Vocational Qualifications (NVQ) in the care or residents. The home does not meet the standard for 50 of its staff trained to NVQ level 2 by 2005. This inspection found that the providers have not promoted training for staff specific for this client groups needs. A carer commented that there is enough staff on duty to care for residents at this home. A resident stated that ‘if there are problems staff are always around and cope with it. I am quite happy, I was born down the road’. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager provides leadership to carers in everyday care issues. Quality assurance audits of residents and visitors views are not carried out. Risk assessments are not available regarding residents windows. EVIDENCE: The registered manager has experience in working with clients who have a wide range of social care needs. This includes people with physical or mental health care needs or who are elderly mentally infirm. The manager has NVQ level 3 in mental health care and is currently undertaking the registered managers award. He has also undertaken statutory training as required. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 22 It was found that the provider does not conduct an in-house quality assurance check or report based on the views of residents as to how this home is managed. The manager confirmed that as part of his registered managers award he in undertaking a module on promoting quality assurance which he would introduce to this home. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence in the homes pre-inspection questionnaire that fire alarm, fire drills and emergency lighting checks are carried out. Staff also undertake fire training as part of the homes initial training and as a regular training event. Certificates were available showing that gas safety inspections have been carried out, electrical wiring checks, and portable electrical equipment checks. However, risk assessments are not available for windows on the ground and first floor, which do not have window restrictors. The homes service record showed that an incident regarding a resident had not been reported either verbally or in writing to the commission as required. West Dean DS0000002396.V319673.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 X 3 2 4 X 5 2 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 2 25 X 26 X 27 X 28 X 29 x 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 2 x x 2 x West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 14(d) Requirement The provider must confirm in writing to the service user that the home is suitable for the purpose of meeting the service users needs in respect of his health and general welfare. The provider must provide the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment. The Manager must further develop existing individual care plans with each resident which identify services and facilities, and how these services will meet the current and changing needs, aspirations and goals of each resident and reflect outcomes. (The timescale of the 01/03/06 has not been met and a new timescale has been given). The provider must carryout consultation with the service user or a representative of his, revise the service users care plan and notify the service user of any revision and obtain a DS0000002396.V319673.R01.S.doc Timescale for action 23/02/07 2 YA5 14(d) 23/02/07 3. YA6 15(1) and (2)(c)(d). 23/02/07 4. YA6 15 (c ) 23/02/07 West Dean Version 5.2 Page 25 5. YA20 13(2) 6 7 8 YA24 YA30 YA35 23(d) 23(d) 18 (c ) (i) 9 10 YA34 YA39 19 24 (a)(b) 11 YA42 13(4)(a) 12 YA42 37 signature confirming that the care plan is agreed. Those risk assessments seen of service users who self medicate must be signed by service users to confirm that they agreed with the terms of the risk assessment. The provider must ensure that all parts of the home are reasonably decorated. The provider must keep all parts of the home clean. The registered person must ensure that persons employed to work at the care home receive training appropriate (specific to this client group) to the work they are to perform The provider must ensure that there are robust staff recruitment procedures. The provider must establish and maintain a system for reviewing at appropriate intervals the quality of care provided at the care home and inform service users of the outcomes of any survey undertaken All rooms without window restrictors must have a risk assessment to minimise the risk to service users. The provider must give notice to the commission without delay of the occurrence of; any event in the care home which adversely affects the well-being of any service user. 23/02/07 23/03/07 23/02/07 23/02/07 23/02/07 23/02/07 23/02/07 23/02/07 West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 26 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 West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 West Dean DS0000002396.V319673.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!