Inspection on 24/11/08 for Ladignac Residential Care Home

This inspection was carried out on 24th November 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ladignac Residential Care Home 38 Crookhays Shaftesbury Dorset SP7 8DX The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Still Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 32 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Ladignac Residential Care Home 38 Crookhays Shaftesbury Dorset SP7 8DX 01747854978 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) : Ms Janet Deaville care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) The maximum number of service users who may be accommodated is 3. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Ladignac is a small home for 3 people who have a learning disability. The manager is Janet Deaville Weekly fees were 495.93 pounds to 657.36 pounds. Care Homes for Adults (18-65 years) Page 5 of 32 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 How we did our inspection: Care Homes for Adults (18-65 years) Page 6 of 32 This is what the inspector did when they were at the care home We talked to some people who lived at the home. We also talked to the manager. We looked at some paperwork. This included care and support plans and health and safety paperwork. We looked at where the medicine is kept and what is written down. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well People living at the home say what they want to make things better. People have the support they need. Staff know how to meet each persons needs. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 8 of 32 People living at the home have more activity if they want. People living at the home are helped to make more choices. What the care home could do better People living at the home must have contracts about what the home gives them. Care Homes for Adults (18-65 years) Page 9 of 32 The information about the home must be clear. Care and support plans must have more information so staff know what people living at the home want in their plan. . When people living at the home are given medication there must be a record to show it has been given. The owner, Janet will do training with other staff about keeping people who live at the home safe and to help people to say things they are worried about. Care Homes for Adults (18-65 years) Page 10 of 32 Electrical equipment must be tested to make sure people are safe. It is important to check that there is always enough staff. Staff need to have more training to make sure they know how to meet the needs of people living at the home. Care Homes for Adults (18-65 years) Page 11 of 32 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 Peter Still 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 32 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 . A review and expansion of the Statement of Purpose will ensure people have the information they need to either make a decision of moving to Ladignac or about what the Home provides and its aims and objectives. The review, being undertaken, of policies and procedures about assessment of needs and information concerning admission will ensure individual aspirations and needs are fully assessed prior to an admission. Individual contracts, setting out terms and conditions of residency at the home will protect the interests of people who live at the Home. Evidence: We reviewed the Statement of Purpose and found it to be too basic. Some changes were made immediately during the inspection, however further review is needed. For example, detail about activity for people living at the home gave an impression that it may be constrained by staff time limits, indicating a lack of staff time. We discussed this and the owner said that there was now much more activity and agreed the document did not provide enough detail and will revise the document. The Statement Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: of Purpose should set out the aims and objectives and philosophy of the home, making clear the services and facilities provided. The Statement of Purpose does provide a picture format. No new people have been admitted to the home for some years and it was understood that no changes are envisaged, however the owner will review and update the admission policy and procedure. Contracts of residency could not be found on any file. Such a contract for each person living at the Home would provide a costed contract/statement of terms and conditions between the home and the individual. Contracts must be kept up to date, whenever there are changes. Care Homes for Adults (18-65 years) Page 15 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A review of the system for care plans and about the detail they provide, will give further protection and support to people living at the home. People living at the home have support to make decisions and choices in their lives. Further development and consideration of risk taking to support the independence of people may help to enhance peoples lives. People living at the home can be assured that confidential information will be handled appropriately. Evidence: We reviewed three care plans and each had photos of the person living at the Home. This provided key brief detail relating to the individual, including the daily record, which had good detail recorded. The daily record included activity people were involved in such as a day trip to a canal and details of the way an individual was feeling on the day and contacts with family and external professionals. Each file Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: contained a risk assessment, which had been reviewed. The care plans for people living at the home were up to date in terms of review, however they were very basic and lacked sufficient detail; the format needs to be reviewed to provide more space. We also found the care files difficult to read through and it would be helpful to include clear tabs to make it easy to locate information. The current system could present a risk of information being within the file but lost. The My Book, which provides detail about individuals, was good and laid out well. The new owner had taken over the previous system and was aware that it needed to be improved. The Annual Quality Assurance document completed by the owner, said that Residents sit in on their care plan reviews to discuss all aspects of their lives. Two people spoken with were able to say they are involved in making decisions about their lives. We found evidence that people living at the home were supported to make decisions and choices in their lives. For example the financial records showed details of clothes purchased and about a chair one person needed. The home has three monthly resident meetings, which were well recorded and showed that people were encouraged to say what they wanted in their daily lives and about the different things they wanted to do. We reviewed the file concerning Risk taking, which was well recorded and did provide evidence of the home supporting people to be independent. Whilst the standard was considered to be met, it should be reviewed to consider more areas of risk for people, with clear detail of how those risks can be supported and reduced. Detail reviewed in the files included road safety and getting lost. Confidential information about people who live at the Home is kept locked away. Care Homes for Adults (18-65 years) Page 17 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home are encouraged to maintain positive relationships with those important to them. People benefit from many amenities local to the Home and have a range of opportunities for leisure activity, and they are encouraged to talk about the activities they wish to enjoy. People are supported to ensure they have a good diet. Evidence: The last inspection noted that activity was an area in need of improvement at the home. For example people wanted to go out more to pubs and cinemas. These standards were looked at in some detail at this inspection. Evidence from residents meetings showed that activity is being discussed with people who live at the Home. The daily record book gave evidence of activity, e.g. a trip out to the Avon and Kennett Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: canal, meals out, including pub meals, cinema shows, shopping etc. One person declined a holiday but another person had been to a holiday hotel in Cornwall, set up to support people with a learning disability. This person said they had enjoyed their holiday. Local facilities are close at hand and were being used, for example: swimming, the local leisure centre, Arts centre and Theatre productions. We reviewed the current list of activity available and it was clear that the wishes of people have been considered and there is now much more opportunity. The home is run by two staff, with only one rostered as working at any one time to care and support individuals. However when the owner is not scheduled to be working, she often takes one or more residents out to places they wish to go to, which is the way the owner has found to ensure there is an increase in activity available away from the home. One person goes to their family every weekend. During the week, all people living at the home spend their day at the local education centre, run by Dorset County Council. Each person has their own daily routine and two people spoken with were able to indicate that they are encouraged to be independent and to make choices. On the day of inspection, we waited for people to return from the education centre, to meet and speak with them. Two people confirmed that there is now more activity available to them and spoke of trips out. People eat together in the kitchen/dining room. People have discussion about the menu and diet is monitored. One person had wished to lose weight and had chosen to have more salad for the evening meal. The menu plan for 17/11/08 was reviewed and a 4 week cycle was being used as the basis for the menu. The menu reviewed was balanced and nutritious. At the weekend, people have full choice and often have different meals. Fresh fruit was said to always be available and was seen for people to have as they wished. People who live at the home do the shopping with staff. Care Homes for Adults (18-65 years) Page 19 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the Home are provided with support in the way they wish and their health care needs are assessed and responded to so their needs can be met. The Medication administration system protects people, however where a medication administration record has not been signed immediately following medication being given, it may put a person at risk. Evidence: People are supported in having their own individual routine. Evidence from the daily record book, showed support was given flexibly, dependent on how a person was feeling on a particular day. Care files showed good evidence of communication with external professionals to ensure needs were recognised and assessed. During the inspection, one GP rang to discuss medication with the owner. A survey response from a parent about how people are treated said: From regular contact by phone and Home book, we are happy about the treatment of the individual. we have a good system of interaction between carers and ourselves. One professional said: They are a very positive, caring and supporting team. They provide a homely environment to individuals with complex needs. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: We reviewed the medication for people living at the Home for the day of inspection. It was found that two medications had not been signed by staff as having been administered. Other medication recording was correct. A review of the process for the administration of medication is important to undertake and an update of staff training in the administration of medication should be sought. Care Homes for Adults (18-65 years) Page 21 of 32 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 who live at Ladignac can be assured the owner will listen to and act on concerns or complaints. Staff need further training in the protection of vulnerable adults to ensure people continue to be protected. The system of handling peoples money must be reviewed and improved to ensure their financial interests are protected. Evidence: It was evident that people living at the home had been able to raise concerns with the owner and that these concerns had been responded to appropriately. People living at the home confirmed that they were satisfied with the actions taken. We considered that it may not be easy for people to communicate a concern if they had one, however, in speaking directly to people living at the Home, there was some indication that people would talk to their family, the owner or to staff at their education centre and one person said they would talk to the owner. The home has an adult protection and whistle blowing policy provided by Dorset County Council. Staff need to have an update of their training in the protection of vulnerable people and the owner who is now running the Home, needs to undertake the second more in depth training. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: No safeguarding referrals had been made since the last inspection. We reviewed the cash and receipts for one person and checked it against the record, finding it to be correct. We also checked the account for an amount spent on clothes and could not see a receipt for the amount. The provider could not easily find it and needed to ring the other member of staff; the receipt was then located. We reviewed the system and found that it was not tight to safeguard people. All receipts for all residents were held together and could not be easily checked against the recording book, which was well recorded. Care Homes for Adults (18-65 years) Page 23 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Ladignac provides a comfortable home for the people living there. The annual testing of portable appliances must be completed to protect people living and working at the Home. Evidence: We made a tour of the home and found it was well maintained, clean and attractively decorated. People living at the Home have their own bedrooms, which they have personalised. The large kitchen/dining room was a focal point and the owners spacious lounge adjoins it; we were told people often use this lounge as well as their own small lounge. The home has a conservatory, which is used flexibly and a new exercise bike was seen in this room. The owner has a plan to improve the one ground floor bedroom. The owner has her own private accommodation within the Home. We could not find evidence of tests to ensure that portable appliances are in a safe condition and this work needs to be completed. Outside, there is parking to the front and a large garden to the rear. The garden provides a variety of areas of interest and has the benefit of a summer house. The Annual Quality Assurance Assessment says that people often enjoy time privately in their own rooms. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the Home are supported by staff who know and understand their needs and are able to meet them. By regular review of staffing arrangements and numbers of staff, people can be assured their needs will continue to be met. Evidence: We reviewed the job description for the one member of staff, which set out the role, responsibilities and qualification. Supervision records were reviewed and were well recorded and up to date. Since the last inspection, there have been changes to the ownership and management and the owner is now living at the home and fully responsible for the care and support provided. Continuity of staff has been provided by the one other member of staff working at the home for nearly four years. We questioned the owner about what would happen if a member of staff was sick and she said she has contingency plans, which include support from the previously and recently registered manager. There may not be staff at the Home during the week, when people attend the education centre and the owner said that staff can be contacted if people wished to return to the Home. Staff would ensure they could Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: support people at the Home if needed. A survey response from the education centre said that We correspond regularly between here and the Home - This gives opportunity to raise any health concerns and deal with them as and when appropriately. We considered that there is good communication between the Home and the education centre. Since people living at the home have experienced a lot of change recently and their needs may also change, it will be good practice for the Owner to regularly review the staffing levels and structure, including when staff are available, to ensure the needs of people continue to be met. Records reviewed showed that the member of staff had completed required training and was due to attend updates to that training. Other training planned includes: Mental Health awareness; total communication and adult protection. The owner has a training package concerning work with people with Autism and said she will work through this with the member of staff. The owner had completed half of the Registered Managers Award before the awarding company ceased to trade and will transfer her work to a new training provider. One professional, responding to a survey question about what could be improved said: Perhaps some additional training on working with people with learning disabilities would be beneficial with particular emphasis on mental health problems. We reviewed this suggestion and considered that whilst the owner is a registered nurse with learning disability as her specialist area, her recent work has not been concerned with learning disability or mental health. It would be helpful for the owner and her member of staff to attend training as suggested, which will ensure that they are able to provide up to date best practice to support the people at Ladignac. The Annual Quality Assurance Assessment, completed by the owner showed that she had already considered plans for training in mental health awareness, which demonstrates that she has been proactive in terms of training. Care Homes for Adults (18-65 years) Page 26 of 32 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 . People living at the home have the benefit of an owner who is demonstrating commitment to ensuring the quality of life for people is improved and that the needs and wishes of people are listened to and acted upon. Evidence: The management of the Home has changed twice since the last inspection, which is likely to have been difficult for people living at such a small Home. The new owner took control of the home with a registered manager in May 2008 but by the end of October, it was necessary for the owner to move in to Ladignac and take control of the Home. Personal reasons had caused this sudden change of direction and this also made it necessary for the newly registered manager to leave her post. Since October, the owner has run the Home with the remaining member of staff who had worked at the Home for nearly four years, which has provided continuity. People spoken with, talked about the previous owner who had established their Home in 1997 and there were indications that people felt a loss, however there had been communication which had been helpful. Since the owner took control of the Home, a number of steps have been taken to Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: review and update policies and procedures. Meetings with people living at the Home have started, to ensure wishes and needs are known and people are involved in making decisions about their daily life at the Home. Quality assurance has begun and Survey responses shows good communication with professionals outside the Home. Examples of comments include: I have met the carers and have found them to be skilled in many areas, with vast experience in this work. I find the carers to be easy to talk to, approachable and willing to discuss issues as they arise. I have found the carers to be positive and forward thinking. The service does well with: Individual care plans; Positive support to meet peoples needs; seek advice from professionals when they feel it is needed and follow/appreciate input. A parent said We have a good system of interaction between carers and ourselves. The owner was aware of the importance of health and safety to ensure the welfare of people is promoted and protected. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be reviewed and expanded to ensure it fully sets out the aims, objectives and philosophy of the home, including its services and facilities. Each person living at the Home should have a written and costed contract/statement of terms and conditions between them and the Home. Review the system used for the care plan files and ensure development of detail is provided to enhance the support provided to individual people who live at the home. Review the care files about risks that may support people in improving their lives, to provide more detail and consider if there are other areas of risk, which should also be included. This will clearly set out the risk, how it can be reduced and who has been involved in agreeing to the steps being taken. Seek a review of the medication process and system for the Home and an update of training for staff. The Page 30 of 32 2 5 3 6 4 9 5 20 Care Homes for Adults (18-65 years) Administration of Medication Assessment record must be signed immediately each medication has been administered. 6 7 8 9 23 23 24 33 Staff should undertake further training in the protection of vulnerable adults. There must be a good system to ensure money held for people protects their financial interests. The annual portable appliance testing must be completed. A regular review of staffing arrangements will ensure any necessary changes, continue to support the needs of people living at Ladignac. Attending training to update knowledge of work with people with learning disability, which includes mental health, will be beneficial to staff. 10 35 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. 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