Inspection on 19/01/09 for Meadoway Homes

This inspection was carried out on 19th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadoway Homes 29/08/06

Meadoway Homes 06/02/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Meadoway Homes 613 Barking Road Plaistow London E13 9EZ     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: Anne Chamberlain     Date: 1 9 0 1 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 31 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Meadoway Homes 613 Barking Road Plaistow London E13 9EZ 02082578183 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) : Meadoway Homes Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The home is registered with the Commission for Social Care Inspection to provide accommodationand and care to four people of either gender, with mental health difficulties and support needs. The premises are situated in East London, Plaistow area on a busy road, close to public transport and other amenities such as Afro-Caribbean Community Centre and West Ham Stadium. Parking is not restricted in this location. The fees at the home cover a wide range between £850 and £1,300. Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This key inspection was undertaken on behalf of the Commission for Social Care Inspaction (CSCI) and the terms we and us will be used throughout. This site visit took place over six hours on one day. We were assisted by the manager and a staff member. We viewed two service user files, two staff files, policies and procedres and key records. We looked at the medication administration arrangements and toured the home and garden. Care Homes for Adults (18-65 years) Page 5 of 31 Care Homes for Adults (18-65 years) Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have their needs and aspirations assessed. They have individual written contracts with terms and conditions. Evidence: We looked at two service user files. Both had adequate assessment information. Service users have a choice about where their formal assessment is undertaken, at the home or at their current residence. They have opportunities to visit the home and spend overnights there before they decide whether they want to move in. Service users had on file contracts. However, although the contracts stated responsibilities of the service users, they had not signed them. The manager had signed them only. The manager explained that service users with mental health needs are often reluctant to sign documentation, especially while they are building up trust in staff. We suggested that the contract is shared with service users, and they are given the opportunity to sign. If they decline then it may be noted that they have had the contract explained and been given the opportunity to sign, but have declined. Care Homes for Adults (18-65 years) Page 9 of 31 Care Homes for Adults (18-65 years) Page 10 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have care plans but they are not up to date, they also have out of date risk assessments. Service users are encouraged to make their own decisions. Evidence: We viewed the care plans for two service users. Service user A had 6 elements to his care plan and he had signed them. The care plans had all been written on 25/2/08 (nearly a year ago) and the review date was 19/8/08. However these reviews had not taken place. The most recent evaluation of the care plan was 30/9/08. There was a care plan for physical and challenging verbal behaviour, but the regular evaluations going back to 2006 stated that there had been no challenging behaviour. It appears that this care plan has been out of date for some time and has not been updated or reviewed. Service user A had a care plan for family and social networks. The last evaluation was on 30/9/08 and the evaluators seem to have been writing the same things since 29/9/06. It is clear that the care plan needs to be updated and new goals set. We spoke to the parents of this service user. They said that they were very happy Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: with his care but wanted him to move on in his life and start to do more with his time. Service user A has interests which can be encouraged and more is said about this in the next outcome area. Service user B had only three care plans. The manager stated that this evidences the progress he has made at the home. The care plans were all dated 13.1.08 (over a year ago) and review was due on 14/7/08. The reviews had not been done and the care plans were not updated. The care plans had been evaluated up until 18/12/08. One care plan referred to inappropriate behaviour. The evaluations stated that there has been no recurrence of this since 22/12/06, so the care plan is clearly out of date and should have been updated. The manager stated that service users are guided and encouraged to make their own decisions. They choose menuss on a weekly basis and buy additional items for themselves. One service users goes out and about on his Freedom pass, another is now very independent, on the point of moving into independent housing. He is out and about in the community all the time. We noted risk assessments on both of the files we inspected. These were comprehensive and included strategies for reducing risks. They had been signed by the manager but not the service users. Service users need to be involved in their own risk assessments and if possible to sign them. As with the contracts they must be given this opportunity and this must be recorded. Risk assessments for service user A were dated 14/5/08 and had not been reviewed or updated. A progress report had been kept only up to 25/11/08 and then apparently discontinued. Keyworking notes had been kept on a weekly basis up until June 2008 and then there was a gap of over six months until 14/1/09 when the next set of keyworking notes was recorded. Service user B had risk assessments dated 25/5/08 and these had not been reviewed or updated. One was for the risk of absconding. According to the manager this service user has progressed and this risk is not now current, so it should have been reviewed and updated. There was a recorded monthly one to one session for 2/10/08 and this was the only evidence of one to one sessions, although the manager stated that a lot of informal keyworking goes on. Keyworking notes which had been monthly earlier in the year had not been completed since 19/11/08. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Service user B had been away from the home from 6.30p.m. on the previous Friday evening and was still away during the inspection on Monday. We were quite concerned about him as according to his file he was vulnerable in a number of ways. However the manager told us that service user B is now very independent and keeps in touch him on his personal mobile phone. The staff were not aware of this. Generally the picture which emerged from the file for service user B and the reality as described by the manager, were quite different and the file was out of date. The quality of recording is discussed separately under standard 41. The homes confidentiality policy states that service user files will be kept in a locked cabinet. On the day of the inspection they were left on the top of a cabinet in the office all day. The manager pointed out that the office is locked. This is true but the storage of files does not follow the policy, so either the arrangements or the policy need to be changed. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to access a range of educational and recreational activities. They have a good community presence and relationships with families are encouraged. Daily routines are individual and meaningful. Meals are healthy and appetizing. Evidence: The manager outlined a number of activities which service users undertake, including gym and meals out. One service user has undertaken a number of college course. There was some evidence to support this. The home has Sky TV and a pool table in the dining room. One service user is keen on gardening. He attends a class and is going to grow produce and flowers in the back garden this year. The whole garden has been cleared and is ready now for planting. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: According to the file of Service user A it is important to distract him from his mental health symptoms and smoking, with enjoyable activities. Service user A really likes football. Every time we saw him on the day of the inspection he referred to it and he was wearing a shirt for his favourite team. He watches football on Sky TV but the manager agreed that he has not been taken out to see a live match in the two years that he has been at the home. He agreed this would be an achieveable goal for service user A. The four service users at the home all have families who are involved with them. As previously mentioned we were able to speak to service user As parents. They visit once a week and once a week he visits them. Another service user has a brother who is his main family contact, and a mum, another has a mum and sisters. We were able to see evidence in the visitors book of frequent family visits. All the service users have individual daily routines, governed by their choice and levels of independence. One service user has progressed to taking on small domestic responsibilities and with encouragement fulfills them. The interaction we observed between staff and service users was respectful. Service users privacy in their own rooms is respected. The two service users whose files we inspected have both made substantial progress in the home, indicating positive treatment outcomes. We noted from records that a variety of foods is available to service users. The fridge and freezer were well stocked. There is a dining room with a large table so everyone can eat together if they want to. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive good personal support and their health care is supported. Medication practice is generally sound, but some improvements are needed. Evidence: Service users are generally quite independent in personal care. However service user A needs a lot of prompting and we observed staff doing this. He also needs assistance to stick to a reasonable smoking programme, spreading his cigarettes out over the day rather than chain smoking. We observed staff assisting him with this. We formed the view that service users receive support in an appropriate and individual way. There was limited evidence on the two files we inspected of the meeting of service users health care needs. There was one item which related to Service user A seeing the dentist in 2006. If a service user sees the GP this is recorded in the daily recording. This was seen for service user A for 7/1/09. The manager stated that all service users have their medication reviewed regularly by the GP. We did see evidence, kept separately, of one service user having regular blood tests. There was no evidence of service users seeing the optician, although the manager stated that an Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: optician had visited the house around July 2008. Service users did not have health action plans. We suggested to the manager that he have a section of the personal files where all activity related to health is recorded and stored. Also that service users are supported to see the optician and dentist regularly. We inspected the arrangements for the administration of medication including the Medication Administration Records Sheets (MARS) and the storage facilities. The MAR sheets were in order but do not have a photograph of the service user attached for identification purposes. Also there were no staff specimen signatures on the medication file. The office has a small medication cabinet which is not adequate to the needs. The medications in the home are stored in a filing cabinet and desk drawer, both have locks, but are quite flimsy and are not bolted to the wall. Also people need access to the other drawers which store other things. The home stores a lot of medication and needs a proper medication cabinet of the appropriate size. We noticed that the keys to the medication are not always kept on the senior member of staff but are sometimes left on the desk. A requirement has been made. The home has good auditing arrangements for medication and there were no discrepancies detected with the medication of the two service users we case tracked. The home supports service users to work towards self medication. The service user who is moving on into independence has achieved this. He only takes one tablet a day and is total control of this himself, under the supervision of the Community Psychiatric Nurse (CPN). The manager stated that some staff have undertaken medication training and some have not. No staff should administer medication without training and a requirement has been made. The home has a policy on death which states that service users would be asked to express any afterlife wishes. However there was nothing recorded on the two files inspected. The home needs to approach this sensitive subject in whatever way they think most appropriate and record the results on file. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an open attitude to complaints and a good system for processing them. Service users are protected from abuse but some improvements need to be made to bring the homes policy into line with requirements. Evidence: We viewed the complaints information. The complaints policy needs to update the address for CSCI, in the body and also on a flow chart. The telephone number should be given so that service users can call as well as write to the commission. There is a complaints book with a good system for logging complaints. No complaints had been logged. We viewed the adult protection policy for the home. It does not state that in the first instance when there is an allegation or suspicion of abuse a referral must be made to the local authority safeguarding team. It needs to state this and this was a requirement of the previous inspection. The timescale to amend the policy was by 30/09/06. It also needs to state that it is followed in conjunction with the local authority policy. The home has a copy of the local authority policy. One file which we viewed had a missing persons information sheet on it and one did not. Neither file had a photograph of the service user. The missing persons sheet omitted the hair colour of the service user and their height. The homes missing Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: persons policy states that two photographs will be held of service users, one portrait and one full length. The manager must ensure that the home holds full descriptions of service users as well as photographs of them for identification purposes. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is good. There are no hygiene or infection issues. Evidence: We viewed the environment of the home, excluding the bedrooms of service users. It was well maintained and decorated, clean and comfortable. The home has a good size rear garden and as previously mentioned this has been cleared for planting this spring. There are no hygiene issues at the home. The washing machine is sited in the kitchen but there is no foul laundry to be washed. Care Homes for Adults (18-65 years) Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment is not currently safe and robust and staff training is absent. Evidence: We viewed the files of two staff. Both appeared to have relevant qualifications (although not necessarily NVQs) and to have some experience of caring. One staff member observed appeared to have appropriate skills to work with service users. The manager stated that all current staff are from agencies. There are no permanent members of staff except himself. Staff Criminal Records Bureau (CRB) disclosures are in the name of the agencies. One CRB stated that an individiual had been convicted in April 2007 of working illegally for Hertfordshire Social Services. He did not have permission from immigration to work in this country. There were two letters from The Home Office on his file but neither of them stated that he was allowed to work in this country. The manager must ascertain whether or not this staff member is working illegally and must not allow him to work at the home again until the matter is cleared up. The references supplied by the agency did not evidence robust recruitment practices. We checked four staff files for photographs of the staff. Of the four files only one had a Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: staff photograph. The manager stated that by the end of this month the home will have recruited a permanent staff team. We advised the manager that safe robust recruitment involves, an application form, personal identification, an interview, two professional references, immigration status to work legally in the country and a satisfactory CRB disclosure. We asked for evidence that staff had been trained. The manager showed us a brochure from a training company. He stated that from the end of the month all staff would be booked on appropriate training courses. He was not able to produce evidence that this had happened. The homes policy on food hygiene states that staff must take and pass a food hygiene certicated exam before they may handle food. We advised the manager that our expectation of basic staff training includes: First Aid Fire Food Hygiene Health and Safety Adult Protection These core topics to be refreshed every one to two years. Care Homes for Adults (18-65 years) Page 22 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in parts, but the manager and staff are not always following their own systems. The recording in the home is not at a satisfactory level. Evidence: There were systems and structures in place to ensure that the home was well run. These appeared to be followed but not totally. One to one formal keyworking sessions were not well evidenced in recording. The manager stated that informal keyworking is going on but not being recorded. Evaluations of care plans and risk assessments, and progress reports were similarly not recorded. The manager stated that the service user who had been away from the home without explanation for three days was in fact in constant telephone communication with him. In this case he needed to advise the staff or record it in the file himself. We felt that recording in the home was not at an acceptable level and needed improvement. The home had a requirement at the last key inspection to ensure that there is an effective quality assurance policy implemented by 31/10/06. There was also a Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: requirement that monitoring visits take place (under regulation 26) and the reports of these be made available to the commission by 30/9/06. Neither of these requirements have been complied with. The manager stated that relatives attend Care Plan Approach (CPA) meetings and reviews, and have a chance there to give their views on the home. He was not able to show us the business plan for the home which he stated was with the responsible individual. From reading various policies, we formed the view that policy and practice in some instances differ. We suggested to the manager that it is time to review and update the homes key policies. The home has a health and safety policy. We viewed evidence of fire protection in the home and on 15/12/08 an outside contractor checked the fire extinguishers. Fridge and freezer temperature and food temperatures were viewed. Portable appliance testing was carried out on 10/7/08. Control of substances hazardous to health (COSHH) products were locked away, but not all products had a data sheet. Care Homes for Adults (18-65 years) Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 24 The Registered Person(s) must ensure that there is a policy in place that would ensure implementation of effective quality assurance and monitoring. 31/10/2006 2 39 26 The Registered provider must 30/09/2006 arrange for monitoring visits to take place on a monthly basis. The subsequently produced reports must be made available to the Manager of the home and the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 25 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 Service users must be given the opportunity to sign their contracts and this must be evidenced. Because the contracts have responsibilities for the service users. 01/04/2009 2 6 15 Service user plans must be up to date and relevant. They must be reviewed six monthly or sooner if indicated. So that the care is informed by the current needs. 01/03/2009 3 8 14 Risk assessments must be reviewed at least six monthly and kept up to date. So that they are current. Risk assessments must be shared with service users and they must be given an opportunity to sign them. This must be recorded. 01/03/2009 4 8 14 01/03/2009 Care Homes for Adults (18-65 years) Page 26 of 31 So that service users are involved in their own care. 5 9 12 Service users personal files must be stored in accordance with the confidentiality policy of the home. So that policy guides practice. 6 19 13 Service users must be supported to see the optician and dentist regularly. To ensure their wellbeing. 7 20 13 No staff may administer medication with having had medication training. For the safety of service users. 8 20 13 MAR sheets must have a photograph of the service user attached. For protection and safety. 9 20 20 The keys to the medication must be kept on the senior member of staff on duty at all times. For security. 10 20 13 Medication must be stored safely. So that it can only be accessed by authorised personnel. 01/05/2009 01/02/2009 01/03/2009 01/02/2009 01/04/2009 01/03/2009 Care Homes for Adults (18-65 years) Page 27 of 31 11 21 12 The manager must seek the afterlife wishes of service users and record them on file. So that their wishes may be followed in the event of their death. 01/06/2009 12 22 22 The complaints policy needs 01/02/2009 to be updated with the current address of the CSCI. The telephone number needs to be added. So that service users have the information they need. 13 23 13 The home must hold full descriptions of service users and a photograph of them. As part of their missing persons information. 01/02/2009 14 23 13 The adult protection policy 01/03/2009 needs to state that in the first instance a referral must be made without delay to Newham Adult Safeguarding officers who would then advise on the course of action. It also needs to state that the policy is followed in conjunction with the Newham policy (previous timescale of 30/09/06 not met). So that the local authority safeguarding team can take the lead. Care Homes for Adults (18-65 years) Page 28 of 31 15 34 19 The manager must ensure that no-one is working at the home without the immigration status to do so. So there are no illegal workers. 01/02/2009 16 35 18 Staff must be adequately trained. To perform their duties adequately. 01/06/2009 17 39 26 The manager must arrange for monitoring visits to take place on a monthly basis. The subsequently produced reports must be made available to the manager of the home and the CSCI (previous timescale of 30/9/06 not met). For quality assurance. 01/03/2009 18 40 24 The registered person must ensure that there is a policy in place that would ensure implementation of effective quality assurance and monitoring (previous timescale of 31/10/06 not met). For quality assurance. 01/03/2009 19 42 13 There must be data sheets available for all COSHH products stored. To conform to the legislation for COSHH. 01/04/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Adults (18-65 years) Page 29 of 31 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 20 40 The medication folder should have a list of staff signatures at the front. We suggest that the manager review and update the homes policies so that policy and practice are in accord. Care Homes for Adults (18-65 years) Page 30 of 31 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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