Inspection on 14/01/10 for Rosedene

This inspection was carried out on 14th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosedene 20/10/09

Rosedene 16/07/09

Rosedene 02/06/09

Rosedene 28/01/09

Rosedene 12/02/08

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

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10 Whitfield Avenue

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Rosedene 128 Franche Road Kidderminster DY11 5BE The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Seel Date: 1 4 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 43 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Rosedene 128 Franche Road Kidderminster DY11 5BE 01562861917 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Minster Pathways Limited Name of registered manager (if applicable) Mrs Anita Homer Golden Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 5 0 0 care home 5 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 5. 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; Learning disability - Code LD. Date of last inspection 1 7 0 7 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 43 A bit about the care home Rosedene is a care home providing personal care for up to 5 people, male and female, with a learning disability, a mental health need, or a combination of both needs. It is an ordinary house in a residential road in Kidderminster. Within the home there are ensuite bedrooms for 5 people, 2 with their own living area as well. There is a shared kitchen, dining area and living room. The house is nosmoking, but there is a covered area in the garden for some people who do smoke. There are facilities such as shops and pubs nearby, and bus services into central Kidderminster. The home is owned by Minster Pathways Limited. The responsible individual for Minster Pathways Ltd is Mr Colin Farebrother. Ms Anita Homer-Golden has been the registered manager of the home since December 2008. Before this Ms Anita Homer-Golden was the acting manager for over a year. Care Homes for Adults (18-65 years) Page 5 of 43 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: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 43 How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out by one inspector who visited the home without telling anyone she was coming. An Expert by Experience and their supporter also visited the home with the inspector. The Expert by Experience is a person who has experience of using services. The area manager and other staff helped the inspector on the day of the visit to the home. The inspector talked to some of the staff working at the home and watched how they helped people who live at Rosedene. The inspector was shown around some of the home and said hello to some people who live there. We looked at some care support plans and plans to help make sure someone keeps healthy. We looked at the medicines and records which tell us how staff help people who live in the home with their medicines. Papers in the office were shown to the inspector to tell them how the home is run. Care Homes for Adults (18-65 years) Page 7 of 43 The manager filled in a form called an Annual Quality Assurance assessment (AQAA). This shows how the needs of people who live in the home are met and what is planned for the future. The inspector would like to say thank you to people who live in the home, area manager, operations manager and staff for helping and making the inspector feel welcome. What the care home does well Staff help people to go to see their doctor and other people if they are unwell or need a check up. Staff are good at looking after medication. They do this because people living at the home cannot do these themselves. People are encouraged and supported to do things for themselves whenever it is safe for them to. Like putting clothes on and cleaning their rooms. Family and friends of people who live at the home are welcomed by staff. The kitchen is clean with lots of choices of food. There is fresh fruit, salad and vegetables for people to have. The home is safe and all equipment that people are helped with is checked so that it works well. Care Homes for Adults (18-65 years) Page 8 of 43 People have keyworkers who they get to know and are able to share their likes and dislikes. What has got better from the last inspection What the care home could do better People who choose to live at the home must be able to get on with the other people who live at the home and this should be written down in any assessments that are done to make sure this can be looked at again when seeing if the home is still suitable place for the Care Homes for Adults (18-65 years) Page 9 of 43 person to live. Information can now be found in plans that tell staff how to keep people safe when they are supporting them so that they are not in any danger. These should be looked at regularly to see if any changes are need to be made or whether any new plans are required so that they still keep people safe. People should be asked if they would like staff that are female or male to help people with their care support. This should be written down in plans for staff to follow and agreed by the person and their representative. The numbers of any medicines that people take must always be noted on each medicine chart so that these are able to be counted to check people are being given their medicines as their doctor has told staff to. All the activities that people take part in should be written down to show how people have chosen their activities so that peoples goals that are important to them can be achieved. The planning of meals should be done with people who live in the home with help from pictures of meals. Some work should be done so that people can have choices of what pictures, ornaments and other items they would like around their home. The home still needs to make sure all staff Care Homes for Adults (18-65 years) Page 10 of 43 know how best to protect people living in the home from being treated badly, or abused. Staff still need training, to make sure they know how to look after people in any situation. The company should be working to improve the home, using the information from surveys they have done. They should also make things better when problems are pointed out by other people, such as this Commission. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sally Seel 77 Paradise Circus Queensway Birmingham W Midlands Care Homes for Adults (18-65 years) Page 11 of 43 B1 2DT 01216005300 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 12 of 43 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to help them decide if the service is right for them. Peoples needs are assessed and they are encouraged to visit the home. Although a review of this process should be considered to make sure people who move into the home fit in with the people who already live there. Evidence: A statement of purpose and service user guide gives people information about what the home is like to live in. This includes the services offered to meet peoples needs, how the service is staffed, complaints procedures and the fees that are charged for people to live there. We were given a copy of the statement of purpose which was stored on the computer. Improvements have been made to the statement of purpose following the last key inspection in July 2009. We saw that there is more information to describe what it would be like to live in the home to help people when making their decisions about whether they would like to live at Rosedene. For example, we saw staffing details and training so that people know the numbers, genders and skill mix of the staff who will meet their individual needs. The service user guide was also shown to us and is made available in the reception area Care Homes for Adults (18-65 years) Page 14 of 43 Evidence: of the home so that people can look through this as they choose. We saw that in the main this information guide has been updated which was indicated by the registered manager in the Annual Quality Assurance Assessment (AQAA). The guide we looked at had pictures to illustrate the written word to help people to understand the information about the home regardless of their abilities. As at the last inspection no new people have come to live at the home and the same four people continue to live at Rosedene. Therefore we could not fully inspect the standards that relate to new people coming to live at the home. Although, we have looked through information that indicates individuals needs have been assessed prior to them coming to live at Rosedene. This would suggest that the registered manager makes sure that peoples needs are able to be met before they come to live at the home. However, there is some room for improvement in making certain all assessments of individuals support needs are kept under review which include risk assessments. This will ensure all support is planned and relevant to help staff meet peoples specific needs. There are three males and one female currently living at the home. The statement of purpose tells us that, Within this home we aim to provide long-term residential accommodation for Five (5) adults aged from 18-65 who have a learning disability and additional mental health needs. The statement of purpose also tells us that a prospective resident can visit the home, join current Service Users for a meal and can stay overnight on a trial basis. This is good practice and helps people to see if they fit in with the other people who are living at the home. However, the Expert described a situation to us:The gentleman told us about another resident who shouts at him and sometimes frightens him. He gestured a clenched fist and waved it at us, to show the type of intimidating behaviour he is exposed to. I was very upset by this. This is domestic abuse, and this gentleman should not have to live in fear or being subjected to verbal abuse this is not acceptable. This in fact highlights the unsuitable placement of having such a young man living with 3 much older elderly residents who are quite vulnerable. In the light of these concerns the management team may want to review their decision making processes to ensure people moving into the home would be able to live with those already there. This should include the practice of how other people living in the home and their representatives are consulted about the compatibility of new people who move into the home. This practice should demonstrate the effectiveness of the admission procedure and ensure people are protected from harm, where their choices and lifestyles are not restricted by a new person moving into the home due to their behaviours. Care Homes for Adults (18-65 years) Page 15 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to continue to be developed, to make sure that peoples needs are met with their choices fully established and risks fully assessed. This will help to ensure that people get the care they need in ways that suit them best, and be supported to stay safe from harm. Individuals choices and options are sometimes restricted which puts into question whether people are currently experiencing a good quality of life. Evidence: We looked at the support plans for two people who live in the home. These plans should be drawn up with each person who lives in the home and or their representative. They inform staff what support people need to live their daily lives as independently as possible with risks minimised. Plans therefore show individuals wishes and goals as well as their needs, with actions needed to meet each persons specified personal goals and any outcomes. Each persons likes, dislikes and preferred daily routines should also be outlined. Care Homes for Adults (18-65 years) Page 16 of 43 Evidence: We saw a range of support plans to meet peoples needs in relation to personal care, bathing and showering, communication, managing personal finances, accessing health professionals, morning and night time routines, social activities, dietary needs and oral hygiene. The support plans have one main picture which illustrates the needs and tasks that the plan relates to. This is important as it enhances peoples understanding and enables them to take part in the planning of how their needs will be met. It is also recognised that some people who live in the home would have difficulties in making sense of the written word. Following the last key inspection support plans have been further developed and it is clear that the registered manager has worked hard in ensuring that these are more person centred. This means that each persons personal wishes and aspirations are written down so that staff practices should reflect these. It is also positive that most people in the home have a keyworker and the statement of purpose confirms this, each Service User has a designated member of staff allocated to them, who is responsible for maintaining a special contact with the service users, for undertaking personal services as far as possible and for co-ordinating the Service Users plan of care. The next area that should be improved is the setting of both short and long term goals which indicate the outcomes that people living in the home should experience in practice. For example, we saw in one support plan to meet a persons needs in relation to communicating their short term goal the practice staff should be following, To encourage me to talk in a clear manner so that my needs, choices, preferences and any concerns can be heard and acted upon. The long term goals were left blank. In another support plan for communication both the short and long term goals were left blank. This shows that the setting of short and long term goals were not always identified on all plans. Improvements in this area will make sure that goals can be clearly measured so that staff know each persons personal wishes and how their goals are to be achieved. Also all support plans should be signed by the staff member who is completing these together with the person who lives in the home and or their representative. This was not always the case in the support plans we saw. Therefore it is not clear how these judgments are made and whether people agree to their contents so that people can be properly supported to do the things in their lives that are important to them. As shared with the area manager at the inspection further improvements now need to be made in the following areas:- Gender specific care needs to have more robust practices in place so that it can be cross referenced with both care plans and staff practices. For example, we looked at one persons support plan where it tells us that the person has no preferences in relation to a female and or male staff member supporting them with their personal care tasks. However, the care plans do not say how this person was enabled to make this choice as we observed that the person has limited understanding and communication skills due to their learning disability. We were told that staff have got to know the person well and Care Homes for Adults (18-65 years) Page 17 of 43 Evidence: their preferences. However, through observations made at this inspection, which are mentioned in the lifestyle and health and personal care standards of this report, show us that we cannot be confident that staff are applying the techniques required to establish the choices of people whose communication is limited. - All staff should sign the care plans to state that they have read these as we saw that some staff had signed them and others had not. This does not reflect that all staff are aware of a persons specific needs and therefore care and or support may not be consistent and or suitable for them. Doing this could help to ensure that the focus of care planning remains person centred, rather than trying to meet the needs of the service and the limits to what it can provide. - Risk assessments must be reviewed as the ones that we saw were all dated July 2007. It is suggested that if the risks highlighted have not changed then this should be reflected in any reviews of these documents and confirmed on the risk assessments so staff can see this at a glance. For people living in the home this means that the risk of hazards occurring can be kept to a minimum, so that people are properly supported to stay safe without unnecessary restrictions being placed upon them. However, as at the last key inspection we found that staff were not necessarily choosing the least restrictive approach to reducing risks to people who live in the home. This is further discussed in the lifestyle standards which are detailed the next section of this report. We asked a senior member of staff about the recordings from house meetings. These meetings provide people with the opportunity to influence how the home is run. At the time of the inspection these could not be found. We also could not establish when the last meeting for people who live in the home was last held. This means we cannot be confident that people who live at Rosedene are given opportunities of truly influencing the running of the home. Care plans and personal records that we looked at show how people are involved in dayto-day activities around the house, according to their individual abilities. These include taking responsibility for cleaning their rooms, washing up and making their beds. We also saw the activity records of two people where these tasks are highlighted but opportunities for people to be involved in daily activities around the house should be further promoted. In particular around menu planning so that people have choices about the meals they eat which are discussed further in the lifestyle standard of this report. We would also expect staff to be promoting peoples independence but an observation made by the Expert tells us this is not always the case:He told me he was going out to get some cigarettes. I was pleased that he was able to go out to the shops and felt confident to do this independently. Care Homes for Adults (18-65 years) Page 18 of 43 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People need more encouragement and support from staff to do things they value, go to places they like and keep in touch with people who are important to them. The planning of activity opportunities needs to improve in order to ensure that people can meet their goals. Evidence: In order to see if people who live in Rosedene are able to do things they value and to go to places they like, we looked at support plans, activity menus, daily recordings, observations of practices, discussions with some staff and where possible spoke with some people who lived in the home. On the day we visited the home two people were supported by staff to attend college and a day centre. The other two people mainly remained in the home apart from one person going to the local shops. We saw two activity menus which are planners that are used to Care Homes for Adults (18-65 years) Page 19 of 43 Evidence: note the activities each person does on a daily basis, such as, going to the shops, drawing, watching a DVD, music, dance, a walk, baking, or going to the pub. As mentioned previously in this report records told us that people do jobs around the house but we did not observe this on the day of inspection. Staff told us that people do a range of activities, such as, feed the ducks, bingo, singing, being pampered, eating out and two people go food shopping. However, it was unclear as to how people made choices around what activities they would like to do. The Expert gave us their observations around daily life in the home:The whole time we were in the lounge, a childrens DVD was playing. I found it odd, as it did not seem a likely choice for people of this age. I think it was just put on by staff without any consideration to the people that would be watching it. With appropriate tools available to support their communication they could choose themselves. This example shows that the quality of daily recording about what activities people participate in continue to be in need of improvement. The sampling of files included activity plans but cross checking with what was recorded daily did not always detail how individual choices of activities were offered. Activities should be purposeful and linked clearly to peoples assessments, care plans and agreed goals. The activity opportunities that people enjoy are prime indicators of their quality of life. If the stated objective of the service is to support people to live independently, then individuals activity programmes should reflect this. There are some examples of this in practice (e.g. jobs around the home, shopping etc.) but there is considerable room for improvement in this area. Supporting people to be as independent as they can be should include a range of opportunities both at home and out in the wider community. Planning for these needs to be more structured and clearly focused on individuals agreed personal goals. As previously recommended, developing the use of person centred approaches in overall care planning and management could make a significant contribution to this. The Expert provided further observations and discussions with one person who lives in the home and staff:During the time I visited Rosedene I observed a person just leaning against the radiator. They had been there for about an hour, and there was no obvious sign that staff were engaging with them and they appeared bored. People should be supported to have meaningful lives, and social interaction is very important. I asked if I could talk to the person and they invited me into the lounge. I asked them about what they like to do for fun. The person said they liked going to the local shops and have a coffee but other than that they could not tell me anymore. Whilst it is important that people have community based activities, I think that with support they could do far more, and contribute more positively to their life. A member of staff said that the person was now being restricted to how much time they spent at a local shop and how often they went. I asked why, and was told because they were being a nuisance in the coffee shop. I challenged this by Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: asking whether a complaint had been made and the member of staff said no, but the person would be there for quite a few hours spending their money. I asked why this was a problem staff member said because the person who lives in the home only has a certain budget each day to spend and would end up spending it all in the local shop. The person certainly should not be restricted to going out by staff, when its clearly one of the few activities they actually enjoy. Observations made at the last key inspection and this inspection were based upon how staff support people with mental health difficulties who may have some problems with motivation. This may well be an issue when people are unwell or low. The AQAA tells us that the registered manager has recognised some of the improvements that need to be made and said, To continue to motivate clients, record ALL choices made by clients, further develop activity menus. However, it is suggested that good record keeping is an essential element of effective care management. Individual members of staff need to recognise their personal responsibilities in this area. The records they write should provide a true and accurate picture of what people do and/or their responses to being offered activity opportunities. These can then be used to help inform future planning, by identifying what works for people, and what does not. The quality of the records kept should be an issue for staff performance management, and dealt with through individual professional supervision, as appropriate. Staff also need to be clear about what individual persons agreed goals/objectives are: it is suggested that enabling them to play a more direct role in care planning could help to improve this situation. As at the last inspection staff have not had training in working with people with mental health needs, and that support for people lacking in motivation has been limited. The Expert looked at the experiences of how people who live in the home are able to make choices in relation to meals:At lunch time people sat in the cold dinning room, and meal times seemed quite depressing as there was no social interaction and both residents had to sit at the table when in fact they should be able to eat their lunch where they want to, because I was allowed to eat my lunch in the lounge. I asked to look at the menus. They were done on a four week basis. There were 2 menus, the standard one and an alternative one, for those who did not like the first menu. There was far too much information; most of it both my supporter and myself could not understand and a lot of it was very repetitive. The same breakfast choices and supper choices appeared on each menu. In a house with only 4 residents why do they need a menu? I think it would be much better to let people choose on a daily basis, and also to encourage people to be involved in the preparation of their own meals and snacks. People with a learning disability would not understand this menu. If they were to continue using a menu, then they should make the menu simpler and more accessible, by means of pictures or symbols and it would mean people were included in making choices and have understanding what they are actually eating. The menu was in a file kept in the office, for people to make a real choice the menu should be available to all residents to see and understand. I was told that all residents are involved in the planning of their menu and Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: were given an opportunity to choose their favourite meals but it was not clear how this was done or how people were supported as one of the residents had very limited verbal communication. On a more positive note some of the menus we saw now document fruit and vegetables so that people are offered the recommended five a day to promote a healthy and nutritional diet. Care Homes for Adults (18-65 years) Page 22 of 43 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care needs are not always being met in appropriate ways that respect individuals gender. Health and care needs are generally documented and attended to so that people get all the support they need to stay healthy and well. Medication practices in carried forward balances need to be robust. Evidence: During our visit we were able to observe that people living at Rosedene were well dressed in cleaning clothing which reflected their age and gender. However, as reported at the last inspection it was observed that people are receiving intimate personal care by staff of both genders. We did look at one persons support plan and it said, I have no preference as to whether a male or female member of staff assist me with my bath or shower. We were unclear how this person had made these choices as they had limited communication due to their learning disabilities. We were also concerned by the vulnerability of this person. Our concerns were also expressed by the Expert:Considering there was a female senior carer on duty, I observed a male carer was supporting a female residents personal care. He had assisted with her showering, then done her hair and make up. It is always best practice to, where possible, have same sex carers. I felt that this was poor practice and could potentially make this woman vulnerable to abuse, especially when there was in fact a female carer to do this. The lady Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: had some very limited verbal communication, and although she could say yes or no, I was not sure she actually understood what was being said to her, and that she was just in fact repeating words. The male carer offered her a cup of tea, but not the gentleman we were sitting with. Peoples dignity should be respected. Due to severity of this persons learning disability and having no preferred communication tools available this person probably did not choose the male carer, and therefore should always be given personal care by a female carer. We now make it a recommendation that all personal care that people receive support with must be reviewed. If individuals are unable to clearly communicate their choices their representative should be available to aid any decisions that are made. This will make certain all people who live in the home and staff are not placed in vulnerable positions. We looked at peoples records to see how their healthcare is planned and managed. There are health action plans, (HAPs), as recommended by the Department of Health. HAPs meet with the Department of Health guidance for people with learning disabilities as they help to ensure that their health is monitored; any problems identified and their good health is being promoted. They can also help to show that individuals special health care needs are recognised and understood and that people are being supported to stay healthy through preventative as well as routine and specialist health care input. Sampling peoples plans we saw there were appointments with health professionals and other members of the multi-disciplinary team. These included GPs, consultant psychiatrists, dentists and opticians. This shows that people living in this home are receiving healthcare where required to help them stay healthy. We now recommend that each persons health action plan is updated and reviewed in a timely manner as the medication stated in one persons health action plan had been discontinued by their doctor. When we pointed this out to the area manager it was immediately removed. An area that must be reviewed and updated is the recording of peoples monthly weights as one persons care records told us that the person was last weighed in November 2009. This is important as any gains and losses can indicate underlying medical conditions. As at the previous inspection we looked at the medication administration records. Overall we found that they were well documented with a signature for administration or a reason was recorded if medication was not given. We audited two peoples medications with a senior support worker and found that in the main the counts and checks on medication were correct. It was noted that a person whose medications we looked at, is currently receiving PRN (as required) medication at this time. We saw appropriate protocols in place so that this medication is given in a consistent manner by all staff. This shows that people who live in the home are receiving their medication as prescribed by their clinician. One area that does need improving are the procedures for accurate auditing of medications as we found that two medications did not have the carried forward balances confirmed on them. Therefore we were unable to audit these medications so we could not Care Homes for Adults (18-65 years) Page 24 of 43 Evidence: be certain that these medications are being given as prescribed in the right doses. A requirement has now been made to make certain that all medication administration records (MARS) detail any carried forward balances so that these can be seen at a glance. We were told that medications are only given to people who live in the home by senior trained staff. This was also confirmed in the AQAA, All staff that administer training have received accredited training and are deemed to be competent. We were given a sample of the training matrix and found that it shows four members of staff are awaiting their medication training certificates, one of these being the registered manager. We looked at a sample of the staffing rotas which show that at least one member of staff who has received medication training is on each shift so this should ensure people living in the home are given their medications by trained staff. Care Homes for Adults (18-65 years) Page 25 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people are happy that their concerns are listened to and taken seriously. Others may need more support to ensure that any concerns they have are raised and dealt with. A framework is in place to help protect people from abuse but staff competencies in this area are lacking and need to be reviewed. Evidence: There is a clear complaints procedure and process which staff are aware of. This is important as people who live in this home may find it difficult to raise complaints in a traditional way and would rely on staff to recognise when they are unhappy. Therefore increased efforts should be made to involve peoples representatives and advocates when choices and decisions are required to be made, particularly when people have limited communication skills. Also it was reported at the previous key inspection that, It would benefit the home to encourage recording of all concerns, even seemingly minor ones, as this will ensure they are able to pick up on any possible areas where they need to improve. We could not find any documentation that is being used for this purpose but the AQAA told us, have put in place a minor complaints and compliments book so as to record things such as a client saying they did not like the way a certain food has been cooked. Also as discussed earlier in this report we cannot be certain regular resident meetings are being held. It is important that these systems are in place as they enable people who live in the home to share any concerns they have either on an individual or on a collective basis. It is also important for people with limited communication skills to feel that they are being listened to. The complaints procedure is also detailed in the statement of purpose and service user guide in formats using pictures to illustrate the Care Homes for Adults (18-65 years) Page 26 of 43 Evidence: written word. The registered manager has told us in their AQAA that there have been no complaints raised in the last twelve months. The Care Quality Commission, (CQC), have received some concerns which have now been discussed with the registered manager and they have shown us that appropriate actions were taken at the time. There is a clear policy in place regarding the recognition of abuse and the actions to be taken. Following the inspection we have raised a safeguarding referral to the local authority. This was in relation to an incident that was observed by the Expert where a member of staff patted a person who lives in the home on their bottom. The Expert reported:This is totally inappropriate. This is not an acceptable behaviour. This type of intimate contact should never happen between a professional paid carer and an extremely vulnerable resident. Examples of this behaviour demonstrate a lack of understanding of basic dignity rights, and safeguarding. We saw that the training matrix tells us that fourteen staff have received Prevention of Vulnerable Adults (POVA) training but it appears that some staff are not putting what they have learnt into practice. Therefore we cannot be certain that people who live in this home are fully safeguarded by staff practices. A requirement has been made to review staffs knowledge and practices to make certain people living in the home are in safe hands at all times. In view of the issues that have been raised in this report we looked at the training matrix to see what training staff have received in relation to, people making choices so that restrictions are not placed upon people unnecessary and risk taking. We saw that staff have not received any training in the Mental Capacity Act and Deprivation of Liberties Safeguarding (DOLS). This training is important due to meeting the individual needs of people living in the home. The DOLS examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. A senior support worker said that this training has been booked for staff to attend but we could not find this as being the case from looking at the training matrix. A requirement has now been made in relation to staff receiving this training to make sure people living in the home are in safe hands at all times. Care Homes for Adults (18-65 years) Page 27 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home was clean and tidy, some parts of the home need further improvements to make it pleasant and homely so that people have a sense of belonging. Evidence: The home is in a residential area and blends in with the other houses in the road. Following previous inspections, a number of issues were highlighted as needing attention and have now been resolved. For example, the window in the office area was fixed, blinds were put in place for a persons room and we were reassured that systems are now in place to monitor water temperatures so that people who live in the home are safeguarded from scolding. The AQAA also tells us that the home has been redecorated and there is a yearly plan for redecoration of the home. This shows that the registered manager is trying to make sure that the home is a well maintained and safe environment for the people who live there. The Expert reported their observations of the homes environment:Upon arrival at Rosedene I immediately noticed how cold it was in the house, and saw that this was because the back door was left wide open, which meant the cold winter breeze was coming into the house. I was directed to an office in the rear of the back garden. I was introduced to the senior on duty, who was also the acting manager. I was asked to sign in and offered a tour of the home. Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: The house was extremely small, considering that the home is for 5 people, and was very impersonal and bare. The lounge had just 2 sofas and a chair. Other than a large TV on the wall the remaining walls were bare. I would expect to the lounge to be homely, with good quality furnishings, pictures on the walls and having peoples own belongings in it. It was very institutional. It lacked stimulation and warmth. It gave people no space for privacy within the house so they could only use their bedrooms. The kitchen was small in size, with very little practical workspace. The second bathroom and separate toilet led off the kitchen, which I thought, was unhygienic and it was very awkward to get to. Off the kitchen was a room, which was supposed to be the dining room. It was very bare, with only a small table and chairs. There were no curtains on the window, the room was very small and cold and the chairs extremely uncomfortable to sit on. It looked almost like something you would keep your fridge and freezer rather than a homely dinning room. I would not want to eat my meals in there or spend any length of time in the room. Upstairs I was shown an empty room, which one of the residents were moving into temporally whilst their own room was refurbished. I was pleased to hear that this persons room was being decorated but was keen to understand whether the male resident had indeed consented to this, and chosen the new colour schemes and furnishings. The garden housed a wooden shed, which was the office, an outdoor laundry room and chemical cupboard. As the Expert reported it was positive to see that a persons room was being decorated and we were told that the person had chosen their own colours. There are some areas of the home which could be improved for people who live there as noted by the Expert. For example, the lounge area lacked homely touches, such as, no pictures or paintings on the walls, ornaments and so on which when purchased should be relevant to the people who live in the home. This has resulted in the homes interior looking bare and unlived in which has the potential to reduce peoples sense of belonging. The dining room could be improved to make certain that the chairs do meet the needs of people who live in the home and it is a pleasant environment for people to spend time eating their meals in. Generally we found the homes environment to be clean and hygienic with no unpleasant odours. There are hand washing facilities in place within the communal areas that we looked at therefore making sure infection control is promoted and people who live in the home are not placed unnecessarily at risk from infections. Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: Care Homes for Adults (18-65 years) Page 30 of 43 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. The people who live in the home are not always cared and supported by staff who put the knowledge and skills that they have learnt from training courses into practice to meet the individual needs of each person. Staff training in important areas, such as, learning disabilities and mental health is lacking. Evidence: On the day of inspection there were three members of staff on duty which included a senior support worker and two support workers. We were told by staff that there is always a senior support worker on duty who administers peoples medications and generally oversees the shift. Also staff told us that one support worker does night shifts and remains awake during the night to offer any support people may need. We looked at some staffing rotas which confirmed that staff levels remain consistent with what we were told. We also saw that on occasions relief staff cover some shifts on a regular basis covering for staff absences so that consistency is promoted when providing care and support to people who live at the home. As discussed earlier in this report observations were made that showed that staff were not always maintaining their professional practices. This could be attributed to a lack of training in areas such as equality and diversity, learning disability and metal health awareness and aspects of ageing. The Expert shared their observations of how staff interacted with people who live in the home:Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: The male carer referred to the female as a cheeky mare. Although this was said in jest, it is totally inappropriate to call someone that and I was horrified by it. He also repeatedly put a cushion over her face saying ooh thats better. Again this is not at all funny, and shows a lack of respect for that person. He continued to address her in a patronising manner, calling her a good little lady, rather than talking to her to in a manner appropriate for her age. It should be acknowledged that all staff were positive about the service provided to people living in the home and comments received were:One big family, regular staff who are familiar to people. Hope to go out more in the summer. Training opportunities have been made available. Staff levels are appropriate to meet individuals needs. Supervised by the manager and feels that he is definitely listened to. Staff morale is good, it is like a family, very loving. As reported at the previous key inspection we could not be certain that all mandatory training has been definitely completed by all staff. This was due to the training matrix not having being updated but we were assured that training that has been highlighted on the matrix as being booked has taken place. We also looked at the staff training plan dated the 1st January 2009 which was displayed on the wall in the office but this was unclear and did not always correspond with the training matrix to confirm if training had taken place. The area manager acknowledged our uncertainties around mandatory training for staff which includes health and safety, food hygiene, moving and handling, medication administration, Control of Substances Hazardous to Health (COSHH) and infection control. However, the lack of an up to date training and development plan for the staff team makes it difficult to assess fully the effectiveness of the training programme. It is recommended that peoples qualifications and training certificates are properly indexed on their personal files, for ease of reference. The Annual Quality Assurance Assessment (AQAA) shows that four staff out of the nine who are working at the home are trained to National Vocational Qualification Level 2 (NVQ), or above, and that training provided meets national standards and statutory guidelines. Improvements in this area need to continue to make sure that people who live in the home are assisted and supported by staff that have the appropriate knowledge and skills to meet their individual and collective needs. Two staff files were sampled. These contained copies of completed applications, two written references and we found checks had been completed in relation to the Criminal Records Bureau (CRB). Examined files also contained copies of job descriptions and Care Homes for Adults (18-65 years) Page 32 of 43 Evidence: declarations of medical fitness to perform allocated duties. However, on one staff file we could not find proof of the persons identity and any supervision that had been completed since they started working at the home. This was shown to the area manager and operations manager who acknowledged this. However, due to the registered manager being on annual leave we could not establish whether there were any other records filed in any other places. It is now recommended that staff personnel files be reviewed and organised so that all the important information can be found in each persons file. This will make certain that staff recruitment procedures and records are as robust as they can be. This will mean that the gathering of important recruitment information is not overlooked and staff employed are able to work with vulnerable people and people are protected from harm. Care Homes for Adults (18-65 years) Page 33 of 43 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager must now continue to ensure that necessary improvements to the way in which the service is run are put into practice. This will ensure that the home operates in the best interests of people who live there and that everyone is supported to stay healthy and safe. Evidence: As at the previous inspection the home is managed by Ms. Anita Homer-Golden who confirms in their AQQA, The registered manager has 7 years experience of supervising or managing a home, has NVQ 3, 4 and RMA (Registered Managers Award). On the day of inspection the registered manager was on annual leave but we were fully assisted throughout the inspection by a senior support worker, area manager and operations manager of Minster Pathways Ltd. A particular feature of the conduct and management of the home has been that when inspecting the home we have found it hard to locate some records. This inspection was no different in this area and means that we cannot be fully confident that the home is managed efficiently for the benefit of people who live at Rosedene. However, following the inspection the registered manager has contacted us and explained there have been Care Homes for Adults (18-65 years) Page 34 of 43 Evidence: some staffing difficulties within the home. This has impacted on us not being able to locate records during the inspection. We have been advised that these issues will now be resolved and the registered manager will ensure that all records within the home are now reviewed and updated. We have provided examples of staff practices within this report where staff training needs to be more robust. This is particularly in the area of supporting people who have learning disabilities and mental health needs which should incorporate supporting people with their behaviour. For example, we saw staff not showing respect to people, not upholding individuals dignity and not maintaining a professional manner which does not support the vulnerable people who live at Rosedene. The Expert commented on staff practices:There were 3 members of staff on duty, and 2 of them spent the majority of the time in the garden smoking. I was very disappointed to see people smoking in someones back garden. It showed a lack of respect, and I thought they could spend their time better by engaging with the residents in a positive way. I felt that Rosedene is not seen as someones home, and that staff show little or no respect for the residents. There was no evidence of a person centred approach during the 3 hours we visited. What was evident is the lack of awareness around person centred approaches, training around best practice, valuing people, and basic respect and dignity. Staff and external managers treated the home as a business whereas it should be supporting people to achieve positive outcomes. I would not like to live at Rosedene, and I felt sorry for the people that did. The AQAA was completed in some parts showing how the manager understands their responsibilities. Other sections hadnt been completed and were left blank, such as, What we could do better in the Personal Healthcare and Support, Concerns, Complaints and Protection, and the Environment sections. However, we have given clear examples throughout this report which should have informed these sections to clearly show that the manager is able to assess the performance of the services people who live at the home receive. It is now suggested that the Key Lines of Regulatory Assessment (KLORA) should be referenced. This provides guidance for identifying future aims and objectives for a service as some other sections of the AQAA, such as, Our plans for improvements in the next twelve months were also lacking in content. We saw that staff meetings are held so that people have the opportunity to discuss any concerns or ideas about the home. The area manager visits the home each month and writes reports about the quality of service being provided. The organisation has made improvements to the contents of these reports so that they sufficiently cover all the areas to show how people who live in the home experience outcomes. These were made available to us at the time of our visit and reflected that the environment was inspected, people who live in the home were spoken to and staff and records were checked. Care Homes for Adults (18-65 years) Page 35 of 43 Evidence: However, we were unable to look at any questionnaires that have been given to people who live in the home, relatives, staff, stakeholders and other external professionals at the time of the inspection. The AQAA tells us, Questionnaires sent out to clients, clients relatives, health professionals - yes. As reported at the previous key inspection senior staff are unaware of any report or response to the views expressed. We did not review the system for the safekeeping of peoples money but we were told that this is robust and we have not received any concerns. It will be looked at when we next inspect the home. Incidents that may affect the wellbeing of people who live at Rosedene are reported to us and where we did not receive a recent notification of an incident the registered manager sent this to us immediately which shows they want to work with us. There are appropriate arrangements to ensure the health and safety of both people who live in the home and staff. For example, appropriate maintenance and inspection certificates for all appliances were seen. We also looked at safety inspections for the fire alarm which have been checked regularly and a written record of tests maintained. Fire drills have taken place but the registered manager must make certain that all new staff have taken part in fire drills. This should ensure that people living in the home can be confident that if a fire breaks out there are well tested procedures in place for staff to follow. Water testing is done to make sure people are protected from scalds and legionella. The gas safety and electrical circuit certificates are both in date. We were told the COSHH (Control of Substances Hazardous to Health) cupboard was secure, as required. It is now suggested that the registered manager engages in assessing and agreeing priorities for taking the service forward. This must include: reviewing the staffing arrangements for the home, developing clear strategies for reviewing support plans and risk assessments. Meetings to include people who live in the home, keyworker meetings, ensuring that staff have clear direction, appropriate supervision, and the support they need to do their jobs more effectively. This should be done in a timely manner, consistently documented and updated, robust in practice and informed by the Mental Capacity Act, and DOLS. As we need to make certain that each person living at Rosedene is able to influence the running of their home and how they choose to spend their daily lives whilst their health and safety is promoted by staff practices which reflect competency in the areas that have been identified in this report. Care Homes for Adults (18-65 years) Page 36 of 43 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 37 of 43 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 7 12 19/02/2010 Choices should be given to service users but where this is not possible then this needs to be formally recorded and the guiding principles of the Mental Capacity Act and Deprivation of Liberties Safeguarding should be used in practice. This will make certain that service users are not having restrictions placed on them which affect their quality of lives and all of their preferences are put into practice whilst living at Rosedene. 2 19 13 The monthly weights of people must be maintained and recorded to show any losses and or gains. 19/02/2010 This will make certain any Care Homes for Adults (18-65 years) Page 38 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action underlying medical conditions are detected at an early stage. 3 20 13 The quantity of any balances 19/02/2010 carried over from the previous cycles must be recorded. This will enable audits to take place to demonstrate the medicines are administered as prescribed. 4 32 12 Staff must show their 19/02/2010 competence both through discussions and in practice in relation to supporting vulnerable people by using appropriate language and actions. . This will make certain that people are fully protected from all forms of abuse whilst living at Rosedene. 5 35 12 Staff that work with people 19/02/2010 with specialist needs such as learning disabilities and mental health needs must have the appropriate training and be able to demonstrate their competence both in practice and through discussions. Care Homes for Adults (18-65 years) Page 39 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This will ensure that people receive specialist care that is based on current good practice and reflect relevant specialist and clinical guidance. 6 39 24 That greater care should be taken when completing the Annual Quality Assurance Assessment in order that it remains factual with clear practices and procedures examples provided in all sections. 19/02/2010 This will ensure that the home is being run in the best interests of people living there. 7 42 12 All new staff must have the opportunity of taking part in fire drills. 19/02/2010 This will ensure people will be protected by robust procedures if a fire should occur. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that the registered manager reviews their admission procedures to specifically examine how the compatibility of other people living in the home is Page 40 of 43 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 considered together with how this is put into practice. This should make sure that people moving into the home will be able to fit in with the other people already living there. 2 6 You should ensure that all care plans reflect peoples personal goals, which should have outcomes that can be clearly measured. This is so that people can see whether or not goals set have been achieved, when plans are reviewed. Develop the use of person centred approaches in order to make this happen. All care plans should be signed by individuals whilst they are taking part in completing these and or their representative to confirm their agreement to how their needs will be met. You should ensure that important information from risk assessments are included in peoples care plans. Clear indexing and cross referencing would help to make sure this happens. This is so that the risk of hazards occurring is kept to a minimum, and people are properly supported to stay safe. 3 7 4 9 5 14 You should ensure that recording of peoples activities is done in sufficient detail to show how choices were made, the purpose of the activity and what was gained from it. Show clear links between activity opportunities and peoples agreed goals and care plans. Doing this will help people achieve their goals and improve their quality of life. Consideration should be given to the planning of meals and how to help people who live in the home to be involved in this through using pictures, photographs and symbols so that individuals are able to influence all meals offered. Health Action Plans for all people who live in the home must be reviewed to make certain these are all up to date. Included in this process should be an up to date record of peoples prescribed medications. This should ensure that people receive health care as required and monitoring takes place. You should ensure that everyone using the service is Page 41 of 43 6 17 7 19 8 22 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 actively encouraged to voice any concerns. Having this as a standing item on the agenda for residents meeting could help to achieve this. This is so that the service can make sure that concerns are being addressed. 9 24 It is recommended that the communal areas, such as, the lounge, dining room and toilets/bathrooms reflect the tastes of people who live in the home with homely touches and meet their physical needs. This should ensure that people live in a home that meets all of their needs, is well maintained, safe and homely. All staff should have knowledge in relation to the Mental Capacity Act and Deprivation of Liberty Safeguarding to ensure that this informs their practice when meeting individuals needs and be able to put this into practice. All staff personnel files should be organised so that information is able to be effectively audited and seen at a glance so that oversights are minimised so that staff recruitment, supervisions and appraisals are robust to safeguard people who live in the home. You should ensure that all members of staff receive regular formal supervision, with written records kept of each meeting. Staff should also receive an annual appraisal of their performance. This is to make sure that they get the support they need to do their jobs well. It is recommended that a review is undertaken in relation to staff smoking in the garden area at the back of the home to reflect on the appropriateness of this. You should ensure that the system for evaluating the quality of the services at the care home is fully implemented, and a written report of the outcomes made available to all interested parties. This is so that it can be seen that the views of people who use the service underpin the way in which it is reviewed and developed. 10 32 11 34 12 36 13 39 14 39 Care Homes for Adults (18-65 years) Page 42 of 43 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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