Inspection on 19/02/09 for The Lodge

This inspection was carried out on 19th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge 12/01/10

The Lodge 17/09/07

The Lodge 30/08/06

The Lodge 29/06/05

The Lodge 08/12/04

The Lodge 24/08/04

The Lodge 01/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lodge, The Lodge, The Bridge End Eldersfield Gloucestershire GL19 4PN     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: Martin George     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Lodge, The Lodge, The Bridge End Eldersfield Gloucestershire GL19 4PN 01452840088 01452840088 eddavics53@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Glevum Farm Trust care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 9 Date of last inspection Brief description of the care home The Lodge provides residential accommodation for a maximum of six adults, one of whom is over the age of 65, who have learning disabilities. The home is located in Eldersfield and forms part of a working farm. The farm is staffed separately from the residential accommodation and offers day activities in farming and horticulture to individuals from the surrounding communities. 9 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home The day activities of residents who live in the home are not limited to the on-site facilities and are developed in a way that reflects individual interests outside the farm environment. Glevum Farm Trust owns the property. The trustees are registered as providers and as such carry responsibilities for the overall development and management of the home. Mr E Davies is identified as the Trust Manager, Company Secretary and Responsible Individual. The home currently has two acting managers. The Glevum Farm Trust operates another establishment in New Street, Ledbury, Herefordshire, which is included in the registration as an annexe of the Lodge. The fee levels for The Lodge range from £314.06 to £584.85 depending on individual assessed needs. Charges that are additional to the fee include personal toiletries and clothing, holidays, major extra outings, hairdressing, leisure and activities. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out by a single inspector between 09:45 and 16.15. As part of the inspection all National Minimum Standards defined as key by the Commission for Social Care Inspection were considered. Information about the performance of the home was sought and collated in a number of ways. Information from the last key inspection report and the Annual Quality Assurance Assessment (AQAA), submitted by the home prior to the inspection, were analysed to formulate a plan for the inspection. Through these sources of information we were able to form an initial idea about the quality of care provided by the home. On the day of the inspection we spoke to the responsible individual, three members of staff and had brief interaction with two people living at the home. We also observed practice, which provided evidence in support of the records we also checked on the Care Homes for Adults (18-65 years) Page 6 of 29 day. This approach allowed us to assess how well outcomes were being met for those receiving a service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed at the outset and inform the care plans that detail how their needs will be met. People need to be better informed about what the home does. Evidence: Assessments of need are completed prior to admission with significant contribution from the placing authority. These assessments of need inform the care plans developed by the home and show how the home will be supporting the person and meeting their needs. The AQAA states that people can request a review of their care plan at any time and the records looked at on the day of inspection supported this, showing how the home tries to involve people in the development of their plans. The statement of terms for members of the household gives information about fees and what is included in those fees. We asked to see the welcome guide provided to people to explain how they will be cared for but unfortunately none of the staff on duty were able to locate one. We were given absolute assurance that the welcome guide has recently been updated but the fact it was hard to find is a little worrying, given that this is a document for people living at the home and their families that explains what the service does. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: Where there is a need to restrict a persons choice or freedom this is included in a risk assessment. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in planning for their care and risk assessments focus on their abilities. Evidence: Each person living at the home has a strengths and needs care plan. Within these plans there is evidence that people have contributed to how their needs should be met. Each individuals abilities are identified and any risks associated with those abilities are assessed and safeguards put in place to protect the person from preventable harm. There is not enough information in the care plans to show how the range of healthcare needs that people have are being met and this is an area of practice that needs further development. There is a need for the home to develop staff skills in assessing capability of people to make decisions, in accordance with the Mental Capacity Act, to ensure the right of people to make decisions is only withdrawn or restricted once an appropriate assessment has been completed. Any outcome from an assessment must be recorded Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: in the care plan to show how the needs of the person will continue to be met. Care planning is an ongoing process and managers need to show more vigilence in ensuring that staff date all documents, so that progress, or lack of progress, toward meeting outcomes can be tracked. Lack of dates also made it difficult to always see when peoples plans had been reviewed. Although there was evidence to show that people are encouraged and supported to manage financial transactions as independently as possible this level of capability needs to be formally assessed in accordance with the Mental Capacity Act to ensure that people continue to be safeguarded in an area of their lives where lack of capability could potentially leave them vulnerable. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are occupied constructively and involved in day to day activities as much as possible. Evidence: Each person living at the home has a routine sheet covering each day of the week, which covers day and evening activities and meals. As with other documents there are several without dates so it is difficult to determine when these have been reviewed to ensure that peoples changing needs have been recognised and responded to. Observation of interactions between staff and people living at the home showed a relaxed and respectful relationship. We observed one member of staff having a discussion with a person to find out his preference for his dinner later that day. We also observed staff encouraging and supporting people to contribute to daily routines, such as hoovering and washing up. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: We saw risk assessments that covered both in house and community activities to ensure people had the opportunity to do things, whilst being kept safe from preventable harm. Once again it was not always easy to find when risk assessments had been reviewed, so making it difficult to be sure whether the risk assessments still continued to safeguarded people. We noted that weight gain/loss is regularly monitored but it was difficult to link this with nutritional monitoring because only one person had their food intake recorded. The home should evidence that nutritional needs are being met and that people receive a nutritionally balanced diet. People are involved in food shopping and during our visit one person returned with a member of staff after having been to the supermarket for the weekly shop. Records seen and discussions with staff and people living at the home evidenced that links with family are encouraged and supported by the home. We found no evidence of how the home deals with people who wish to have intimate relationships but equally had no reason to suspect that intimate relationships would be seen as a problem. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with personal and healthcare issues but how this meets their changing needs is unclear. Evidence: Records of all medical appointments are kept up to date showing that the home is responsive to regular and unexpected health needs. The AQAA states that people are registered with a General Practitioner and dentist of their choice. Although there is a section in the care plans for healthcare information these are inconsistently completed, some containing limited and vague information and others containing no health information at all. We were told that it was thought the responsibility for healthcare laid with health professionals, so the home did not prioritise this aspect of recording. The home is however required to monitor peoples health and therefore needs to show how they do this in the healthcare section of the care plan. Through discussions with the responsible individual and three members of staff we did not identify any concerns about the impact on people living at the home, but the ability of the home to provide evidence of how healthcare needs are monitored and responded to needs to be addressed through the introduction of health action plans. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: The level of personal care provided to people is responsive to their needs and we observed how staff regularly checked with people to see if they needed help with things. The medication system being used by the home was introduced on the advice of a pharmacist and we are satisfied that it is a system that satisfactorily safeguards people from preventable medication errors. Although the system safeguards people we were less happy to be told that none of the staff have received accredited medication administration training. A small number of staff were shown how to use the system by the pharmacist at the time it was introduced but all staff are involved in administering medication. Medication administration records (MAR) that we checked showed no evident shortfalls but to ensure that people continue to be fully safeguarded from medication errors it is necessary for all staff to undertake an accredited medication administration course. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People need to be given information in a suitable format on how to complain and should be cared for by staff who are conversant with current safeguarding procedures. Evidence: It was very difficult to determine how well complaints are dealt with by the home as the complaints records could not be found. We were told it was likely that one of the people living at the home had taken it as he had recently been using every opportunity to take things that were not locked away. We were assured that complaints are taken very seriously and the AQAA states that how to complain is explained in the welcome guide issued to people living at the home and is done with the use of symbols. Unfortunately a welcome guide could not be located to provide evidence of this, although we were categorically assured that this document had been recently updated. The home needs to ensure that people living there are kept fully informed of how to express disatisfaction and records need to show how this is managed. One person living at the home we spoke to indicated that he knew what a complaint was and when asked if would be happy to make a complaint if unhappy he said yes, but it was difficult to be sure about his level of understanding. The home has a policy on the safeguarding of vulnerable adults and on whistleblowing. The training records we looked at showed a training shortfall because we could find no evidence that any of the staff had completed Protection of Vulnerable Adults (POVA) training to provide them with up to date knowledge on safeguarding processes that Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: are designed to protect the vulnerable people they care for. Our observation of practice on the day gave us no concern that people were at risk but because safeguarding is such a critical area of practice it is necessary for those with primary responsibility for vulnerable people to be conversant with current safeguarding procedures. Discussions with staff suggest a sufficient level of knowledge about basic safeguarding procedures that should ensure people are not placed at risk of significant harm. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and reasonably well maintained environment. Some hygiene standards need better monitoring. Evidence: The home provides a comfortable environment for people living there. Decor is in a reasonable state and furnishings are of good quality. All equipment is of a domestic quality so that people can access it freely if capable to do so. The home uses the safer food, better business system but is not using it as fully as it should to show how risks associated with infection control and cross contamination are being reduced or eliminated to safeguard people living at the home. Although the fridge and freezer temperatures are being monitored regularly there is no evidence that the cleaning schedule, a critical infection control measure, is being followed. We were told that proper cleaning does take place but there is no recorded evidence to show how people living at the home are protected from risk. The annexe in Ledbury, part of the registration, is currently occupied by one person, which is likely to remain the case as it is felt this meets the persons needs. The ground floor of the annexe is now rented out to a member of staff. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: People are supported to access local amenities but becaue of the somewhat isolated location of the home transport has to be provided. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a consistent and flexible staff team, but support and training for those staff needs further development to ensure people continue to have their needs met. Evidence: The recruitment practices adopted by the management ensure that people living at the home are provided with staff who have been properly vetted. All necessary checks are completed before staff are allowed to start work at the home. We were told that people living at the home are not actively involved in any stage of the recruitment process but we were assured that if they expressed a dislike of any prospective candidate when they came to look around this would be taken into account when deciding on appointments. Records identified that some staff need to update their training to ensure their knowledge and skills enable them to provide people with care that is consistent with current guidance and regulation. Safeguarding, safe food handling and health and safety in the workplace all appeared to either be out of date or absent, meaning that people living at the home may be left vulnerable to the risk of inadequate standards of care. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: The AQAA states that equality and diversity training takes place but records we looked at provided no evidence of this. Sensitivity to the diverse needs of people with complex care requirements means staff need to be provided with this training. The home needs to ensure that the induction programme provided to staff is consistent with the Skills for Care induction programme to ensure new staff are given the initial knowledge and skills required to provide safe care to vulnerable people. Most staff have now completed the required National Vocational Qualification (NVQ) to evidence they are competent to care for people living at the home. Through discussion we discovered that the home thought that because staff were doing their NVQ this met the training requirement but service area specific training is still required to ensure staff maintain the necessary knowledge and skills to provide safe care. The majority of staff are part time and this allows a degree of flexibility to ensure there is consistent care of people from staff with whom they are familiar. Discussions with those on duty gave us a mixed view of the levels of support given to staff and how this impacted on morale. There seemed to be a general consensus though that levels of support could be improved. Improved levels of support may improve morale, which should reflect positively on those living at the home. We were unable to see staff files on this visit but discussion with the responsible individual gave us assurance that they contained all necessary information. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who receive inconsistent levels of support and direction, due largely to the continuing absence of a registered manager. Evidence: There is still no formally recognised registered manager in place and currently there are two acting managers. One of these used to be the registered manager of the home some years ago and the other acting manager is currently completing his NVQ 3 award, after which he will be completing the relevant management award, with a view to applying to become the registered manager. Bearing in mind the mixed response from staff about levels of management support (mentioned in the staffing outcome section) it will benefit them to know who is in charge, with the associated benefit for people living at the home who will have their needs met by staff who are given clear direction and consistent support. This long standing shortfall is contrary to regulations and needs to be rectified. To ensure the home complies fully with regulations an application needs to be submitted without undue delay. Quality assurance systems in the home are underdeveloped and do not clearly show Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: how service delivery leads to improved outcomes for people or how people are protected from preventable harm through the safe working practices adopted by the home. The Responsible Individual explained to us that he thought the completion of the Annual Quality Assurance Assessment (AQAA) was sufficient evidence of quality assurance. The home needs to develop a system that shows how they are continually self monitoring working practices and shows how they develop and/or improve services in response to consultation with people living at the home and their families or advocates. We noted that first aid boxes were only checked twice in 2008, the last time being in May. According to the records we looked at this was also the last time they were restocked. More frequent checks are recommended to ensure that effective initial intervention can be provided to people in the event of any minor injuries. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 11 An application for a registered manager must be submitted without undue delay. The absence of a registered manager is contrary to regulations 30/06/2009 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 welcome guide needs to be readily available for people living at the home and their families in a clear and accessible format, providing them with information about services and costs so they know how their needs will be met. Peoples capacity to make safe decisions about a range of day to day issues need to be assessed in accordance with the Mental Capacity Act to ensure they are safeguarded from potential vulnerability. The home should develop the way it monitors nutritional intake of people to show that their nutritional needs are being met and that they are being provided with a nutritionally balanced diet. Page 27 of 29 2 7 3 17 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 19 The healthcare section of peoples care plans should be fully completed to show how the home monitors and responds to their ongoing healthcare needs. The introduction of health action plans should happen without undue delay. All staff need to complete an accredited medication administration course to ensure they continue to fully safeguard people from preventable medication related risks. People living at the home need to have information about how to complain in a format suited to their needs that is readily available to themselves, family and advocates. A staff training programme should be developed that equips all staff with the necessary knowledge and skills to safeguard vulnerable people and gives them opportunities to refresh their knowledge at required intervals to ensure people continue to be cared for by staff who are conversant with current legislation and practice guidance. Regular one to one support should be provided to staff to ensure proper monitoring of standards and practice so ensuring people living at the home are consistently safeguarded by competent workers. The home needs to fill the vacant registered manager position without undue delay by supporting the acting manager in completing required qualifications so he can apply for the post. The home should introduce a quality assurance system that provides evidence of continuous monitoring and development of service delivery and how this improves outcomes for people living at the home. 5 20 6 22 7 35 8 36 9 37 10 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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