Inspection on 30/09/08 for Woodstock

This inspection was carried out on 30th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Woodstock 06/11/06

Woodstock 05/01/05

Woodstock 28/11/04

Woodstock 18/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Woodstock 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Schwarz     Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Woodstock 186 White Lion Road Little Chalfont Amersham Bucks HP7 9NR 01494765401 Telephone number: Fax number: Email address: Provider web address: manager.woodstock@fremantletrust.org Name of registered provider(s): Name of registered manager (if applicable): The Fremantle Trust The registered provider is responsible for running the service Name of registered manager (if applicable) Mrs Linda Perkins Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 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: Learning disability - LD Date of last inspection Brief description of the care home Woodstock is a large detached property located in Little Chalfont. The home is close to local shops and is accessible by public transport. It is owned and staffed by The Fremantle Trust and registered to provide accommodation for up to eight people with learning disabilities. There is a large enclosed garden at the rear and a front garden Care Homes for Adults (18-65 years) Page 4 of 30 8 Over 65 0 Brief description of the care home with parking spaces. Each service user has a single bedroom, two of which are on the ground floor. The home has been arranged to reflect a large family type environment and is indistinguishable in the road as a care home. The people living at Woodstock have varying care needs, some of which are complex. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted by Chris Schwarz over the course of a day and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 6th November 2006. Prior to the inspection, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, staff and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the homes required Care Homes for Adults (18-65 years) Page 6 of 30 records, observation of practice and a tour of the premises. Peoples equality and diversity needs were taken into account throughout. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 8 of 30 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: There are procedures for admitting people to the service contained within the corporate operations manual, a copy of which was in the office. One new admission had taken place since the last inspection of Woodstock. Records on the persons file showed that information had been obtained from the placing Social Services Department, covering areas such as the reason for referral, situation current at the time of referral, family composition, personal care and health care requirements. A care needs assessment had been undertaken by the manager three to four weeks before the person moved in and this contained a range of details about care needs, including cultural needs and personal beliefs, compatibility with other people living at the home, the prospective users views on coming to live at the home and implications for staffing. There was also a record of visits made by the manager to the persons family home and day service and of the person and their family visiting Woodstock to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: look around and meet people. This included invitation to join people for a meal at the home and, just before admission, being given a door key. An admission form (for the placing local authoritys purposes) had been completed and an inventory of personal belongings noted. A signed contract was in the file (and other files examined). All evidence suggested that the admission had been well handled and that the person and their family had been given ample opportunities to visit before making a decision to move in. For anyone considering moving to the home, there is written information in a statement of purpose and service users guide. An accessible version of the service users guide had been produced using photographs of the home and people using the service and accompanying plain text. The manager was aware that updating was needed to these documents to reflect change of management and some information which had been highlighted during a quality review of the service such as removing users names. Fees for the service were 698.39 pounds per week. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Person centred care plans need to be produced which reflect each persons diverse needs and take into account their wishes and aspirations to ensure that their care matches their requirements and expectations. Carers should be fully involved in these to make sure that their experiences and observations are considered. Evidence: Information about peoples care needs was distributed across three files for each person. Files which staff said contained the care plans were kept upstairs in the office. Other files which they use to record things such as daily notes, outcomes of medical appointments and food intake were kept downstairs in a locked cupboard. Third files were kept in the office containing a mix of old and possibly current information, in one of these there was the only copy of a users moving and handling assessment located at the back behind out of date day service review notes. This three file system was confusing and it took effort to try and find basic information about peoples care, their risk assessments and deciding what was likely to be out of date information and Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: perhaps best suited to an archive file. A corporate care plan system was being used which has the potential to reflect peoples needs well. The care plan of the newest user was looked at and needs had been noted under headings such as general physical health, preferred daily routine, likes and dislikes, family information, spiritual beliefs, leisure and recreation and socials activities. There was a photograph of the person for easy identification at the front. The user had signed her care plan and there was evidence of it being reviewed a few weeks prior to the inspection to add in some assessments such as a dependency assessment. The persons preferred name, keyworker details, date of birth, religion, and other essential details had been recorded and there was a record of aids and equipment needed to carry out personal care. Various risk assessments had been prepared although a moving and handing assessment could not be located. In another care plan, which followed the same format, under the individual pen picture, the first sentence read: (name of person) is Downs Syndrome. This could have been better worded before it was typed up and placed in the file and perhaps the information could have been contained further into the pen picture rather than appearing to categorise the person by his disability. The persons ethnic origin and religious needs had not been noted under specific sections. Some of the service users risk assessments had been produced in 2005 with a note to say they were reviewed in November 2007 although they still bore the name of a member of staff who does not work at the service. Staff commented in surveys that their suggestions about peoples care had not been listened to and they said they had not been involved in producing care plans or attending reviews. This has implications for the accuracy and effectiveness of care plans without the contribution of the people who provide personal care each day. Some rationalisation of files is needed so that staff easily have all the information they need to hand in one place and for the plans to be developed along person centred lines with full involvement of carers and other interested parties. A requirement is made to this effect. The need to produce person centred plans had been identified during the quality audit of the service at the beginning of the year. All files that were looked at contained a copy of recent local authority review notes that involved family, day service staff and the home. Peoples money was being managed using the providers residents savings scheme. Records were in place of imprest claims with receipts and the claim forwarded to the providers head quarters each month for auditing. Care Homes for Adults (18-65 years) Page 14 of 30 Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are available to people using the service to provide them with stimulation and contact with family and friends is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are being met. Evidence: People using the service attend local day services during the week. They are collected and returned to the home by each day services transport and staff. Various records on peoples files show that they access a range of activities as part of day service attendance and have opportunity to try new things. One person said she enjoyed doing cookery each week. Staff at the home were aiming to improve peoples community presence, especially on their home days, and to ensure that they were involved in going out to buy their own toiletries which they had not been doing before. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Meals were being prepared from fresh ingredients and staff were rightly proud of their abilities to cook and provide nutritious food that people enjoyed. A chicken curry was being made for the evening meal using good quality meat and an alternative meal had been made for a user who has specific likes and dislikes. People using the service were seen to have the freedom to move around the home and their preferred form of address was noted in care plans. Staff were flexible in providing one persons meal earlier than everyone else, at his wish. Contact with peoples families and friends was being supported by staff and visitors are welcome at the home. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are being met by staff and they work in partnership with other agencies to keep users well. Care plans need to reflect each persons health care needs accurately and the involvement of other agencies is required where issues affect professional boundaries, to protect users from risk of harm. Evidence: Records of appointments showed that people using the service are enabled to access health care services when they need them. Everyone living at the home has the ability to make use of community resources therefore it was not clear why a visiting optician and chiropodist had been used at the home. A doctor commented positively on aspects of care such as respecting users privacy and dignity, seeking advice appropriately and supporting and meeting social and health care needs. A consultant psychiatrist also expressed positive comments overall although he added that communication could be improved. He said two of the things the home did well were a caring attitude and professional approach. He also pointed Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: out that a serious medication error (by the pharmacy) had been spotted and handled appropriately. A community nurse commented that the home acts upon recommendations and that users health care needs were usually met. Comment was made that a users anxiety was heightened by the approach a carer took and required intervention to calm the situation. Care plans have not been developed in a person centred way yet and staff have not been permitted to contribute to what is recorded about how people prefer their care to be delivered. There were two examples of a care plan not recording what staff had been doing in practice. The manager advised that she became aware of one persons medication being disguised by staff in yogurt. She said she had spoken with the doctor who would be prepared to write in agreement with this practice but there was no written protocol and agreement from other interested parties (such as the care manager from the local authority and the family) and no account of this in the care plan to support what staff had been doing. The quality audit report from March this year reflected a hygiene practice which the persons family were said to insist upon, which had not been discussed with the persons care manager from the local authority regarding acceptability for professional carers to undertake this. It was not reflected in the care plan as an identified need. The practice had not been happening for the past few weeks when the new manager became aware that is was still happening. A medication policy was in place in the operations manual for the home and medication was stored securely. Medication administration records had been completed accurately. No controlled drugs were being used. Rectal diazepam guidance was in place for one of the users and authorised by the doctor in April 2006. It is recommended that this be reviewed at the persons next medication review to make sure it is still relevant. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures are in place to respond to complaints and safeguard vulnerable adults to reduce the risk of harm to people using the service. Evidence: The home had a copy of the corporate complaints procedure in place which had been updated to reflect revised contact arrangements for the Commission for Social Care Inspection. A complaints log was being maintained - this contained a range of compliments about care practice and showed no complaints being made in the past year. The Commission has not received any complaints about the service either. A procedure was in place for safeguarding vulnerable adults. No safeguarding issues were indicated on the pre-inspection self-assessment and the Commission has not been made aware of any issues. Training records for five staff showed that three had undertaken safeguarding training within the past fourteen months and for two staff there was no record of this type of training. The manager advised that she has already identified a trainer from another home who would be able to come and update staff training. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Evidence: The home is located in Little Chalfont and is close to a doctors surgery and local shops. There are public transport links close by. The building is a large detached property with parking at the front and a garden area plus a large enclosed garden at the rear. Inside, all of the bedrooms are single occupancy and vary in size and outlook. Two bedrooms are located on the ground floor. Bedrooms had been decorated and arranged to reflect peoples different tastes and made to look and feel comfortable. Toilets and bathrooms were close by to bedrooms. On the ground floor the bathroom contained a Parker bath and a shower room was located opposite it which is suitable for people with disabilities. The upstairs bath is fitted with a chair hoist. People using the service had a spacious lounge. The manager advised that new sofas are to be purchased as the ones in place were starting to look worn. The kitchen was clean and equipped with the necessary equipment for the home, the dining area leads off the kitchen. The laundry was orderly and clean. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Staff had opened windows to ventilate the building and the heating was on a low setting to keep the home warm. There were no unpleasant odours at the home. Clinical waste was being managed effectively and all toilets had been stocked with the necessary supplies. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is staffed by a stable group of carers who have not been given full opportunities to contribute to decision making, which could affect how peoples care is delivered. Evidence: The pre-inspection self-assessment showed that no staff had left the home in the past year and that all carers were female. No agency workers had been needed to help cover shifts. Rotas reflected that two staff generally cover morning and afternoon/evening shifts with one waking member of night staff. Nine of 12 staff had achieved National Vocational Qualification at level 2 or above plus one other person was doing it. Training records showed that some updating was needed to a few mandatory courses to bring people up to date and the training log showed that the manager had already identified some gaps and was addressing these. Epilepsy awareness training and use of rectal diazepam had been undertaken by the staff whose files were looked at, first aid, fire safety, food handling, infection control and medication training were well covered. The manager was advised to make good use of free training provided to care homes by Buckinghamshire County Council and also to consider approaching the community team for people with learning disabilities for any specialised input that may be required. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staff said in surveys that there were few staff meetings held at the home. Records of meetings were sparse - for the past year there had been three meetings, one of which had recently been held by the new manager. A recommendation is made to aim towards at least six meetings a year to make sure that staff have opportunity to discuss and share ideas. Staff also commented in surveys that supervision did not take place regularly (not checked) and they had not felt supported by the previous manager. One added that staff had been always left in the dark. Those who commented said communication between carers was good though. One person added the only thing we dont have in the house is the support of the manager. The manager doesnt really know whats happening with clients if staff dont tell her. One relief carer had joined the staff team from another home since the last inspection. The personnel file at Woodstock contained a copy of the persons birth certificate and Criminal Records Bureau clearance from 2003. No other details of the person could be located. A requirement is made to ensure that recruitment checks are undertaken before staff start working at the home. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety is well managed and systems are in place to monitor and audit quality of care for people using the service. Evidence: The homes manager had been in post for a month at the time of the inspection. She has worked within the organisation for some time in another home for adults with learning disabilities and is working towards the Registered Managers Award and registration with the Commission for Social Care Inspection. She had already identified some deficiencies in practice at the home and was keen to address these and to involve staff fully in improving the service. There has been regular monitoring of the service by the provider and operations manager and a quality audit took place at the start of this year. Not all of the issues highlighted for improvement from the audit had been met, such as introducing person centred planning and putting in place a care plan to support a personal hygiene practice. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Staff had a policies and procedures manual to refer to in the office. Generic risk assessments had been updated in November last year and certificates were in place to verify gas safety, satisfactory electrical installation, pest control measures, boiler servicing, servicing and testing of thermostatic water valves and showers, servicing of hoisting equipment, portable electrical appliance testing and satisfactory water sampling. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Person centre care plans, 01/02/2009 which take into account users, carers and other interested parties views, are to be produced and kept alongside other up to date and relevant information about peoples care needs, ideally in one file per user. This is to make sure that staff have easy access to current information about peoples care requirements. The full range of recruitment 30/11/2009 checks needs to be in place before staff start working at the home to make sure that people using the service are not placed at risk of harm. 2 34 19 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 30 1 20 The rectal diazepam protocol produced in April 2006 is to be reviewed as part of the service users next medication review to ensure it is relevant to her current needs. Staff meetings should take place at least six times each year to make sure that people have opportunity to discuss and share ideas and to be updated on new policies, procedures and different ways of working. 2 33 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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