Inspection on 02/06/09 for Friern Residential Care Home

This inspection was carried out on 2nd June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Friern Residential Care Home 30/09/08

Friern Residential Care Home 29/04/08

Friern Residential Care Home 28/01/08

Friern Residential Care Home 12/06/07

Friern Residential Care Home 28/11/06

Friern Residential Care Home 26/06/06

Friern Residential Care Home 20/02/06

Friern Residential Care Home 26/09/05

Friern Residential Care Home 07/01/05

Friern Residential Care Home 26/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX     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: Duncan Paterson     Date: 0 2 0 6 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX 02083686033 F/P02083686033 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Bijaye Luxmi Thambirajah,Mr Vevegananthan Thambirajah care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One exception for over 65 years Date of last inspection Brief description of the care home Friern Residential Care Home is a private care home, which opened in 1989 and is registered to provide care to eighteen adult men and women who have mental health problems. Mr & Mrs Thambirajah are the registered providers and jointly own the home. Mrs Thambirajah is the registered manager and Mr Thambirajah is the deputy manager. The stated aims of the service are to meet residents needs in a friendly and efficient way and to strive to preserve and maintain residents dignity, individuality and privacy. The premises have been converted from three adjoining houses. All bedrooms are on the ground and first floors. There are sixteen bedrooms. One of the single bedrooms on the ground floor and one on the first floor have been arranged as self-contained flats with their own kitchen and bathroom. There is one main kitchen. There are also two lounge areas and two dining rooms. To the rear is a garden and patio area. The home is in a quiet residential part of Friern Barnet, close to shops, and transport links. The fee range for residents living in the home is £474.74 - £800 per Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 18 0 6 1 0 2 0 0 8 Brief description of the care home week depending on their needs. Care Homes for Adults (18-65 years) Page 5 of 31 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: This key inspection took place on 2 June 2009. The inspection involved talking with residents, the manager and staff. The Annual Quality Assurance Assessment (AQAA) form was received by us before the inspection and was taken into consideration. The inspection also involved the assessment of a range of the homes records, procedures and forms as well as observation and a tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 31 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 31 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 8 of 31 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 9 of 31 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. The service is now more organised and focused about working with individual residents to address their needs and develop programmes to support them to move to more independent living. Evidence: There has been no change to the statement of purpose and service users guide. These were revised in 2008 and provide clear information for residents and others about the aims and objectives of the service. This includes details about equality and diversity. The manager reported via the AQAA, that individual preferences had been incorporated into the care planning process such as provision of culturally appropriate food and support for residents to attend places of worship. Residents confirmed that support and help was provided or offered. The promotion of independence is a key aim of the service and this is set out in the statement of purpose. The AQAA returned to us by the service refers to motivating residents to live as independently as possible. This was borne out to an extent by the inspection. One resident had moved to an independent living placement since the last Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: inspection, a number of residents said that they were being encouraged to do things for themselves and staff felt they had made a difference to a number of residents lives. For example one resident was much more involved in cooking and preparing food. The AQAA set out ways how the service could improve. These include more encouragement of input from residents friends and family as well as increasing outdoor activities and use of community based resources. The AQAA stated that the way forward would be to focus on providing staff with the skills that respect and maintains residents dignity, builds their self-esteem, confidence and independence. There was evidence from the inspection that this building of residents confidence and self-esteem was happening. Individual staff referred to work they carried out individually with residents as well as help from external professionals such as counsellors and occupational therapists. The challenge will be to sustain this work. Many of the residents have lived at this home for a number of years and clear, sustained programmes will be needed to develop residents. There have been no new admissions since the last key inspection of 6 October 2008. Therefore, the assessment standard was not assessed at this inspection. Care Homes for Adults (18-65 years) Page 11 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning arrangements allow detailed care plans to be drawn up which reflect residents needs. They are reviewed regularly and help to provide residents with the care they need. The service would improve by developing more ways to assist residents with decision making and involve them more in the running of the home. Evidence: We were shown a sample of the care plans. These were detailed and up-to-date and reflected the work that the home was doing with each resident. Feedback from residents and staff was that much more was being done to engage with residents and work with them. The care plan objectives are being reviewed regularly and staff provide a keywork session on a regular basis. The staff spoken with during the inspection know their residents well and provided insight as to what progress was being made. More work is needed to support residents to make decisions and to achieve greater participation from residents in the running of the home. There are regular meetings Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: which are recorded. There is also a great deal of informal interaction between residents and staff. This was observed throughout the inspection with residents regularly coming to the office to find staff to talk with. For example, more work is needed to support residents to make decisions about how they manage their finances. The manager still does the bulk of this work on behalf of residents. Similarly, key holding arrangements need to be reviewed. The manager said that front door keys had been issued but, of the residents spoken with, none had a front door key. The meetings to obtain residents views can be extended. Feedback is received about food provision and activities as well as arising matters but more work could take place to involve residents in other aspects of life at the home. It also needs to be clear. One resident was unhappy about the routine for locking the back door at night. However, after discussion with the manager the actual practice was different and there had been a misunderstanding. Records are kept confidentially in the office. Care Homes for Adults (18-65 years) Page 13 of 31 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. There have been improvements in this area with more support and encouragement available for residents to follow their interests. More links need to be made with providing residents with activities that equip them with independent living skills. Providing a greater range of activity resources at the home will assist. Evidence: There have been improvements in this area since the last key inspection. Some additional resources have been obtained such as an electric typewriter for a resident and tables in residents rooms. More is being done with residents such as one-to-one assistance to go to religious places and day centres as well as on trips out of the home. Some of the residents spoken with referred to activities that they took part in such as art and activities at day centres. And a number of residents said that life at the home was better now. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: Staff said that they had sufficient resources to provide activities and work with residents although there was feedback that it was difficult to take residents out of the home with the staffing numbers they have. There are quite good links with the community. Residents go out to day centres, shops and places of worship and some visit relatives regularly. But none have jobs. On the day of the inspection the majority of residents were in for lunch. The manager said that a computer with internet access was on order. This is to be used to give residents the access to the internet and a computer to use for activities. It will be helpful to develop links with supporting the development of residents independent skills. For example, there are two flats at the home which have kitchens. These could be used to assist with residents learning. The serving of lunch was observed during the inspection. Residents take it in turns to assist with aspects of the meal such as preparation, serving and then clearing away. A choice of light meal was provided and the food served looked tasty and attractive. Residents ate at three small tables in the dining area. Menus were seen and these provided evidence that a varied range of meals are provided. The resident meeting minutes indicate that the meals are residents choices. There was fresh fruit and vegetables available for residents. Care Homes for Adults (18-65 years) Page 15 of 31 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. Health care arrangements are now much better organised. More detail is needed about how residents are being supported and encouraged to make decision about personal care. Medication arrangements need more regular auditing to ensure they are safe. Evidence: There have been improvements in this area sustained since the last key inspection. The information held on care plans is detailed and residents are being encouraged and enabled to take up preventative health care appointments. Staff were observed to be encouraging some residents to carry out their own personal care. However, more could be done to encourage some residents to make decisions about choosing their own clothes. One resident spoken with said that he did not go out of the home and another that, the manager buys my clothes. Some problems with the recording of medication were identified. Five gaps in the recording of medication were noted. Some of these gaps related to night time medication. There had been a recent audit of the medication system by a NHS Trust but the gaps found indicate that regular auditing by the manager is needed to make Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: sure that medication is given as required and recorded properly. A requirement is given about this. In addition, some staff still have not had medication training and this must now be carried out. Care Homes for Adults (18-65 years) Page 17 of 31 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. The complaints system operates reasonably well with residents able to voice their concerns. Safeguarding arrangements are adequate. The arrangements to look after residents money need further development work so that residents have more involvement and so that the homes procedures have a back up arrangement. Evidence: The complaints records are reasonably well maintained. Where there were matters that needed more explanation this was discussed with the manager. There was some overlap between complaints and safeguarding issues and these were discussed with the manager. The manager undertook to look into one matter in more detail. Safeguarding arrangements are also reasonably clear. There is a policy and staff had had at least internal training. It is recommended that external training is also provided. The arrangements to look after residents money was also discussed with the manager and a sample of records were seen. Residents now all have their own bank account and there was an audit trail from the records about how the money came from source and how spent. There is still a complication with how the money is taken from residents accounts to pay the fees to the care home. The manager takes the responsibility for this. However, this arrangements means that residents do not get involved very much and the service is losing an opportunity to develop resident skills Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: in this area. Residents said that they left this to the manager. In addition, should the manager not be available to carry out this work there is no alternative arrangement. A back up procedure should be introduced. Care Homes for Adults (18-65 years) Page 19 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have benefited from improvements to the physical standards over the past year. Unfortunately, in some areas work has either not been finished or finished poorly resulting in the provision of a poor quality environment for residents. The garden is particularly poor. Evidence: A premises tour was carried out and a number of residents bedrooms visited where residents agreed. Over the past year work has taken place to redecorate and improve the whole home including communal space and residents bedrooms. The communal areas have improved and are now more smartly decorated and inviting. Similarly, many of the residents bedrooms have been redecorated and where these have been done residents were happy with them and said that they had been involved in selecting colours. However, some of the finish of the decorative work is poor. For example, the new laminate flooring has not been edged well and there are numerous gaps giving an unsightly and unprofessional appearance. The garden was not presented well. The day of the inspection was bright, sunny and warm with many residents sitting outside. However, the only chairs available were either marked and worn plastic chairs or wooden chairs which would normally be used only internally. These chairs were also Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: worn. There is a wooden smoking shelter available in the garden but the rear of this was broken with a piece hanging off it. Behind this shelter was some old furniture which was stored there awaiting disposal. Two residents bedrooms had not been redecorated as part of the homes redecoration programme. Residents here said they had not been asked about their choice. In addition, residents pointed out some defects either in the communal parts of the home or in their bedrooms. For example, one residents bed was very unstable and in danger of collapse, doors were not shutting properly and carpet loose. Some fire doors were still not shutting properly. All these matters must be attended to. A programme of checking and repairing on a regular basis is needed as the current system is not working efficiently. The outdoor smoking area should be reviewed with the residents. There was some dissatisfaction about the area expressed by residents and there had been a complaint from a neighbour about noise. Other options should be considered. Care Homes for Adults (18-65 years) Page 21 of 31 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. To improve the service provided to residents the manager needs to provide new staff with training relevant to their role and all staff with regular supervision. There has been a lowering of standards in these areas. A review of staffing levels is needed to see whether additional staff time can be provided to devote to building residents independent living skills. Evidence: On the day of the inspection there were three staff on duty. One was involved with assisting a resident to go to a health care appointment. The manager arrived at the home later in the morning. The staff rota was inspected. Typically, there are three care staff on duty in the morning and two in the afternoon. At weekends there are only two staff on duty throughout the day. Such a level of staffing can result in shortfalls at times. The weekend cover is light and when staff assist residents to take up health care appointments the remaining staff have to provide activities and prepare lunch and provide support for residents. Consideration should be given to employing an extra care worker during the day to either provide activities or work solely with residents developing their independent skills. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: Recruitment was not assessed at this inspection as there have been no new staff members recruited. There are 12 staff in total. Of the 12 six have completed NVQ training at level 2 or above. The manager advised that three more staff are completing NVQ studies. Training records were inspected. There is a computer log of these which had not been updated since October 2008. A range of training has been provided but the newer staff at the home need training input. Only internal training has been provided so far. The training records must be updated with new staff provided with mandatory training. Staff supervision was discussed with staff and the manager and records were inspected. Feedback from staff varied but there was some comments received that more regular staff supervision was needed. The records showed that there had been meetings with staff but these were more about training than supervision. Sometimes the supervision provided had been group supervision rather than on a one-to-one basis. In addition, the majority of the records seen were dated in 2008, although one person had had an appraisal in April 2009. The manager provided a record sheet which contained details of meetings but the notes had not been written up. Overall, there was not sufficient evidence available to demonstrate that staff were being provided with regular supervision. A requirement is given about this. Care Homes for Adults (18-65 years) Page 23 of 31 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. There have been improvements and the management and aims of the home are clearer. There are ways for residents to comment on the quality of the service. The next step is for the service to link the clearer management system with ways of involving residents more in decision making and influencing how the home is run. Evidence: There is an experienced manager at the home who has been running the home for many years. The aims and objectives of the home are clear for staff and residents. Many residents like the home and gave positive comments. There is a quality assurance system in place which allows residents to give voice to their opinions. Residents are encouraged to give informal feedback as well and a number of examples of this was seen throughout the inspection. For example, residents spoke to staff and came to the office to ask for guidance or express concerns. The manager has been able to build on improvements made in the last year. For example, there is much more openness and clarity about how the service is run. Having said that, there is still some unhappiness expressed by some of the residents Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: and some of the arrangements could be clearer. For example, the key holding arrangements. There is also the need to involve residents more in day-to-day decision making about their lives and finances and to include residents more in saying how the home is run. Completing these tasks are the next challenge for the manager and her team. Health and safety records and records of the servicing of the homes equipment were not inspected on this occasion. Care Homes for Adults (18-65 years) Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R 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 1 24 23 The home redecoration 02/02/2009 programme must be completed attending to the parts of the home where the finish is poor. A previous requirement was given in this area and minor works needed to complete. Care Homes for Adults (18-65 years) Page 26 of 31 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 20 13 Provide new staff with medication training. To ensure that all staff on duty are equipped and trained to provide a safe medication system. 01/10/2009 2 20 13 Carry out regular audits of the medication system and medication administration records. To make sure that a safe system of medication is in operation. 01/08/2009 3 23 17 Have a back up system in 01/09/2009 operation to manage residents accounts for occasions when the manager is absent. The current system does not provide an alternative for when the manager is absent from the home. Care Homes for Adults (18-65 years) Page 27 of 31 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 4 23 17 Involve residents more directly in the management of their finances. Residents do not currently have full control of their finances. 01/09/2009 5 24 23 Repair fire doors so that close properly. A risk is presented to staff and residents from defective fire doors. 15/07/2009 6 24 23 Carry out routine monitoring 01/08/2009 of the physical standards and complete repairs promptly. There needs to be a system in place that identifies and rectifies repair matters speedily. 7 24 23 Make repairs to defective parts of the home including sticking doors, carpets and gaps in flooring. Parts of the home were poorly maintained and in parts, unsafe. 01/08/2009 8 33 18 Monitor night time staff 01/09/2009 members regularly and keep written records. Night time monitoring will enable the manager to make sure that standards of care Care Homes for Adults (18-65 years) Page 28 of 31 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 are consistent throughout the 24 hour period. 9 33 18 Review the staffing levels 01/09/2009 exploring whether additional staff can be provided during the day. Additional staff to provide activities and extra support for residents. 10 35 18 Keep staff training records up-to-date. Accurate staff training records assists with planning future training needs of staff. 11 36 18 Provide staff with regular supervision, keeping written records. providing staff supervision allows the manager to address any care issues as well as provide staff with opportunities for development. 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 01/08/2009 01/08/2009 1 7 Explore ways of assisting residents to make decisions about their day-to-day lives, including management of their own finances, budgeting and buying their own clothes. Extend the ways that residents can participate in making Page 29 of 31 2 8 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 decisions about the running of the home. Extend the residents meetings and explore alternative ways of obtaining residents views. 3 11 Consider ways to make use of the homes resources to provide residents with opportunities to develop their independent skills. Continue to obtain additional resources at the home for residents such as a computer. Provide new garden furniture, clear garden of old discarded furniture and review the location of the residents smoking shelter. Review the front door key holding arrangements. Providing a key for residents who wish one unless otherwise indicated by a risk assessment. 4 24 5 26 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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