Inspection on 22/04/10 for 1, 3, 5, 7 Exmoor Drive

This is the latest available inspection report for this service, carried out on 22nd April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1, 3, 5, 7 Exmoor Drive 25/04/07

1, 3, 5, 7 Exmoor Drive 11/05/06

1, 3, 5, 7 Exmoor Drive 27/10/05

1, 3, 5, 7 Exmoor Drive 23/06/05

1, 3, 5, 7 Exmoor Drive 03/03/05

1, 3, 5, 7 Exmoor Drive 15/09/04

1, 3, 5, 7 Exmoor Drive 18/03/04

1, 3, 5, 7 Exmoor Drive 12/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 1, 3, 5, 7 Exmoor Drive 1 Exmoor Drive Bromsgrove Worcestershire B61 0TW The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Seel Date: 2 2 0 4 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 42 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: 1, 3, 5, 7 Exmoor Drive 1 Exmoor Drive Bromsgrove Worcestershire B61 0TW 01527576591 01527871853 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.worcestershire.gov.uk Worcestershire County Council Home Care Services (DCA) Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 12 Date of last inspection 0 7 0 5 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home About the care home Twelve people with learning disabilities live at the home. Some people also have physical disabilities. Exmoor Drive is a large bungalow building, set in its own garden. It is flat, so if you have a wheelchair it is easy to travel around in. The bathrooms and toilets are easy to get in and out of and fully accessible for people. The home is split into three separate units. The people that live there have their own single bedroom. Each unit has a kitchen with dining tables and lounge area. The house is close to shops, pubs and Bromsgrove Town Centre. People can use trains and taxis to go places and the home supports people to make these trips. There is a patio and grass area at the back of the house where people who live in the home like to meet up and talk to each other. Information about the home is provided in the statement of purpose and service user guide. The weekly fees start from £65.00 to £108.10 although these may vary depending on peoples individual needs. Care Homes for Adults (18-65 years) Page 5 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 42 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by one inspector who visited the home without telling anyone she was coming. A pharmacist inspector also visited the home to look at the medicines and records which tell us how staff help people who live in the home with their medicines. An Expert by Experience and their supporter also visited the home to talk with some of the people who live in the home and staff. The Expert by Experience is a person who has experience of using services. The manager and other staff helped the inspector on the day of the visit to the home. The inspector talked to some of the staff working at the home and watched how they helped people who live at Exmoor Drive. The inspector was shown around some of the home and said hello to some people who live there. We looked at some care support plans and plans to help make sure someone keeps healthy. Papers in the office were shown to the Care Homes for Adults (18-65 years) Page 7 of 42 inspector to tell them how the home is run. Seven survey forms were returned from people living in the home and or their relative. Four staff survey forms were also returned to us. The manager filled in a form called an Annual Quality Assurance assessment (AQAA). This shows how the needs of people who live in the home are met and what is planned for the future. The inspector would like to say thank you to people who live in the home, manager and staff for helping and making us all feel welcome. What the care home does well People have keyworkers who they get to know and are able to share their likes and dislikes. People are helped to look clean and dress in good clothes by staff. Staff help people to go to see their doctor and other people if they are unwell or need a check up. Family and friends of people who live at the home are welcomed by staff. Care Homes for Adults (18-65 years) Page 8 of 42 People are encouraged and supported to do things for themselves whenever it is safe for them to. Like putting clothes on, taking a bath and cleaning their rooms. Staff hold weekly meetings with people living at the home to discuss what works well, what needs to get better, changes in the home and choices of menus. Each person has their own bedroom which is decorated in their own styles with furniture that has been replaced where needed and is filled with personal items that people like, making it their room. Staff do not start work in the home unless proper checks have been done, to make it less likely that poor quality staff work there. The home is safe and all equipment that people are helped with is checked so that it works well. The manager is experienced and people living in the home like him. What has got better from the last inspection A book that tells people about how the service works has pictures so people can see what it is like to live at Exmoor Drive. The care plans of the people who live in the home have more details to help the Care Homes for Adults (18-65 years) Page 9 of 42 staff to give good support. Staff know how to care for people if they are unwell and know how to sensitively meet peoples needs so that they are comfortable towards the end of their lives. The manager and staff make sure that the home is painted and any furniture replaced so that people live in a comfortable home that looks good. Staff have been given more training to help them meet peoples needs. The home checks what it is doing on a regular basis, to see how it can do things better for people living there. The manager has got a new management qualification. What the care home could do better Plans that tell staff about peoples needs should be done using pictures and symbols so that people can have more say in writing down their choices about how they would like their needs to be met. Plans should be agreed by the person and their representatives with this written down in plans. How medicines are kept and given to people who live at Exmoor Drive must continue to get better. This is important Care Homes for Adults (18-65 years) Page 10 of 42 has people are unable to do this themselves. If there are any bruises and of marks on a persons body these need to be held on records within the home for monitoring and reviewing purposes. Where these records need to be removed a photocopy needs to be kept at the home. To ensure that people living in the home are able to enjoy an active lifestyle with lots of choices of things they can do. People told us that they would like more activities at weekends and outings. The planning of meals should be done with people who live in the home with help from pictures of meals. Staff have been telling the Care Quality Commission (CQC) of incidents when they happen so we know what is going on. These need to have more details on them so that we know what the home has done about them. Care Homes for Adults (18-65 years) Page 11 of 42 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sally Seel 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 12 of 42 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 are given information about the services offered at the home to help them make an informed choice about whether they would like to live at Exmoor Drive. Peoples needs are considered prior to living at the home to make certain individuals needs can be met and the manager has good ideas about supporting someone new in settling in. Evidence: The service users guide and statement of purpose give people information about the home. They are available in the reception area and we saw from looking at care records the people who come to live at Exmoor Drive are given a copy of the guides so that people can refer to them if they want. One person who has recently come to live at home was given a copy of the information guides and staff have a checklist which reminds them to explain to each new person about the information in the guides to help individuals own understanding. Since our last key inspection the guides have been reviewed and we saw that the fees charged for living at the home are now detailed in the guides so that people are able to see how much it may cost to live at the home. Also the contact details for the Care Quality Commission (CQC) are now included so that people are able to choose who they contact if they have any complaints or concerns about the home. It is suggested that the manager may want to review the statement of purpose as in the Care Homes for Adults (18-65 years) Page 14 of 42 Evidence: complaints section there are no contact details for the CQC although it states there are which could cause some confusion. Also it would be useful for the telephone number of the CQC is in the guides so that people are able to contact us by telephone rather than writiing to us. The service user guide has some pictures to illustrate the written word and the AQAA tells us, The service user guide and statement of purpose could be in more accessible formats. We agree with this as consideration could be made to developing the guides into audio visual formats and the statement of purpose could be made available using pictures to aid peoples understanding of what the home is about as this has been done for the service user guide. Introductory visits and stays are arranged at the home prior to admission which is confirmed in the AQAA, Service users will visit at various times of the day and for different lengths of time to help them decide if they want to choose to live there and to meet other people who already live here. The service user is also given the opportunity to stay overnight on more than one occasion, so that get a good idea of whether they would like to live at Exmoor. The manager has done some good work at making sure that any new people who come to live at the home are fully supported by a key member of staff and documentation has been developed which staff use as a checklist. We saw that one new person who has come to live at the home was given a copy of the complaints procedures, shown around the home, fire escapes were pointed out, time given to enable the person to spend some time in each area of the home to socialise with others and so on. This good practice should give people reassurance and help them to settle into their new surroundings. From looking at one new persons care records we saw that an adult care assessment had been completed by the social worker or care manager. We are told in the AQAA, Exmoor Drive then uses its own assessment form, completed by the manager with the service users, families, significant others and input is gained from those who may already provide a service of some kind. We certainly found this to be the case when reviewing the assessment process for one new person who has come to live at the home. We looked at their pre admission assessments and found it had good information about the persons needs so that the staff knew they could meet their needs. We received seven surveys from people who use the service and two people indicated they were not asked if they wanted to move into the home with five people saying that they were asked. One survey confirmed that not enough information about the home had been supplied before they moved in, with six people saying that they had received sufficient information. Care Homes for Adults (18-65 years) Page 15 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been updated to show assessed and any changes in peoples needs. Individuals are being supported to take some risks. Individuals and their representatives level of involvement in planning peoples support, goals and ambitions needs to be recognised in care plans and these plans should be in formats to aid peoples participation where appropriate. Evidence: Care plans were sampled for two people who live at Exmoor Drive to see if there was sufficient information about individuals needs to guide staff in providing care and support to each person. We found care plans have been updated following our last inspection visit by the manager. Each person has a care plan which identifies their care and health needs so that staff are able to provide the level of assistance and or support to each person living at the home. For example, we found care plans to meet peoples needs in personal care, finances, behaviour, incontinence, health and activities. The care plans and risk assessments we looked at matched the care needs described in assessments. Reviews with key workers had taken place appropriately to make sure that the information was relevant to peoples current needs. Care Homes for Adults (18-65 years) Page 16 of 42 Evidence: We would expect to see that care plans are developed into formats to aid peoples inclusion in them where able, such as, using pictures and symbols to illustrate the written word. We were told that some people in the home would not always be able to take part in planning their care but others may if the care plans were developed into easy read formats. If some people are not able to take part in their care planning then their representatives should be involved. When this is the case it would be good practice for relatives and or representatives to sign care plans to state their agreement with how individuals needs should be met to ensure personalised goals and aspirations are fully promoted. We saw communication plans with information about how staff use peoples individual communication styles, such as, facial expressions, pictures, symbols and objects of reference. These plans make sure that all staff are aware of individuals preferred communication to promote individuals understanding and consistency in support is maintained. As at the previous inspection daily records gave us some information about how people spend their days, any health appointments, how people are on that day, together with concerns highlighted. These help staff to communicate with each other and for all communication to be smooth from one shift to another. Relatives made positive comments about the care provided by the home; these included, The patience of staff and Everything has changed for the better since a new manager was appointed last year and the improvements would appear to be ongoing. Positive comments were also made by staff, Overall the service we provide is done to the best of our abilities and The needs of the service user is known greater than it used to be. Risk assessments should contain specific guidance as to what staff needs to do to support people safely. We saw risk assessments to cover, eating and drinking, epilepsy, kitchen use, medications and moving and handling. These did not result in unnecessary restrictions in peoples lives. For example, we saw a risk assessment that promoted a person having their bath but staff verbally checking if they were safe thereby supporting people to take reasonable risks to enable them to have a normal life. Each person has a key worker and we saw records that showed that the key workers play an important part in supporting people. Each week there is a meeting with people who live in the home and staff where meals are planned. This means that people can be involved in making decisions about the home. The Expert reported:During my visit I observed staff with the people who live there. All of the staff spoke to the residents with respect. I thought the staff were encouraging people to be independent Care Homes for Adults (18-65 years) Page 17 of 42 Evidence: and make their own choices. It especially pleased me when I observed the Manager of the home with one resident in particular, the lady asked him to make her a cup of tea and he said Im not making it for you, you can do it yourself. This is really positive, as it is important that people are encouraged to do things for themselves when they are able. I also observed the Manager reassuring one of the residents when she thought she could hear someone crying outside the home. There was nobody there but he took her out to have a look to put her mind at rest. It showed that he takes the time to listen to residents and takes their concerns seriously. Overall I was very pleased with the good mixture of male and female staff on duty as well as the age range. It seemed to tie in very well with the age and gender of the residents. Care Homes for Adults (18-65 years) Page 18 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the people living in the home experience a range of activities. These could be further enhanced to make certain activities are individually meaningful to each person. Generally people are offered a healthy diet and although people are assisted to choose what they want to eat and drink this practice could be improved by using aids, such as pictures. Evidence: As at the previous inspection there is no dedicated activity organiser who works at the home and therefore activities are planned by staff. We found in the care records that we sampled that peoples plans show what activities people enjoyed doing and what they disliked. In the care records we looked at we saw examples of people taking part in a range of activities, such as, going out for a meal, cleaning kitchen, peeling potatoes, sitting in garden, watching a film, trip to Bromsgrove (local shops), laid table, read books and magazines. In the AQAA it tells us, The keyworkers take responsibility for gathering the views of the users and helping them organise activities. Joint ventures include going to the pub, daycentre, theatre and shopping. This action should make sure that people Care Homes for Adults (18-65 years) Page 19 of 42 Evidence: have the opportunity of a wide and varied choice of activities that are meaningful to each person. We shall look at this in-depth when we next inspect the home to make certain peoples preferences are being reviewed and monitored regulary with them to ensure they are met within their daily lives as the comments received were very mixed. For example people and their relatives told us:The outings have increased considerably. Short breaks - perhaps Monday to Friday or short weekends (sometime through the year). They make sure I access my day centre. Help to do my shopping and go out. If it had transport it could take us out more often. Like to the pub or the park at a weekend. The staff would all like to do more with us but does not have the time so an activity person would give us more to do at weekends. More activities would be nice. The AQAA confirms, Staff support service users in accessing the community. This is backed up by clear care plans, activities offered are recorded along with the service users choice to accept or decline. However, we did discuss with the manager that daily recordings in relation to peoples meals and activities participated in and or declined, on any specific day, are not always being recorded but left blank. The manager has told us in their AQAA that this is an area where improvements could be made, We need to improve our recording of service user choices to evidence where service users have chosen activities along with refusal to take part. Daily recordings of activities and meals should be recorded so that these can be used to monitor and review the choices of activities and meals offered together with how peoples own preferences have been met in these areas of their daily lives. As at the previous inspection the garden area of the home should be considered for improving so that people as they choose are able to tend to vegetables and or flowers as we were told that people would enjoy this. The grass in the rear garden needs cutting. It was clear from the care records we looked at that people are encouraged to stay in touch with their families whether this is family members paying visits to the home and or people going to visit their families. This means people are being supported to stay in touch with people who are important to them. The Expert reported:I asked people what they did during their week. The Manager showed me some activity plans. Some of the people go to a day service whilst others are flexible and just do what Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: they want to do on the day. I noticed that some people didnt appear to be doing that much and were just staying at home watching TV. The Manager told me that as the people are older they dont always want to go out and do activities and prefer to stay around the home. I was told that some people like to plan what they are going to do where others like to be more flexible. It is fine for people to want to stay at home more during the day as long as they are being given the choice of doing other things. One of the men was attending a place called Where Next where he was learning skills for work on a market garden. It pleased me that the man was being encouraged to do this especially as many people would see him as being over working age. The Manager told me that the man had started calling the work school or college and that staff were encouraging him to call it work as he is an adult and he is doing a job. This is good. The people that went to the day service were doing cooking, yoga, music and sensory room. I was a little concerned that the people in the home were not getting the opportunity to do things as individuals as they were all going to the same daycentre but the Manager told me that they do get to go out individually and that they originally met at the day service before they moved in together. People at the home go on day trips and some go to the theatre in the evening. I asked if everyone has to go on the trips together and was told that they dont, if people dont want to go they dont have to. The Manager said they try to arrange different trips that suit everyone. One of the women in the home told me that she goes to the womens group at Speak Easy, which is the local self advocacy group. It is good that she attends a self advocacy group, as everyone with a learning disability should be aware of their rights and speaking up for themselves. I was told that the home doesnt get any funding for transport so they dont own any themselves, however they have a good relationship with the day centre and they are able to borrow theirs if they need to. They also use Bromsgrove Urban and Rural Transport. I was told that a wheelchair accessible taxi to the centre of Bromsgrove would cost a person around £30 and peoples DLA didnt stretch that far so the home try and get them free transport. I was pleased to hear this as it meant that the lack of affordable transport wasnt stopping people going out. Staff comments told us:Have more support in getting services out i.e. minibus needed to enable wheelchair users regular trips out during the day and not having to pay a £40.00 round trip to town and back. Have our own minibus to save money and time. County could provide transport, as peoples mobility declines, it is getting more expensive to take people out, as taxis for wheelchair users have to be booked. We saw in the care records we looked at that there are key consent forms in place which Care Homes for Adults (18-65 years) Page 21 of 42 Evidence: support the choices and decisions people make in relation to holding their own room keys. This demonstrates that each persons rights appear to be upheld and protocols are in place to protect these. The food is purchased locally and staff prepare the meals as needed each day. Records showed a balanced and varied diet is being offered. We were told that people are offered fruit and vegetables to help them maintain the recommended five a day to promote a healthy nutritional diet. There are no set times for meals and drinks, and snacks are available throughout the day. We observed people being offered drinks and at lunchtime people can choose to sit around the table in each bungalow areas to have their meals. The Expert reported:I asked the people who lived at the home about the meals they have. They told me that they discuss the menu in their weekly meetings and decide what they are going to have. I was shown some menus. There were 2 choices for each meal but everyone told me that they could have things that are not on the menu as this is just a guide. Whilst I was there I observed people being asked what they wanted for their tea, which is good. It is good that people can be flexible and that they dont have to stick to a set menu. I asked what time everyone has their tea. They said about half past five but they dont have a set time so they can eat when they want. The menu was kept in a folder and was written, I would have liked to see a picture menu that people could choose from properly. The evidence of compliance for these standards was mixed and the organisation must develop strategies to ensure that people experience consistently good quality standards in the outcome areas in this section. Care Homes for Adults (18-65 years) Page 22 of 42 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 can be confident that their health and care needs are documented and attended to, and that they are treated with respect. Further improvements in the recording and storage of all medications must be completed to give greater confidence to people that medication is being managed safely and effectively at all times. Evidence: During our visit we were able to meet with most of the people currently living at Exmoor Drive. We saw that they were all well dressed in clean clothing of good quality. What they wore reflected their individual personalities, and was appropriate to their age and gender. We could also see that they had received the support they needed with their personal care and hygiene. We saw and heard staff interacting with people. Some of the staff have worked at the home for a good number of years. This helps to promote continuity of care. We saw people approaching the manager and members of staff for support. They treated them in a respectful way, with warmth and friendliness. It is clear that they are comfortable in each others company. As we reported above, people all have detailed care plans, so staff have clear guidance about how they like to be supported. We looked at plans to support a person with their epilepsy, incontinence and behaviour. In the plans to meet a persons incontinence it would be good practice to include the size of pads used to ensure all care is consistent. We saw that usually people are being Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: weighed to make certain that staff are able to identify any losses and or gains which could indicate underlying health conditions. However, in one persons care records we could not find that a baseline weight had been done but we acknowledge that the person recently moved to live in the home in March. In another persons we saw that their weights were not being done on a regularly monthly basis. The manager is aware of the importance of ensuring peoples weights are done regularly. We looked at peoples records to see how their healthcare is planned and managed. There are health action plans, (HAPs), as recommended by the Department of Health. HAPs meet with the Department of Health guidance for people with learning disabilities as they help to ensure that their health is monitored; any problems identified and their good health is being promoted. They can also help to show that individuals special health care needs are recognised and understood and that people are being supported to stay healthy through preventative as well as routine and specialist health care input. These included GPs, consultant psychiatrists, dentists, opticians, and social workers/care managers. On the day we visited staff were making an appointment for a person to visit their GP. Another person was physically sick and we saw staff helping this person using reassurance to support this person with their feelings. This was done in an unhurried manner which is important for people who may have communication difficulties. This shows that people living in this home are receiving healthcare where required to help them stay healthy. We noticed in one persons care records that body map to show bruising on this person was not in the records we looked at. The manager told us that this was with the nurses. Therefore we discussed this with the manager that consideration should be given to keep a copy of body maps in a persons records to ensure people are protected and staff are able to access these at all times. However, in another persons records we did find body maps to show any areas of bruising and or marks but practice should be consistent to reflect that people are being protected from any potential risks wth their safety being paramount to all care. The manager told us that staff experience and skills in the giving of end of life care has significantly improved since we last inspected the home and confirmed this in their AQAA. We have learnt from the experience of supporting a service user that was at end of life that planning this process in some depth improves the quality of care both individuals and their families/significant others receive. The pharmacist inspector visited the service on 21st April 2010 in order to check the management and control of medicines. We looked at medication storage in all three bungalows including some care records and medication administration records. We spoke to two members of staff and gave feedback to the Manager. Medication was stored within locked cupboards in each bungalow. However, the keys for each locked cupboard were stored within a small combination safe located in a visible and accessible area. We were informed that all staff know the number code to open the safe. This means that more than one person could have access to peoples medicines at any Care Homes for Adults (18-65 years) Page 24 of 42 Evidence: one time and increases the risk of access to medicines. The medicine cupboards were neat and tidy, which made it easy to locate peoples medicines and we saw that medication was available to give to people as prescribed. Controlled drug medication, which requires special storage, was stored in a controlled drug (CD) cabinet. However, the CD cabinet was not secured to the wall according to the legal requirements of the Misuse of Drugs Act 1971 and the Misuse of Drugs (Safe Custody) Regulations 1973. We discussed this issue with the Manager who agreed to ensure it was secured correctly. The storage temperatures of medicines requiring refrigeration were not being monitored correctly each day and it was not possible to ensure that medicines were being stored at the correct temperature. For example, we saw that the digital thermometer placed on top of the refrigerator with a probe going inside the refrigerator, was not working and was recording a reading HH 77. We were shown temperature records documented by staff as HH 77, which was not correct. We were informed that staff had not informed the manager that there was a problem and no action had been taken. We found a second thermometer inside the refrigerator which was reading five degrees C and is within the safe temperature range for medicines storage. Overall, this means that staff were not checking that the temperature was safe for the storage of peoples medicines. We looked at the medication administration record (MAR) charts, which were printed by the pharmacy and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. Sometimes the MAR charts were not always clear in ensuring that the record was accurate. For example, we saw two MAR charts that were not clear. The first example was for a medicine that was prescribed as take one or two at night. The MAR chart record was signed to say the medicine was given, however there was no record to show how many tablets were given to the person. The second example was for a MAR chart which was completed for the four week cycle, however staff continued to sign for medicines using a section lower down on the MAR chart. We found the MAR chart confusing to follow although we acknowledge that the record showed that the medicines were given. We discussed these issues with the manager in order to ensure that all medicine records were accurate and recorded what medicines were given to people. We found that medication records were generally available although it was not always possible to check that medicines had been given. We saw this in particular for medicines that were in a box or a bottle. For example, the date of receipt of peoples medicines were recorded, however the date of opening of the box or bottle was not recorded. This meant that we were unable to count and check the amount of medicines that had been given using the MAR chart records. We discussed this with the manager who agreed to ensure that there was a record documented. This meant that it was not always possible to ensure there was a clear audit trail of medicines arriving into the home. Page 25 of 42 Care Homes for Adults (18-65 years) Evidence: Information about peoples medicines were not always recorded and kept up to date in their care plans. We looked at two peoples care plans. The first person was prescribed medicines to help control and prevent seizures. There was no information about these medicines recorded in the persons care plan. This means that the persons care plan did not contain important information about the persons medicines to ensure their health and welfare needs were being met. The second person was prescribed a medicine for anxiety and agitation to be given when required. We saw an entry in the care plan dated 16/4/2010 If X acting in an aggressive manner....should administer PRN. The information did not document the name of the medicine or document what specific behaviour would require a tablet to be given. We found a document next to the persons MAR chart which described in detail the persons behaviour and named a medicine that should be given, however this medicine was no longer prescribed for the person. This means that information was not up to date or available to ensure the person was only being given this medicine when they needed it in order to help their agitation and anxiety and therefore keep them safe from harm. Care Homes for Adults (18-65 years) Page 26 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that the views of the people living at the home are listened to and acted on. Staff have the knowledge to generally ensure that the people living there are protected from abuse, neglect and self harm. Evidence: The CQC, has not received any complaints regarding this service in the last twelve months. The AQAA tells us that there have been no complaints received by the manager in the last twelve months but there is a log in place to record any complaints as required. As at the previous inspection there is a clear complaints procedure and process which staff are aware of. An easy to understand version is available and displayed so that people can readily access this, discreetly if they choose. We saw that the complaints procedure is also detailed in the service user guide. The surveys that people who live in the home had completed reflected that people knew who to voice their concerns and or complaints to. However, it was noted that one person said, I think so with another confirming No. Surveys from staff inform us that staff do know what to do if concerns and or complaints are made known to them. This is important as the people living in this home would need a lot of help to voice any concerns and or complaints that they had. There is a clear policy in place regarding the recognition of abuse and the actions taken. We saw the local authorities safeguarding policy and procedures in the office for staff to access as required. There have been a number of safeguarding referrals with the majority of these in relation to the administration of medications but the manager has told us in their AQAA, More in Care Homes for Adults (18-65 years) Page 27 of 42 Evidence: depth training for staff, this is a two day training course which requires the individual to gather evidence of their competence and pass an exam. We are also aware that audits of medications have taken place and reviews undertaken to make certain medication practices are robust thereby protecting people who live at Exmoor Drive. Also has mentioned earlier in this report a pharmacist inspector reviewed and audited medications at this visit where requirements have been made which must be met. The staff training matrix shows that nine staff have received safeguarding training. Some staff spoken with knew what was expected of them in relation to protecting people who live at Exmoor Drive and demonstrated how they would report abuse. The Expert reported:During my visit I was quite shocked to see a male resident inappropriately touch a female member of staff. The member of staff told the man to behave but she did not do anything else to address this. The man should be supported to realise this is not acceptable. This was reported to the manager at the time of our visit who assured us that this would be addressed so that people were supported to recognise what is acceptable behaviour to prevent any acts of potential abusive situations arising. Looking through the care records we were satisfied that there is a basic awareness of the Mental Capacity Act within the staff team to ensure that peoples capacity to make decisions is accurately assessed, and their choices and freedoms are not compromised. In one care record we noticed that a best interest meeting and or assessment could be considered for this person. We saw that people had personal inventories in the records we looked at. This ensures staff know what possessions each person has and it is easier to track if things should go missing therefore protecting people who live in the home. The home manages the personal monies of people at the home. This means that they have access to their own money to pay for extra items when needed. We did not audit peoples monies at this inspection but we were told that there have been no difficulties in this area. We will inspect individuals personal monies when we next inspect the home. The systems in place for the recruitment of new staff are generally satisfactory. Care Homes for Adults (18-65 years) Page 28 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 manager is committed to ensuring that the environment meets peoples physical needs and reflects their choices. Improvements have been made to the environment and there is a programme of maintenance in place. These actions should improve quality and safety for people living in the home and staff. Evidence: The Expert reported:The home is made up of 3 bungalows that are all joined together by a long corridor. When I arrived the Manager told me a bit more about the home and the people who live there. He told me they had room for 12 people but there were 11 people there at the moment. All the residents are older people and have moved there because they need more support due to mobility issues. There are 4 bedrooms in each bungalow and one of the bungalows has been adapted for people in wheelchairs. The main entrance to the home is at the side of the building, which I found confusing at first, as I would expect the entrance to be at the front. However, I was pleased that everyone had their own front door to their bungalow. The Manager showed me around the 3 bungalows. I was pleased to see that he asked if it was ok to go into each bungalow before he entered. The Manager also introduced me and my supporter to all of the residents and told them what I was doing there, this pleased Care Homes for Adults (18-65 years) Page 29 of 42 Evidence: me. I saw 4 peoples bedrooms; the staff asked the people if they minded showing me their rooms first. I could see that the bedrooms were personal to people and had lots of their personal possessions in them. One lady liked to keep the keys to her room with her and locked and unlocked the door herself. I was told that this lady used to share a room with her partner at the home, but unfortunately he had now passed away. I was really pleased to hear that they had been supported to live together as a couple. Following the last inspection, a number of issues were highlighted in relation to improving the home for people who live there; for example, there is now an electrically operated door which means there is now a push button so that people are able to use this including those individuals who use wheelchairs therefore people can easily leave the home. It also means that this maintains peoples safety whilst promoting their independence. In the AQAA the manager tells us about other improvements to the homes environment:- The bathroom in one area has been re-fitted to make it a better environment. There has been work completed to the property to remedy a damp problem. The manager also explained further improvements are planned to bedrooms and we were told about a meeting in relation to, ...decorate the building externally and possibly looking at new fences etc. Also the manager is ensuring that all new work done within the home meets the physically needs of people who live there, such as, sinks/hand wash basins are an appropriate height and people are supported to choose furniture for their rooms. The manager and staff are also investing some of their time to paint rooms. This shows that the manager is making sure that the home is well maintained and people are influencing all of the new work that is being completed. We were told that the equipment in the home is not always stored appropriately and the manager may want to look at this whilst they are considering other work in the home. Comments from people who live in the home:He likes his room. Would like better furniture. The home looked clean and we were told that people living in the home do complete tasks in the kitchen with some assistance from staff. The comments received in the surveys from five people said that the home is usually fresh and clean with two people stating always. The AQAA told us that nine staff have completed infection control training which is also indicated on the staff training matrix. This is good practice as it will help reduce the risk of infections among the people living in the home. Care Homes for Adults (18-65 years) Page 30 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made and are ongoing in the arrangements for staff supervision, training and development. This is to ensure that staff have the support, knowledge and skills they need in order to do their jobs well, for the benefit of the people in their care. Evidence: We were told that staffing levels have not changed since the previous inspection. This means that a minimum of four staff are on duty during the day. During the night one staff remains awake and another sleeps to make certain that people have any support they may require. We sampled the staffing rota for the last four weeks and in the main this confirmed what we were told. The staffing rota does document relief staff who work at the home on a regular basis covering for staff vacancies so that consistency is promoted when providing care and support to people who live at the home. The AQQA also confirms that 115 shifts in the last three months have been covered by relief staff. There are eleven care staff who work part time with four care staff who work full time. The culture and gender mix of the staff team reflected the culture and gender mix of the people living at the home so that care is provided in an understanding way. For example there are eleven female members of staff with four male staff which is confirmed in the AQAA. From talking to staff and observing them during the day we could see that staff morale was good, and the interaction with people living at the home was also good. Care Homes for Adults (18-65 years) Page 31 of 42 Evidence: The manager told us their AQAA that there are nine permanent members of staff and ten staff have achieved their National Vocational Qualification Level 2 (NVQ), or above. We have also been informed by the manager that one senior staff member has started the Leadership and Management in Care NVQ Level 4 and another senior member of staff will be placed on the next intake. This should make sure that people who live in the home are assisted and supported by staff that have the appropriate knowledge and skills to meet their individual needs. At the previous inspection the manager was unable to show us a staff training matrix and or up to date certificates of all staff members in relation to the training staff have achieved. However, this is an area that the manager has worked hard to make certain all training required has been planned and any deficits can be seen at a glance so that people can be confident that staff have the appropriate knowledge and skills to meet their individual and collective needs. Further improvements could be made to the matrix by including dates when staff require refresher training in relation to all mandatory courses together with when training courses have been booked these could also be detailed on the matrix for ease of reference purposes so that no training is overlooked in the future. We were shown the training matrix and this reflects that sixteen staff have received training in emergency first aid, five have completed health and safety training and ten staff have completed food hygiene training. One staff member has completed manual handling training and will now train other staff members. The AQAA confirms that, currently we have only one member of staff who has not completed LDQ (learning disability qualification) or attained an equivalent qualification. This person is due to start her LDQ in April. It is important that staff have completed LDQ training as people who live at Exmoor Drive have learning disabilities. All new employees complete an induction to introduce them to the home and the policies. It is positive that we were told that people who live in the home are included in the recruitment of new staff which means that individuals get an opportunity to influence who supports them in their daily lives. We reviewed three staff files and found that these contained copies of completed applications, two written references and we found checks had been completed in relation to the Criminal Records Bureau (CRB). This should make sure that staff employed are able to work with vulnerable people and people living in the home are protected from harm. We were told that staff meetings do take place but sometimes these happen on an adhoc basis. It is good practice to hold regular staff meetings with agendas in place to facilitate discussions and sharing of important information among the team and among people living in the home. Care Homes for Adults (18-65 years) Page 32 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made and are ongoing in all areas of practices within this home to ensure peoples health and safety. The manager now needs time to continue with the improvements that are outstanding together with sustaining those that have been made so that the home is run in the best interests of the people who live there. Evidence: Mark OBrien is the manager of Exmoor Drive and has been in post since November 2008. At the time of this inspection Mr. OBrien was awaiting outcome of his application to become registered manager of the home. This shows the managers commitment and provides stability to people who live at the home. In their AQQA the manager has told us that they have completed their NVQ Level 4 in Leadership and management. This ensures they have gained further skills and knowledge to provide effective leadership in a care home. It is clear from our visit that many areas in the service have been improved and requirements from the last inspection have been met. We are satisfied that an ongoing programme of work is in place and the manager shows that they are committed to follow Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: this through so that people live in a home that meets their needs. Staff feel well supported by the manager and that the manager will generally listen to their views. Comments from staff included:I enjoy working here very much, the manager is very supportive. Things are now improving with the manager in place. There is a staff supervision programme in place, with supervisions taking place regularly. This further safeguards the people living at the home by ensuring that staff have the skills, knowledge and support they need to meet peoples needs. Staff comments were, supervision is every couple of months, it feels safe to discuss, manager is always available and sessions are good, supportive. People living in the home are given questionnaires to complete which show whether people are satisfied with their care and support. In the AQAA it confirms, Service user questionnaires need to be re-implemented with more appropriate questions and in a better format. We were told that relatives meetings do not take place but the manager adopts an open door policy so that relatives and or representatives are able to voice any concerns and or suggestions they may have. In the future the manager may want to consider holding more formal relatives and representatives meetings. The home has a quality assurance system in place to monitor the quality of the service being provided. Unannounced visits are undertaken by a senior manager and these happen on a monthly basis. Reports document these visits and we sampled some of these. They informed us that people living in the home are spoken with and staff. Samples of care plans are checked and the environment is inspected. Prior to the inspection the manager had completed the AQAA and this gave us details about the service provided, how it had improved and how the home wanted to improve further over the next year. The manager had a clear vision for how the home could move forward and this should ensure a proactive rather than a reactive approach. The CQC does receive Regulation 37 notifications from this service which tell us when incidents happen that may affect a persons wellbeing. The management team informs us of accidents and injuries as required by law. Sometimes these do not hold sufficient information about incidents that have taken place, such as, full background information as to what happened and action taken. The manager and some staff that we have spoken with have recognised this. Therefore we have made it a requirement that all notifications show full information to reflect that appropriate actions are taken following incidents to ensure good outcomes for the individual. Care Homes for Adults (18-65 years) Page 34 of 42 Evidence: The manager has been proactive in looking at how improvements could be made and a senior member of staff has started the NVQ Level 4 with another one being considered for the next course. This should assist staff to complete some management responsibilities with the knowledge and skills required which can then be passed on to the staff team which reinforces good practice for the benefit of people who live at Exmoor Drive. Records of servicing, tests and maintenance in respect of health and safety for utilities, appliances and equipment such as fire, electrical appliances are well maintained. Water temperatures are checked so this should ensure that the potential for scalding is minimised. As mentioned throughout this report a number of improvements to the service have been made and are ongoing, such as, reviewing care plans, medication practices, staff training, consistency in supervisions and staff meetings. We are confident that the manager will make certain that further improvements are made to ensure these are then sustained in everyday practices for the good of the people who live at Exmoor Drive. Care Homes for Adults (18-65 years) Page 35 of 42 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 18/06/2010 To make arrangements to ensure that medication administration records are accurately maintained. The reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication administration record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the medication administration record in respect of each individual person at the time of administration. This is to ensure that the care service maintains accurate records of medicines administered to people including reasons for non administration of Care Homes for Adults (18-65 years) Page 37 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action prescribed medicines. 2 20 13 To make arrangements to ensure that all medication is administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. 18/06/2010 This is to ensure people are receiving their prescribed medications. 3 20 13 To make arrangements to ensure that medication is stored safely and securely. 18/06/2010 This is in order to ensure that peoples medicines are safe in order to prevent misuse or abuse. 4 20 13 To make arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain. 18/06/2010 This is in order to ensure that controlled drugs are Care Homes for Adults (18-65 years) Page 38 of 42 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action stored safely to prevent misuse. 5 20 13 To make arrangements to 18/06/2010 ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for care staff to give medicines prescribed when required. 6 20 13 To make arrangements to ensure that medication is stored at the correct temperature recommended by the manufacturer. 18/06/2010 This is to ensure that medication does not deteriorate which can make the medication ineffective and possible harmful to people living in the home. 7 42 37 Notifications to the 18/06/2010 Commission must be made in accordance with current guidance and completed with sufficient information to include full details of all actions taken. Page 39 of 42 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to comply with the law. This is to ensure that health, safety and welfare are protected. 8 42 13 Body maps must be in place so each mark and or bruises upon a persons body are recorded for reporting, monitoring and reviewing purposes. 18/06/2010 This is to ensure that peoples wellbeing and safety are fully protected by procedures and practices within the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Consideration should be given to further developing the statement of purpose and service user guide into audio visual formats as a further aid to people gaining an understanding about the service. Care plans should highlight where a person and or their representative has taken part in the writing of these so that agreement can be seen in how each persons needs will be met including goals and their aspirations. Care plans should be further developed into formats that Page 40 of 42 2 7 3 7 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people livening in this home are able to understand to aid their participation in writing these. For example, in larger print, using pictures and symbols to illustrate the written word. 4 12 Activities must be reviewed and based on individuals needs. Following this review an action plan should be drawn up and findings implemented so that each person has an activity planner that meets their specific needs in a meaningful way. Utilising my life work book would assist with this task. People should have opportunities to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. Pictorial menus should be developed to enable the full involvement of people in planning their meal choices. Some thought should be given to displaying this so that people can see their choice of meals in pictorial formats. 5 13 6 15 7 19 Each persons weight recordings should be done on a consistently regular basis to make certain that any losses and gains can be seen in a timely manner as these could detect underlying medical conditions. Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 42 of 42 - 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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