Care Home: 37 Hill Top View

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What the care home does well Care plans are in place and contain a lot of information about each person living at the home, what they do and the support they need.People are encouraged to take part in the daily routines of the home where possible.The home is clean and comfortable and is adapted to meet their needs of people using the service.We found that policies and procedures have been reviewed regularly. What has improved since the last inspection? This is the first inspection of the service since the provider changed the company name. What the care home could do better: We asked the service to provide information in a form that people using the service can easily understand.We saw that staff need to receive training.We said that people need to have a wide range of activities of their choice.We asked that people using the service are involved in planning their care.Medication needs to be stored properly.We need the acting manager to register with us. Key inspection report Care homes for adults (18-65 years) Name: Address: 37 Hill Top View 37 Hill Top View Rugeley Staffs WS15 4DG The quality rating for this care home is: one star adequate 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: Wendy Jones Date: 0 3 0 2 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 37 Hill Top View 37 Hill Top View Rugeley Staffs WS15 4DG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Langston Care Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users to be accommodated is: 4. The registered person may provide personal care only - Code PC, and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disabilities Code LD (4) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Care Homes for Adults (18-65 years) Page 5 of 33 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 Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced key inspection visit that was carried out over one day by one inspector. We spoke to staff and people using the service and looked around the home. We looked at records and information. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well Care plans are in place and contain a lot of information about each person living at the home, what they do and the support they need. People are encouraged to take part in the daily routines of the home where possible. The home is clean and comfortable and is adapted to meet their needs of people using the service. Care Homes for Adults (18-65 years) Page 8 of 33 We found that policies and procedures have been reviewed regularly. What has got better from the last inspection This is the first inspection of the service since the provider changed the company name. Care Homes for Adults (18-65 years) Page 9 of 33 What the care home could do better We asked the service to provide information in a form that people using the service can easily understand. We saw that staff need to receive training. Care Homes for Adults (18-65 years) Page 10 of 33 We said that people need to have a wide range of activities of their choice. We asked that people using the service are involved in planning their care. Medication needs to be stored properly. We need the acting manager to register with us. Care Homes for Adults (18-65 years) Page 11 of 33 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 Wendy Jones 77 Paradise Circus Queensway Birmingham W Midlands 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 33 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 33 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. People who may us the service cannot be confident that the information they receive about the service is upto date or in a form that can easily understand. But can be sure that their needs will be assessed. Evidence: The service told us in the AQAA that, We rarely have beds available for potential residents; we open small homes at the request of parents and social workers. Homes and staffing etc are opened and developed in response to potential residents and their familys needs and preferences. We believe you cant get much better choice of home than that. Essentially our homes are bespoke services. We specialise in providing high quality, 24hr care. Staff receive intensive training that educates them with all the varied and indepth care needs of each individual resident. The service has a Statement of Purpose, but this is very out of date and has not been produced in a user friendly format. Each person using the service has a copy of both the Service user Guide and Statement of Purpose in their care records, but there is no evidence that they or their representatives have read and understood it or have signed to say they have. The information in the Service User Guide does not include the fee range Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: or the breakdown of the charges people can expect to pay. There have not been any new admissions to the home, since the last time we visited. The evidence of previous visits is that the service carries out detailed pre admission assessments of prospective users of the service, including the involvement and assessment of any health or social care professional. Families or carers of the individual are also included in this process. Staff said in surveys, This is a fantastic Home. Care Homes for Adults (18-65 years) Page 15 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their support needs are known, but need to be sure that they are routinely involved in decision making and planning their care. Evidence: The service has told us in the AQAA that,As the service we provide is very bespoke, we are very confident that our residents needs are fully met, care plans and associated procedures are constantly undergoing review and frequently change. Reviews of all care plans and associated procedures/programmes are carried out 6 monthly. Where residents are able, they are involved with devising and updating their own care plans. We found that each person using the service has detailed support plans and information about their needs and how they should be met. But there is little evidence of how people using the service are involved in care planning or review. The format of the plans is not user friendly and the service has not considered this. We spoke to the acting manager of the service who said, I know that we need to work in a more person centred way and have started to up date the plans to reflect that, but have yet to fully implement PCP. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: We are told that staff have/havent received PCP training we spoke to 2 care staff about PCP. They said, the manager and the seniors tend to do those and weve been told we will be asked for our views. We saw that some care plans have not been reviewed on a regular basis as it is recommended that they are, we could not tell if people using the service have been spoken to about the plans or involved in their implementation or review. We saw risk assessments have been carried out and reviewed. We saw that staff record in the daily handover sheets for each person these are individualised. A monthly summary of events is also recorded for the manager to audit. The new manager said, Everyone also has a diary which is used to record events and appointments, this then goes home so that parents can see what they do. When we checked records of people using the service we couldnt evidence that this was the case. Care Homes for Adults (18-65 years) Page 17 of 33 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 People using the service are supported to make choices in their daily life and are encouraged to retain as much independence as possible. Evidence: The service has told us in the AQAA that,As the service we provide is highly bespoke, we are very confident that our residents lifestyle preferences are fully met to the best of our ability and within the constraints of residents individual financial restrictions. We introduced a low E number ethos to menu planning and grocery purchases and have since expanded on this to include 5 aday, healthy eating, high fat / protein diets where needed. Residents are helped to buy nice fashionable / serviceable clothes, shoes, sports accessories, DVDs, Cds, booking activities, hobbies and holidays etc. An Aroma therapist visits monthly for massages of tired feet and hands. All our residents expressed personal interests are met including horse riding, shopping, trampolining, swimming, Alton Towers. We have been told that there have been improvements in the opportunities people have Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: to go into the community and engage in activities out side of the home. New activities include swimming, attending gateway club in the evening. We saw that individuals have weekly activity planner in their records. But these are not user friendly and not accessible to the individual. Staff told us that they talk to service users about the plans for the day, but we saw that people using the service were told what the activity of the day was, no choice was given and it is difficult to know if people using the service understand that they should be able to make a choice. The activities we saw in the records are mainly group activities rather than individual ones. We have been told that people using the service are supported to be in contact with families and friends. We have not received surveys from relatives to confirm this. Staff told us that the people using the service receive aromatherapy sessions at the home this is confirmed in the AQAA. We talked to staff about food choices and menu plans we have been told that these are completed by staff and based upon the known preferences of individuals rather than offering them real choice of meals. But there is evidence that the service takes seriously its responsibilities in promoting healthy eating and makes great efforts to encourage the government guidelines of 5 a day ie 5 portions of fruit and vegetables per day. We saw innovative ways staff have incorporated fruit and vegetables in the diet, For example staff said, we usually try to have a surprise fruit or veg for the week and try to include that in meals, examples given were pineapple, asparagus and this weeks veg, green chilli. We saw that people using the service are supported to be involved with kitchen chores and jobs. Including washing dishes and preparing food for the meals. Care Homes for Adults (18-65 years) Page 19 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be confident that their medication is being stored and managed properly and that staff are trained and assessed as competent to administer it. Evidence: The information in the AQAA tells us, We respond to all residents health care needs very quickly. We involve the local Community Learning Disability nurse and team to help meet residents needs as soon as problems arise or if we need advice or have concerns. We ensure residents have regular medication reviews. Family members are consulted re medication and care. We are working with the local Health Facilitator to produce resident specific Health Action Plans. We found that Medication storage is not suitable for the purpose. The current facilities are lockable wooden vanity units in the bathroom. This doesnt comply with current guidelines and requirements re medication storage. We saw that Medication Administration Records (MARS) are signed properly from the sample seen. However we also saw that medication charts are often handwritten and that although the record of medication received is recorded, any carried over medication from the previous months supply is not. This means an accurate audit of medication in the home cannot be carried out. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: We saw that homely remedies such as paracetamol are recorded when administered but there is no record of the amount received in the home so we cannot complete an audit trail. The acting manager told us that she has reviewed the medication policies and is waiting for them to be approved by the providers. The new policies include homely remedies, receipt and return of medication, also secondary dispensing. We discussed secondary dispensing as at the moment the service does this for home leave medication. We saw in one care file that a consent to medication form had not been completed. We talked about medication training, the acting manager stated that two staff have just completed the Boots foundation course, we saw the certificates as evidence. But other staff have received in house medication training by the previous manager. We could not be sure that this training is sufficient to meet the standards expected. And recommend that all staff responsible for the administration of medicating undertake a recognised medication training course and also have competency assessments. We saw records of people health appointments that demonstrate that the service supports people to receive regular healthcare. We saw evidence of dental, chiropody, GP and consultant appointments. Care Homes for Adults (18-65 years) Page 21 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that the service will act promptly to address any concerns about the well being. Evidence: The service has told us in the AQAA that, We have a detailed Complaints Procedure available to residents, staff, outside agencies etc. We listen, we cooperate, and we act where necessary. We understand the need for self criticism and are willing to learn and adapt. We understand the need for change and development and always take on board suggestions or concerns. In the case of adult protection we act fast, responsibly and with the best interests of our residents. We follow our own detailed policies and procedures, notify all external bodies and aim to clarify the situation with speed and discretion. Families are kept informed, reassured and updated. We work well with multi disciplinary teams and cooperate with all outside agencies as required. We maintain extremely high levels of professionalism and confidentiality. We found that a complaints procedure is in place but recommend that it should be in a format that people using the service can easily understand. We have received one complaint about this service, this was referred through safeguarding procedures and satisfactorily resolved. We are aware that another referral was made by the service, we have been satisfied that the home has acted promptly and appropriately to ensure the well being of people using the service. Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: Staff have received training in safeguarding and recognising and reporting suspected abuse. Recruitment procedures are in place and records show that the service carries out appropriate pre employment checks of potential employees. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have a comfortable and well maintained home in which to live. Evidence: We have been told in the AQAA that, We have a full time maintenance man that looks after many aspects of the home environment, inside and out. Serious maintenance issues are dealt with straight away as he is also on call for emergencies and we have a list of other specialist companies for more specialised jobs such as plumbing or electrical work. We have a rolling maintenance programme and a record is kept to show what jobs the maintenance man has been working on and when. Therefore we consider that the homes are easily accessible, safe and well maintained. Residents own rooms are designed and decorated with their own preferences and needs in mind. We redecorate, refresh and update decor and furnishings when needed. 37 Hill Top View provides accommodation for up to 3 people. Bedrooms are for single occupancy, two on the first floor and one on the ground floor. Adaptations have been made to areas of this home to accommodate one person who is wheelchair dependent. The communal space includes a comfortable lounge, separate dining room and kitchen. All areas of the home appeared well maintained and decorated. The acting manager stated that there are plans for further improvement to the service including new flooring. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The ground floor bathroom is spacious. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that there are sufficient staff to meet their needs, but need to be confident that staff are supported by regular staff supervision and meetings and receive the training necessary to deliver good quality care and support. Evidence: We have been told in the AQAA that, We have intensive policies and procedures in place; tracking an employee from the day they join our employment to the day they leave. We have a clearly defined recruitment procedure in place, this procedure has many sub processes within it including a new employee process which covers in significant detail the required actions needed to ensure pre employment checks, references, shadowing, and supervision levels during the first few months of employment are in line with current guidance. Furthermore we have a thorough induction programme based on our own 12 Stages of Competence. Staff training is a continual process. Staff have the opportunity to have 1:1s with their line manager as and when required or needed at their request or at a managers request. We consider management to be approachable at all times. We saw that people using the service have two staff on duty for the majority of the day, but during the evening this reduces to one, which potentially limits peoples access to community activities. We spoke to the acting manager, who told us, We have recognised that this is an area for further development and have started to deploy additional staff when we have a planned activity in the evening. We saw evidence of this in staff rotas. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: We would continue to recommend that the number of staff deployed in the evening is kept under review. The acting manager has told us that there are no staff vacancies at the moment and the service has not used agency staff. The service provides one waking and one sleep in night staff. We looked at the records of staff supervision and are concerned that some staff have not had supervision sessions with their line manager for months. We saw examples where staff have not received a supervision session since August 2009. We saw 6 examples where the records show that staff have not had a supervision sessions and 5 examples where staff have received one supervision session in a 5 month period. We spoke to two member of staff, one stated she hadnt received a supervision session for approximately 6 months, the other said she has received a supervision since the new manager has been appointed. We recommend that staff receive 6 supervision sessions per year. We talked to the acting manager about staff meetings and have been told that regular staff meetings have not taken place, but since she has been appointed she has arranged at least one meeting and has plans for others on a monthly basis in addition to senior care meetings. We saw evidence of this. We spoke to two members of staff who confirmed this. We asked the acting manager about staff training, as the records we have been provided with show gaps. The acting manager told us that she has arranged a programme of staff training for the next 12 months that will address any gaps in staff training and any over due updates. We recommend that staff also receive Mental Capacity Training and Deprivation of Liberty, that staff receive medication training that meets the recommendations of the guidance in Medication Administration in Care Homes, including staff competency assessments. We also advise that the provider sources Rectal Diazepam training for staff. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service need to be confident that the management of the service is robust. Evidence: We received an AQAA but had to remind the service to send it within the timescales we had stated. We saw that the AQAA contains detailed information about what the service does well and how it intends to improve. But we also found that the AQAA contained some information that we have not been able to evidence during this visit. Areas not supported by the evidence we found include, staff supervision and staff training. We have been told in the AQAA that; The Acting Home Manager is directly mentored by the company founder and director. The Senior Staff Team consists of the Acting Home Manager, Head of Houses and Home Leaders followed by a Senior Support Worker and Staff Mentors. All senior staff have supernumerary time, supported by the Manager and Administration Officer. We have an excellent working relationship with many members of multi disciplinary teams. Quality assurance surveys are sent out annually. Policies and procedures are regularly updated to reflect any changes needed. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: We have been told that the registered manager no longer works at the service, a new manager has been appointed, but has yet to apply to be registered with us. She was present throughout the inspection site visit and demonstrated that she had an understanding of her role. We have been told that the acting manager has a teaching background and was previously employed at the home as the deputy manager. We do have some concerns with how the service has been managed since the last key inspection and as discussed in other areas of this report. We noted that the acting manager has been carrying out her own audit of the service and knows what she needs to do to correct things. We are concerned that staff havent received training or guidance relating to The Mental Capacity Act or Deprivation of Liberty. We also spoke to the provider about this. People using the service should be involved in day to day decisions making and in the implementation and review of support plans. They should be supported by a staff team that have been trained in person centred planning (PCP, so that they can be confident staff understand how they are expected to support people. Information should be available to people using the service in a format they can more easily understand, to demonstrate that the service actively tries to included and involve people. We saw that the provider has been carrying out monthly audits of the service and has developed an action plan with the acting manager to work on during the next few months. We saw that the records for peoples finances have been accurately maintained. We saw that each person has a bank account held for them by Langston Care. We asked if individual statements could be provided on request and have been told that they can. None of the people currently using the service manage their own money. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 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 20 13 Medication must be stored properly. 03/05/2010 To ensure that it is safely managed. 2 20 13 Staff must receive medication training. 03/05/2010 To ensure that they have the knowledge to administer and manage medication safely. 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 1 1 The Statement of Purpose should be up to date and reflect the current service. The service user guide should be in a user friendly format and specify the fees and costs of the service. Care Homes for Adults (18-65 years) Page 31 of 33 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 3 6 The provider should ensure that it can evidence how people using the service are involved in planning and reviewing their care. To demonstrate that the service includes them in decisions affecting their lives. Staff should receive training or guidance relating to Person Centred planning and its implementation so that people using the service can be confident that they be properly supported. The provider should make further efforts to ensure that peoples activities are individualised. The provide should review current medication record keeping procedures to ensure that an accurate audit of medication can be undertaken at any time. Staff should receive training and guidance relating to the Mental Capacity Act and Deprivation of Liberties. The provider should ensure that staff receive the training they need to deliver appropriate care and support, including updates. The provider should ensure that regular staff meetings are arranged. The provider should ensure that staff receive regular one to one supervision. The service should ensure that a new manager applies to be registered with us. So that people using the service can be confident that an approved person is managing the home. 4 6 5 6 12 20 7 8 32 32 9 10 11 36 36 37 Care Homes for Adults (18-65 years) Page 32 of 33 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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