Care Home: Milton Keynes Community Care Services

What the care home does well Prospective service users have a pre-admission assessment and are admitted on a trial basis to ensure that the service is appropriate to their assessed needs. Service users are provided with the appropriate support from staff to enable them to maintain a fulfilling lifestyle.Service users are seen as part of the local community, which mean that their rights as citizens are recognised and promoted. Service users are aware of how to make a complaint and were confident that their concerns would be responded to in a way that respects their race, age and disability. Provision is in place to ensure that regular service meetings are held and their views are listened to and acted upon. What has improved since the last inspection? The service has produced a customer service handbook, which contains information about the service and the local area. All staff have had training in the safeguarding of vulnerable adults to ensure that service users are looked after by staff who have been trained to protect them from any potential harm or abuse. The service`s recruitment procedure has improved, which mean that service users are looked after by staff who are fit to work with vulnerable adults. Four flats have been decorated to ensure that service users live in a safe and comfortable environment. Consultation meetings with service users have commenced to discuss the reorganisation of the service provision. What the care home could do better: To ensure that staff`s practice in the recording and administration of medicines is consistent to promote service users` safety and well-being. CARE HOME ADULTS 18-65 Milton Keynes Community Care Services 1 Fletchers Mews Neath Hill Milton Keynes Buckinghamshire MK14 6HW Lead Inspector Joan Browne Unannounced Inspection 18th February 2009 09:30 Milton Keynes Community Care Services DS0000015066.V374252.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 Milton Keynes Community Care Services DS0000015066.V374252.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. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton Keynes Community Care Services Address 1 Fletchers Mews Neath Hill Milton Keynes Buckinghamshire MK14 6HW 01908 660364 01908 231407 karen.fairbrother@scope.org.uk www.scope.org.uk SCOPE 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) Miss Karen Fairbrother Care Home 15 Category(ies) of Physical disability (0) registration, with number of places Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical disability (PD) The maximum number of service users to be accommodated is 15. Date of last inspection 24th April 2008 Brief Description of the Service: Milton Keynes Community Care Service is registered as a care home. The service consists of a staff base at the resource centre and individual properties situated around the Neath Hill estate. Staff provide personal care and support to service users in their own flats by prior arrangement or on request, via a twenty - four hour intercom system. Milton Keynes Council owns the properties. Scope, the organisation, is tenants of Milton Keynes Council. The properties are located within a mile radius of the staff base. And are accessible to Milton Keynes centre and local shops via the red route, which is specifically adapted for wheelchair users. The weekly range of fees are £870.00- £2000.00 Milton Keynes Community Care Services DS0000015066.V374252.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 unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection (CSCI), was undertaken by Joan Browne on 18 February 2009 and lasted for approximately seven hours. The CSCI Inspecting for Better Lives (IBL) involves an annual quality assurance assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection process and is referred to in the report. The information contained in this report was gathered mainly from records kept at the service and information contained within the AQAA. We also looked at care plan documentation, staff recruitment files, training records, medication documentation and had discussions with service users and staff. Surveys from twelve service users were received and their comments have been reflected in the report. A visit to three service users flats was made as part of the inspection process. One requirement and three recommendations were issued on this visit. Please see outcome areas for individual needs and choices, health and personal care, for full disclosure. All service users were Caucasian and reflected the population of the area in which the service is situated. Feedback was given to the manager who facilitated the inspection process. We (The Commission) would like to thank all staff and service users who made the visit so productive and pleasant on the day. What the service does well: Prospective service users have a pre-admission assessment and are admitted on a trial basis to ensure that the service is appropriate to their assessed needs. Service users are provided with the appropriate support from staff to enable them to maintain a fulfilling lifestyle. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 6 Service users are seen as part of the local community, which mean that their rights as citizens are recognised and promoted. Service users are aware of how to make a complaint and were confident that their concerns would be responded to in a way that respects their race, age and disability. Provision is in place to ensure that regular service meetings are held and their views are listened to and acted upon. 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. Milton Keynes Community Care Services DS0000015066.V374252.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 Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that prospective service users have a pre-admission assessment prior to being admitted which should ensure that all identified needs could be fully met. EVIDENCE: A recommendation was made at the previous key inspection for the statement of purpose and service users guide to be provided in a suitable format. The manager stated that the service users guide was amended by service users and it is now referred to as a customers handbook. The current service users were happy with its present format. Some service users have been issued with a copy of the statement of purpose electronically and others were happy to have it in a paper format. The manager confirmed that admissions were not made to the service until a full needs assessment was undertaken. For individuals referred through care management the service ensures that a copy of the assessment summary is obtained from the placing authority. Since the last key inspection the service has had one admission. Evidence seen in the service users care file documentation confirmed that a pre-admission assessment was undertaken. A copy of the statement of terms and conditions of occupancy was seen in the care plan documentation. The service user was spoken to and he confirmed that he was visited by the homes staff prior to being admitted. He had also visited the service to look around and the staff had given him information Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 9 about the service and explained how it was run and organised. People who responded to the Commissions survey said that they had received enough information about the service before moving in. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to make decisions about their lives including their finances, which mean that their rights and choices are promoted by staff. EVIDENCE: Each service user has a copy of their care plan in their flat and a copy is kept in the main office. The care plan files reflected individuals goals and what help was required with personal care, mobility, health care and domestic duties. Wherever possible, plans were signed by service users. The standard of recording in the three care plans examined was uneven. The system in place for evaluating individuals needs and objectives was not clear. Consideration should be made to ensure that the care plan is an up to date working tool which can be easily used by staff who are not familiar with individuals to deliver a personalised any tailor made service. We were told that care plans are reviewed six monthly or as and when required. Yearly reviews with care managers take place. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 11 The three service users spoken to were confident that they make their own decisions about their lives. Nine people who responded to the Commissions survey said that they always make their own decisions. Two respondents said that they usually make their own decisions and one said that they sometimes make their own decisions. The annual quality assurance assessment (AQAA) stated that the service operates a keyworker system. This enables service users to have a named worker who can support them with personal care, household chores and other activities. If required staff support individuals to access the services of an advocate. All the service users spoken to were managing their own finances. From discussions with staff and service users it was evident that service users were able to live the life they choose and to promote an independent lifestyle with the appropriate risk assessment in place taking into consideration their disability and diverse needs. Files seen contained risk assessments for moving and handling and outside activities and these were based on individuals diverse needs. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The service ensures that people are able to take part in activities, which are appropriate to their diverse needs. Staff provide support to enable people to maintain their independence and keep in touch with family and friends. EVIDENCE: The manager stated that there were no service users attending the local college or involved in distance learning training. The annual quality assurance assessment (AQAA) reflected that several service users were accessing the day centre and this was either self funded or built into their care profiles. Service users are very much part of the local community and were registered on the electoral register. One service user was a member of the Parish Council. Individuals spoken to confirmed that they are able to go on shopping trips to the City centre visit restaurants and pubs and follow their personal interests. Staff spoken to confirmed that key times are sometimes spent escorting service users on shopping trips. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 13 Service users choose whom they wished to see and when. Family and friends are able to visit and stay overnight. One service user confirmed that she often entertained her family members and friends and they were able to overnight if they wanted to. Staff are expected to ring service users bells and announce who they are and request to be let in. Individuals preferred form of address was recorded in their care plans. Staff were responsible for housekeeping tasks such as, washing, cleaning and cooking. Service users were in receipt of three meals daily. Staff members cook all meals in service users flats. Individuals choose what they wish to eat. A weekly food allowance is allocated to service users and they are expected to purchase their own food shopping with support from staff if required. A concern was raised by a service user during the inspection regarding staffs assistance at meal times. The individual felt that staff were not being sensitive to their needs. The concern was referred to the manager and it is pleasing to report that it was addressed immediately. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffs practice in the administration and recording of medication needs to be consistent to ensure that any potential risk of harm to service users health and well being is minimised. EVIDENCE: Care plans outlined the level of support individuals required with their personal and health care needs. The times for rising and retiring, daily routines and outside activities. Service users who responded to the Commissions survey felt that the delivery of personal care was not always flexible and depended on which staff member was providing it. We were told that all service users were registered with a general practitioner (GP) of their choice. Service users visit the doctor as and when needed and staff will escort them if a request to have an escort is made. Access to specialist treatment was via the GP. Evidence seen in care plan documentation indicated that service users have regular dental and optical checks. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 15 Staff were assisting some service users with their medication. In each flat there was a lockable storage cupboard to store medication. The service has a medication policy supported by procedures and practice guidance but not all staff appeared to be following the procedures. For example, unexplained gaps were noted on three medication administration record (MAR) sheets. Some handwritten entries on the MAR sheets were not countersigned by a second staff member to minimise the risk of errors when transcribing. A handwritten entry on the MAR sheet for a particular service user that was prescribed for a cream treatment did not state the frequency when the cream should be applied. The manager said that all staff had undertaken training in the safe handling and administration of medication however, staffs practice in the safe handling and administration of medication was not consistent. One service user was in receipt of controlled medication. Two members of staff were administering the medication and staff were taking the medication to the service users flat. To comply with best practice the manager has been advised that the controlled drug cupboard can be placed in the service users flat. Two members of staff are still required to administer the medication and a record of the controlled medication should be recorded on the MAR sheet and in the controlled record book. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22&23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are aware of how to make a complaint and there are systems in place to ensure that concerns are looked into and action taken to put things right. There are procedures in place to ensure that service users are safeguarded from abuse and neglect. EVIDENCE: The annual quality assurance assessment (AQAA) reflected that within the last twelve months the service had received two complaints. The complaints record folder was examined and it reflected that the complaints made were fully investigated with satisfactory outcomes. One of the complaints was referred to the safeguarding adult protection team as a safeguarding incident. People who responded to the Commissions survey said that they knew how to make a complaint. The Commission has not received any complaints about the service since the last inspection. Information in the AQAA indicated that since the last key inspection the home has had three safeguarding adult referrals, which were investigated by the local social services safeguarding vulnerable adults protection team. The outcome of which resulted in a member of staff was referred to the protection of vulnerable adult (POVA) register. The Commission was made aware of the safeguarding referrals. The AQAA stated that as part of the services improvement plan safeguarding is discussed in staffs supervision sessions and at staff meetings to ensure that staff understand fully the organisations Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 17 safeguarding policy. The manager confirmed that training of staff in the area of safeguarding of vulnerable adults had taken place and was ongoing. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that service users living accommodation is safe and fitted with the appropriate aids and adaptation to promote independence. Consideration is needed to ensure that times allocated for cleaning are adequate. EVIDENCE: Three service users flats were looked at during the site visit. The flats were in a satisfactory and decorative condition. In one flat work was being carried out to install new aids and equipment to promote the individuals safety and enhance independence. Information in the annual quality assurance assessment (AQAA) revealed that within the last twelve months four flats had been redecorated and all gardens had been maintained. Several service users who responded to the Commissions survey raised concerns that the service no longer provides a dedicated cleaner. Instead staff were expected to carry out this task and the standard of the cleaning was not as it should be because of the limited time that was allocated to staff to carry Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 19 out cleaning tasks. This information was shared with the manager for consideration and improvement. Each flat is equipped with washing machines and staff are expected to assist service users with their personal laundry and linen as and when required. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that service users are supported by staff who have been appropriately trained and recruited to meet their diverse needs. EVIDENCE: The service employs a multi-cultural staff team to meet service users diverse needs. The staffing roster reflected that six staff are rostered to cover the morning shift from 07:00 am to 15:00 pm. This number is reduced to five in the afternoon from 15:00 pm to 22:00 pm. Two staff cover the night shift from 22:00 pm to 07:00 am. The annual quality assurance assessment (AQAA) reflected that within the last year two staff members had left the services employment and two team co-ordinators had been recruited into the management team to provide positive hands on leadership. Fourteen staff had completed the national vocational qualification (NVQ) in direct care at level 2. Three staff personal files were examined and reflected that thorough recruitment processes had been followed with all the necessary checks undertaken and original documentation available at the organisations human Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 21 resource office. We were told that service users are part of the interview panel for staff recruitment. Staff spoken to confirmed that they were in receipt of regular supervision. Training records seen demonstrated that mandatory and other training was being well managed. The manager said that service users were invited to participate in staff training when they are facilitated in- house. One service user confirmed that she had undertaken training in safeguarding of vulnerable adult, equality and diversity and the mental capacity act. Service users who responded to the Commissions survey said that staff always or usually listen and act on what is said. The following additional comments were noted by a respondent: Sometimes staff do whats quicker for them and dont always want to listen to my way. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has policies and procedures in place, which should ensure that service users safety and human rights, are promoted and they have confidence in how the service is run and managed. EVIDENCE: The manager has over twenty years experience working in the care sector. She holds a national vocational qualification (NVQ) in direct care at level 3 and 4 and the registered managers award. She updates her knowledge and skills by attending updated training and networking with other managers in the organisation. Evidence seen indicated that the manager meets regularly with the staff team and service users. Staff spoken to said that the manager was approachable. Evidence was seen of reports from regular regulation 26 monitoring visits undertaken by service managers on behalf of the provider Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 23 The annual quality assurance assessment (AQAA) was returned to us by the date it was requested. All sections of the AQAA were completed. The evidence to support the comments made was satisfactory, although there were areas where more supporting evidence would have been useful to illustrate what the service has done in the last year. Information in the AQAA demonstrated that health and safety checks were routinely carried out which included fridge, food and water temperatures in service users flats. Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 3 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 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement Staffs practice in the recording administration of medicines must be consistent. This is to ensure that service users health and welfare are not compromised. Timescale for action 01/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA18 YA20 Good Practice Recommendations Consideration should be made to ensure that the care plan is an up to date working tool, which can be easily used by staff who are not familiar with service users. Consideration should be made to ensure that staff provide personal care in a flexible and consistent manner at all times. Consideration should be made to have regular management checks to monitor compliance of the homes medication record. Milton Keynes Community Care Services DS0000015066.V374252.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. Extracts may not be used or reproduced without the express permission of CSCI Milton Keynes Community Care Services DS0000015066.V374252.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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