Care Home: 7 Blunt Street

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What the care home does well The care home finds out what people need and write this down. Staff read these reports so that they can help people to keep healthy and as active as possible. People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect. The care home`s policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules. People were living in a comfortable and homely environment. Staff have training so they understand how to meet people`s needs. What has improved since the last inspection? There was a new sensory garden. New double glazed windows were fitted. A new fridge was in the kitchen. The care home had new records. More staff had received training. More people were being asked their views on the care home. Staff were finding out about peoples individual needs. What the care home could do better: People`s medicine records must be completed clearly and accurately so that they receive the right levels of medication prescribed for them. There must always be enough staff on duty so that people are safe. The care home must be managed so that people`s needs are met and they are safe. Key inspection report Care homes for adults (18-65 years) Name: Address: 7 Blunt Street Stanley Common Ilkeston Derbyshire DE7 6FZ     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: Anthony Barker     Date: 2 2 1 2 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 © (2009) 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 26 Information about the care home Name of care home: Address: 7 Blunt Street Stanley Common Ilkeston Derbyshire DE7 6FZ (0115)9323491 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Blunt.Street8@unitedresponse.org.uk www.unitedresponse.org.uk United Response care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 7 Blunt Street is a semi-detached house in a small village development. People who live here are provided with adequate accommodation and single rooms. There is a reasonably-sized rear garden. The Service offers personal and social care to people with a severe learning disability with associated conditions that include autism, sensory disability, epilepsy and challenging behaviour. Activities are planned to meet individual needs. 1 2 0 3 2 0 0 9 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspector visited at short notice. The last key inspection at this care home was on 23rd December 2008. We had asked the Acting Manager to complete a questionnaire about the care home, before this inspection. We had asked other people to tell us what they think about the home. Nine people sent us their views. We looked at what staff had written about one persons life. We also looked around the care home. The people who live in the care home were not able to talk to us as they had high levels of dependency. But we saw how staff treated people and we spoke to the Senior Support Worker in Charge. Care Homes for Adults (18-65 years) Page 5 of 26 The weekly fees at the time of this Inspection were from 1255 pounds to 1769 pounds. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 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. Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: August 2004 was the last date that a person was most recently admitted to the Service. This persons file contained a range of pre-admission assessments, which were assessed at a previous inspection. Care Homes for Adults (18-65 years) Page 9 of 26 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 who use the Service had individual plans of care which demonstrated that their health, personal and social care needs were being met. Evidence: The care plan of one person, living at the Service, was examined. We call this focussing on the experiences of one person, case tracking. There a good set of care plan records that were holistic, very person centred and included a well worded set of future goals. These records included a Pen Picture of the person along with a photograph and a section entitled, My dreams. These records were a significant improvement over those examined at the last inspection. The Senior Support Worker in Charge told us that a new system of monthly reviews of peoples care plans was in its early stages. Formal person centred care planning meetings were normally being held annually to provide a full multi-professional review of peoples needs. However, due to the lack of an allocated social worker for the case tracked person, there had been no review meeting since August 2008. The Senior Support Worker in Charge said that a formal review meeting would be held by January 2010, for the case tracked Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: person, regardless of Social Services staff availability. Daily records comprised Shift Plans, where staff record their initials beside a typed task, and Keeping Track sheets where staff record the degree of engagement with people they support by means of a letter code. Although this daily record system was an improvement from that in place at the last inspection it did not appear to encourage staff to record their reflections on peoples achievements of personal goals or non-goal related behaviour, as part of the care planning review system. Learning logs were an additional means of staff recording their views and experiences on peoples involvement in daily activities and their behaviour. However, only one Learning Log had been completed, dated 11 August 2008, in respect of the case tracked person. It was also noted that the Keeping Track sheets contained no staff signatures in order to provide ownership of these records and enable audit trails to be kept. We were provided with evidence of how people are involved in making decisions and choices. Objects of reference are used to help the case tracked person know what activity is planned - for example, getting swimming trunks out of the drawer. Photographs are used with another person when, for example, planning a holiday. The Senior Support Worker in Charge described a planned Communication Focus Group which would comprise one staff member and one supported person from each of the local group of United Response care homes. This would provide, an exchange of ideas and mutual support, she told us. The Acting Managers self-assessment stated, We support people to complete a decision making matrix to give clear guidance on how people are able to make choices, decisions and what support they prefer. However, this matrix was not in general use as the Senior Support Worker in Charge was not aware of it. Well worded risk assessments were in place to address the risks that the people living at the Service were exposed to. They included Benefits from me taking the risk as well as action needed to minimise risk. They were very person centred and in this respect were an improvement from those examined at the last inspection. Care Homes for Adults (18-65 years) Page 11 of 26 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. The Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: Two people who live at the Service were being provided with a day service from Derbyshire Adult Social Services on four days of the week with one week day based at the Service. The case tracked person spends each day at the Service. We were given examples of people taking part in activities that were valued by them and fulfilling. The Acting Managers pre-inspection Self Assessment form told us that, People we support have been supported to attend a ball for the first time in their lives. Photographs of this event were displayed on the dining room notice board and showed everyone thoroughly enjoying themselves. There was evidence of the people living at the Service having a positive involvement Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: in the local community. This included using local shops and supermarkets, pubs, hairdressers and a leisure centre pool. Two staff members reported in their completed pre-inspection surveys that, We have good access to the community and We are now becoming more and more focussed on involving people in their community and promoting life skills. The Acting Managers pre-inspection Self Assessment form stated that, One person we support goes swimming regularly with (their relative) and support worker...one person has a friend that visits them...one person is supported to visit their friend. The Senior Support Worker in Charge explained that these three separate examples referred to each of the three people living at the Service and indicated that good links were being maintained with family and friends. Two staff members reported in their completed pre-inspection surveys that, Number 7 is a good communicator with families and We work well with families. We were provided with evidence of how routines, at the Service, are flexible to meet peoples individual needs and circumstances and, also, of how routines promote peoples independence. The Senior Support Worker in Charge showed us a specimen Routine Chart, with words and pictures/symbols, that gave a clear image of personal routines for each person. A varied and nutritious three-week rolling menu was seen. However, this had not been reviewed since May 2005 and was not obviously person centred. The Senior Support Worker in Charge showed us a new three-week menu to start in January 2010 which includes food preparation activities for each individual person. Also, a food photo library had been started. There was some reference on the case tracked persons care plan to their food preferences but these were not recorded in an easily accessible way. Food stocks were found to be at a good level, including fresh fruit and vegetables. A new refrigerator had been fitted in the kitchen. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service was providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: Two relatives of people living at the Service told us in their completed pre-inspection surveys that, The service they give to (my relative) is excellent...(my relative) is very content and bonds well with the staff and they treat (my relative) with respect. There was evidence of equipment in place that maximises peoples independence. There was evidence of person centred communication systems within the Service. Wallets of picture cards were available for each person living at the Service: staff use these to help explain and involve people in making choices and decisions. There were also some photographs on walls that are used as communication tools. The Acting Managers pre-inspection Self Assessment form stated that, One person has been supported to go to the bank, to take a personal profile with a picture and names and signatures of staff. The Senior Support Worker in Charge told us that this person now has a bank card, giving them greater independence. Each person living at the Service had a My Health File in place that was well laid out Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: in person centred terms. The way that medical appointments were being recorded had improved since the last inspection. There was evidence of involvement of a range of external health professionals, including optician and dentist. An Emergency Grab File was in place which provided a useful immediate source of information. Telephone numbers, a disaster plan and emergency information sheets regarding each member of staff and each person living at the service, were in this file. A relative of someone living at the Service told us in their completed pre-inspection survey that, The service always keeps us in touch about any medical concerns. The Medication Administration Record (MAR) sheet of the case tracked person was examined. This was satisfactory except that staff had recorded, by means of their initials, that an evening dose of Topiramate 25mg had been administered over the previous 15 days, in addition to a morning dose. The evening dose had been deleted by means of a cross on the left side of the page but staff had not paid attention to this. However, examinination of the blister pack showed that only one dose a day had actually been administered. This indicated a lack of MAR sheet monitoring. The Senior Support Worker in Charge told us she would ask all staff to check MAR sheets at the start of a shift, cross referencing with blister packs. There was a good system of separate blister packs containing tablets used by people who live at the Service for use when they attend day services. There was a record of staff signatures/initials to ensure that signatures can be cross-referenced against staff names. Medicines were securely stored in personal medicine cabinets in peoples bedrooms. However, a copy of the Services Medicines Policy was no longer being kept in the case tracked persons cabinet. No controlled drugs were prescribed. All staff had received training in the safe use of medicines within the past three years. Care Homes for Adults (18-65 years) Page 15 of 26 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. Procedures for handling complaints and abuse were in place to ensure that people were fully protected. Evidence: United Response had a robust procedure for dealing with complaints. The Services complaints procedure had been updated since the last inspection and now makes reference to the Care Quality Commission. A copy of the procedure was displayed. It made appropriate use of symbols so that people who live at the Service could better understand it. The Acting Managers pre-inspection Self Assessment form stated that, Weve put a system in place to review and monitor what people are telling us through their behaviours and expressions, to recognise that they may be making a concern or complaint. We examined this system, that comprised a good set of person centred records, although no records had yet been made. The Acting Managers pre-inspection Self Assessment form indicated that no complaints had been received during the 12 months previous to this Inspection. The Service had a written policy and procedure on prevention of abuse linked to the statutory procedures and prepared by United Response. The Acting Managers preinspection Self Assessment form stated that, there has been a reduction in incidents of challenging behaviour. The Senior Support Worker in Charge described improvements in the behaviour of one person she supports, and these were based on a sensitive and person centred approach. The staff training matrix showed that most Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: care staff had been provided with training, on the subject of Safeguarding Adults, within the past three years. The Senior Support Worker in Charge said she thought about half the staff group had received training in the Timian system of conflict management and physical interventions. She herself hadnt had this training and we were concerned at this, especially given the behaviour of one person whose behaviour many staff find challenging. The case tracked persons personal money record was examined. This was satisfactory. The Acting Manager and the Senior Support Worker in Charge on the day of this inspection had both undertaken training on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). A full discussion, at a staff meeting, had taken place regarding a consideration of potential applications under DoLS, the Senior Support Worker in Charge told us. Care Homes for Adults (18-65 years) Page 17 of 26 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 were living in a comfortable and safe environment that was clean and hygienic. Evidence: The premises were well decorated and furnished. The wall beside one bedroom door frame was, again, in need of redecoration. Bedrooms were equipped with visual stimuli according to the individuals needs and all people living at the Service had a 4foot bed to provide more comfort and safety in the event of a seizure. Each of the bedroom doors had a suitable lock although none of the people living at the Service would be able to hold their own door key. An attractive sensory garden had recently been completed to the rear of the premises. The Acting Manager informed us, in his pre-inspection Self Assessment form, that this, includes visible and audible accessories. He also informed us that new double glazed windows had been fitted throughout the premises. We noted that all bedrooms had been fitted with bedside cabinets to hold personal monies and records. From the tour of the premises there was evidence of satisfactory standards of cleanliness and hygiene, with no unpleasant odours. No communal rooms have to be passed through by staff between bedrooms and the laundry room. The Acting Manager informed us, in his pre-inspection Self Assessment form, that four of the five permanent staff had completed Infection Control training. Care Homes for Adults (18-65 years) Page 18 of 26 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. The Service had a well-trained staff group but there were not consistently enough staff to ensure that people living here were safe and their needs were met. Evidence: The Acting Managers pre-inspection Self Assessment form stated that four of the five permanent care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. This well met the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The Senior Support Worker in Charge said that two of these four staff members have an NVQ in Care at level 3 and this includes herself. The Acting Managers pre-inspection Self Assessment form stated that, We need to recruit a larger relief pool to avoid using agencies to cover annual leave, training courses and sickness. We also noted that use had been made of temporary staff in 78 shifts in the three months prior to completion of this Self Assessment form. One persons relative helped to complete one of our pre-inspection surveys. In this survey, we were told that the Service could improve by providing, more permanent staff. We noted from the staffing rota that, over the whole week-end 5/6 December there was only one staff member on duty. The rota also indicated other periods of time, in the near future, when there was a sole member of staff on duty. The Senior Support Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: Worker in Charge said there were plans for agency staff to cover these Christmas periods. She added that there were, currently, two part time staff vacancies totalling 48 hours a week. We are aware of the Services risk assessment that addresses lone working, and the actions necessary to control associated risks. It states that on-call staff can arrive within 10 minutes of a telephone call and, if immediate support is needed, staff from one of the adjoining services can arrive within 2 minutes. However, we feel that a full week-end with only one staff on duty is potentially unsafe, particularly given the behaviour exhibited by one person living here. Also, the Service cannot guarantee that staff would be released from a neighbouring service, in an emergency. On 24 December 2009, two days after this inspection, we received a call from someone who wished to remain anonymous indicating their concerns about staffing levels not reflecting the assessed needs of the people living at this Service. We asked the Registered Provider to investigate this matter. The staffing rota showed no recorded hours for the Acting Manager. The Senior Support Worker in Charge, in response to a question we raised, said she estimated the Acting Manager works about 10 hours a week managing the Service. She added that there were some days when she did not see the Acting Manager (see the next section, Conduct and Management of the Home). There had been one member of staff recruited since the last inspection but, in the Acting Managers absence, the Senior Support Worker in Charge did not have access to confidential staff files. We were therefore unable to confirm whether the Service was following good practice regarding recruitment practices. However, this has not been an issue of concern in the past. Training records showed that all staff had been provided with mandatory training in Basic Food Hygiene, First Aid, Moving & Handling and Fire Safety, within the past three years, except for two staff without recent training in Basic Food Hygiene. All night staff were being provided with additional Fire Safety training - an improvement from the last inspection. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The welfare of people who live at the Service were being potentially compromised by the management systems in place. Evidence: The Acting Manager had 18 years experience of working with people with learning disabilities and had an NVQ in Care and Management at level 4. He had been in this post for 15 months before this Inspection. He has recently made application to us to become the Registered Manager. This is after we had reminded the Acting Manager several times about the requirement to become registered. We also had to remind him to return his pre-inspection self assessment form which we received more than five weeks after the date we asked for it to be returned. Given the comments made by the Senior Support Worker in Charge, regarding the hours worked by the Acting Manager, we asked her if she felt she was taking on the day to day management role in the Service. She said yes and added that the staff perceive matters this way too. Additional to this matter, we had already had concerns, during this inspection, about the lack of Medication Administration Record(MAR)sheet Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: monitoring by management, and the ongoing monitoring of safe staffing levels. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were taking place. We examined the Services 2009/10 annual Service Plan which was well worded but included no action dates. Quality assurance questionnaires were being sent to staff, relatives and external professionals, for their views on the quality of service provided. The Acting Managers pre-inspection Self Assessment form stated that, Relatives are encouraged to feedback to the manager for each visit or contact they have by completing a questionnaire which asks what they have tried, learned, are pleased about and concerned about. These are used to make improvements to the service and to quality of life for the people we support. The Senior Support Worker in Charge confirmed that one persons parent has completed several 4 1 person centred forms and these have been positive. Good food hygiene practices were noted. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The Acting Managers pre-inspection Self Assessment form indicated that equipment at the Service was being maintained and good Health and Safety practices followed. Regular fire alarm tests were being carried out as well as fire drills. Monthly Health & Safety audits were taking place, the Senior Support Worker in Charge told us. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 13(2) Staff must accurately, 01/03/2010 and with consistency, record the medicines administered to the people they support. This is to ensure that people have received their medicines as prescribed. 2 32 18 18(1)(a) There must be sufficient staff working at the Service at all times. This is to ensure the safety of people living at the Service and of staff. 01/03/2010 3 38 11 12(1)(a) The registered 01/03/2010 person must ensure that the Service is adequately managed. This will ensure that the needs of the people living here are met and that they are safe. Care Homes for Adults (18-65 years) Page 24 of 26 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 6 A recording system comprising regular meaningful entries should be put in place that reflects the achievement of peoples personal goals or significant non-goal related behaviour. All entries within records, made in respect of the people supported at the Service, should be signed by the staff member. Peoples care plans should be reviewed at least every six months. Peoples food preferences should be recorded in a way thats easily accessible to staff. A copy of the Services Medicines Policy should be kept beside or in each persons bedroom cabinet. Staff should be provided with Timian training to give them confidence in addressing the behaviour of one person that they find challenging. The staff member, without recent training in Basic Food Hygiene, should be provided with this training. The Acting Manager should ensure that the hours he spends managing this Service are recorded on the staffing rota. The Services 2009/10 annual Service Plan should include action dates. 2 6 3 4 5 6 6 17 20 23 7 8 30 33 9 39 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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