Care Home: Alness Lodge

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What the care home does well People continue to be supported in a safe, secure and comfortable environment when they would not be able to cope on their own living in the community. People with enduring mental health problems have been supported to remain healthy and well and not experienced any return to a hospital or more restrictive environment. Examples were seen where people had long-term reductions in their need for anti-psychotic medication and behaviours that had caused them to be at risk had been reduced or changed altogether. A comment from a mental health worker confirmed that that the staff team provided `consistently reliable` levels of care and the support provided has promoted an `increase in people`s level of functioning`. A relative of a person also highlighted how much their mental health had improved since living at Alness Lodge.People`s general healthcare needs were also seen as a priority by the management and staff team. An example was seen of where a person was being supported by the manager and staff to access specialist healthcare services and good liaison with the local mental health services to try to make sure that the person was able to make an informed choice about the health treatment they wanted. Management have been very active in developing a staff team that has the skills and knowledge to support people`s needs. Time has been spent with staff to further develop their skills and knowledge of understanding and supporting people with mental health problems. Comments from people living at the home and others, such as relatives, all made positive comments about the staff team and how they support people. One person commented that staff treated them really well and were ready to talk about their worries and problems. What has improved since the last inspection? What the care home could do better: Staff have access to an Induction Programme and are then supported to undertake the NVQ Level 2 vocational qualification. Staff do participate in other training events but at the time of the inspection there was no clear record of what training staff had attended or required, such as refresher training. It was also recommended that, like the Induction and NVQ qualification, that a system be developed to assess staff competence in applying and implementing the skills and knowledge that they had gained through training and awareness raising events. CARE HOME ADULTS 18-65 Alness Lodge 50 Alness Road Whalley Range Manchester M16 8HW Lead Inspector Sue Jennings Unannounced Inspection 5 December 2007 12:00 th Alness Lodge DS0000021600.V342056.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 Alness Lodge DS0000021600.V342056.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. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alness Lodge Address 50 Alness Road Whalley Range Manchester M16 8HW 0161 226 4313 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) Mr Mohan Ramsumair Mrs Peggy Ramsumair Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2006 Brief Description of the Service: Alness Lodge is a residential care home providing 24-hour personal care and accommodation for 10 persons with mental health problems. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes. It is sited on a residential street and was originally a purpose built home for older people. It has a small car park to the front and a garden at the rear. Bedroom accommodation is on the ground and first floors. All the bedrooms are single with hand washbasins. The home is unable to offer a service to people with restricted mobility due to the layout and lack of access around the building. Communal space is provided on the ground floor with a dining room that leads to a large lounge and through to a conservatory with access to the garden. The kitchen and laundry facilities are also situated on the ground floor. The philosophy of the home focuses on maintaining independence and rehabilitation. The manager stated that it is their aim to build on peoples skills and enable people to participate in the day-to-day running of the home. Information about the home can be found in the Statement of Purpose and Service User Guide and is provided to prospective residents. Inspection reports can be made available through direct request to the home. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home last had a key inspection in May 2006. Additional information that was taken into account included incidents notified to the CSCI and information provided through other people and agencies, including any concerns and complaints. Before the site visit, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home view the service they provide in the same way that we see the service. We felt this form was completed accurately and that a lot of time and effort had been given to filling it in. To try to find out people’s views of the home we sent out a number of surveys. Nine people who live at the home, two members of staff and three people who have regular contact with the home returned surveys. During the inspection site visit time was spent talking to people, the staff and manager and observing how they work with people. Documents and files relating to people and how the home is run were also seen and a tour of the building was made. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the home and to decide how much work the CSCI needs to do in the future. What the service does well: People continue to be supported in a safe, secure and comfortable environment when they would not be able to cope on their own living in the community. People with enduring mental health problems have been supported to remain healthy and well and not experienced any return to a hospital or more restrictive environment. Examples were seen where people had long-term reductions in their need for anti-psychotic medication and behaviours that had caused them to be at risk had been reduced or changed altogether. A comment from a mental health worker confirmed that that the staff team provided ‘consistently reliable’ levels of care and the support provided has promoted an ‘increase in people’s level of functioning’. A relative of a person also highlighted how much their mental health had improved since living at Alness Lodge. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 6 People’s general healthcare needs were also seen as a priority by the management and staff team. An example was seen of where a person was being supported by the manager and staff to access specialist healthcare services and good liaison with the local mental health services to try to make sure that the person was able to make an informed choice about the health treatment they wanted. Management have been very active in developing a staff team that has the skills and knowledge to support people’s needs. Time has been spent with staff to further develop their skills and knowledge of understanding and supporting people with mental health problems. Comments from people living at the home and others, such as relatives, all made positive comments about the staff team and how they support people. One person commented that staff treated them really well and were ready to talk about their worries and problems. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alness Lodge DS0000021600.V342056.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 Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs and goals had been identified and they had the opportunity to experience the home before deciding to live there. EVIDENCE: The most recent person to come and live at the home was placed by a local authority. The pre-admission assessment documentation was seen and found to contain relevant information collated over a period of time. This information included a range of personal and clinical information relating to the persons emotional needs. The manager stated that they had a number of discussions with the purchasing authority and the person had come to visit on several occasions before any decision was made as to whether their needs could be met and that the person wanted to live at the home. Alness Lodge DS0000021600.V342056.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): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s changing needs and support are identified and recorded and they are supported to take decisions and make choices. Risks to people’s wellbeing are recognised and acted upon. EVIDENCE: The purchasing authorities had provided a care plan for each person setting out, in general terms, the support they needed. These care plans were reviewed, at least on an annual basis, through the Care Programme Approach (CPA) multi-disciplinary review process. From the pre-admission assessment information and through knowledge gained about the person a care and risk assessment plan for each individual was developed. The care plan includes a range of personal, social and emotional needs and goals and how to support the person. It also includes personal and historical information about the person’s life and significant Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 10 events that affected them. Information relating to people’s cultural and family needs were identified and guidance on how these needs were to be supported. Risk assessments were undertaken to identify potential hazards relating to people’s environment, behaviour and mental health and also included how people manage their medication and finances. Both care plans and risk assessments were reviewed by the manager and staff on a regular basis to keep them updated on changes to peoples needs and the way they were supported. People were supported and encouraged to make decisions on a day-to-day basis and in the major decisions about their lives. However, due to people’s mental health and associated problems there were agreed restrictions placed on people such as use of alcohol, cigarettes and access to money. A relevant risk assessment and agreement had been developed with the person. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were offered opportunities to take part in valued and meaningful activities both within the home and the community. The daily routine was relaxed and informal and people were supported to maintain relationships with their families. Meals were based on peoples’ preferences and offered choice and nutritional balance. EVIDENCE: Several people are independent in the community and use the local community facilities when they want to. Others have a structured programme of events and activities that they participate in that are provided by the local mental health service such as drop-ins and other specialist leisure and education services. People were offered the opportunity to go on holiday during the summer. People have access to television, videos, music, reading, craft activities and games. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 12 The previous inspection report raised the issue that people were, at times, very reluctant to participate in social and leisure activities in the community, even with staff support. The issue of some people not having the motivation or choosing not to take part in the opportunities offered by the home was discussed with the manager. It is recommended that the home record the opportunities offered to people to take part in leisure and social activities even if they refuse. People’s routines continued to be relaxed and informal with no strict times set for activities such as personal care or visitors. People would take part in household activities according to their abilities and the state of their health. Family and friends were encouraged to visit and maintain contact and relationships with people as much as possible. Where identified as a need people were supported to visit their families. People still enjoyed their meals and had a choice of the things that they liked. People’s nutritional needs were known and they were encouraged to follow as healthy a diet as possible. Several people shopped for and cooked some of their own meals. Mealtimes were usually a communal event and a chance for people to catch up with each other. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People’s personal care and general and mental healthcare needs was being supported so that they maintained their health and wellbeing. EVIDENCE: A number of people were independent in maintaining their own personal care whilst others still required prompting and encouragement. Where a person did require additional support this was recorded in the person’s care plan. Any risks associated with moving and handling had been identified. People’s general and mental health needs were identified through their care plans and specialist assessments. Where required, people were supported to attend regular appointments with their GP, dentist, well woman and men clinics as well as more specialist healthcare providers. People’s mental health was monitored on an ongoing basis by the community mental health services and access to psychiatric services when this was required. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 14 The manager was aware of the introduction and impact of the Mental Capacity Act 2005 around the issues of people making decisions about their own health care. The medication administration system was assessed and found to be working well. Administering, deliveries and returns of medication were being recorded. A new medication monitored dosage system had been introduced and was working well. Only the senior support staff and the management administered medication and they had received relevant medication training. The changes and improvements to the system required in the previous inspection report had been actioned. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies, procedures and practices are in place to support people to remain safe. EVIDENCE: The Complaint Policy set out the process and the timescales involved in making a formal complaint. The contact details of the Commission for Social Care Inspection were included. The policy was available to people and was seen attached to the notice board in the dining room. There had been no formal complaints made to the manager since the last inspection. People were able to explain that if they had any concerns or worries then they were able to speak to the staff and manager to help resolve them. An example was seen where a person had raised a concern with the manager and they had acted on this to resolve the problem. It is recommended that a record be maintained of the concerns and worries that people raise that requires the manager or staff team to take some action to resolve the persons concerns. The home follows a clear Adult Protection Policy and procedure that had been read by the staff team. The staff team had participated in Adult Protection training events. The previous inspection report had required that the procedures for managing and recording people’s personal finances were reviewed. The procedures had Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 16 been reviewed and a record of all transactions was being made. The management were no longer the appointee for any person and any risks or restrictions around people’s money and spending had been risked assessed. There were some areas where further improvements could be made in terms of recording and it is recommended that all transactions and charges are recorded separately (e.g. shopping and travel costs), that the recording of the transaction be clearer and more descriptive, that receipts are numbered and cross referenced on the recording sheet to allow for a clear audit trail and that the amount of people’s cash kept on the premises does not exceed the amount covered through insurance. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, well-maintained and homely home. There are systems in place to maintain the cleanliness and hygiene of the home. EVIDENCE: The home was clean, well maintained and decorated and had a homely atmosphere. Since the previous inspection the dining room and two bedrooms had been redecorated and a new stair carpet fitted. People had been able to choose their own bedroom decoration. People spent time in the communal areas or in their own bedrooms. There was a no smoking policy in the house and people can only smoke in the garden. Staff carried out the majority of the daily cleaning of the home and staff supported and encouraged people to undertake their own domestic tasks and keep their own bedroom clean. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 18 The kitchen contained clear instructions on the use of colour coded food preparation boards and the boards were seen. The laundry room contained a domestic washing machine and a tumble dryer that was sufficient to meet people’s needs. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a staff team who have the skills and competence to meet their needs. Systems are in place to ensure that staff that work with vulnerable people are safe to do so. EVIDENCE: The staff team consists of the manager and nine support workers working various hours covering the day and night shifts. Throughout the day there are at least two staff on duty in addition to the management cover. At night one person is on waking duty and one person sleeps. Staff were observed spending time with people and the interactions appeared friendly and respectful. The manager has a flexible work schedule to be able to cover the times when people need supporting to attend health appointments and organised social/leisure events. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 20 The staffing levels were discussed with the manager and it is recommended that the flexibility and use of staff to support people in the community and during the night be reviewed to make sure that people are being supported in the most appropriate way. Of the current staff team six have achieved at least the NVQ Level 2 vocational qualification and the remaining staff were currently undertaking the training. Staff files sampled contained the required documentation and information relating to their application and employment. Criminal Record Bureau (CRB) disclosure certificates are sought prior to staff starting work and the Protection of Vulnerable Adults (POVA) First system was used when required. The home had an induction programme based on the Skills for Care Induction Modules. A sample of the Induction was seen and found that the manager and staff sign each part of the programme when completed. The manager stated that staff continued to have access to a range of in-house and other training organisations. At the previous inspection each member of staff had their individual training log and plan. This information could not be found during the site visit so the manager must ensure that clear and accurate training records are maintained. It is also recommended that a system for assessing and evidencing staff competence be developed to show that staff have implemented the skills and knowledge gained through all training and awareness events. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from an experienced and qualified manager with the systems and practices in place to maintain the health and safety of those living and working in the home. The systems for seeking people’s views in terms of quality assurance have still not yet been fully implemented. EVIDENCE: The manager is also the joint owner of the home. They have the management experience, skills and qualifications required to manage the home to meet its stated aims and objectives. The manager shows a commitment to maintaining people’s mental health and wellbeing and to support people’s needs with a stable and competent staff team. Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 22 The previous inspection report highlighted the need for the home to develop its own quality assurance system based on the views of people who use and have contact with the service. The manager was aware of the role of a quality assurance system and so it is recommended that a system of quality assurance be implemented. Information provided through the AQAA and site visit showed that regular health and safety checks in respect of fire, water and food storage temperatures were being maintained. Gas, electric and fire equipment was being serviced on an annual basis. The home had the relevant documentation and information regarding COSHH and RIDDOR and a policy on the reporting of incidents and notifications to the CSCI and other relevant organisations. Alness Lodge DS0000021600.V342056.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 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 3 X Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 YA12 Good Practice Recommendations It is recommended that the home record the opportunities offered to people to take part in leisure and social activities even if they refuse. It is recommended that a record is maintained of the concerns and worries that people raise that requires the manager or staff team to take some action to resolve the persons concerns. It is recommended that all transactions and charges are recorded separately (e.g. shopping and travel costs), that the recording of the transaction be clearer and more descriptive, that receipts are numbered and cross referenced on the recording sheet to allow for a clear audit trail and that the amount of people’s cash kept on the premises does not exceed the amount covered through insurance. 2. YA22 3 YA23 Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 25 4 YA33 It is recommended that the flexibility and use of staff to support people in the community and during the night is reviewed to make sure that people are being supported in the most appropriate way. It is recommended that a system for assessing and evidencing staff competence be developed to show that staff have implemented the skills and knowledge gained through all training and awareness events. It is recommended that to show that staff have participated in relevant training and that their continuing training needs had been assessed a clear record of individual training undertaken and planned should be in place. It is recommended that a quality assurance system be implemented that seeks the views of people and relevant others in assessing the quality of the service people receive and to establish where the service may be improved. 5 YA35 6 YA35 7 YA39 Alness Lodge DS0000021600.V342056.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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