Care Home: Unicorn House (16)

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What the care home does well Care plans reflect what is important to people, what their capabilities are, and what support they need to achieve their personal aspirations and wishes. A visiting relative told us the attitude of the staff was on the whole very good and that they were particularly impressed with the contribution made by their loved ones key worker. One person told us "my key worker helped me make my care plan, I like my key worker, they help me do things". Visiting health professionals told us they had been impressed with the current staff team who they described as "very caring and enthusiastic". There are good health and safety arrangements in place. What has improved since the last inspection? What the care home could do better: There has been a high turnover of managers and staff at this service in recent years; each new manager has brought with them new initiatives and made improvements. However as a result of the turnover of managers the service has had a poor track record when it comes to sustaining these improvements. The relatively new registered manager has in the short-term made significant improvements at the home. The challenge to the registered provider and the registered manager is to sustain these improvements and to establish a team that can take into account the long-term needs of the residents. There have been failure`s in the past to make sure that people`s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. No new people have moved in since April 2007, this prevents any further judgement on the ability of this service to ensure that these assessments are appropriately carried out. The Commission will continue to monitor how the home admits new people to the home. Challenging behaviour strategies should be continuously reviewed and updated to reflect any changes in peoples needs or circumstances and take into account the views of all the relevant parties, including the person; their representatives and relevant health and social care professionals.The challenging behaviour policy should be revised to reflect the services aims and objectives about never subjecting people to any form of physical intervention techniques. The homes Statement of Purpose and Service Users Guide could also be updated to reflect this non-physical approach to dealing with behaviours that challenge the service. Care plans should contain more detailed information about how staff can deal with identified risks and these should be updated to reflect changes in need and/or circumstances so that people are kept safe from avoidable harm. Care plans should also take into account the views of all the relevant parties, including the person; their representatives and relevant health and social care professionals. The home should seek the advice of relevant professionals when drawing up protocols for the use of as required mediation. The Statement of Purpose should accurately reflect the conditions of the homes registration. The door on the ground floor toilet should be fixed so that it offers privacy to people while they are using the toilet. Copies of the registered providers visit reports (Regulation 26 visits) should be sent to the Commission so that we can monitor that these visits are being carried out at the home on a monthly basis. We would like to thank people who use the service, staff, the visiting relative and health care professionals and the registered manager for their comments and support during the inspection process. CARE HOME ADULTS 18-65 Unicorn House (16) 16 Campden Road South Croydon Surrey CR2 7EN Lead Inspector James O’Hara Key Unannounced Inspection 24 , 25 & 27 of November 2008 11:00 th th th Unicorn House (16) DS0000025864.V373148.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 Unicorn House (16) DS0000025864.V373148.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. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Unicorn House (16) Address 16 Campden Road South Croydon Surrey CR2 7EN 020 8688 1907 020 8686 0135 unicornprojects@hotmail.com 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 Maharajah Madhewoo Ms Deborah Clarke Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. 3. Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 No new service user with a mental health condition may be admitted to the home. 30th May 2008 Date of last inspection Brief Description of the Service: Unicorn House is a twelve bedded home that is registered to provide care for people who have a learning disability. The location of the home is within easy reach of good public transport links and the centre of Croydon. This results in people being within easy reach of local amenities and services. The current fee charged for living at the home is between £770 and £1500per week. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the residents now experience good quality outcomes. In total we spent twelve hours at the home. We spoke to two residents, a relative of one of the residents, the registered provider, the registered manager, the deputy manager, two support workers and three visiting health and social care professionals. We also met, albeit briefly, all the other residents who currently live at the home and six other members of staff. We looked at the records for two people we chose to case track. We also looked at variety of other records and documents that related to the general management and day to day running of the home, as well as some photographs. On the first site visit we sat in on a staff handover meeting between the early and late shift teams, and on the second day we observed an assessment carried out by two visiting mental health professionals. Finally, we toured the premises. Following the last key inspection on the 30th of May 2008 a statutory notice was served on the home for failing to notify the Commission about a serious incident. The notice stated that the registered provider must ensure that the Commission is notified without delay of the occurrence of any event in the care home which adversely affects the well being or safety of any person using the service. Any oral notification must be confirmed in writing. What the service does well: What has improved since the last inspection? Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 6 The home is undergoing a serious concerns review under Croydon Councils Safeguarding Vulnerable Adults procedures following concerns raised about the home in May 2008 by the Croydon Physical Disabilities Care Management Team and the Commission for Social Care Inspection. As a response to those concerns the Care Home Support Team, a new initiative funded by the Primary Care Trust, South London and Maudsley Trust and Social Services was called in to support the home. The team consists of a Community Psychiatric Nurse a Registered Nurse and a Social Worker. Their objective is to enable care staff to improve the quality of care provided in care homes. The registered manager has been in post for just over six months and has addressed all of the requirements and recommendations set at the last inspection. She has introduced a number of new initiatives to improve the outcomes for people. People now have contracts that give clear information about their terms and conditions. People are more involved in the day-to-day running of the home and can make more informed decisions about their lives. People have a greater choice of what they want to eat; a dietician has helped with planning healthier meals and a picture menu has been developed for the benefit of some people. People are now holding meetings at least once a fortnight and sometimes weekly. One person told us they “liked going joining the meetings and staff would listen to them and put things they liked on the menus”. Some progress has been made so that people can engage in a wider variety of more meaningful activities within the home however there remains considerable scope to improve these arrangements, especially with regards community based outings and events. Improvements have also been made in respect of the range of opportunities people have to maintain and develop their independent living skills, although the registered manager acknowledges that there is considerable scope to increase the number of opportunities people have for personal development. A visiting relative told us they felt their loved one was now being given far more opportunities to join in and enjoy a wider variety of interesting social and recreational activities, both within the house and out of it. A visiting health care professional told us they believed people were taking a far more active role in the day to day running of the home since the appointment of the registered manager. Medication is well managed by the home and people have good access to appropriate healthcare professionals. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 7 Improvements have been made to the décor and furnishing. The home is now being well maintained so that people can live in a clean, comfortable, homely and safe environment. A visiting relative told us the whole place looked much brighter and bigger as a result of the recent redecorate work and that they were pleased with all the work carried out to improve the interior décor of their loved ones bedroom. All managers and staff have attended safeguarding training. Serious incidents are being reported to the Commission and other appropriate parties when they happen. People who use the service and the home’s financial recording system have improved. All of the people who live there, visiting relatives and health care professionals we met told us that they were very impressed with the open and approachable leadership style of the registered manager and the deputy manager. This 2 star quality rating marks a significant improvement on the 0 star rating received at the previous key inspection. It was clear from the evidence gathered at this inspection that the service now has significantly more areas of strength than weakness. What they could do better: There has been a high turnover of managers and staff at this service in recent years; each new manager has brought with them new initiatives and made improvements. However as a result of the turnover of managers the service has had a poor track record when it comes to sustaining these improvements. The relatively new registered manager has in the short-term made significant improvements at the home. The challenge to the registered provider and the registered manager is to sustain these improvements and to establish a team that can take into account the long-term needs of the residents. There have been failure’s in the past to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them to the home. No new people have moved in since April 2007, this prevents any further judgement on the ability of this service to ensure that these assessments are appropriately carried out. The Commission will continue to monitor how the home admits new people to the home. Challenging behaviour strategies should be continuously reviewed and updated to reflect any changes in peoples needs or circumstances and take into account the views of all the relevant parties, including the person; their representatives and relevant health and social care professionals. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 8 The challenging behaviour policy should be revised to reflect the services aims and objectives about never subjecting people to any form of physical intervention techniques. The homes Statement of Purpose and Service Users Guide could also be updated to reflect this non-physical approach to dealing with behaviours that challenge the service. Care plans should contain more detailed information about how staff can deal with identified risks and these should be updated to reflect changes in need and/or circumstances so that people are kept safe from avoidable harm. Care plans should also take into account the views of all the relevant parties, including the person; their representatives and relevant health and social care professionals. The home should seek the advice of relevant professionals when drawing up protocols for the use of as required mediation. The Statement of Purpose should accurately reflect the conditions of the homes registration. The door on the ground floor toilet should be fixed so that it offers privacy to people while they are using the toilet. Copies of the registered providers visit reports (Regulation 26 visits) should be sent to the Commission so that we can monitor that these visits are being carried out at the home on a monthly basis. We would like to thank people who use the service, staff, the visiting relative and health care professionals and the registered manager for their comments and support during the inspection process. 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. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 9 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 Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 10 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 & 5 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to use the service cannot be confident that their needs will be met as the home has failed to make sure that people’s needs are assessed by a suitably qualified or suitably trained person prior to admitting them. The Commission will continue to monitor how new people are admitted. EVIDENCE: The home is registered to support up to twelve people whose primary care needs on admission to the home is learning disabilities. A condition was placed on the home’s registration on the 2nd of May 2006 that no new person with a mental health condition may be admitted. The registered manager started working at the home in May this year, she had recently updated the home’s Statement of Purpose. The Statement of Purpose stated that the service was a registered residential care home for adults with learning disabilities and associated challenging behaviour and or associated mental health problems, autism, physical disabilities, schizophrenia, multiple sclerosis, dementia and Gilles De La Tourettes. The Statement of Purpose emphasizes that people without a learning disability cannot be considered for placement at the home. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 11 The registered manager was reminded of the condition that no new person with a mental health condition may be admitted. The registered manager told us that she had included the diagnosed conditions of all the people who use the service because it was reflective of the people currently living at the service. The Statement of Purpose must be reviewed and amended to accurately reflect the conditions of the homes registration. The last two admissions brought into question whether those responsible for the admissions process were putting those who are in need of services at the centre of all their activities. Both admissions had been on an emergency basis involving individuals who had elements of their needs that the staff had not been trained or sufficiently experienced to immediately provide the care. No new people have moved in since April 2007. This prevents any further judgement on the ability of this service to ensure that assessments of new people are appropriately carried out. The Commission will continue to monitor how new people are admitted. There is a serious concerns review currently taking place under Croydon Councils Safeguarding Vulnerable Adults procedures. The first serious concerns meeting was held on the 7th May 2008 following concerns raised about the home by the Croydon Physical Disabilities Care Management team and the Commission for Social Care Inspection. Croydon Safeguarding made a decision in October 2008 to place an embargo on making placements into the home. The registered manager told us that peoples’ contracts had been reviewed and updated accordingly in the past six months. Contracts were produced on request for the people whose care we had chosen to case track. As required in the previous inspection report contracts agreed between the person and/or their representatives and the service have now been amended to include details about the accommodation, food and personal care offered, and how much the service will charge for them. The contracts viewed also covered the fees charged for so called ‘additional’ items and/or services, which were not covered by the basic cost of each placement. Both the contracts were relatively jargon free and gave the person and/or their representatives a clear understanding of what they could expect to receive and pay for facilities and services provided. One contract had been signed by the person, while the other had not. The registered manager told us that people had been involved in drawing up their new contracts and that the vast majority had now been signed by the individual and/or their representatives as proof that they agreed with its contents. The Service Users Guide has been updated and produced using words and widget; although this may be of benefit to some people other people may have difficulty understanding. The home has developed other communication tools Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 12 such as pictures and photographs to aid communication between people who use the service and staff. It is recommended that the Service Users Guide be developed using pictures and photographs for the easier understanding of the people who live there. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 13 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 can be sure that their needs are being met because care plans reflect what is important to them, what their capabilities are, and what support they require to achieve their personal aspirations and wishes. Significant progress has been made by the service so that people are more involved in the day-to-day running of the home and can make more informed decisions about their lives. People are actively encouraged and supported to take ‘responsible’ risks, although there remains significant scope for the home to improve its risk assessing arrangements. Care plans need to contain far more detailed information about how staff should deal with identified risks and these should be up dated to reflect changes in need and/or circumstances so that people are kept safe from avoidable harm. EVIDENCE: Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 14 We case tracked two people throughout the inspection process; we looked at their files. Both had admission profiles, service users contracts, person centred plans, risk assessments, care plans and health action plans. Person centred plans were written in plain language, relatively easy to understand, and covered all aspects of these individual’s personal, social, and health care needs and wishes. Both plans contained detailed information about their unique spiritual and cultural needs and wishes and food and drink preferences and dislikes. One care plan referred to the individual’s specialist communication needs and set out in detail what certain words meant to them in order to help staff communicate more effectively with them. Two staff met demonstrated a good understanding of some of the key words this individual chose to use and what they meant to them. Both persons had signed certificates indicating that they were involved in developing their person centred plan and risk assessments. The registered manager told us the home continues to operate a key worker system and that people are allocated key workers. One person spoken with at length told us “my key worker helped me make my care plan, I like my key worker, they help me do things”. One support worker, a designated key worker, told us they are responsible for encouraging people to be involved in the ongoing development of their care plans by working with them on a one to one basis at regular intervals to ascertain their views and wishes regarding the care they receive. The registered manager told us that all of the people who live there had their placements reviewed by care managers from their placing authority this year. A number of care managers returned surveys to the Commission. One care manager commented “the service has maintained a stable placement for our service user for over two years - the service recognises that improvements need to be made and continue toward that objective”. The registered manager told us that residents meetings were now being held at least once a fortnight and sometimes weekly. Written evidence in the form of the minutes taken at meetings in the past eight weeks confirmed this practice. The minutes of the last three meetings showed they had been well attended by the people who lived there and had covered a wide variety of relevant topics that were clearly of interest to them. Also included were weekly menu planning, ideas for community based activities, proposed key worker changes, how to make a complaint, and the role of CSCI inspectors. One person told us they “liked going joining the meetings and staff would listen to them and put things they liked on the menus”. The registered manager told us that people are actively encouraged and supported to take ‘responsible’ risks within an appropriate risk framework in order to help individuals maintain and develop their independent livings skills. During the course of this three-day inspection a number of people were Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 15 observed being supported by staff to make their own hot drinks (See the Lifestyle section of this report for more details). Furthermore, evidence was produced from the two care plans being case tracked to show that risk assessments are carried out. However, the completed risk assessments viewed were all rather basic (i.e. lacking in detail), especially with regard the action to be taken by staff to minimise any identified risk. We also noted that despite being notified about the recent occurrence of two significant incidents, which had clearly put the people involved in real potential danger of harm, their care plan did not contain up to date risk assessments or management strategy to minimise the likelihood of similar incidents happening in the future. The registered manager told us staff had been briefed about the potential dangers associated with people going on unplanned absences following the recent incident, but conceded care plans had not been up dated to reflect this new risk. Finally, we noted that where limitations are in place, there is little evidence to show these decisions are agreed with the individual, their representatives and the relevant health and social care professionals. We therefore concur with the comments made by a visiting community nurse who suggested their ‘clients’ risk assessments would be significantly improved if the manager was to seek the advice of the relevant professionals when drawing up risk management strategies. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 16 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. Some progress has been made so that people can engage in a wider variety of more meaningful activities within the home however there remains considerable scope to improve these arrangements, especially with regards community based outings and events. Appropriate arrangements are made so that people can have regular contact with their friends and families. Dietary needs and preferences are well catered for ensuring people are offered a daily choice of varied and nutritionally well-balanced meals. EVIDENCE: A number of requirements were set at the last key inspection in relation to people’s access to community activities, individual programmes and developing independence. It was identified during previous inspections that people had Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 17 little opportunity to access day services or other meaningful activities outside of the Unicorn Projects. At the last inspection the registered manager conceded opportunities for this to happen on a regular basis remained variable. Since then the registered manager has developed individual programmes for all people. Some people now attend Croydon College and social clubs on a regular weekly basis. The registered manager told us that she was contacting a day service for people with physical disabilities in Purley to see if they can offer a service to some people who use the service. People have also tried activities such as kart racing and bowling to see if this were something they would like to continue with. We case tracked two people throughout the inspection process; one persons individual programme indicated that he attended Croydon College on Monday evening, Unicorn day service two mornings a week and Debbie’s Club on Wednesday evenings. This person was observed leaving the home to attend these activities over the three days of the inspection. The other person also had an individual programme indicating activities such as day services and visiting local pubs and restaurants. This person told us that they didn’t get a chance to go out much. The daily activity records for this person indicated that they had been out of the home only once in the last three weeks. Records also showed that they were visited by their relatives, chatted with staff, played dominoes, watched television and participated in cooking. The registered manager told us that the home had offered this person opportunities such as karting and bowling however after he had tried them he didn’t want to do them again, the person didn’t always like to attend the day service and preferred to stay at home and have a lay in. It is recommended that the registered manager arrange a placement review with the person’s care manager and keep record opportunities offered to people even if they are refused. The home was still trying to find activities that he might find more interesting During a tour of the premises a wide selection of far more ‘age’ appropriate and stimulating games, art resources, and home entertainment equipment was noted. We also saw a lot of board games and puzzles in the games room, and a good selection of far more meaningful films, TV serials, and books conspicuously displayed in the main lounge for people’s use. Various pictures and inscriptions of a spiritual natural were also seen in one person’s bedroom, which reflected their cultural and religious heritage, as stated in their care plan. A visiting relative told us they felt their loved one was now being given far more opportunities to join in and enjoy a wider variety of interesting social and recreational activities, both within the house and out of it. The registered manager also told us she felt this was an area of practice that had significantly Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 18 improved its performance in since her arrival. The registered manager has introduced a record of all the activities people can participate in each day. The visiting relative also told us they could always visit their loved one whenever they liked and staff always made them feel welcome and the relatively new manager was very approachable. As required in previous report people now have far more opportunities to maintain and develop their independent living skills. As previously mentioned staff were observed on numerous occasions actively encouraging and supporting several people to participate in various households and generally do more things for themselves. For example, a member of staff was observed supporting two people to make their own hot drinks in the kitchen after they had requested too, while another person was seen laying tables in the dinning room for lunch on the third day of this inspection. A member of staff also showed us some recently taken photographs of a person engaging in all manner of household chores, including helping staff to prepare meals, making a drink and vacuuming their bedroom. A health care professional who visits the home on a regular basis told us they believed people were taking a far more active role in the day to day running of the home since the appointment of the new manager. A record of all the household chores people have agreed to participate in each week was included in the two care plans viewed. A weekly schedule of all the household chores people have agreed to do is also conspicuously displayed on a notice board in a communal area. One person asked about the meals served at the home told us “the food is nice here” and “I sometimes go food shopping with staff to buy the things I like to eat”. Since the last inspection the registered manager has revised the four weekly rotating menus to ensure people are always offered an alternative choice of meal at mealtimes. At lunchtime on the first day of this inspection we observed one person choosing to have spaghetti on toast, while another decided to have a sandwich. Both these choices were reflected on the planned menu for that day, which was conspicuously displayed in the dinning room. The registered manager has also introduced a menu book that contains numerous pictures and photographs of various items of food and meals to help people choose the meals they want put on the menus. The registered manager told us the book was still a work in progress, but hopes to have finished it by Christmas (2008). A visiting relative told us their loved ones favourite food, which they had acquired a taste for a child when they lived abroad, was regularly on the menu. A detailed record of the meals actually consumed by people is Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 19 maintained each day; this showed the aforementioned individuals meal preference had been served on one occasion in the past month. As required in the previous report people are now being offered a healthier diet. The registered manager told us advice about the nutritional balance of the new menus was always sought from a qualified dietician to ensure people were offered a healthy diet. She was able to produce a letter on request that showed the contribution of the local authorities dietician in respect of the new menus. During a tour of the premises, which included the cellar, the kitchen, and pantry, a lot more fresh vegetables and fruit was found in stock. The registered manager told us she had got rid of a lot of the tinned foodstuffs we found stocked in the cellar at the previous inspection, which we were able to confirm during our tour. She also told us that staff go shopping with people on a more regular basis to buy fresher produce. During the first day of the inspection staff were observed returning to the home with fresh meat bought from a local butchers that was going to be used for that days evening meal. All items of food stored in the fridge, including those taken out of their originally packaging, were correctly labelled and dated in accordance with basic food hygiene standards. One member of staff lives on the premises with their partner. Both have up to date Criminal Record Checks. The registered manager agreed that if the member of staff had a visitor then the visitor would have to walk through the home passing by some of the bedrooms. The registered manager agreed that this was not an ideal situation however this was an arrangement made by the registered provider. She told us that it was not the practice of the member of staff to have visitors as they preferred to visit their friends, if they did have visitors they would be expected to sign the visitors book when entering the home. It is recommended that the home develop a policy for members of staff who live on the premises receiving visitors. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 20 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 can be sure that their health care needs are met because medication is well managed by the home and they have good access to appropriate healthcare professionals. EVIDENCE: During the course of this three-day inspection people were observed dressed in well-maintained ‘age’ appropriate attire that was suitable for the season. The two care plans being case tracked contained up to date health care action plans that set out in detail these individual’s unique health care needs, the support they required to have them met, and all the appointments attended with various health care professionals. We met three community based health care professionals during the course of this inspection who were visiting to carry out various check ups assessments of their ‘clients’. The registered manager told us working relationships with community based health and social care professionals and/or agencies was another area she felt the home had significantly improved in the based six Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 21 months. All three visiting professionals concurred by telling us they felt the relatively new manager was very approachable and easy to engage with. As required at the last key inspection the registered manager contacted the continence advisor at May Day Hospital for one person and an assessment was carried out. She showed us guidance and advice obtained from the continence advisor, there is now a programme in place to manage and support the person’s continence. New non-slip flooring and a bed have also been provided. The accident book revealed there had only been one ‘significant’ event involving a person sustaining a minor injury. The registered manager told us a member of staff who received basic first aid training appropriately dealt with the accident at the time. No recording errors were noted on any of the medication administration sheets used in the past eight weeks for all the people prescribed as required (PRN) medicines. Staff met confirmed it was the responsibility of the senior person on each shift to audit the medicines and associated records at the end of each shift. We agree with the deputy manager’s comments that this quality assurance system is very good practice and will enable staff to ‘spot’ any medication errors made at an early stage. The registered manager told us that the home does not currently stock any controlled drugs on behalf of people. No controlled drugs were found in the medication cabinet. All the medication records inspected accurately reflected a current stock of medication held; medication was securely stored in a locked metal cabinet in the office. The registered manager was able to produce protocols for the use of as required medication for all people prescribed them. Medication records showed staff were clear when and how to give this type of medication. However, we agree with the comments made by a visiting health professional who suggested the manager seeks the advice of the relevant medical professionals when drawing up guidelines for the use of as required medication. The registered manager told us one person who is willing to take far greater control of their medications was actively encouraged by staff to help them administer it. We recommend the willingness and capacity of all the people to take control (so far as reasonable practicable) of their own medication is assessed within an appropriate risk framework as a means of promoting independence. A record of the outcome of these risk assessments should also be kept on each person’s care plan and be made available for inspection on request. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 22 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. People can be sure that their complaints and concerns are listened to because there is a clear complaints procedure that that they can understand. People can be sure that they are protected from harm and abuse because there are policies in place for safeguarding adults and staff have completed training on adult protection. EVIDENCE: Two people and a visiting relative told us that they felt able to express their views if they were dissatisfied with the service provided. All people, the visiting professionals and the one relative asked about the registered manager told us they felt confident she would listen to any concerns they may have and act upon it. The complaints procedure is clearly written and as recommended in the previous report is now available in an easy to read picture format. The new pictorial policy is conspicuously displayed on communal notice boards located throughout the home. The registered manager was able to produce the complaints log on request. The record showed that no complaints have been made about the home’s operation since it was last inspected. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 23 The home is undergoing a serious concerns review under Croydon Councils Safeguarding Vulnerable Adults procedures following concerns raised in May 2008 by the Croydon Physical Disabilities Care Management Team and the Commission for Social Care Inspection. As a response to those concerns the Care Home Support Team, a new initiative funded by the Primary Care Trust, South London and Maudsley Trust and Social Services was called in to support the home. The team consists of a Community Psychiatric Nurse a Registered Nurse and a Social Worker. Their objective is to enable care staff to improve the quality of care provided in care homes. The team has provided training and support on challenging behaviours; person centred planning, communication, incident and accident reporting and safeguarding adults. Croydon Social Services Safeguarding Co-ordinator facilitated training on Safeguarding in August and the homes managers attended Advanced Safeguarding Adults for managers. The deputy manager confirmed he had attended the training and told us he had found it very useful. In addition to this training the registered manager told us all the homes staff team have now completed the local authorities e-learning safeguarding module. One area considered under the serious concerns review was the management of people’s finances. We spoke to the administrator; she told us that Croydon had carried out an audit of the home’s finances and that she had positive feedback about how finances were being managed. Another finance audit is planned for December 2008. The administrator told us that all of the people’s care manager’s have audited their client’s accounts. Following a recent concern made to the Commission a care manager visited the home to audit their client’s accounts. He told us that he didn’t think there had been any discrepancies or mismanagement of the client’s financial affairs. The administrator told us that care managers from each local authority responsible for placing their clients are the appointee’s for all but two people. These two people’s relatives are the appointees. When people need money the home provides this for them and then claim it back from their care manager/family. The administrator showed us individual receipts for items purchased by the people, monthly records are kept in envelopes to make it easier to audit. People also have copies of these receipts in their rooms. The administrator told us that she audits all of the people’s finances, including receipts on a weekly basis and the registered manager also audits the finances on a regular basis. People’s shopping is planned with the registered manager and their key workers before going out and care managers/relatives approve larger amounts. Regular electronic statements of people’s accounts and petty cash are sent to relatives and care managers. Following the last key inspection on the 30th of May 2008 a statutory notice was served on the home for failing to notify the Commission under regulation Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 24 37 of the Care Home Regulations. The notice stated that the registered provider must ensure that the commission is notified without delay of the occurrence of any event in the care home which adversely affects the well being or safety of any person using the service. Any oral notification must be confirmed in writing. The registered manager produced a record of all incidents and accidents that had occurred since the last key inspection. All of these had been reported to people’s care managers and the Commission under regulation 37 of the Care Home Regulations. In the last six months records showed a low number of referrals made as a result of lack of significant incidents, rather than a lack of understanding about when incidents should be reported. The registered manager demonstrated a clear understanding of the reasons for reporting incidents to the Commission, the Safeguarding Adults Team and the local authorities responsible for placing people at the home. Four members of staff including the registered manager and the deputy manager were asked about the use of physical intervention techniques in the home. They told us that they were not permitted to use such techniques as it contravened the home’s philosophy of care. The two support workers spoken to at length were very clear that they would only use what they referred to as ‘de-escalation’ and ‘diversion’ tactics to deal with incidents of challenging behaviour. One member of staff told us “I would talk very calmly to the residents concerned, try to find out what might have upset them, and where appropriate consider using as required PRN medication”. Both staff confirmed they would not physically intervene to deal with an incident of challenging behaviour. The registered manager confirmed that the staff team had received other training around dealing with physical and verbal aggression in 2008, which advocates a non-physical approach. There is a managing challenging behaviour policy, which indicates that staff are permitted to use approved physical intervention as a last resort. We feel this statement sends out a rather confused and mixed message to people, their representatives, and staff about the use of physical intervention in the home. The policy needs to be revised to make it clear people are ever subjected to any form of physical restraint. As required in the previous report challenging behaviour risk assessments had been reviewed and updated to reflect any changes in need in the two care plans being case tracked. As previously mentioned in this report the registered manager had already acknowledged that they respond to new incidents of challenging behaviour needed to be reviewed as current arrangements were inadequate (See Requirement 1 and National Minimum Standards 9). Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 25 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. Improvements have been made to the décor and furnishing. The home is now being well maintained so that people can live in a clean, comfortable, homely and safe environment. EVIDENCE: As required at the last key inspection new non-slip flooring has been laid in a bedroom and a new bed provided. The room had also been redecorated. The incontinence adviser has visited and a support programme is now in place. The room no longer has an offensive smell. The manager told us arrangements had been made for the scuffed wooden flooring in the dinning room to be re-varnished by Christmas. Progress made to achieve this aim will be assessed at the next inspection. A requirement was set at the last key inspection that the latch fitted to the new ground floor toilet door must be replaced with a more suitable locking Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 26 device that can be overridden by staff in an emergency. This would ensure that the people who use the service are kept safe. The latch fitted to the ground floor toilet door has been removed. The registered manager told us that this was so that staff could access the room in an emergency. Although this would help in an emergency it raises the issue of peoples privacy when using the toilet. The registered manager must make sure that the door on the ground floor toilet offers privacy to people while they are using the toilet. As recommended at the last key inspection a new settee, a new armchair and cushions and a new video and DVD player have been purchased for the lounge. There was a good selection of video’s, DVD’s and books for people to watch and read if they wished. New fish have been bought and placed in the fish tank. People who use the service were observed relaxing in the lounge throughout the three days of the inspection. The lounge was also being redecorated. The registered manager told us that most people’s bedrooms, and the hallway had been redecorated, the office had been moved around, table cloths and flowers had been purchased for the dining area, a tread mill had been removed from the activities room, a rope had been removed from the staircase, coats at the entrance to the home had been removed to let in more light, glass for fire doors were installed and a washing line and pegs had been purchased. We viewed two newly decorated bedrooms during a tour of the premises. Both rooms looked more homely and bright. One person told us they “had picked the colour their bedroom was recently painted”. A visiting relative commended that “the whole place looked much brighter and bigger as a result of the recent redecorate work and that they were pleased with all the work carried out to improve the interior décor of their loved ones bedroom”. Throughout the course of this three-day inspection the home remained clean and tidy, and always smelt fresh. The visiting relative also told us she had noticed the home looking a lot cleaner in the past few months and the smell of urine they always encountered as they entered had been eliminated. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 27 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 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be sure that they are safe because there is enough competent and trained staff on duty at all times. They can have confidence in the staff because checks have been done to make sure that they are suitable to care for them. EVIDENCE: The staff team consists of a registered manager, a deputy manager, four full time staff, three part time staff and three bank staff. Five members of staff have completed an NVQ level 3 in Care and three members of staff have completed an NVQ level 2 in Care, the remaining members of staff are currently completing an NVQ. The registered manager and the deputy manager told us that they are currently completing a City and Guilds course on Community Care and Mental Health. She produced evidence that staff had attended a one-day training course on mental health facilitated by an external training provider. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 28 Two people who use the service have been diagnosed with autism. The registered manager told us that staff had attended training on autism at the Unicorn Training Institute facilitated by the registered provider. The registered provider showed us a training resource file developed by a Community Learning Disability Nurse from Croydon Social Services on autism and an autism training package purchased from an online training provider, he told us that he had used these to train staff on autism. The registered manager showed us that she had reviewed the staff teams training records and developed a training programme for 2009. This has been passed onto the training department to organise. The training programme included training on food hygiene, fire safety, moving and handling, medication, physical disabilities, dementia, infection control, mental capacity, non-crisis interventions, the holistic approach to care planning and equality and diversity awareness. She told us that she had plans to contact Croydon Councils person centred planning co-ordinator for advice on person centred planning. A visiting relative spoken to at length told us they thought the attitude of the staff was on the whole, very good and that they were particularly impressed with the contribution made by their loved ones key worker, especially during a recent home visit. Visiting health professionals also told they had been impressed with the current staff team who they described as “very caring and enthusiastic”. All the support workers met during this inspection were observed consistently interacting with the residents in a very caring and respectful manner. Typical comments made by one resident spoken with at length included, “the staff are nice”, and “staff take me out”. There was consistently enough staff on duty to meet the needs of people throughout the course of this three-day inspection. We sat in on a staff handover on the first day of the visit and were impressed with the high levels of participation and information sharing of all the staff involved, which included temporary bank workers. The handover was also well attended and conducted in a very professional manner. By the end of the handover all the staff scheduled to work the late shift were fully aware of all the events that had occurred that morning. The registered manager acknowledged that with three support workers leaving in the past six months the service had experienced relatively high levels of staff turnover in a relatively short period of time. However following a recent recruitment drive she was in the process of appointing two new staff which would leave the home only two staff members down on its full compliment. Duty rosters showed there is little use of any agency staff, as the home tends to rely on its own bank staff that is more familiar with the needs and preferences of the people who use the service. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 29 A new member of staff has been recruited since the last inspection. This individual’s personal staff file was inspected and was found to contain all the relevant documents and checks the provider is legally obliged to carry out. This included an up to date Criminal record bureau and protection of vulnerable adult check, two written references (including one from their last employer, which involved working with vulnerable adults), a full employment history, proof of their identity, a completed job application form, Home Office approved work visa, and notes taken during their interview. It was positively noted that in line with good recruitment practices one person’s relative had been invited to participate in the interview process and a person who lives there had recently sat on the interview panel for another possible member of staff, furthermore the prospective new staff member had been asked a number of equality and diversity related questions. A record of the induction received by the homes most recent recruit was made available on request. The induction was very thorough and had covered safe working practices, their carer role and responsibilities, and the needs of the people who live there. Supervision records show that the frequency of staff formal supervision has increased since the last key inspection, May 2008. The registered manager produced documentary evidence that staff meetings are taking place on a regular monthly basis. The registered manager told us that none of the staff has an appraisal however she had experience of appraising staff at her previous employment. It is recommended that the registered manager develop an appraisal system. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 30 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 can be sure that their needs are met and wishes are taken into consideration because the home is well managed. People can be sure that hey are protected from harm because good health and safety arrangements are in place. EVIDENCE: The registered manager started work at the home on the 9th of May 2008. She holds an NVQ 4 in management, the Registered Managers Award, and an NVQ assessor’s award. She is currently completing a City and Guilds course on Community Care and Mental Health. Since the registered manager started working at the home there have been significant improvements in all the outcome areas of this report. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 31 The registered manager clearly has good people skills, understands the importance of person centred care, and has enthusiasm for the role and the challenges it presents her. As mentioned throughout this report all the people met and visiting relatives and health care professionals were very impressed with the open and approachable leadership style of the new manager and her deputy. The registered manager told us that some people’s relatives attended a garden party in the summer. She told us that this was arranged in order to meet with them, socialise and find out their opinion about the quality of the service. The registered manager told us that all of the people and their representatives had recently been sent satisfaction questionnaires to enable them to have their say about how they viewed the home. We were told that on the whole feedback received was very positive. We recommend that the home formally analyses this feedback, acts upon their findings, and publishes the results to enable all the major stakeholders to access them. A warning letter was sent to the registered provider on the 22nd of January 2007 informing him that he must ensure that regulation 26 visits be carried out at the home on a monthly basis. Another warning letter was sent to the registered provider on the 8th of February 2008 that referred to a persistent breach of regulations including regulation 26. During this inspection the registered manager produced regulation 26 visit reports for July, August and October 2008. She could not produce reports for June and September. The visit for November 2008 had yet to take place. The registered manager has made significant improvements in the service; she told us that she and the registered manager for another service in the Unicorn Project are now carrying out visits under regulation 26 on each other’s services. In order to monitor that that regulation 26 visits are being carried out at the home on a monthly basis the registered manager is required copies of the reports to the Commission. The fire records revealed its fire alarm system continues to be tested on a weekly basis in line with recommended fire safety guidance. Fire drills are also being carried out on a monthly basis ensuring all the homes staff, including those that regularly work at night receives fire safety instruction at regular intervals. During a tour of the ground floor it was noted that none of the fire resistant doors were being inappropriately wedged open to prevent automatic closure in the event of a fire. As required in the previous report release mechanism attached to fire resistant doors to ensure their automatic closure in the event of the fire alarm being activated were noted to be in good working order. The fire resistant door leading to the kitchen closed flush into its frame when tested at random on the first morning of this inspection. The fire risk Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 32 assessment for the building was last revised in July 2007 and up dated by the deputy manager to reflect any changes. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 33 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 2 2 2 3 X 4 X 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 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 3 X X 3 X Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 34 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 YA1 Regulation 4(3)b Requirement Timescale for action 31/01/09 2. YA9 13(4) & 17(1)(a), Sch 3.3(q) 3. YA23 4(1)(a) & 13(7) The Statement of Purpose must be reviewed to accurately reflect the conditions of the homes registration. 15/12/08 When significant incidents involving people occur risk assessments must be carried out and be clearly recorded, detailing any action staff will be expected to take in future to minimise the likelihood of similar incident reoccurring. Risk assessments and associated managing challenging behaviour strategies must be continuously reviewed and up dated to reflect any changes in need or circumstances. This will ensure that so far as reasonably practical people receive all the support they need to keep them safe. The homes managing 31/01/09 challenging behaviour policy must be revised to reflect the services aims and objectives about never subjecting people to any form of physical intervention techniques. The Statement of purpose and Guide must be up DS0000025864.V373148.R01.S.doc Version 5.2 Unicorn House (16) Page 35 4. YA24 23(2)a 5. YA39 26(5) dated to reflect this non-physical approach to dealing with behaviours that challenge the service. This will minimise the risk of people being physically harmed and/or abused and ensure they receive the support they require. The registered manager must make sure that the door on the ground floor toilet offers privacy to people while they are using the toilet. In order to monitor that that Regulation 26 visits are being carried out at the home on a monthly basis the registered manager is required to send copies of the regulation 26 visit reports to the Commission. 31/01/09 31/12/08 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. 2. Refer to Standard YA1 Good Practice Recommendations It is recommended that the Service Users Guide be developed using pictures and photographs for the easier understanding of the people who live there. It is recommended that the registered manager arrange a placement review with the person’s care manager and keep record opportunities offered to people even if they are refused. The way in which the service draws up risk assessments and associated management strategies should be reviewed in order to take into account the views of all the relevant parties, including the person, their representatives and relevant health and social care professionals. This will ensure people’s rights are not restricted unnecessarily and that they receive the person centred care they require to keep them safe. It is recommended that a policy for members of staff who live on the premises receiving visitors is developed. This DS0000025864.V373148.R01.S.doc Version 5.2 Page 36 YA6 3. YA9 4. YA15 Unicorn House (16) 5. YA20 6. YA20 7. 8. YA35 YA39 will ensure that people so far as reasonably practical are kept safe. When drawing up protocols for the use of as required PRN mediation the advice of relevant professionals should be sought. This will ensure staff have all the information they need to minimise the risk people receiving in correct levels of medication they do not require. People should be offered the opportunity to take control of their own medication if within an appropriate risk framework they are assessed as willing and able too. This will ensure the rights of people to live their lives as independently as possible is promoted. It is recommended that the registered manager develop an appraisal system. The way in which the service deals with the feedback they receive from major stakeholders about the home should be reviewed. The results of the homes own self-monitoring stakeholder satisfaction questionnaires should be formally analysed and published. This will ensure that interested parties have access to this information making the service more open and transparent. Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Unicorn House (16) DS0000025864.V373148.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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