Inspection on 11/06/09 for Milestones

This inspection was carried out on 11th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milestones 27/06/07

Milestones 08/03/06

Milestones 09/11/05

Milestones 13/03/05

Milestones 24/05/04

Milestones 11/03/04

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 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Milestones 9 Commercial Street Cinderford Glos GL14 2RP     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: Simon Massey     Date: 1 1 0 6 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: Milestones 9 Commercial Street Cinderford Glos GL14 2RP 01594825777 01452760786 bev@steppingstonesru.co.uk 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) : Stepping Stones Resettlement Unit Limited care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 4 Milestones is a registered residential care home and provides care for adults with learning disabilities. The home is close to the town centre; there are local shops within walking distance of the home and all other amenities to promote integration into the surrounding community. The home is a domestic style house in a residential area of Cinderford in the Forest of Dean. The house consists of four levels, all the rooms exceed the National Minimum Standard required for living space, and the rooms are comfortably decorated and maintained. The accommodation can accommodate up to four adults who may have moderate learning disabilities and present various levels of challenging behaviour, mental disorders, communication difficulties and some emotional disturbances. Milestones is owned and operated by Stepping Stones resettlement and have a number of homes within its unit, for adults with learning difficulties and provide accommodation within the area of Gloucestershire. The weekly fees in the home are from #1075:00 to #1263:00. The reports produced by the Commission are available in the home. Care Homes for Adults (18-65 years) Page 4 of 29 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 Inspection was undertaken on 11/06/09 and lasted for seven hours. The Inspector met with the acting manager, care staff and two of the people living in the home. Records relating to care planning, health and safety, medication and staff training were examined. An inspection of the environment was also undertaken. This was a positive inspection that showed that improved outcomes in some areas were being achieved for the people using the service, particularly in terms of activities and lifestyle choices. The acting manager has made a positive start to improving the culture of the service to be more enabling and empowering for people living in the home, promoting choice and independence. However these improvements have been compromised to some extent by the shortfalls in the support and scrutiny provided by Care Homes for Adults (18-65 years) Page 6 of 29 the Provider. 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. The needs of people admitted to the home are assessed before admission to ensure that these can be met. Evidence: The home has a Statement of Purpose and this was reviewed last year along with the Service User Guide. These documents could be better presented with information being made available in formats that would be easier understood by some service users. Copies of the Service User Guide should be provided to all people living in the home. There have been no admissions to the home since the previous inspection. The admission process was inspected at the last inspection and found to be satisfactory. Staff from Stepping Stones in conjunction with the homes staff complete assessments and organize visits to ensure that needs can be met. People would be provided with the opportunity to stay in the home and meet the staff and other service users prior to moving in permanently. Care Homes for Adults (18-65 years) Page 10 of 29 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. Improved outcomes for people using the service have been achieved but a care planning process that fully involves the person could provide clearer goals and objectives and a pathway to how these will be achieved. The lack of person centered risk assessments on independent travel in the community could compromise peoples safety. Evidence: An examination of the care planning process and records were undertaken. A new care planning process has been introduced into the home. The process has some person centered aspects to it and people living in the home are involved to a large extent in the process within the home. People have a person centered plan, which has been completed with the key worker and service user and manager. Besides the care plan there is also a Pathways to Independence document that staff have been adding to over a period of years, as skills have been learnt and acquired. There is also a Personal and Social Skills Development Plan. Some plans have identified goals and objectives Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: but there is some inconsistency between thee plans. Some parts of the care plans contain information that suggests there should be identified goals and objectives but these have not been completed, or are located in different parts of the file. At the end of each file is an annual review document that has been completed following a review of the placement that has been conducted by the clinical team within Stepping Stones. Some people living in the home appear to have had little or no involvement in this part of the process. This review document contains various reports, including ones from the home, the day centre and medical staff. For a system to be fully person centered the service user should be fully involved in all parts of the care planning process as far as they are able. It was also observed that some of the goals and objectives identified in the care plans within the home are not reflected in the annual review document. For example one person who has a clear objective of living more independently, possibly in their own accommodation at some point, does does have a clear pathway for this objective or any established medium or long term goals that can be achieved. Nor is there any guidance or action plans for the home, or Provider, as to how they support and move these plans forward. There was also no attendance lists for these reviews or minutes from the review meetings. Whilst there is a lot of positive work being undertaken by the staff in the home and there is evidence of good outcomes, there is a need for greater clarity over the connection of the different processes and formats being used and ultimately a better connection between documentation and practice. People living in the home had an awareness of their care plans but there is room for considerable improvement in making the system fully person centered with people being placed at the centre of the process and being empowered to plan their futures with identified goals and aspirations. There is regular recording of daily events and any incidents that may occur. People have monthly reports complied but some of these were fairly brief and simply contained the facts already in the daily recording. If goals and identified objectives are in place these monthly reports could contain evidence of progress made towards these. People are encouraged to make choices and to take risks as part of their daily lives. There are detailed assessments in place for people being left in the home unsupervised for limited periods of time. These had all be appropriately reviewed. There is need to establish detailed risk assessments for people going independently into the community. This issue was discussed with the manager. Care Homes for Adults (18-65 years) Page 13 of 29 Care Homes for Adults (18-65 years) Page 14 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 using the service are supported to undertake activities of their choosing and pursue their interests and hobbies. People are encouraged to develop their independence skills. Evidence: Two of the people living in the home were spoken to and both expressed their satisfaction with the level of activities they are supported to undertake. Discussion with staff and examination of records evidenced that there has been an increase in the opportunities that are being offered and undertaken with staff support. This was an objective identified by the acting manager and there was evidence from house meetings and staff meetings that this was being acted upon. People said they had enough to do in the evenings and weekends and never got bored. Examples were given of various hobbies and interests that were supported and how these were Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: encouraged by the staff on duty. People living in the home have been supported to be more involved in domestic chores and tasks such as cooking, laundry and menu planning and food shopping. There is scope to provide a more structured and planned approach to the developing of skills and confidence around independence through the person centered planning approach that is being implemented. Comments about the care planning process are contained in the previous standards. Evidence was seen that people are supported to maintain positive and appropriate relationships with families and friends through visits and phone calls. People living in the home were positive about the food and the choices they are provided with and confirmed they have opportunities to be involved in cooking and shopping.The food was described as great and very healthy by one person. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health needs are met and they are encouraged to follow healthy lifestyles. Evidence: The acting manager has introduced a new system for the monitoring of medication administration which involves regular auditing, and recording of this action. All medication was correctly stored and all records were up to date and completed satisfactorily. There was good information in place regarding the medication being given and also a list of staff who are able to administer, as they have completed the required training. People living in the home all have Health Action Plans in place which contain good personalized information. There was clear recording of all health appointments that had occurred and when required there was additional guidance for staff. People spoken to expressed satisfaction with the personal care that was delivered. People living in the home are encouraged to adopt a healthy lifestyle whilst having Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: their choice respected. One person in particular is supported to undertake a variety of healthy active activities, many of which they do independently. One person spoken demonstrated a good awareness of their health needs and the reasons for visiting the doctors and other health professionals. Care Homes for Adults (18-65 years) Page 18 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 living in the service are provided with a safe environment where their dignity and safety is promoted but shortfalls in some staffing arrangements could compromise this. Evidence: People living in the home said they felt safe and able to raise concerns with staff and the manager. Examples were given of issues that had been raised and recorded. Staff interviewed said that restraint or physical intervention was not required within the home and that they felt that it was a safe working environment for service users and care staff. People using the service were observed as being confident and relaxed in their home and were observed being treated with dignity and respect by the staff. There is a complaints procedure in place but no complaints have been made to the home or to the Commission in respect of the service. 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. The service provides a safe and homely environment which is enjoyed by the people living in the home. Evidence: The home was well decorated and maintained throughout and appeared to be a comfortable and homely environment. The home was clean and hygienic at the time of this visit. Some planned areas of maintenance were identified by the manager and all the people living in the home spoken to were positive about their home and the quality of the environment. People said they were happy with their rooms and that they chose the fittings and the decor. All the rooms were well maintained and reflected personal tastes and preferences. People said that staff respected their privacy and always knocked before entering their rooms. People said that staff helped them to look after their rooms and that appliances were safely maintained. Care Homes for Adults (18-65 years) Page 20 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. Needs are met by a motivated staff team who work well with the people living in the home but this is compromised by the use of relief staff working unsupervised without having completed the necessary induction. Evidence: People living in the home were positive abut the staff team and their individual key workers and people were observed interacting in a professional and appropriate manner. People confirmed that the correct staffing levels are maintained and that if additional activities are planned, that the staffing can be arranged to cover this. It is evident that the staff team are motivated and flexible in their approach and have a positive approach to providing care and support. Staff spoken to were positive about the changes the acting manager has been introducing with regards to increasing the independence skills of the people living in the home When additional cover is required staff are provided from another registered service run by the same Provider. This service is also on the same site as the day service run by the Provider. The Inspector identified some concerns around this practice and clarification was provided by the Provider which stated that all staff who asked to work at the home, to cover sickness and holidays, have previously worked in the home and Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: are familair with the needs of the people living in there. Staff should not be undertaking this responsibility without proper knowledge of the fire safety procedures and some form of induction regarding the needs of the service users, particularly those who can present challenging behaviors that need to be managed. This cover if often provided in a lone working situation. The Inspector was later informed that all staff who provide relief cover have had some form of induction from the manager. The home must keep a record of the details of these staff and a record of the induction that has been undertaken. Staff continue to occasionally work long shifts often doing late to early with a sleeping in duty included but there has been a reduction n the length of some shifts. Staff spoken to stated they were happy with the current arrangements. There was also evidence that staff are flexible and willing to change and move their hours around to meet the needs of the people living in the home. The Provider has a Lone Working policy for the organization but the staff and manager were not fully aware of this. It would be good practice for the home to develop its own Lone Working policy or protocol that relates specifically to the service and the particular requirements or issues that could be identified with regards to working in the home. All of the permanent staff were up to date with the required statutory training, with the exception of one person who needed to have a fire safety training update. Staff have received training in the managing of challenging behaviors and demonstrated an awareness of low arousal and deescalation techniques and the accompanying issues. This training is provided in general terms and staff were positive about the content and delivery of this training but there may be some advantages to the staff team in having training provided that is superficially related to the needs of the people living in the home. The training is monitored centrally by the Provider but it would be beneficial for some record of training completed to be also kept within the home. There have been four staff meetings in the home in 2009 so far and these were well attended and show that a variety of issues were discussed and actions agreed. There have been no staff recruited since the previous inspection and staff records were not checked as part of this inspection. The main files for all staff are kept on the main site run by the Provider. There is a need for an up to date staff list to be kept in the home which contains the basic details of all staff who work in the home and the content of this list was discussed with the manager. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: A criticism was made in the previous inspection report regarding the lack of involvement of the home in recruitment. It is again recommended that staff and service users are involved in the recruitment of new staff, although it is good practice for the required checks and processing of applicants to be undertaken by the administration team of the Provider. 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. The acting manager has provided leadership and direction to the staff team and improved outcomes for people living in the home. This progress has been compromised by insufficient support and scrutiny from the Provider. Evidence: The home currently has an acting manger who has submitted an application to be registered with the Commission. Staff spoken to were positive about the leadership and direction that has been given and felt the manager was approachable and supportive, and listened to issues or concerns that are raised. People living in the home were also positive about the new manager and said they were able to raise concerns and discuss things if they wanted to. The manager was originally qualified as a nurse, though this registration has now lapsed. They have completed an NVQ level 3 but are yet to start the required training for the managers role, the NVQ4 Leadership and Managers Award. This should be started as a matter of urgency by the Provider. They have also worked as a senior carer in another service run by the same Provider. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The manager explained how they are trying to develop the culture of independence in the home, with changes for service users and also increased direction for staff in this area. Evidence of these changes were seen at this inspection. Staff confirmed they received formal supervision on a regular basis, as well as good levels of informal supervision and support. Staff were positive about their supervision and the direction the manager was taking the home. The Inspector was concerned that the acting manager has received inadequate support and supervision during her time in the role. Records showed that they have received infrequent formal supervisions and that also regulation 26 inspections have not always been completed every month. Considering the manager is not fully qualified, and in an acting position, they should have been provided with regular structured supervisions providing guidance, support and where necessary action plans for the improvement of the service. There should also be more scrutiny of the home during this period. Despite these shortfalls in relation to the management standards there was evidence that the acting manger has made a positive and progressive start to the role and has implemented a number of changes and initiatives that are producing better outcomes for people living in the home All health and safety checks were being completed and fire safety tests and servicing had been completed and recorded. The home is arranged over four floors with the staff sleeping in room on the top floor. Comment is made in the staffing standards about relief working without a basic induction. The Inspector expressed a concern about staff sleeping in, without a fire safety induction, in a room on the top floor. This room also did not have a phone point at the time of the inspection. This matter was addressed during the inspection. This issue further emphasizes the need for all staff working in the home to be properly inducted before working unsupervised in an unfamiliar environment. 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 1 1 5 People living in the home 22/08/2009 must be provided with copies of the Service User Guide People living in the home should be aware of what the service provides and know that their needs can be met 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 9 13 Risk assessments and 22/08/2009 guidance must be completed for people going independently into the community Clear guidance and protocols should be in place to support people going into the community unsupervised. These should provide guidance for staff on the arrangements that are in place and link to the homes missing person policy 2 34 17 The home must keep an up 21/08/2009 to date list of staff who work in the home The home must have details about staff working in the Care Homes for Adults (18-65 years) Page 27 of 29 home available. This must include names, addresses, contact details, start dates and a photograph 3 39 26 The Provider must complete monthly regulation 26 inspections The service should receive appropriate scrutiny and feedback on progress 4 39 18 The acting manager must receive regular supervision and support from their designated line manager The manager should receive support and guidance particularly during the period before registration is completed 22/07/2009 22/07/2009 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 home could provide its Statement of Purpose and Service User Guide in different formats, including pictures and symbols. The home should fully involve the people living in the home in all aspects of their care planing to ensure that it is fully person centered Minutes should be kept of care plans reviews that are completed and these should include the extent of the involvement of the person using the service. The home should develop its own Lone Working policy or guidelines that all staff should be aware of. The acting manager should register on the appropriate training as soon as is possible. 2 6 3 6 4 5 33 37 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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