Care Home: 64 Brighton Road

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What the care home does well The service uses Person centred planning to help people say what is important to them in their lives. There is good information for staff about the way people communicate. People that live in the home are safe and are supported to maintain their health and well being. People are supported to be as independent as possible in their daily lives. What has improved since the last inspection? The Statement of Purpose has been updated so that people looking to move to the home have all the information they need. All the staff have been given a copy of the General Social Care Council (GSCC) code of conduct. This is to make sure that they know the standards they are expected to work to. Health Action Plans have been introduced to help people maintain healthy lifestyles. Person Centred Active Support has been introduced to support people to be independent and involved in the service. A new kitchen has been fitted in the home and some rooms have had new carpets fitted. A new patio has been laid and the garden made safer for people to use. What the care home could do better: The person centred plans could be further developed to include people`s hopes and dreams for the future and how these could be achieved. People`s wishes and needs about their sexuality and their personal relationships should be agreed with them in their plan.The daily records should be better maintained so that the Manager can see that people`s needs are being met. There should be enough staff on to meet people`s social needs. Training certificates for the courses that staff attend should be kept in the home to evidence their competence in their roles. The Surrey Multi-Agency Safeguarding Adults policy should be made available to staff. CARE HOME ADULTS 18-65 Brighton Road (64) 64 Brighton Road Horley Surrey RH6 7HT Lead Inspector Jo Griffiths Unannounced Inspection 13th March 2008 10:30 Brighton Road (64) DS0000013526.V359185.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 Brighton Road (64) DS0000013526.V359185.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. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brighton Road (64) Address 64 Brighton Road Horley Surrey RH6 7HT 01293 822891 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) glebe.house@theavenuestrust.co.uk The Avenues Trust Ltd Richard Huggett Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 32-65 YEARS One (1) named person may be aged over 65 years. Date of last inspection 11th July 2006 Brief Description of the Service: 64 Brighton Road is a registered care home for five adults with moderate to severe learning disabilities. The building is detached house with accommodation provided across two floors. There are two lounges and an open plan kitchen with dining room on the ground floor. There is a toilet to the ground floor and two bathrooms on the first floor. The five single bedrooms are located on the first floor. Outside there is a large enclosed garden to the rear of the property. The home is set off the main Brighton Road with parking spaces at the front. It is close to the facilities of Horley town centre and transport links are nearby. The fees for this service range from £1107 to £1135 per week. This is dependant on the individual assessment of needs and further information can be obtained from the Manager of the home. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and was carried out by Jo Griffiths on 13th March 2008 between 10.30am and 3.30pm. The deputy manager was on duty and helped with the inspection. There were five people at home during the inspection. To help form a judgement of the quality of the service, observations were made throughout the day of the support provided to the people that live in the home. Two people using the service and one staff member were spoken with at various intervals. Some of the records and documents in the home were inspected. What the service does well: What has improved since the last inspection? What they could do better: The person centred plans could be further developed to include people’s hopes and dreams for the future and how these could be achieved. People’s wishes and needs about their sexuality and their personal relationships should be agreed with them in their plan. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 6 The daily records should be better maintained so that the Manager can see that people’s needs are being met. There should be enough staff on to meet people’s social needs. Training certificates for the courses that staff attend should be kept in the home to evidence their competence in their roles. The Surrey Multi-Agency Safeguarding Adults policy should be made available to staff. 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. Brighton Road (64) DS0000013526.V359185.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 Brighton Road (64) DS0000013526.V359185.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): Standards 1 and 2 People that use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with the information they need to make an informed decision about using the service. Prospective service users can be confident that they will have a full assessment of their needs to ensure they can be met before they are offered a service. EVIDENCE: The Statement of Purpose and Service User Guide have been updated since the last inspection. These now give people up to date information about the qualifications of the staff team. Both documents have been produced in an easy to read format using pictures, photographs and symbols. Everyone that currently lives in the home has been provided with a copy of the Service User Guide and one person produced their copy for the Inspector to see. There have been no new admissions to the care home and the group of people that currently live at Brighton road have been in residence for many years. The Avenues Trust has an admissions policy and a standard form of assessment to be used for anyone looking to move to the home. The needs of the current service users have been kept under review through the care planning process. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 People that use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have an individual plan that meets their needs, but they need clear records to reflect that the plans are being followed. They are supported, through person centred planning, to make decisions about their lives, but would benefit from further support to achieve future dreams. People have clear risk assessments to enable them to lead independent lifestyles. EVIDENCE: The individual plans for two people were inspected. These include care and goal plans for specific areas of support. They also include Person centred planning tools that are used to help the person plan the support they need and express what is important to them. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 10 The care and goal plans that are in place provide staff with information about how to support the person with a specific area of their life. These have been linked to risk assessments and the risk assessments have been recently reviewed. For one person there were clear guidelines and risk assessments for managing self-injurious behaviour. The Manager of the home receives support in developing guidelines from a challenging behaviour advisor employed by the organisation. The plans also state how people’s social needs will be met, however, the records to evidence that these are being followed were not being completed consistently. People’s needs with regard to their sexuality and personal relationships have not been included in the plans. The plans do reflect their cultural needs. The person centred planning tools have been used to involve people in the planning of their support. Photographs have been used to help people express their interests and hobbies. There was evidence in both plans that time had been spent with people establishing their methods of communication and their preferences regarding their care. A speech and language therapist was involved for one person and recommended the use of ‘objects of reference’ to aid communication. The staff team had implemented this and they said it was working well for the person. Whilst Person centred planning has been used to help people express their preferences about their daily lives it could be further developed to help people make decisions about what is important to them in their future. One person’s plan stated future dreams including a desire to live alone and to marry. The person has limited verbal communication skills and it was not clear how they had expressed these preferences or whether they were based on staff interpretations of the person’s wishes. There was no action plan in place to help the person to fulfil these stated aspirations. The Manager should ensure that any aspirations for the future have a clear action plan for helping the person achieve their life goals. The Deputy Manager said that Person Centred Active Support (PCAS) had been introduced for all service users in January 2008. This is designed to ensure that people maximise their independence and lead busy and involved lifestyles. The daily care plan records have been replaced with PCAS reports, but it was found that these have not been completed consistently, particularly through February and March 2008. This meant that there were a number of days each month with no records to reflect the support given or the person’s well being. Where there were reports in place there were no records of the community activities that people participated in. For example for March 2008 both people’s reports show that they were involved in a number of independent living tasks (ie making their own drinks) but there were no entries in the community activity sections of the report. For February 2008 one person’s PCAS reports Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 11 showed two occasions of going out to activities and the other person had four recorded occasions. The Deputy Manager said that people have been going out for activities but that the records were not being completed. Brighton Road (64) DS0000013526.V359185.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): Standards 12, 13, 15, 16 and 17 People that use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People would benefit from more community based activities and clearer records to monitor whether their social needs are being met. There was insufficient evidence to support that people’s social needs are currently being met. People’s rights are respected in their daily lives and they are supported to maintain family relationships. People’s needs and wishes regarding personal relationships should be explored. People enjoy a balanced and healthy diet. EVIDENCE: People have an individual plan for their weekly activities. The planned activities are based on individuals’ needs and preferences. It was not possible to Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 13 accurately assess whether people’s social needs were being met as the records to show what activities they are involved in had not been completed consistently. The Manager said that the planned activities for the current week had not taken place due to staff shortages and that this had been and issue for several weeks due to staff sickness. Staff said that service users are often taken for a drive out. During the inspection service users planned activities did not take place as there were only two staff on duty. However, three people were taken out for a drive. The Manager should review the activities provided to ensure they are meaningful and ensure that records are kept to allow him to monitor whether people’s social needs are being fully met. The Manager must also ensure that sufficient staff are on duty to meet people’s social needs. People’s needs regarding personal and intimate relationships have not been identified as part of their plan. Their Keyworkers support them to maintain contact with family members. People’s rights and responsibilities are outlined in the Service User Guide and contract of support. People were spoken to in a respectful manner throughout the inspection and their right to privacy was seen to be upheld. People are involved in the running of the home and are supported to be as independent as possible in their daily lives. A menu is planned every two weeks and this is based on the staff’s knowledge of service users likes, dislikes and needs. The staff are working with service users to develop a selection of food pictures to enable them to be more involved in the planning of the menu. Service users were seen to be involved in the preparation of their lunchtime meal. The staff said that people can choose to have something different to the planned menu if they wish. Brighton Road (64) DS0000013526.V359185.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): Standards 18, 19 and 20 People that use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive their personal support in the way they prefer and that meets their needs. They have their health needs fully met. People are supported to manage their medication safely. EVIDENCE: Two individual plans were inspected and found to have clear guidance for staff on how to support people with their personal care. The plans reflect people’s preferences about their personal care routines. Since the last inspection Health Action Plans have been implemented for each person. This includes a record of all involvement of healthcare professionals. The plans cover all areas of health need including the need for well man clinic appointments and psychological and emotional support. The plans are presented in a user-friendly format and are easy for service users and staff to access. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 15 All medication was seen to be stored securely. Medication is administered by staff using a Monitored Dose System. All staff have received training in medication and have had an assessment of their competence to give medicines. Service users preferences regarding the way they take their medication are recorded in their person centred plan. Brighton Road (64) DS0000013526.V359185.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): Standards 22 and 23 People that use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that any concerns they have about the service will be taken seriously. People in the home are safeguarded from harm and abuse. EVIDENCE: The complaints procedure is presented in picture format to help service users understand the procedure to follow if they have any concerns. Most people have the support of family members who will help them to raise any issues. All people that use the service have the involvement of a Care Manager from their funding authority. There have been no complaints received by CSCI or by the home about the service provided. The Avenues Trust has a policy for safeguarding adults and this refers to the local multi agency policy. The staff and Manager had a clear understanding of the need to report any allegations of abuse or neglect through their line Manager and all staff have completed training in safeguarding adults. The Surrey multi agency policy was not available in the home. The Manager must ensure that staff are aware of this policy and that senior staff in particular understand the procedures that need to be followed to ensure all allegations of abuse are reported correctly to the local authority for investigation. The home has a policy for Whistle blowing to ensure staff are able to raise genuine concerns anonymously if they need to. There have been no safeguarding adults issues in the home. Brighton Road (64) DS0000013526.V359185.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): Standards 24, 25, 27, 28 and 30 People that use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from a safe, clean and comfortable home. They have access to suitable shared and private space and sufficient numbers of bathrooms to meet their needs. EVIDENCE: The home is well maintained and clean. Since the last inspection a new kitchen has been fitted and the carpets to the hallway and stairwell replaced. The carpets in some bedrooms have also been replaced. Each person has a single bedroom and this has been furnished and decorated in the way they have chosen. All bedrooms have a wash hand basin and there are sufficient numbers of bathrooms and toilets near to bedrooms and communal areas to ensure service users needs are met. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 18 There are two lounges in the home and a dining room. Service users have access to all areas of the home. The environment of the care home is comfortable and homely for the people that live there. There is a large rear garden and this has been improved to make it safer for service users to use. The patio and pathways have been improved and the old shed and greenhouse removed. Staff said that the service users enjoy growing vegetables in the garden. Brighton Road (64) DS0000013526.V359185.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): Standards 32, 33, 34 and 35 People that use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People in the home would benefit from a review of staffing arrangements to ensure there are sufficient numbers of staff on duty to meet their social needs. People are supported by trained staff, but would benefit from better records of the training provided and from more staff completing the NVQ award. People in the home continue to be safeguarded by the home procedures for recruiting new staff. EVIDENCE: The home usually has three staff on shift during the day and one person on a waking night shift. The rotas examined showed a number of occasions throughout March 2008 where there were only two staff on duty. The Deputy Manager said this was due to some staff sickness and some vacancies, but that new staff had been appointed and would be starting in the home soon. Whilst there appeared to be sufficient staff on duty to meet the needs of the service users when they are at home the staff shortages have clearly affected people’s Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 20 opportunities for community based activities. The Deputy Manager said that the planned activities for the current week had not been able to take place as there were insufficient numbers of staff on duty. Agency staff are usually used to fill shifts but the regular agency staff had not been available to cover. The training files for three people were inspected. There were printed records from a database to show the courses that people have completed with the Avenues Trust, however, there were no certificates available to support these records. The training records show that staff have completed training in all the key areas they require to be able to safely support people. Staff on duty confirmed the courses they have completed and these reflected the printed records. There are nine staff employed at the home, not including the Manager, with three staff having completed their NVQ and one staff working toward this. The staff on duty said they had received a copy of the General Social Care Council (GSCC) code of conduct and a copy was seen on the staff notice board. The staff recruitment files were not available on the day of the inspection as the Manager was not on duty. There have been no new staff appointed since the last inspection and there were no concerns at the previous inspection with regard to recruitment practices in the home. The Avenues Trust has a robust policy for recruiting new staff. Brighton Road (64) DS0000013526.V359185.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): Standards 37, 39 and 42 People that use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People in the home benefit from a well managed service. They are consulted on their views of the home at regular intervals. The home is run in a way that promotes the health and welfare of the people that live there. EVIDENCE: The registered Manager has completed the NVQ4 in care and in management and the Registered Managers Award. The records show that the Manager has also completed various management courses, 1st aid, Makaton, Safeguarding adults, Diversity, Care Standards, Moving and Handling, Medication and Food hygiene. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 22 The provider ensures that Quality Monitoring visits are completed monthly and these include service users views and experiences. The Avenues Trust has a Quality Assurance department that carries out an annual review of the home. Records showed that a Quality review had been carried out in June 2007. The home has an up to date development plan. It was clear that areas for improvements on the plan were being addressed including the new kitchen being fitted and Person centred planning being introduced. The development plan for the service is included in the home’s Statement of Purpose. The Manager carries out a monthly Health and Safety check of the service. Risk assessments are completed and have been reviewed and all equipment in the home has been safety checked. Staff have completed training in Health and Safety, Infection Control, Fire Safety and First Aid. The incident book was reviewed and this showed that all accidents and incidents are responded to effectively. The staff said that not all incidents of self-injurious behaviour are recorded in the incident book, but that they are recorded in the daily notes. It is recommended that a body map for this particular service user may be a useful way of recording minor scratches. Brighton Road (64) DS0000013526.V359185.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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA33 Regulation 18(1)(a) Requirement Sufficient numbers of trained staff should be provided to meet the needs of service users, including their social needs. Timescale for action 30/04/08 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 Refer to Standard YA7 Good Practice Recommendations It is recommended that Person centred planning be used to establish people’s aspirations for the future and how these may be achieved. It is recommended that people needs and wishes regarding their sexuality and personal and intimate relationships be established. It is recommended that the records of service users activities be improved to evidence that their social needs are being met. It is recommended that training certificates be held in the home in addition to the written record to evidence staff DS0000013526.V359185.R01.S.doc Version 5.2 Page 25 2 YA15 3 YA12 4 YA35 Brighton Road (64) 5 YA23 competence in their roles. It is recommended that the Surrey Multi-Agency Safeguarding Adults Policy be made available to all staff in the home. Brighton Road (64) DS0000013526.V359185.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone 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. 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