Inspection on 07/09/07 for Woodbridge House

This inspection was carried out on 7th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodbridge House 30/01/09

Woodbridge House 06/02/08

Woodbridge House 28/02/07

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Woodbridge House 151 Sturdee Avenue Gillingham Kent ME7 2HH Lead Inspector Joseph Harris Key Unannounced Inspection 7th September 2007 10:00 Woodbridge House DS0000068213.V348561.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 Woodbridge House DS0000068213.V348561.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. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodbridge House Address 151 Sturdee Avenue Gillingham Kent ME7 2HH 0208 502 4466 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) www.achuk.com Aitch Care Homes (London) Limited Ellen Luck Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disabilities (LD) The maximum number of service users to be accommodated is 10. Date of last inspection 28th February 2007 Brief Description of the Service: Woodbridge House is a large detached corner property situated on the outskirts of Gillingham town centre. The home can take up to 10 service users aged between 18 and 65 with a learning disability and complex needs. The home is on a main bus route and the Gillingham town centre main line railway station is approximately 1 mile away. The home has easy access to local library and shops. The fees range from £1,300 to £1,550 per week Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection process culminated in a site visit to the home on 7th September 2007. The site visit commenced at approximately 10am and concluded at 5.30pm, lasting for around 7.5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the organisation’s Director of Operations, the Regional Manager, staff members, service users and relatives. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home had not returned the Annual Quality Assurance Assessment (AQAA) form at the time of the site visit. What the service does well: What has improved since the last inspection? What they could do better: 5 requirements and 6 recommendations have been made as a result of this inspection process. The home has had a succession of managers since opening due to circumstances beyond the control of the organisation. However, this lack of leadership and direction has been a significant contributory factor to the shortfalls noted within this report. Discussions were held with senior managers Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 6 in the organisation who were able to demonstrate the urgent actions that are already underway to begin to address a number of these shortfalls. The general administration and record keeping in the home is poor and adds to confusing and, sometimes contradictory information. This is especially pertinent in respect of individual service user plans, risk assessments, health and safety information and accident/incident recording. Recommendations were made relating to developing and improving the programme of activities on a group and individual basis; ensuring regular resident and staff meetings and continuing to develop quality assurance processes. Improvements can be made to the service user’s guide and healthcare recording. Staff competency assessments could be developed covering key training areas such as medication, fire safety and adult protection. 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. Woodbridge House DS0000068213.V348561.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 Woodbridge House DS0000068213.V348561.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): 1, 2 and 4. Quality in this outcome area is adequate. Prospective service users have satisfactory information prior to choosing to move into the home. Their needs are assessed, although this information needs to applied more robustly in the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service users guide in place covering all required information. The service user’s guide has been developed using illustrative pictures and universal signs to aid understanding. Due to the needs of service users the home should consider developing alternative formats to relay this information such as spoken word, video or picture book formats. Refer to recommendation 1. The organisation has a central referral team through which all prospective service users are screened. The referral manager gains a detailed history of the individual from care management documentation and other sources before visiting the client with a senior member of staff from the home. A comprehensive and holistic assessment is completed at this point and suitability and diversity issues are taken into account. Following the initial visit(s) the prospective service user and significant others are invited to spend Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 9 time in the home on a flexible basis to suit individual needs. This can range from short orientation visits to overnight stays dependent on needs and wishes. The assessment information gained is used to form a plan of care, but this needs to be more clearly and robustly applied in the home. A number of service user pre-admission assessments were examined along with subsequent plans of care, but omissions were noted in some circumstances. Refer to requirement 1. Woodbridge House DS0000068213.V348561.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 and 9. Quality in this outcome area is adequate. Service user plans are disorganised and lack clarity. Risk assessments are in need of further development. Service users are supported to make decisions where possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of individual service user plans were examined during the course of the site visit. However, this information was disorganised, disjointed and lacking in constructive detail. It was reported that a recent archiving exercise has been completed, but this has been poorly managed and followed through. The current plans of care on file are extremely lengthy documents that, in some cases, are based solely on the initial pre-admission assessment. They show little evidence of continuous development or addressing changing needs. Aspects of care and elements of risk have been omitted on occasion. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 11 Additionally, these individual plans provide vague information to enable staff to consistently meet needs and support service users. Guidance about how to meet assessed needs is minimal with an over-reliance on jargon and vague terminology. The plans show little evidence of review. However, additional files were found that are not in current use that contained an improved level of detail and showed evidence of the on-going development of care needs. This information requires updating and review, but provided improved levels of guidance for staff and addressed a wider range of needs and support issues. Refer to requirement 2. Similarly the risk assessments and behavioural management plans currently in use do not provide a suitably robust risk management framework. There are no individualised physical intervention plans in place or de-escalation techniques described. Some areas of risk are addressed, but the action plans lack specific detail and focus on differing aspects of risk that may be encountered. As with the plans of care; additional information was found in another file, which provided improved levels of detail. Refer to requirement 3. It is noted that the home has been open for approximately 1 year and there has been a succession of managerial changes in that time, which has compounded the lack of clarity and cohesion in this area. Service users are supported to make decisions affecting their lives where possible. Due to the nature of service user’s needs in the home there are limitations in this area. The home does not take on appointee role for any individual with all finances managed through independent sources. Woodbridge House DS0000068213.V348561.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, 16 and 17. Quality in this outcome area is adequate. Service users have opportunities to engage in recreational and occupational pastimes and to be part of the local community, although there is scope for further development in this area. Visitors are welcome and a healthy and balanced diet is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are able to participate in a range of activities throughout the day and in the evening. Each service user has an activities timetable and there is a generic timetable for group activities. Discussions were held with all the staff members on duty throughout the day and a consistent level of feedback surrounded the range and time for activities. A number of staff reported that they would like a more varied timetable of activities and increased scope to do more 1:1 work including walks to the local park, shopping and other leisure Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 13 pursuits. It was also reported that although swimming is a regular feature on the timetable this has not been accessed by service users for sometime. Some service users access external groups such as evening clubs, day centres and college amongst other things. Refer to recommendation 2. Visitors are reported to be welcomed into the home at all reasonable times. Two relatives were spoken to during the visit who expressed satisfaction at the service received in the home. The home aims to liaise with relatives when any significant issues occur. A healthy and well-balanced diet is provided demonstrated by the menu records. There is a nicely fitted domestic sized kitchen, which had adequate food stocks including fresh fruit and vegetables. Service users are encouraged to participate in the planning of the menu, shopping, meal preparation and tidying. Woodbridge House DS0000068213.V348561.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 and 20. Quality in this outcome area is adequate. The personal and healthcare needs of service users are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff assist the majority of service users in meeting their personal care needs through encouragement and more direct support. Staff were observed to treat residents with dignity and respect ensuring that personal care is given in a private setting. Service users confirmed that staff in the home are caring and thoughtful and provide personal care in a manner that they prefer. The plans of care do not, however, provide clear guidance for staff on how residents wish and prefer their personal care needs to be met. Refer to requirement 2. Records are maintained regarding healthcare issues, although these could be retained in a more organised fashion and provide more detail regarding the outcomes of any healthcare appointments and consultations. Refer to recommendation 3. Service users are registered with local GPs and receive regular input from the Community Learning Disability Team and care Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 15 managers. Complimentary healthcare is provided through chiropodists, dentists and opticians on a regular basis. The home maintains clear medication records and storage facilities are suitable for the needs of the home. A number of medication errors occurred around 6 months ago, but the home has taken appropriate steps to eradicate such issues and there have been no reported problems since the introduction of these measures. There are appropriate policies and procedures in place and staff administering medication have been provided with appropriate training. It is advised that the home develops competency assessments for medication trained staff to ensure knowledge gained through training is retained and built upon. Refer to recommendation 4. Woodbridge House DS0000068213.V348561.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 and 23. Quality in this outcome area is adequate. There is a robust complaints process in place. The home needs to develop measures to ensure that service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear complaints process in place ensuring that any issues raised are dealt with in a minimum of 28 days. The home aims to address any concerns on an informal basis in the first instance, but should this prove unsatisfactory there is a formal process overseen by the area manager and/or Director of Operations for the organisation. The organisation has developed adequate policies and procedures relating to safeguarding against abuse. Staff have also participated in adult protection training and this issue is also covered through the induction programme. The majority of staff have also completed breakaway and physical intervention training including de-escalation techniques through an accredited provider. It was reported that the incidence of physical interventions are relatively low. However, an intervention did occur 3 months prior to the site visit, but no individualised strategies are in place relating to physical interventions or behaviour management plans. Additionally, it was not possible to locate any incident or ABC forms relating to any incidents that have occurred since the last inspection. The area manager in attendance confirmed that these had Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 17 been received at the organisation’s head office and that they are reviewed by a senior manager on receipt. An adult protection alert has been raised in relation to the home following a number of complaints made directly to the Commission for Social Care Inspection. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The home is suitable for the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodbridge House is situated on a residential road close to the town centre of Gillingham. The building is set over two floors and is of relatively recent construction providing a safe and conducive environment for the needs of the service users. The organisation has invested in the premises to ensure that residents have a safe, comfortable and spacious home with good quality furniture and fittings. There is a large lounge that is bright and spacious and a smaller dining room that currently has the facility to seat a maximum of 8 people. The rearrangement or addition of dining furniture may be beneficial to enable all service users and staff to share mealtimes together. Refer to recommendation 5. There is further communal space available including a Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 19 quiet room and a meeting room. A number of bedrooms were viewed, all of which are single occupancy that were of a good size and decorated to individual tastes. There is an enclosed garden to the rear of the property that is accessible to all service users and provides a comfortable space to relax outdoors. The kitchen and laundry are well-equipped and domestic in size. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is adequate. Service users are supported by a competent staff team in adequate numbers. Staff training requirements are met. Recruitment issues are managed through a central personnel department. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has been open for approximately 1 year and around half of the staff team have been in employment at the home for less than 6 months. The organisation actively encourages and supports staff to work towards National Vocational Qualifications (NVQ) and currently 5 staff members have achieved level 2 in care or above. A further 2 staff are working towards these qualifications. Discussion were held with all staff members on duty throughout the day both formally and informally. In all cases the carers demonstrated a commitment to the service users and enthusiasm for their work. This was underpinned by a good level of knowledge and skills to ensure that service users are supported and cared for appropriately. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 21 It was not possible to examine recruitment records and training certificates at the time of the site visit. However, training records were sent to the Commission for Social Care Inspection following the site visit demonstrating that the organisation provides all required training within the first 6 months of employment. It was reported that the home has also introduced the Common Induction Standards to complement the in-house induction package. Additional courses are also provided in service specific topics such as Breakaway and Physical Intervention techniques, management of aggression, epilepsy and autism. It is advised that the home introduces competency assessments for staff covering key training topics such as medication, first safety and adult protection amongst others. Refer to recommendation 6. It was reported that all recruitment issues are managed through a central personnel department within the organisation and that clear processes are in place to ensure all information is gathered prior to appointment. It was not possible to fully inspect this standard. The home operates with 5 staff throughout the day and 2 waking night staff. Staff reported that they felt these levels enable them to meet individual needs, but did state that there are occasions when there are only 4 staff during the day, which, due to the needs of service users, level of activity, intensive support for one individual in particular and additional household chores creates difficulties. The Area Manager present stated that the home is encouraged to fill any staff shortfalls using bank or agency staff to maintain the staffing levels at all times. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. The home does not have a Registered Manager. There are reasonable welldeveloped quality assurance processes in place. Some attention needs to be paid to health and safety issues in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The former Registered Manager of the home left her post approximately 2 months ago. At the time of the site visit interviews were being conducted to appoint a successor. The home has had 3 managers in the first year of service, which has detrimentally affected the development of the home. A discussion was held with the Operational Director and Area Manager who acknowledged Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 23 this as having had a significant impact on the home and has contributed to the shortfalls noted throughout this inspection process. Additionally resident and staff meetings have ceased to take place on a regular basis, which need to be reintroduced. Refer to requirement 4. The organisation has developed effective quality assurance processes including satisfaction questionnaires, which are compiled within a monitoring report. The area manager conducts monthly monitoring visits, which are comprehensive in the topics addressed. However, a note of concern is that the issues surrounding care planning, risk assessment and fire safety in particular were not identified or remedial action taken to address these shortfalls, which needs to be reviewed. Refer to recommendation 6. The home needs to pay more attention to health and safety monitoring with particular reference to fire safety checks, accident/incident records and administration. The home has a fire safety risk assessment in place however fire safety records have been sporadically completed since the home opened. In general the administration in the home is of poor quality with no clear systems in place and records filed in various places and duplicated. Service and maintenance certificates were located and were up to date with the exception of the CORGI gas certificate, which it was reported has recently been completed, but the home is awaiting the certificate. Refer to requirement 5. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 24 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 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 1 X 2 X X 1 X Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 25 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 YA2 Regulation 14(1) Requirement To ensure that pertinent preadmission assessment information is applied within the care planning and risk assessment processes. To review and update care planning processes for all service users ensuring that information is: a) Accessible. b) Organised. c) Clear and directive. d) Action focussed. e) Regularly reviewed. To ensure risk assessments are detailed and address all areas of perceived risk including individualised physical intervention and behaviour management plans. To appoint a Manager who is to be put forward for registration with the Commission for Social Care Inspection. To ensure all health and safety issues, in particular fire safety measures, are maintained and kept up to date. Timescale for action 01/11/07 2. YA6 15(1) 01/11/07 3. YA9 13(4) 01/11/07 4. YA37 8, 9 01/11/07 5. YA42 13, 23 01/11/07 Woodbridge House DS0000068213.V348561.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. 1. 2. 3. 4. 5. 6. Refer to Standard YA1 YA14 YA19 YA20 YA24 YA39 Good Practice Recommendations To consider developing alternative formats to improve accessibility of the Service User’s Guide. To develop a wider range of activities in and out of the home promoting personal choice and flexibility along with more organised pursuits. To develop more organised recording systems for monitoring healthcare needs including outcomes of appointments and consultations. To develop staff competency assessments relating to medication issues. To consider providing additional seating in the dining area. To ensure that quality monitoring visits are suitably detailed to identify service shortfalls and put in place action plans. Woodbridge House DS0000068213.V348561.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Woodbridge House DS0000068213.V348561.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. 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