Key inspection report

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1 Key inspection report CARE HOME ADULTS Endymion Road, 2 2 Endymion Road London N4 1EE Lead Inspector Margaret Flaws Key Unannounced Inspection 28th September :00 Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 1

2 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards Care home adults can be found at or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: Online ordering from the Stationery Office is also available: The mission of the Care Quality Commission is to make care better for people by: Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 2

3 Reader Information Document Purpose Inspection Report Author Care Quality Commission Audience General Public Further copies from (telephone order line) Copyright Copyright (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Internet address Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 3

4 SERVICE INFORMATION Name of service Endymion Road, 2 Address 2 Endymion Road London N4 1EE Telephone number Fax number address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration Choice Support Manager Tom Lindsay (not yet registered) Care Home No. of places registered (if applicable) Category(ies) of registration, with number of places 6 Learning disability (6) Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 4

5 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd October 2008 Brief Description of the Service: 2 Endymion Road is a large converted terraced house situated in the Finsbury Park area of North London. The home is registered to provide personal care for up to 6 residents of either sex and over the age of 18 who have a learning disability. The stated aim of the home is to provide a supportive environment where residents can live their lives according to their individual wishes and needs with the assistance of staff. There are 3 floors and all residents have single rooms. There are 6 single bedrooms and 1 sleep-in room for staff; none of the rooms are en -suite. There are 3 bathrooms, and 4 toilets, a kitchen and a lounge. The accommodation is not suitable for residents with physical mobility problems. Choice Support, a large organisation that provides residential services for people with learning disabilities nationally, operates the home. Some housing management is provided by London and Quadrant. Placements at the home costs around 1,300 for each person per week. Residents are expected to pay separately for some toiletries. Following 'Inspecting for Better Lives' the provider must make information available about the service, including inspection reports, to residents and other stakeholders. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 5

6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 28 September Regulation Inspector Margaret Flaws was accompanied by Maggie Kemmner, Head of Reviews and Studies for the Care Quality Commission (CQC). The Choice Support Service Manager spoke to us in the morning and the Home Manager (who has applied for registration with CQC) assisted throughout the inspection. We spoke to several staff present throughout the day. The inspection comprised a tour of the home and grounds, interviews with the managers and staff, observations of and brief interactions with people using the service, and an examination of written records, including care records, staff files, health and safety and general home records. The home provided us with an Annual Quality Assurance Assessment, which gave us good information for this inspection. The quality rating for the service is Two Star Good. What the service does well: The home provides sound support to people with learning disabilities, particularly people with varying degrees of autism who don t communicate in conventional ways. Staff interactions with residents were observed to be positive. Choice support has improved the management arrangements for the home and the organisation has an improvement agenda for the home that it acts on. What has improved since the last inspection? Residents who want them have working televisions in their rooms. Repairs have been made to residents bedrooms. The laundry floor and sink have been replaced. Work has been done to improve hygiene in the home, while addressing some residents challenging behaviour. Domestic hours have been increased. Staffing levels have been reviewed match residents needs. A new Manager has been recruited and has applied for registration with CQC. The management communication systems have improved. Fire safety recommendations have been acted on. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 6

7 What they could do better: The home must review its financial arrangements and inform CQC and the placing authorities of how residents and staff will be protected by these arrangements. The home must obtain information about the potential side effects of medication. This should be easy for staff to understand and follow. Damp in a resident s room that appeared to be caused by a blocked drain on the roof should be addressed. Exit access from the basement front and back door must be improve for safe egress. The home must review its training plans to ensure that staff systematically receive refresher training. It is also recommended that the frequency of medication be improved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website You can get printed copies from or by telephoning our order line Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 7

8 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 Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 8

9 Choice of Home The intended outcomes for Standards 1 5 are: 1. Prospective service users have the information they need to make an informed choice about where to live. 2. Prospective users individual aspirations and needs are assessed. 3. Prospective service users know that the home that they will choose will meet their needs and aspirations. 4. Prospective service users have an opportunity to visit and to test drive the home. 5. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents, their support people and referrers have clear information about the service offered and can be confident that people s needs will be fully assessed before moving in. EVIDENCE: There have been no admissions to the home for several years. The home has a clear referral and assessment process for prospective residents who may move into the home. We looked at the files of four people. Each person s needs had been assessed before moving into the home, with assessments completed by the service, by placing authorities and by a range of professionals involved in the service user s care and support. Residents have had their care reviewed annually by the placing authorities. The home has a service user guide, which is clear, in large print, with pictures to help people living in the home to understand it. The guide is personalised for each resident, with photographs and information about personal preferences. Choice Support calls this a Communication Passport. The Service User Guide now includes information about what is included in the home s fees. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 9

10 Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 10

11 Individual Needs and Choices The intended outcomes for Standards 6 10 are: 6. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. 7. Service users make decisions about their lives with assistance as needed. 8. Service users are consulted on, and participate in, all aspects of life in the home. 9. Service users are supported to take risks as part of an independent lifestyle. 10. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents individual and changing needs are reflected in good quality care plans. Residents are supported to make decisions about their lives, within their abilities, and risks and challenges are assessed to protect them. EVIDENCE: Towards the end of this inspection, we were able to observe interactions between the residents and the staff. Due to the nature of their learning disabilities, residents don t communicate in conventional ways, and it was difficult to gain their opinions of life in the home. Staff appeared to communicate well with the residents and could interpret and understand their expressed wishes. Staff we spoke to were able to give good descriptions of how they supported people with their choices and how they communicated with them and understood their needs. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 11

12 Residents choices were documented in their care plans. These are called Person Centred Plans. The home has a key worker system and each key worker reviews residents progress with them each month. Each resident has different folders of information about their support needs and how they are to be met. There were clear risk assessments in place for each resident. These had been regularly reviewed and noted actions to be taken to minimise risk. Risks assessed included maintaining balance, risk of falling and risk of choking while eating. The risk assessments were reviewed regularly and staff could describe how they worked to minimise risks while supporting the residents to increase their life choices. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 12

13 Lifestyle The intended outcomes for Standards are: 11. Service users have opportunities for personal development. 12. Service users are able to take part in age, peer and culturally appropriate activities. 13. Service users are part of the local community. 14. Service users engage in appropriate leisure activities. 15. Service users have appropriate personal, family and sexual relationships. 16. Service users rights are respected and responsibilities recognised in their daily lives. 17. 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): This is what people staying in this care home experience: 12,13,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported in their choices of daily activities inside and outside the home and supported to meet their personal development goals. Residents participate in shopping, the preparation of meals and menu planning. EVIDENCE: On the day of the inspection, all residents spent time out in the community, either at day centre or out in the community. We were able to observe residents on their return home later in the day. They appeared comfortable expressing their wishes about what they liked to do. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 13

14 The home continues to improve the scope and range of activities available. Examples include playing sport, swimming and going to the gym, visiting local community restaurants, pubs, discos and the cinema, visiting the West End and going on holidays. The home has a basement sensory room where residents can take part in one to sessions with the staff. Activities on offer in the space include aromatherapy sessions, foot spa, art activities and playing games. We saw some evidence of how residents are supported in their personal development. Goal planning also provides guidance for staff about the residents ethnic, cultural and religious needs and preferences. Some residents use Maketon and other sign language to communicate with each other and the staff. Sections in residents care plans identify their dreams and aspirations and cover practical ways in which these can be addressed. Staff could describe how they supported residents using simple action planning. One way they assess and so this is through using visual communication. The home has digital camera for each resident and staff take photos which are added to the care plans and used with the residents to develop their ideas and choices. Staff said that this was a very workable way of communicating with the residents, which they really liked. Key workers are now doing the care plans with the residents, another improvement since the last inspection. The home continues to develop pictorial menus for the residents. We did not observe a meal on this inspection but the food available in the home appeared of an average quality and what people wanted to eat. Staff told us that residents contribute to menu planning, shopping and food preparation. There have been some improvements to the kitchen space. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 14

15 Personal and Healthcare Support The intended outcomes for Standards are: 18. Service users receive personal support in the way they prefer and require. 19. Service users physical and emotional health needs are met. 20. 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. 21. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 18,19,20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care and health needs are assessed. Their wishes are respected and needs assessed and documented. They are generally protected by the home s medication policy, procedures and day to day practice. EVIDENCE: There was reasonable information in the care files about how peoples personal care needs were being met. Staff gave some examples about how residents wishes were respected. These were also documented in the care plans. We looked at the healthcare information in people s files. The information was generally detailed, up to date and of reasonable quality. Doctors, dentists and opticians provide residents with regular healthcare check-ups. Check ups were planned for and recorded. All residents have a health action plans. Accessible Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 15

16 information about their health needs are included in their Communication Passport documents, which are pictorial and explain health issues and checks in a simple format. The home is continuing to develop novel pictorial ways to communicate with residents about their health needs. We discussed how one resident s behaviour in the past had been affected by pain from his teeth which had not been identified at the time. Staff demonstrated that they had learnt from this experience and improved the healthcare monitoring. There are reasonable medication arrangements in place to meet peoples needs. Medication reviews have taken place on regular basis. Staff could describe the steps they take in administering and recording medication. They also described how information about medication is communicated and how the team carries out medication checks to ensure the residents safety. The medication policies and procedures in the home cover how medications are stored, administered and recorded in the home. The medication is provided by Boots in the bubble pack system. The medications were stored securely, appropriately and at appropriate temperatures. There were records of administration and all medication coming in and going out of the home. We checked the MAR (medication administration records) and no errors or omissions were identified on this inspection. It is recommended that the frequency of medication training is improved. It is also required that the home obtain information about the potential side effects of medication. This should be easy for staff to understand and follow. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 16

17 Concerns, Complaints and Protection The intended outcomes for Standards are: 22. Service users feel their views are listened to and acted on. 23. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives are able to express their views, which are taken seriously to protect their interests. Residents are safeguarded by the home s policies and procedures. EVIDENCE: There is a clear complaints procedure available to residents in an accessible format. It is plainly written in large print, with pictures to help residents to understand the process. Complaints received had been properly recorded and investigated. There have been improvements in how complaints investigations are carried out and recorded. We saw evidence of good complaints recording. Compliments were also kept and fed back to staff. Choice Support has a clear safeguarding adults policy and procedure. This incorporates the local authority s procedures. Staff are trained in safeguarding adults as part of their induction. At the time of the inspection, some money had gone missing from residents money tins and this was the subject of a police and local authority Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 17

18 safeguarding investigation. Regardless of the results of this process, the home s financial arrangements, which multiple tins for money and complex petty cash systems, appeared overly laborious and time consuming for staff. A requirement is given that the home reviews its financial arrangements and informs CQC and the placing authorities of how residents and staff will be protected by these arrangements. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 18

19 Environment The intended outcomes for Standards are: 24. Service users live in a homely, comfortable and safe environment. 25. Service users bedrooms suit their needs and lifestyles. 26. Service users bedrooms promote their independence. 27. Service users toilets and bathrooms provide sufficient privacy and meet their individual needs. 28. Shared spaces complement and supplement service users individual rooms. 29. Service users have the specialist equipment they require to maximise their independence. 30. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 24 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home environment is gradually improving to benefit people living in the home. Hygiene arrangements in the home are complex because of the nature of residents disabilities. EVIDENCE: The physical environment of the home has been an ongoing issue of concern over several inspections and, in the past, the organisation has struggled to keep on top of maintenance and physical improvement planning. Also, because residents can present with challenging behaviour, regular damage can occur to the fabric of the building and its fixtures. Over the past two years, the Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 19

20 improvement plan for the environment has been the focus of considerable action and work. In the kitchen, gas piping under the water heater has been replaced. Bathrooms improvements have been ongoing. The Manager told us that bathrooms are kept bare because of some residents behaviours. Minor repairs have been made to bathrooms and bedrooms. Residents have new televisions in their rooms, meeting a requirement from the last inspection. The quality of some maintenance work was basic, for example, tile grouting. A new oven and hob have been purchased for the kitchen. We toured the home with the Manager. While improvements have been made, some residents rooms appeared more comfortable and homely than others. We noted some damp that appeared to be caused by a blocked drain on the roof. A requirement is given that this is fixed and the damp addressed. The staff told us that one resident likes to spend time in a small kitchen that is generally not used. Exit access from the basement front and back door must be improved to improve safety. A requirement is given. The cleaning and domestic arrangements in the home have improved. We spoke to the cleaner who told us that he works five days a week. There are ongoing issues with keeping supplies of paper towels and toilet paper in the communal bathrooms. This is mainly because one of the residents can use the paper to block toilets. The Manager described the steps he and staff take to minimise the risks associated with this behaviour while addressing the home s hygiene needs. A previous requirement is met. Incident recording continues to improve and staff training records showed that the staff are generally trained in health and safety. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 20

21 Staffing The intended outcomes for Standards are: 31. Service users benefit from clarity of staff roles and responsibilities. 32. Service users are supported by competent and qualified staff. 33. Service users are supported by an effective staff team. 34. Service users are supported and protected by the home s recruitment policy and practices. 35. Service users individual and joint needs are met by appropriately trained staff. 36. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 32,34 and 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are safely recruited and generally, appropriately trained to meet the assessed needs of residents. EVIDENCE: On the day of the inspection, there were three staff on duty on the morning shift and three staff on duty in the afternoon. The rota indicated that there were generally three staff on each day shift and two at night. In addressing the requirements from the last inspection, the Manager told us that the staffing levels have been reviewed and increased. The home is now fully staffed and the staff rota reflected this. We checked the records for four staff. The main staff files are held at the Choice Support headquarters and copies held at the home. In the files we saw, all staff had had pre-employment checks completed before they started work, Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 21

22 including Criminal Records Bureau checks and written references obtained. Four new staff had been recruited since the last inspection. Staff confirmed that they had had a thorough induction, with good initial training and shadowing time in place. Inductions were properly documented. Staff all confirmed the thoroughness of the pre-employment checks they received prior to starting work. Supervision records indicated that formal supervision had improved since the new Manager had come into post early in 2009, although he agreed that improvements are still needed. We looked at the staff training records for four people. These showed that mandatory training for staff in areas such as fire safety, health and safety, manual handling, food hygiene and medication were generally completed over a period of two, rather than one year stated in the organisation s training programme. Access to training by some staff has not met the organisation s own preferred frequencies. A requirement is given that the home review its training plans to ensure that staff systematically receive refresher training. We spoke to four staff as a group. They said they felt they were well resourced and generally supported to do their jobs. They also told us that team morale had improved over the past year. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 22

23 Conduct and Management of the Home The intended outcomes for Standards are: 37. Service users benefit from a well run home. 38. Service users benefit from the ethos, leadership and management approach of the home. 39. Service users are confident their views underpin all self-monitoring, review and development by the home. 40. Service users rights and best interests are safeguarded by the home s policies and procedures. 41. Service users rights and best interests are safeguarded by the home s record keeping policies and procedures. 42. The health, safety and welfare of service users are promoted and protected. 43. 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. This is what people staying in this care home experience: JUDGEMENT we looked at outcomes for the following standard(s): 37,39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home now benefit from improved management. Quality assurance systems are in place to consult with the people who use the service. People living in the home are protected by the home s health and safety policies and procedures. EVIDENCE: A new Manager was appointed to the home earlier this year. The home has clearly benefited from his commitment to improvement, and from his enthusiasm and experience. He has applied for registration with the Care Quality Commission and was due to be interviewed for registration in Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 23

24 November This meets a requirement given at the last inspection. The Manager told us that he received good support from other Choice Support managers in his months in post. This was confirmed by the Service Manager. She also told us that the home is in the process of recruiting a deputy manager. Management communication systems have improved. The home now has two computers, one of which is connected by and login arrangement, to the Choice Support main office system in Bow. This has enabled the Manager and staff to remain in the home while doing paperwork, rather than travelling to the head office. The fax machine works and staff understand how to use it, meeting a previous requirement. Management systems and recording have continued to improve since the last inspection. The Choice Support Quality Assurance team remains heavily involved with the home and their last audit took place in July 2009 and the home is working on their recommendations. The home has a quality assurance system, a satisfaction survey given to the residents, to give them a chance to say what they think of the service. This was in large print and has pictures to help people living in the home to understand it. We saw health and safety records, which were of a reasonable quality. Water, fridge and freezer temperatures were monitored. There is a good organisational health and safety policy and procedure in place. Fire alarm and fire equipment checks had been done and the home has a fire risk assessment. Actions identified by the fire service in the risk assessment have been taken by the home, meeting a requirement from the last inspection. Staff have been trained in fire safety. Health and safety certificates were up to date and no issues outstanding. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 24

25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded (Commendable) 3 Standard Met (No Shortfalls) 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 CONCERNS AND COMPLAINTS Standard No Score Standard No Score X 4 X ENVIRONMENT 5 X Standard No Score 24 3 INDIVIDUAL NEEDS 25 X AND CHOICES 26 X Standard No Score 27 X X X 8 X X STAFFING Standard No Score LIFESTYLES 31 X Standard No Score X 33 X X 36 X CONDUCT AND MANAGEMENT OF 17 3 THE HOME Standard No Score PERSONAL AND HEALTHCARE 37 3 SUPPORT 38 X Standard No Score X X X 43 X Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 25

26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1. YA23 12(1) The Registered Person must 01/01/10 review its financial arrangements and inform CQC and the placing authorities of how residents and staff will be protected by these arrangements. 2. YA20 12(1) The Registered Person must 01/01/10 ensure that home obtain information about the potential side effects of medication. This should be easy for staff to understand and follow. 3. YA24 12(1) The Registered Person must ensure that the cause of damp in a resident s bedroom is investigated and repaired. 01/01/10 4. YA24 12(1) The Registered Person must ensure that exit access from the basement front and back doors be improved. 5. YA32 18(1) The Registered Person must review its training plans to ensure that staff systematically receive refresher training. 01/01/10 01/01/10 Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 26

27 RECOMMENDATIONi These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 YA32 It is recommended that medication training frequency is improved. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 27

28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: Web: We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Endymion Road, 2 DS V R01.S.doc Version 5.3 Page 28

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