Inspection on 14/04/09 for Barlby Road

This inspection was carried out on 14th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barlby Road 21/07/08

Barlby Road 08/10/07

Barlby Road 15/08/06

Barlby Road 05/12/05

Barlby Road 09/05/05

Barlby Road 25/10/04

Barlby Road 12/07/04

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Barlby Road 37 Barlby Road North Kensington London W10 6AN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Lycholit     Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. that people have said are important to them: They reflect the things 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Barlby Road 37 Barlby Road North Kensington London W10 6AN 02089648543 02089648156 info@yarrowhousing.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Yarrow Housing Limited care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: PC Care home only to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability Code LD Date of last inspection Brief description of the care home 37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited in a building owned and maintained by Kensington Housing Association. All of the service users, two men and two women, are supported by RBKC. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home users attend day services in the Borough and are supported to pursue a range of interests in the home and in the community. Care Homes for Adults (18-65 years) Page 5 of 29 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 peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place on Tuesday April 14th 2009 from 10am until 3.50pm. At the start of the visit one service user was at a day service and another service user was collected later to attend the same service for a specific activity. Both people returned later in the afternoon. Two service users were at home all day. There were initially 5 staff on duty. There were no senior staff present as the Manager was on a rest day and the Deputy Manager was coming on duty at 4pm. The Manager had completed an Annual Quality Assurance Assessment and was spoken with by phone the following day. All service users received support to complete a survey questionnaire. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 7 of 29 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 8 of 29 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. Information about the service is well designed, in an easy read format and is regularly reviewed. Evidence: Copies of the service users guide and contract were seen for each housemate. These were comprehensive and in an easy read format. All service user guides and contracts had been recently updated and had been signed by the Manager. Copies were filed on the induction file, rather than on housemates individual files which should be reconsidered. Housemates needs are regularly reassessed by relevant members of the multi professional Learning Disability Team. No new people have been admitted to 37 Barlby Road since the last inspection. The previous admission of a new housemate was very well planned and managed, with the full involvement of the prospective housemate, her family and the Learning Disability Team. Staff report that she has settled into life at the house, while maintaining close contact with family members. Care Homes for Adults (18-65 years) Page 9 of 29 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. While person centred plans are well developed for each person, the implementation of steps agreed at reviews has not always progressed, largely because of the absence of a consistent staff team. Evidence: Copies of PCPs and recent reviews were seen on the induction file where they had been filed for ease of access for new bank and agency staff. Accessible versions of PCPs were available on one of the computors but were not seen at this inspection. Action plans had been developed following reviews. From discussion with staff it was clear that steps had been taken to implement some of the agreed decisions, for example planning for holidays was well advanced. Staff shortages had curtailed some activities, such as trips out and swimming. Recording of PCPs is of a good standard but interim action taken is not currently recorded, other than in the communication book or in daily logs. The Manager said that a decision had been taken to use alternate team meetings to look at progress in relation to PCPs, key working and any other developments in relation to housemates. Alternatively or in addition, monthly Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: summaries could be compiled to ensure that agreed action is implemented and that support to housemates remains focussed. Housemates cultural needs are identified in PCPs, with action taken to support their cultural identity for example through visits to restaurants, holidays to country of family origin and participation in festivals and events in London. Communication passports developed with the Speech and Language Team are available for all housemates. Staff commented that these are becoming out of date and need to be revised, especially for new staff who are unfamiliar with housemates means of communication. Risk assessments were seen for each housemate on the induction file. Generally risk assessments are of a good standard and written with an understanding that challenging behaviour is usually a means of communicating that the person is unhappy or distressed. Some recent risk assessments reflect a different approach and do not refer to signs of distress or frustration which may precede unwanted behaviour. Good use is made of the local advocacy service to represent housemates interests regarding various issues. The Manager has arranged best interest meeetings to promote individual housemates welfare and access to services. Care Homes for Adults (18-65 years) Page 11 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans are in place to support housemates in a wide range of activities, although staff shortages have curtailed the number and scope of activities over the past 6 months. Evidence: Activities form an important part of the programme at 37 Barlby Road as all housemates benefit from and enjoy taking part in local specialist and community based services as well as holidays and trips out. The activities programme also encourages housemates independence. In addition to staff shortages and changes since the last inspection, the activity programme has also been restricted by one person being suspended from daily attendance at the Boroughs day service and by the lift being out of order at the building which houses The Gate. On the day of the inspection, a full staff team was on duty, although without a senior member of staff. The weather was good but no plans were made to support people to go out other than a walk for about an hour in the middle of the day. Staff should ensure, for example at Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: handover, that staff are deployed to best meet service users needs. Discussion with staff indicates that plans are in hand to arrange individual annual holidays for all housemates as in previous years. Past holidays have supported housemates family links and cultural background. Records indicate that good relationships have been maintained with the families of two housemates, although one family has raised some concerns about individual incidents. One person visits her family, staying overnight on a regular basis. The home has a 4 week rolling menu which is based on housemates choices. Staff are aware of the importance of healthy eating and steer housemates towards healthy choices. The kitchen was clean and tidy at the visit, with opened food correctly stored and labelled. Little fresh food was available as staff said that there was no money left for shopping, as it had all been spent over the Easter weekend. A member of staff was preparing the evening meal from the freezer, consisting of chicken pies. The Manager confirmed that while staff did not have access to the homes bank account, money could have been obtained from Yarrows head office in Hammersmith. Care Homes for Adults (18-65 years) Page 13 of 29 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. Support profiles are person centred and detailed, providing clear guidance on how the person wishes to be supported. Staff failed to ensure a service users dignity during the inspection, although there is no evidence that this was other than an exceptional lapse. The handling of medication needs to be more consistent. Evidence: Support profiles were seen for each housemate. These give detailed guidance to staff on supporting housemates, who all require assistance with personal care. One incident occurred during the visit where a housemates dignity was not protected in the presence of visitors to the house. This was discussed with the Manager, who had not been present, on the following day. She confirmed that staff had not followed the agreed procedure for supporting the housemate in the presence of other people and that she would discuss the incident with the staff that had been on shift that afternoon. Housemates health care needs are given a high priority. Health action plans are available for each housemate, with dates for action to be taken. A best interests meeting had been arranged for one housemate to try to ensure that she has improved Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: access to services. Records show that staff work closely with health care colleagues to obtain advice and referral to specialist services. One service user is still without a suitable wheelchair following a reassessment, in spite of staff taking action to follow up the referral. Recent MAR sheets were looked and the storage of medication. Staff had not signed for medication given to one person on the morning of the inspection, although the handover sheet confirmed that it had been given. Comments from the Manager in the communication book indicate that staff frequently need reminding to sign for medication. In discussion staff were unclear about the codes for non administration of medication and may need to be reminded to ensure consistency in recording. MAR sheets did not always give a start date, which could lead to confusion. One duplicate, undated sheet had been started in error. Pre-printed MAR sheets provided by the Pharmacist would save staff time and reduce errors. Medication is regularly sent home with one service user but is not fully recorded. Staff should follow Yarrows procedure for leave medication or discuss the provision of a separate supply with the Pharmacist. As the medication is in liquid form it cannot be dispensed into a dosset or similar container. Care Homes for Adults (18-65 years) Page 15 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Yarrow Housing has a well designed and accessible complaints procedure. Complaints recording needs to include concerns raised verbally as well as in writing. Generally the safety of housemates is given a high priority. However events over recent months indicate that not all staff consistently adhere to established good practice at the home. Evidence: The complaints procedure, which is in an easy read format, is displayed in the office. Staff spoke of the difficulty in placing copies elsewhere in the house because of one housemates habit of removing all displays. Information about making a complaint is also available in the service users guide. The complaints folder and AQAA indicated that no complaints had been received during the previous 12 months, although it was clear from other information that at least one complaint had been made by relatives. All complaints and concerns raised should be recorded, both to ensure a response and to contribute to service development. Training records show that permanent staff have attended training in safeguarding adults and some staff have received SCIP training. Three safeguarding referrals have been made since the last inspection. An investigation is currently being undertaken by Yarrow Housing into the most recent referral. An earlier safeguarding alert indicates that a number of staff feel able to raise any concerns about the welfare of housemates. While the report on the current investigation is not yet available, earlier alerts indicate Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: the need for a stable staff team who have developed strategies based on accepted good practice when supporting housemates. No housemate is able to handle money or their financial affairs. Housemates money is checked at handovers. The recent financial records of two people were looked at during the inspection. Records showed that receipts are obtained for all purchases and that accounts are reconciled at least monthly. Yarrow Housing senior and financial staff check housemates finances periodically. Care Homes for Adults (18-65 years) Page 17 of 29 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 building, which is located in a residential area, close to shops, services and public transport, has been well adapted on the ground floor for one person who uses a wheel chair. The house is pleasantly decorated and furnished to meet housemates needs. Evidence: The house is indistinguishable from others in the street. It is close to shops, services and is on a bus route. The garden continues to benefit from the attention of a regular gardener and provides a pleasant area for housemates in the summer. The sitting/dining room was looking less attractive than at previous visits. Staff said that a new sofa has been ordered and that curtains are to be replaced. A new TV has also been ordered. All single bedrooms are of a good size and the house is well equipped with bathrooms and lavatories. There is a sensory room on the first floor, with a range of equipment. Two housemates bedrooms were seen. Both were clean and tidy. There have been difficulties in having a regular domestic assistant for over a year, with support staff having to clean the house. Generally staff had been successful in keeping the house clean, in particular the kitchen and bathrooms. In view of the current pressures on staff who are having to induct new permanent and bank staff, a regular cleaner is needed to ensure that the building is kept clean. The office/sleeping Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: in room is understandably not a priority for staff who have a number of other areas to keep clean but would benefit from being included in the cleaning schedule. Care Homes for Adults (18-65 years) Page 19 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team at 37 Barlby Road has been carrying a high level of staff vacancies for a considerable period, with a consequent impact on the quality of life of service users. Evidence: Staff vacancies, including senior staff posts, have put additional pressure on permanent staff. The complex needs of service users at Barlby Road, including their communication needs make it difficult for new and temporary staff to support them, particularly outside the house. The Manager confirmed in discussion and by means of the AQAA that there are 6.5 vacancies, which is a slight reduction from earlier in the year. The staff vacancies include senior staff posts. The Deputy Manager is on maternity leave, with no arrangements in place to cover her post and there is a parttime vacancy for another Deputy Manager. The senior staff team therefore consists of 1.5 staff instead of 3. As a result, the majority of shifts have no senior staff member on duty. The Manager confirmed in the AQAA that she receives confirmation of satisfactory criminal record checks for all new staff from Yarrows HR team who undertake all recruitment checks. Yarrow Housing provides staff with a range of in house training relevant to working with people with a learning disability, as well as access to a NVQ programme. Training records show that staff have attended or are booked to attend mandatory training, including refresher training, as well as other workshops. The percentage of staff achieving NVQ2 remains low at 44 , largely as a Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: result of permanent staff with the qualification leaving. Records show that Team Meetings have recommenced after an interval. Notes of monthly meetings were on file for November, January and March. The Manager said that 2 further meetings had taken place, which had not yet been written up. She plans to hold fortnightly team business meetings, with alternate meetings focusing on service users. Care Homes for Adults (18-65 years) Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is aware of areas where the service needs to improve and has an understanding of the needs of housemates. However she has been hampered by the lack of a consistent and experienced staff team. Visits on behalf of the provider are not taking place as frequently as required and/or are not recorded promptly. Evidence: A permanent Manager was appointed in February 2008. She confirms that she has recently started the process of applying for registration. The Manager is experienced in working with people with a learning disability and is completing her NVQ4. As discussed under standard 32, vacancies in the senior staff team in additional to support staff vacancies create pressure on the Manager and part-time Deputy Manager, who is relatively new to the service. Copies of service users surveys, which form part of Yarrows QA system were seen on file. Yarrow Housing has established a range of service user involvement initiatives, including a regular forum and newsletter, though none of the housemates at 37 Barlby Road attend the forum. Health and safety records are up to date and all staff receive training in health and Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: safety as part of their induction. The fire risk assessment was reviewed on 21st February this year. The fire alarm system is serviced 4 times a year and fire drills take place at least 4 times a year. Records show that the alarm is tested weekly. Accidents and incidents are recorded in detail. Waking night staff undertake a number of health and safety checks, including checking fridge and freezer temperatures and the temperature of the hot water accessible to housemates. A recent visitor saw handwash which could be accidentally drunk by a housemate not locked away. All products were locked in the cupboard or inaccessible on the day of the inspection visit. A number of reports of visits on behalf of the provider were missing from the file. The visitors book and /or reports showed that 2 visits had taken place in February, including one at the weekend, and one in April. The previous report on file related to a visit in September 2008. The gap in reports is surprising both because of the need to adhere to the regulations but also in view of the severe staffing shortages at the service. Visits must take place in line with the regulations, with a report made available to the Manager. Care Homes for Adults (18-65 years) Page 23 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 24 of 29 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 Requirement 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 Requirement Timescale for action 1 6 15 Action taken in relation to reviews, progress and developments, should be regularly updated, for example by means of monthly summaries or at team meetings. To ensure that agreed action is implemented and that support to service users is focussed. 30/06/2009 2 14 16 Service users should be supported to take part in activities in line with their PCPs and action plans. To ensure that service users have access to a range of community facilities. 30/06/2009 3 17 16 Steps should be taken to 30/06/2009 ensure that money is always available for essential food shopping. Care Homes for Adults (18-65 years) Page 25 of 29 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 Requirement Timescale for action To ensure that service users have wholesome and nutritious meals. 4 18 12 Staff should be reminded of the need to ensure the privacy and dignity of housemates at all times. To ensure service users are treated with respect. 5 20 13 Consistency in the handling of medication must be improved, including recording on MAR sheets, use of agreed codes and establishing a procedure for leave medication. To ensure the safe handling of medication. 6 22 22 All complaints and concerns raised should be recorded in the complaints file, with action taken. To ensure senior staff are aware of complaints, action is taken and any lessons learnt. 7 23 13 Steps must be taken to ensure that staff adopt a consistent approach to working with housemates based on agreed strategies and on accepted good practice. 30/06/2009 30/06/2009 30/06/2009 30/06/2009 Care Homes for Adults (18-65 years) Page 26 of 29 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 Requirement Timescale for action To ensure that no unnecessary restraint or restrictions are applied to housemates. 8 32 18 A strategy must be in place 30/06/2009 to recruit and retain a consistent and experienced staff team. Senior staff posts should be covered as a priority. To ensure that service users are supported by staff who are competent and know their needs. 9 37 8 The provider must ensure that an application for registration of the Manager is made promptly. To ensure a registered manager is responsible for the service. 10 43 26 Visits on behalf of the 30/06/2009 provider must take place at least monthly and be conducted in line with the regulations. A report on the visit must be made available to the Manager promptly. In order that the provider monitors the service and is aware of any concerns. 30/06/2009 Care Homes for Adults (18-65 years) Page 27 of 29 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 6 The good standard of risk assessments should be maintained by ensuring that they are written in a way that emphasises positive behaviour and communication. Action should be taken to ensure that the domestic assistants post is covered and that the office/sleeping in room is included in the cleaning schedule. 2 30 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!