Inspection on 29/09/09 for Gatehouse Cottages Care Home

This inspection was carried out on 29th September 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gatehouse Cottages Care Home 28/01/10

Gatehouse Cottages Care Home 18/01/08

Gatehouse Cottages Care Home 18/01/07

Gatehouse Cottages Care Home 27/06/06

Gatehouse Cottages Care Home 01/12/05

Gatehouse Cottages Care Home 10/06/05

Gatehouse Cottages Care Home 20/12/04

Gatehouse Cottages Care Home 29/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Gatehouse Cottages Care Home Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP 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: Jane Lyons Date: 2 9 0 9 2 0 0 9 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 50 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 50 Information about the care home Name of care home: Address: Gatehouse Cottages Care Home Stallingborough Road Immingham Grimsby North East Lincs DN41 8BP 01469574010 01469574005 gatehouse.cottages@craegmoor.co.uk www.craegmoor.co.uk Health & Care Services (UK) Ltd care home 27 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 27 20 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home with Nursing, Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Learning Disability, Code LD, maximum number of places 27 Physical Disability, Code PD, maximum number of places 20 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 50 A bit about the care home Gatehouse is a care home for adults with a learning disability aged between 18 and 65. It provides care support for up to 27 people, some have complex needs. Gatehouse Cottages is in the country and is a few miles from Immingham. It is in a quiet area with only one other house nearby. You can get to the care home by bus or by the care homes own mini- bus. Care Homes for Adults (18-65 years) Page 5 of 50 Rooms are in 3 buildings. No one has their own toilet and bathroom. 2 of the rooms are shared bedrooms. The care home has many things that people can use to support them in their daily life. There is space to park in front of the care home. There is a private garden behind the home and a large sensory garden. When this report was written, it cost from 500 pounds and 1185 pounds a week to live there. If people want extra services like hairdressing and private care for their feet, they could pay a bit Care Homes for Adults (18-65 years) Page 6 of 50 more. Care Homes for Adults (18-65 years) Page 7 of 50 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 8 of 50 How we did our inspection: This is what the inspector did when they were at the care home The inspector wanted to see how well the home was doing as there had been lots of problems reported about how the home was looking after people and keeping them safe. Before the visit, the home sent us lots of information about how they run the home and about things that were affecting the health and happiness of the people living there. The inspector used this information to help her plan her visit. Care Homes for Adults (18-65 years) Page 9 of 50 The main inspector was Jane Lyons, another inspector Steve Robertshaw visited the home as well. The inspectors spent 1 day in September at the home. The inspectors did not tell the manager that CQC were visiting. CQC sent surveys to some of the families. The inspectors also talked with professionals such as nurses and social workers who visit the home to help with peoples care. The inspector used their answers to write some of this report. The inspectors spoke with some of the people living at the home, staff and the manager. Some of the people living there Care Homes for Adults (18-65 years) Page 10 of 50 found it hard to talk. So the inspectors spent some time watching how they were being cared for. The inspectors looked at papers about how the home works and cares for people. The inspectors gave Gatehouse Cottages 1 star. This means the people who live in the home get adequate services. Care Homes for Adults (18-65 years) Page 11 of 50 What the care home does well Relatives and friends are welcome to visit anytime. The home helps people to stay in contact with their families and some people have regular visits back home. If people are unhappy about something at the home the manager will look into this and try and put things right. Care Homes for Adults (18-65 years) Page 12 of 50 What has got better from the last inspection Things are not as good as they were before. This maybe due to a number of things including changes of manager, a high turnover of staff and a number of safeguarding referrals all within a short period of time. Care Homes for Adults (18-65 years) Page 13 of 50 What the care home could do better The home needs a lot of redecoration and new furniture provided. The staff working in the home need more specialised training, guidance and supervision to help people living in the home. Care Homes for Adults (18-65 years) Page 14 of 50 More activities need to be offered to suit everyone living in the home. The care plans need to be kept up to date so they tell staff what people need and want. They also need to say more about what people are like. Risk assessments need to be kept up to date so the staff can support people properly. Care Homes for Adults (18-65 years) Page 15 of 50 Instructions from other professionals need to be followed by staff. 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 Jane Lyons St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 Care Homes for Adults (18-65 years) Page 16 of 50 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 17 of 50 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 18 of 50 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their representatives have access to a range of information about the home, more of this information could be provided in formats more accessible to people. The home ensures peoples needs are fully assessed prior to admission, this enables staff to be sure their needs can be met at the home. Assessments must be reviewed so that peoples needs are accurately recorded. People who use the service must have an agreed contract with the service so their rights are protected. Evidence: The home has a statement of purpose and a service user guide, which give information about the home. Both these documents have been updated to show changes in management and staffing. The service user guide has been reproduced in an alternative format combining the use of symbols and photographs, which better enables people who use the service to understand the information. An updated copy of this document is available in the corridor however individuals care files were seen to contain copies which are outdated. Care Homes for Adults (18-65 years) Page 19 of 50 Evidence: Five care files were examined as part of the inspection. All contained assessments of need and care plans completed by the local authority. The home added to these with their own assessments and risk assessments, and also obtained assessments completed by other health professionals. The information was used to provide plans of care for people. There has been one new admission to the service since the previous inspection visit and records show that detailed assessment procedures had been followed by the home and staff had liaised with a variety of professionals involved in supporting the individual to ensure their needs could be met at the home. Assessments for those people living in the home need to be reviewed an updated to reflect changes in need. When we visited last time we made a recommendation that updated copies of peoples contracts or statement of terms and conditions documents should be held within their files, there was no evidence that this had been put in place. To protect peoples rights the organisation should ensure that people, their families and representatives have clear and accurate information about the service at Gatehouse within the contract statement of terms and conditions and this should include the fees, payable by whom and the placing authority and representatives should be consulted. People who use the service are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff at the present time. Peoples choices in this matter are recorded in their care files. Care Homes for Adults (18-65 years) Page 20 of 50 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. Not all peoples care plans and risk assessments are up to date and so they may be at risk of not having their health, social and emotional care needs met safely and in a way that they have chosen. Evidence: All people who use the service have very detailed individual care plans but much of the information held on the five care plans checked was old and out of date. A recommendation from the recent investigation by the community learning disability team identified that all the care plans need to be more person centred which the management have started to address, staff are scheduled to receive training in this area next month and we saw evidence that staff have started to rewrite a number of the care plans. A member of staff told us The care plans are not up to date but the manager is working with us to get these plans to a much higher standard. It is important that the individuals have care plans that reflect their current needs, goals and aspirations so that they can receive appropriate support. Records showed that there was some inconsistency in the standards of recording throughout the home, a small number of care plans in the main facility had been rewritten earlier in the year, these were found to be detailed and Care Homes for Adults (18-65 years) Page 21 of 50 Evidence: included a lot of person centred information, however there was no evidence that the individual or their representative had been consulted in the development of the plans which should be addressed. Care plans seen throughout the units had not been reviewed and evaluated regularly, some of the evaluation records detailed changes in need however the plans had not been updated to reflect these changes. The care plan is not yet available in a language and format that people living at the home can understand but some of the content is available in symbol format, for example, the complaints procedure and the service users guide. The staff complete daily records of care, we saw that these were very focused on the care support that people had received and would benefit from more descriptions about how people have spent their day and how staff have supported them to make choices in how they had spent their time. There are detailed risk assessments in place for each area covered in the care plan, and all of these are specific to the individual concerned with clear guidance to staff in how to minimise any perceived or actual risk. However there was little evidence that these have been kept under review. The home accesses support for individuals from local advocacy agencies when required. There was good evidence that the manager had arranged a best interests meeting with all relevant agencies to discuss one individuals continued care support. Formal reviews are held every year, this should be carried out every six months to ensure that the care plans contain current information and that people are receiving the correct level of care. A number of the people who use the service attend unit meetings in the home and also attend Your Voice forums at local and regional level. During the visit we observed that one individual displayed behaviours which upset a number of other individuals in the unit, we saw guidance in the care file from health care professionals for staff to follow which would prevent this, but this wasnt being carried out. Staff spoken to told us that they were struggling to manage this individuals behaviours, one staff member said We have asked for training in Autism. We spoke with the manager who confirmed that one- to- one funding for this individual had recently been withdrawn however the home was working closely with the intensive support team from the Care Trust Plus to assess the suitability of the placement and identify the support that staff need to currently manage the individuals needs. Some of the people who use the service display behaviours which may pose a risk to themselves or others, we looked at some of the behaviour management plans which were detailed but showed that they needed review. It is important that the management audit all incidents to identify potential triggers and demonstrate that action has been taken to reduce these where possible. Care Homes for Adults (18-65 years) Page 22 of 50 Evidence: Care Homes for Adults (18-65 years) Page 23 of 50 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. Some people using the service have limited opportunities to access a variety of leisure activities and spend their time in a meaningful way. People are supported to maintain relationships with their friend and family. Concerns raised about peoples nutritional needs not being met are being addressed however peoples choices should be supported at each mealtime. Evidence: Staff said the routines of the home were planned around the individuals needs and wishes, those who reside in the main facility are reliant on staff and family members recognising and identifying their likes and dislikes. Individuals who reside in the Lodge and Studio flat have more opportunities to make decisions and exercise choices. The majority of people who use the service have complex or significant needs and require a high level of support from the staff team, therefore few of the individuals would be able to participate in work college placements, the manager told us that he was looking into suitable work placements for some individuals. A small number of people who use the Care Homes for Adults (18-65 years) Page 24 of 50 Evidence: service are able to access day services in the community. In discussion staff displayed good knowledge of individuals needs, likes, dislikes, family support and records contained information on peoples religious observances. At present none of the individuals access any religious services, however one of the staff team is currently working with individuals to identify any needs in this area. Care plans record a persons hobbies and their current interests. Family and friends have been asked for their input in gathering this information. Everyone has an activity plan for the week and this records an activity for the morning, afternoon and evening on seven days per week, however there was little evidence from observation during the day and from activity records that the activity plan was being fully implemented. There are two activity co- ordinators employed at the service who we saw supporting individuals positively with various activities during the day such as a swimming outing, walks around the grounds and time in the sensory area, however there was little evidence that care staff are involved in supporting the activity programmes. We observed that people residing in the Lodge and Studio areas were occupied well during the day however people residing in the main facility were left for long periods in the dining room, sitting at tables or looking out of the window or in the lounge area watching T.V. which they did not appear very interested in. Records show that some individuals regularly access activities within the community such as meals out, swimming, ice skating, discos, shopping and sports for all however a number of individuals did not regularly participate in these activities although they were identified on their activity plans. The home has two mini- buses to provide transport in the community, there is a shortage of drivers within the service which has impacted on their use. The manager told us that he is aware of this issue and is encouraging staff to use more public transport and is reviewing the type of transport provision at the home. All the people who use the service have an allocated key worker, staff in this role spend one- to - one time with the individual, carryout personal shopping on their behalf and maintain family contact. Staff told us that due to staff turnover the key worker system had been affected, one relative wrote on their survey My daughter has had a number of key workers over the last year as staff have left, this isnt good as it takes time to develop relationships and for them to get to know her. Interaction between staff and the people who use the service was generally positive during the visit but a small number of instances were observed where staff communication with individuals could have been better. We discussed this with the manager who told us that he is taking steps to improve communications in the home; the staff have all accessed training recently in Makaton however it is clear that the majority of individuals in the main facility are not able to use this type of communication, although the manager considers this is a start and it is raising the staffs awareness of effective communication. Further training in intensive interaction communication is planned for the Care Homes for Adults (18-65 years) Page 25 of 50 Evidence: staff. Care plans seen contained communication plans however people with very complex needs in this area should have more detailed ones in place which would provide staff with more direction in how to communicate effectively with the individual. Records and discussions with staff identified that few people who use the service were able to access a holiday last year and have not been able to access one this year. A trip to Reighton Sands for a small number of people took place last summer. One relative wrote in their survey xxx did not get a holiday last year and it seems he will not get one this year. Also because of a shortage of willing drivers he has not had days out to the coast to compensate. We noted that care plans in The Lodge and Studio include information about each persons responsibility for housekeeping tasks, these varied depending on the capabilities of the person concerned. People in The Lodge and Studio areas are supported to plan their menus, shop and the meals are prepared within those units. Menus indicated that individuals receive a varied and well balanced diet. We were concerned that people in the Lodge told us they had run out of coffee and werent allowed any more until the next shopping trip, staff told us that they were trying to educate individuals about budgeting although when we discussed this issue with the manager he was not aware of this limit made by staff and confirmed he would ensure people had access to the drinks they preferred. It is important that budgetary education is carried out within peoples capabilities and that restrictions are understood and agreed with individuals. New menus have been developed in the main facility with some picture and photograph formats, the cook told us that they are providing some lighter menus which people are enjoying. For the main meals such as lunch and dinner individuals are shown the meals and are able to choose for themselves where possible. We observed the breakfast time and noted that people werent given a choice of meals other than Weetabix or Readybrek, no other cereals, toast or eggs were offered, when we asked staff about this they told us they did not have time to prepare the meals. We also observed at breakfast time that one member of staff had the role of feeding all the individuals who required assistance, this is considered a very task orientated approach and efforts should be made to provide individuals with more person centred, individualised care support. There was evidence that some people in the main facility had been involved in the menu planning and were now able to participate in some of the shopping for the meals, which is positive. The community speech and language therapy team continue to be involved with many of the individuals at the service, detailed assessments and guidance were found in a number of files however not all care plans had been updated to reflect the specific support to be put in place. Feedback from this team identified that there had been a number of issues in recent months with a lack of consistency with staff towards the support needed, for example staff continued to assist some individuals where it has been assessed that they should feed themselves and one individual has a low tolerance to noise and should take Care Homes for Adults (18-65 years) Page 26 of 50 Evidence: their meals in a quiet area but staff had not always carried this out, however recent visits to the home had identified improvements and staff were now following the guidance to ensure peoples eating experiences were more safe and positive, which was observed during the visit. Any food and drink likes and dislikes are recorded in care plans, along with allergies and other special dietary needs. The cook told us she had recently completed a nutrition course at the local college. The kitchen is scheduled for some refurbishment when the cooker, dishwasher and extractor fan will be replaced. The homes kitchen facilities, policies procedures and food hygiene practices were inspected recently by the Environmental Health Officer and the home was awarded a four star rating which is a positive achievement. Care Homes for Adults (18-65 years) Page 27 of 50 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. Peoples basic health needs are generally met but guidance from health professionals must be followed consistently by staff to ensure peoples complex needs are properly met. The administration of medication in all areas of the home is well managed but storage in the main facility is poor. Evidence: All the people who use the service are registered with a G.P. and records of visits by health care professionals are maintained. Records showed individuals have access to relevant professionals from the local community health team. As detailed in a previous section of the report a number of professionals have completed assessments and their reports identify guidance to be followed by staff however care plans have not always been updated to include this guidance which would direct staff to provide the care that people need. Many of the files seen did not contain a Health Action Plan and those seen had not been reviewed within the timescale indicated on the document. The manager told us that the Health and Wellbeing Co -ordinators employed by the Care Trust Plus had taken many of the Health Action Plans away to be renewed with a new format. Hospital Passport records had been produced to support admission to hospital however these documents were missing from a number of the files. Other files seen contained dental health plans and evidence of regular medical reviews. Before the inspection visit we Care Homes for Adults (18-65 years) Page 28 of 50 Evidence: spoke with a number of health care professionals closely involved in the home, they consider that the management and staffing changes have affected some standards of care and communication within the home over the last year. Some of the comments include We put in a lot of training and support for staff which the residents really benefited from, unfortunately most of the staff have left which has meant working a lot with the new staff, but it is important now that the nursing staff and management monitor the support given by care staff to ensure clinical guidance is followed. Discussions with the senior physiotherapist identified that following staff changes the exercise programmes for individuals werent being followed and she has had to provide physiotherapy assistants to visit the service regularly to carry out the programmes. A recent complaint investigated by the home about an individuals personal care needs not being met highlighted some areas of concern. Following the investigation of the complaint, some improvements have been made to the systems in place and the recording of care support provided for this individual. This includes more detailed directions for staff and records of personal care delivery however during the visit a small number of gaps were identified on the charts. This individual also receives sensory support from an outside agency, we spoke to the outreach worker who told us she has concerns about aspects of care support provided to the individual and had reported these concerns recently to her manager. The concerns include: poor oral hygiene, poor personal hygiene, the individual always being in bed and soiled pads disposed in the bin in the individuals room. We asked the manager to look into these issues. Staff are monitoring individuals weights on a regular basis, we saw evidence of this in all the files seen. However some of the records are confusing, in one file we saw weights recorded on three separate documents and there is some inconsistency in the recording of cumulative weight gain/ loss. We asked the manager to look into this. For some individuals, records are in place to support monitoring of bowels, food and fluid intake and menstrual cycles etc, we looked at these records and found that some had not been properly maintained. These records are important in monitoring peoples health and personal care needs and ensuring people receive the support they need. Concerns had been identified recently regarding the practice management of Percutaneous Enteric Gastrostomy (PEG) feeds and a clinical nurse specialist from the community team learning disability is currently working with the home to make the necessary improvements needed to ensure people are supported safely. The homes policies and procedures for PEG feed administration are detailed and reflect current practice. Staff have received some training in recent weeks and their competence will be formally assessed, storage of the feed is being reviewed and standards of hygiene have improved. During the visit we observed staff give a number of bolus feeds, when we asked the nursing staff about the frequency that the feeding tube was rotated to ensure patency, there was some inconsistency in their responses which needs to be addressed, the specific care relating to individuals feed tube management was clearly detailed in the Care Homes for Adults (18-65 years) Page 29 of 50 Evidence: individuals care plan and staff must follow these directions. Surveys received from relatives indicated that they were generally satisfied with the level of care support provided at the home. One person wrote In my daughter’s case the general personal care (personal hygiene, baths every day etc) have always been to a high standard. Relatives also told us that the home informed them of important issues. At this visit we examined the medication systems. Detailed and up to date policies and procedures are in place, which cover all areas of management. Recording on the medication administration records was seen to be accurate, including the record of drugs received and detailed information about the use of PRN (as required) medication, and we noted that any handwritten entries on medication records had been signed by two members of staff to ensure accuracy. There were no persons self medicating and no controlled medications in use at the home,at the time of the visit.The nursing staff administer medication in all three areas of the home. Medication is stored in each area. It was identified at the last inspection visit that storage in the main facility is very limited and we were told that alternative storage in the home was being arranged. This has not taken place, storage areas were seen to be very cramped, the carpet in one area was seen to be very dirty and numerous items were stored on the floor. Attention is required to the hygiene and storage in this area, we consider that alternative storage for medications in the main facility needs to be a priority. Care Homes for Adults (18-65 years) Page 30 of 50 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. People understand the complaints procedure in place at the home. The home hadnt taken all the necessary action following an incident, this means that a person may have been put at risk of further harm. Evidence: Each care plan that we examined had a copy of the complaints procedure included that was written in symbol format. People spoken to during the visit told us that they knew who to speak to if they were not happy and how to make a complaint. The home has received two complaints in the last twelve months, both complaints were upheld. We saw records relating to the management of these complaints, detailed outcome letters had been sent to the complainants describing action that had been taken by the management in respect of the issues raised. Surveys received by relatives indicated that they knew how to make a complaint and that the service had responded appropriately if concerns had been raised. As detailed in previous sections of the report a number of concerns have been raised by health care professionals to the home regarding issues such as standards of hygiene in the home, competency with PEG feeding, communication and nutritional support. There was evidence that issues raised to the manager have been taken seriously and that he has taken steps to address the concerns and improve practice. Training records evidenced that all staff have now undertaken training on safeguarding Care Homes for Adults (18-65 years) Page 31 of 50 Evidence: adults from abuse. In addition to this, 67 of staff have achieved National Vocational Qualification (NVQ) Level 2 in care, the topic of abuse is covered in these training awards. Staff have to sign to say that they have read and understood policies and procedures in place at the home, and this includes the policy on safeguarding adults from abuse. There have been five safeguarding referrals made to the local authority in the last six months, one of these has been investigated by the police and there was insufficient evidence for them to proceed and the issues have been passed on to the home to investigate further. The other four referrals have been investigated by the social services department as part of a detailed investigation carried out in July and August. A number of recommendations have been made as part of this investigation which the home have taken action towards and are addressing such as improvements to care records, communication, staff supervision, standards of hygiene, sexuality awareness and education for people who use the service and staff training. Two of the incidents were reported to the local authority by the home in accordance with procedures and notified to CQC as per regulation. During the visit we identified concerns around the safety of one individual, care records described how this person had been found late one evening having run a bath and had got in by themselves having partially barricaded the door. Following the incident some action had been taken by the home to reduce the risk of this happening again for example removing the plug in one of the baths, however we discussed the need for closer monitoring by staff which the manager told us he would put in place. Risk assessment documentation had not been completed. There was no incident record completed, nor had the incident been reported to CQC or the individuals care manager. Following the visit we discussed the incident with the individuals care manager and a decision was made to make a referral to the safeguarding team. Care Homes for Adults (18-65 years) Page 32 of 50 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. Many areas of the home now require redecoration, refurbishment and equipment replacement to provide people with a homely, attractive place to live which suits their needs. Evidence: The accommodation comprises of three separate units, there is a purpose built ground floor main facility, the first floor of this is the Studio which has three bedrooms and there is a separate three bedroom house nearby which is called the Lodge. During the visit we looked around all areas of the service. Extensive redecoration and refurbishment had taken place within the main facility in 2006, many areas now require further redecoration which has commenced in part, the dining room has recently been redecorated and the tables are being re-varnished. A number of individuals bedrooms now require some redecoration. Works to upgrade the kitchen areas are in place and a new cooker, extractor fan and dishwasher are on order. There was an offensive stale odour in the main lounge area, the other lounge area did not appear to be used often which staff confirmed, during the visit we noted that the T.V. and music equipment was placed on the floor therefore many of the individuals would experience difficulties using it. A number of carpets require cleaning in individuals rooms and in the medication storage area. Some issues around the standard of hygiene were identified during the recent local authority investigation and the management have taken Care Homes for Adults (18-65 years) Page 33 of 50 Evidence: steps to address these, a weekly walk of the unit is carried now out and maintenance and cleaning issues are identified. Records of these audits were seen. However in one individuals room we identified concerns that the suction catheter was on the floor uncovered, gauze swabs were on the floor and the oxygen masks were uncovered, these issues were passed on to the manager to address during the visit. A number of towels were found to be very worn and frayed, more regular linen audits should be carried out so peoples dignity is properly maintained. When we last visited the service we were told that hand washing facilities would be provided in the main laundry area, this has not taken place, this facility must be provided as a priority to ensure adequate infection control practices in this area. There are plans to develop a vacant room into a therapy and clinical area, the provision of an improved clinical area is also a priority given the cramped medication storage at present. The studio areas were found to be tidy however the carpets were seen to be very dirty and in need of cleaning or replacement. The laundry floor was seen to be stained and needing replacement. Hot water pipes in the bathroom and toilet areas should be protected to ensure the safety of the people who live in the unit. Staff told us that the tumble dryer had been broken for the last four weeks and that the management are slow to carry out maintenance work or replace equipment when needed. A tour of the Lodge revealed that decorative repairs were needed to areas of the home such as the office, where on one wall areas of plaster are missing. The hot water pipes in one individuals room require covering and where pipes have been covered in another individuals room, the woodwork requires painting. The porch area requires attention following birds nesting inside. The recreation room does not appear to have been in use since the previous inspection visit, it is now used for storage. In the kitchen, there was no lid on the dust bin, staff told us that they were waiting for a replacement bin to be provided. Unit meetings had been held the week before the visit for people who live at the home. Records show that the majority of requests were for redecoration, new furniture, TVs and equipment such as a Karaoke machine. We spoke to the manager about all the decorative improvements needed to the interior of all the units and that a detailed maintenance plan needs to be developed which identifies all improvement works to the facilities in the home with clear timescales for completion. It is important that people live in surroundings which are safe, pleasant and homely. All bedrooms seen throughout the service were personalised to suit the individual, many contained personal items such posters, pictures, mobiles, TV’s and sensory equipment. Training records evidenced that most staff have undertaken training in infection control and we saw good hygiene practices being followed on the day of the site visit. Arrangements for access to and from the building are suitable for the people living at the home. All the doors to the main facility are alarmed. We saw that repairs had taken place Care Homes for Adults (18-65 years) Page 34 of 50 Evidence: to some of the exterior woodwork, paths and parking area. The plants and shrubs in the sensory garden are maturing and this area is well maintained, staff said that people liked to spend time in this area especially in the warm weather. Care Homes for Adults (18-65 years) Page 35 of 50 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. Staff turnover has affected the continuity of care for some people living at the home. People are supported by a staff team that in general are trained, caring and well meaning however the lack of adequate guidance and supervision mean that peoples needs may not always be met. Recruitment practices afford sufficient protection for people who use the service but staff must know the status of all visitors to the home to ensure people are fully protected from harm. Evidence: The home has experienced significant staff turnover since the last inspection visit, records show that twenty two staff have left the service within the last twelve months, this includes managers, care staff and registered nurses. This has clearly had an affect on the continuity of care support for individuals residing at the home, given the high use of agency staff to maintain staffing levels. Recruitment has been generally positive in relation to appointing care staff and the manager confirmed that the staffing complement in this area has almost been met. Recruitment of registered nursing staff has been more problematic and the home continues to use a high volume of agency nurses, however the home has been able to provide some consistency by using a small group of agency staff. The manager told us that senior management had reviewed aspects of recruitment and retention to attract more staff, for instance pay scales have been reviewed and that he Care Homes for Adults (18-65 years) Page 36 of 50 Evidence: was due to hold interviews for qualified staff the following week. A deputy manager was employed in January who has a learning disability qualification and has provided some stability since his appointment. We received a lot of comments in surveys returned by relatives regarding their concerns about the staff turnover, some of these include There are a lot of agency people passing through, they do the job but do not seem to care for my son, being impersonal so cannot read his moods and needs and The home should improve stability for staff which would lead to them getting to know the clients thus provide a more effective service. Another person wrote The home should employ more permanent staff and not so many agency personnel who because they are there for a short time do not know the residents enough. The manager told us that he does interview staff before they leave however no records are kept of these discussions, we think that formal exit interviews should be carried out which may support improved staff retention practices. The staff rotas show there are enough staff planned to be on duty to meet peoples needs. On the day of the visit enough staff, were observed, to be available to meet peoples needs in a relaxed and calm manner. The home is fully occupied. Staff told us that there had been times when the home had been short staffed and they were concerned that many of the good staff had left, but felt that as more staff had been employed staffing levels had been better maintained. The manager has recently reviewed and changed the shift times, some of the staff told us that they were concerned that the shorter morning shift time may impact on the opportunity for people to have day trips away from the service. We discussed this issue with the manager who confirmed that appropriate staffing support would be provided to support outings across shift times. The home employs a team of ancillary staff which includes a cook, domestics and maintenance person. The administrator left the home in July and the manager told us that he has experienced difficulties in recruiting a replacement, however recent recruitment had been more positive and he was hoping to appoint a new administrator shortly. Health care professionals have told us that skill levels vary between the staff group. People who use the service are protected through robust recruitment procedures. Staff recruitment records sampled during the visit are well maintained and up to date, they contain the appropriate information and all required checks are completed prior to new staff starting in post. However during the visit we met with an outreach worker from the organisation Sense who was visiting an individual regularly to provide multi- sensory support. Staff nor the management at the home were aware that this person was visiting the home to carry out this work and were under the impression that the person was a relative or representative of the individual. It is important that the home is aware of the status of all visitors to the home and that proper authorisation has been checked to ensure they are safe to work with vulnerable persons. Care Homes for Adults (18-65 years) Page 37 of 50 Evidence: The home has a corporate induction programme which all new staff undertake, this ensures that they know the home and their responsibilities, the programme meets Skills for Care Common Induction Standards and the existing Learning Disability Award Framework (LDAF). We saw records to confirm this training was completed. All new staff work alongside more experienced staff as part of their induction which was confirmed in discussions. There is an annual training plan in place and records seen and discussions with staff show that they are generally up to date with safe working practice training that includes: fire safety, food hygiene, moving and handling, infection control and first aid. Records show that a small number of staff require annual updates in some courses, however this is mainly for staff who are on long term absence and the manager confirmed that training updates have been scheduled for remaining staff where possible. Other courses they have accessed this year are: safeguarding adults, health and safety, equality and diversity and management of challenging behaviour. At the last inspection there was evidence that staff were accessing arrange of specialised training which would provide them with the skills to care for people with more complex needs however due to staff leaving, this knowledge base and skill has been affected. The manager has identified that staff need more training in areas such as nutrition, PEG feeds, communication, person centred care, sexuality awareness, mental capacity legislation and autism which he has started to arrange and access. Staff have accessed training recently in PEG feeding and communication with further support and training in these areas arranged. The lead in person centred care approaches from the CTP is scheduled to deliver training to staff in October and sexuality awareness support will be provided by the community clinical psychology team. The home has maintained the target for the number of care staff who should gain a National Vocational Qualification (NVQ) at Level 2.Currently 67 of staff have achieved this qualification which is a very positive achievement given the turnover of staff in recent times. Support systems for staff at the home have been affected by the management changes in the home, discussions with staff and records show that the supervision programme has not been maintained for sometime. One staff member told us I cant remember the last time I had one, probably about a year ago. The manager is addressing this issue and has developed a new supervision schedule which is to be implemented over the next few weeks. Records also showed that staff have not had a yearly appraisal where their performance and training needs can be discussed formally. Staff meetings have continued to take place regularly. Care Homes for Adults (18-65 years) Page 38 of 50 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. Management changes have affected the quality of service provision at the home. People tell us that the manager is working hard to make the required improvements. Health and safety for people living and working at the home is promoted via the policies and procedures in place but staff training does not necessarily result in a skilled and competent staff group. Evidence: There have been a number of management changes since the last inspection visit which has affected the overall running and development of the service, this has impacted on the quality of care for the people live at the home. Comments in relatives surveys reflect this, Changes of staff are too frequent especially at management level ,After a period of stability there are changes again, hoping the new manager will stay and As my sons advocate I am concerned about the turnover of managers and staff over the past few years and hope the current manager will be in situ for a longer period of time. This would greatly benefit both clients and staff. Another person wrote There has been a large turnover of managers that have always left loose ends. Mr Keith Bush is the new manager for the home and was appointed in June. He is a Care Homes for Adults (18-65 years) Page 39 of 50 Evidence: registered nurse with learning disability qualification and has held previous management positions. He has not completed the Registered Managers Award. The manager told us that he intends to submit his application to the CQC for registration as the manager of Gatehouse Cottages. Staff members spoken with described the manager as approachable and supportive. Comments from relatives include The current manager has very good communication skills and operates a policy which encourages open discussion. Health care professionals and staff told us that the manager and deputy manager are working hard to make improvements at the home and we acknowledge that some improvements have been made following issues and concerns raised earlier in the year. However there are continuing concerns about staff turnover, staff competency, activity provision, the environment and health care needs not being fully met. The manager told us that the lack of administration support in the office has hampered the amount of time he has been able to spend on the floor, we feel that it is vital the manager spends more time getting to know each person who lives at the home to understand their individual needs and that he can also spend time working with and supporting staff to improve consistency in the quality of care provided. The manager said he was well supported by senior management and had access to supervision, advice and support from them as required. He confirmed that senior management visited the home regularly and reports to support visits made under regulation 26 of the care homes regulations are completed and held at the home. The home has a quality assurance system in place that consists of monthly audits and surveys to relatives to obtain their views on how the home is managed. The manager told us that the company send out the surveys and provide the home with the results. It is recommended that other relevant parties are surveyed for their views including visiting health professionals, care management and staff. The home undergoes an external audit from the company usually annually, however due to concerns raised about the service these are taking place more regularly and prior to the inspection visit we were sent copies of audits carried out in May and August. These audit results showed that the overall rating for the home was poor in June and this had moved to adequate in August. Meetings have been held with people who use the service, minutes detail improvements requested to the decor in The Lodge and Studio areas and new equipment such as T.V.s and a karaoke machine. Relatives also have access to regular meetings with the management of the home. The manager is aware that the results from the quality monitoring programme need to be published. We looked at some of the health and safety documentation in the home. There are appropriate policies and procedures in place, environmental risk assessments have been completed and fire safety arrangements are good, in house fire tests and drills take place consistently and the fire systems in the home have recently been checked by an Care Homes for Adults (18-65 years) Page 40 of 50 Evidence: authorised person. There is a gas safety certificate in place, bath hoists and moving handling equipment have been serviced and water temperatures are tested on a regular basis. We noted that regular checks are carried out on the safety of peoples wheelchairs. Staff have completed health and safety training, including first aid, basic food hygiene, fire and infection control. Accident records were completed properly and audited by the management. Attention is needed to cover a number of hot water pipes accessible to individuals who reside in The Lodge area, this will better protect their safety. As detailed in a previous section of the report, handwashing facilities must be provided in the laundry area in the main facility.The building is secure. Care Homes for Adults (18-65 years) Page 41 of 50 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 42 of 50 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 2 14 10/12/2009 Individuals assessments must be reviewed and updated to reflect changes in need. This will inform the care plans to ensure peoples health, personal, emotional and social needs are met. 2 6 15 Individual’s behaviour management plans must be evaluated and updated regularly to reflect changes in need. 05/12/2009 This will ensure that the plans reflect peoples needs and provide direction for staff to meet these needs consistently. 3 6 15 More detailed communication 10/12/2009 plans need to be put in place for individuals with complex needs in this area. Page 43 of 50 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 will ensure peoples needs are properly met. 4 6 15 Individuals care plans must 10/12/2009 be evaluated regularly and updated to reflect changes in need. This will ensure the plans accurately reflect peoples needs and choices and provide direction for staff to meet needs consistently. 5 9 13 Individuals risk assessments 10/12/2009 must be evaluated and updated to reflect changes in need. This will ensure potential risks to the individual have been identified and people can be supported to manage those risks. 6 14 16 People who use the service 10/12/2009 must receive support to take part in activities they choose and to maintain contact with the local community. People need opportunities to take part in activities they enjoy to meet their diverse needs. 7 18 12 Concerns raised during the 26/11/2009 Care Homes for Adults (18-65 years) Page 44 of 50 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 visit about the standards of personal care support for one individual must be looked into. This will ensure the individual’s needs are met. 8 19 12 Systems in the home to provide individuals with safe percutaneous enteric (PEG) feeding must be in place. 26/11/2009 This will ensure peoples health needs are safely met. 9 19 12 Information about peoples health and support needs must be up to date and reviewed regularly; this includes health action plans and guidance provided from the community health team. 10/12/2009 This will ensure peoples health needs are appropriately planned for and met. 10 20 13 Adequate and clean 18/12/2009 medication storage facilities must be provided in the main facility. This will ensure people are protected from harm. 11 23 13 Incidents in the home must 26/11/2009 Care Homes for Adults (18-65 years) Page 45 of 50 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 be recorded properly with detail of action taken to reduce further risk of harm. This will ensure peoples safety. 12 24 23 Ensure the recreation room 20/12/2009 in The Lodge is fit for use by the people who live there. This will ensure people will have adequate facilities which meet their needs. 13 24 23 05/12/2009 A maintenance and refurbishment programme, with appropriate timescales for completion must be developed and provided to the CQC which details all the decorative, maintenance and refurbishment work required in all three areas of the home. This will ensure that people live in a home that is safe, homely and attractive which meets their needs. 14 30 16 Hand washing facilities must 10/12/2009 be provided in the laundry area in the main facility. This will ensure that people Care Homes for Adults (18-65 years) Page 46 of 50 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 who live and work in the area are protected from harm. 15 35 12 Further staff training and guidance must be provided to staff to ensure they have the skills to communicate effectively with the people they support. 20/12/2009 This will ensure peoples needs and choices are met. 16 36 18 Systems must be put in place to ensure that all care staff have supervision at least six times per year. 10/12/2009 This will ensure staff receive regular direction and support to carry out their work properly and any issues can be discussed and documented and actions planned to address any shortfalls in practice. 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 2 People, their families and representatives should have clear and accurate information about the Service at Gatehouse Cottages within the contract/ statement of terms and conditions and this should include the fees, payable by Care Homes for Adults (18-65 years) Page 47 of 50 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 whom. This will better protect peoples rights. 2 6 Supplementary records such as monitoring records for fluid/ food intake, bowels etc should be maintained accurately to ensure people receive the support they need. Care plans should follow more person centred planning principles. These need to reflect peoples real experiences, their needs, wants and aspirations and should demonstrate that they or their representatives have been involved in the development. The organisation should review all of the information that is required by individuals and ensure it is produced in a format which is accessible to them. Formal reviews of peoples care support should take place every six months to ensure people are receiving the care that they need and that the care plans are recording this accurately. People should receive appropriate and agreed budgetary education and support within their capabilities to ensure their rights and choices are upheld. The home should review the provision of suitable drivers for the existing transport at the home or provide alternative transport to enable individuals easy access to the community. All of the people who live in the home should have the opportunity to take a five day holiday or a series of one day outings of their choosing so that they are given a break away from the people they live with and have enjoyable, different experiences. Individualised care support at meal times should be promoted throughout the home at all times. The breakfast menu in the main facility should be expanded to provide adequate choices to meet peoples individual meal preferences. Put in place clear systems to record peoples weights so that any issues can be easily identified and followed up. Incidents of behaviour which pose a challenge to an individual or other persons should be audited regularly to 3 6 4 6 5 11 6 13 7 14 8 9 17 17 10 11 19 23 Care Homes for Adults (18-65 years) Page 48 of 50 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 identify any potential triggers which would inform best practice. 12 23 The status of all visitors to the home must be understood by staff. This will ensure that persons visiting the home to provide support to individuals have the appropriate authorisation and that they have undergone checks to ensure they are safe to work with vulnerable people. Action should be taken to eliminate the stale odour in the lounge and to ensure carpets in the home are clean. All staff should be provided with Autism training that follows best practice guidelines so that staff have the skills to support the people that live in the service. Annual appraisals should be completed for all staff which give clear information on the training and development needs of the worker to ensure training plans and priorities reflect the training and development needs of the staff team. The organisation should ensure that the homes Quality Assurance system is developed to include consultation with stakeholders, that information is collated and a written report is produced. 13 14 30 35 15 36 16 39 Care Homes for Adults (18-65 years) Page 49 of 50 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. Copyright © (2009) Care Quality Commission (CQC). 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