Care Home: Ardgowan House

What the care home does well The home supports people to have interesting lives. People can take as long as they need to decide if they want to live in the house. People are asked about what they need. And a lot of information is collected before people move in to make sure their needs can be met. There is a good standard of hygiene around the home. Staff help people keep in touch with their families. There is a good standard of record keeping. There is a very good level of staff training. What has improved since the last inspection? The level of staff training continues to improve. The kitchen has been refurbished. Dining room furniture has been replaced. Fires have been replaced in two communal rooms. Some bedding and curtains have been replaced. Five bedrooms have been extended. Five en-suite facilities have been added to bedrooms. Blinds have been fitted. Carpets have been replaced in some areas. The lounge,dining room and hallway have been decorated. A ramp has been fitted to make the rear of the building more accessible. Some bedrooms and the staircase have been decorated. Bedroom furniture has been replaced. The appropriate checks are carried out before staff are appointed. What the care home could do better: Care plans should be broken down to show the amount of care and support that staff need to provide to help the person living at the home achieve the task.Food and fluid charts should be maintained to record the food and drink offered or taken by a person as they become frail and are unable to eat a normal diet. A policy must be written for the use of the personal monitors outlining when they can be used and who should carry them in order to maintain the privacy and dignity of service users. Staffing levels should be kept under review to ensure the needs of people living at the home are met as individually as possible and to ensure their safety. Staff supervisions should be carried out every two months. Key inspection report Care homes for adults (18-65 years) Name: Address: Ardgowan House 4 Middle Street Newsham Blyth Northumberland NE24 4AB     The quality rating for this care home is:   two star good 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: Karena Reed     Date: 1 0 0 9 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 28 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 28 Information about the care home Name of care home: Address: Ardgowan House 4 Middle Street Newsham Blyth Northumberland NE24 4AB 01670-367072 01670546391 annie@anniejobson.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs A Jobson care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Ardgowan House is a large, detached house with a small front garden and rear yard. The home is registered to provide personal care to twelve adults with mental health problems and one adult with a learning disability. Five of the places are for people over sixty-five years of age. Nursing care is not provided. The home is situated in a residential area on the outskirts of Blyth. It is close to local shops and pubs. The town centre and coast are also close by. Each person has their own bedroom apart from one married couple and two people who choose to share a double bedroom. Communal areas include a dining room/combined lounge, separate lounge, conservatory and a quiet room. A passenger lift is not available but some bedrooms are situated on the ground floor of the property. A bathroom and shower room are fitted with equipment to assist physically dependent people. A Statement of Purpose and service user guide are available for prospective residents and their relatives to give them information Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 1 7 1 5 0 9 2 0 0 8 Brief description of the care home about the services provided by the home and the relevant charges. Fees payable for living at the home at the time of inspection in September 2009 are £410 85. Additional charges are payable for hair dressing, personal toiletries, private chiropody, holidays and outings. Care Homes for Adults (18-65 years) Page 5 of 28 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm.In future,if a requirement is repeated,it is likely that enforcement action will be taken. How the inspection was carried out: Before the visit we looked at information we have received since the last inspection in September 2008,how the service dealt with any complaints and concerns since the last visit,any changes to how the home is run,the providers view of how well they care for people and the views of people who use the service and their relatives, staff and other Care Homes for Adults (18-65 years) Page 6 of 28 professionals. The Visit:an unannounced visit was made on 10/09/2009. During the visit we talked with people who use the service and staff,looked at information about the people who use the service and how well their needs are met,looked at other records which must be kept,checked that staff had the knowledge, skills and training to meet the needs of the people they care for,looked around parts of the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the person in charge what we found. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should be broken down to show the amount of care and support that staff need to provide to help the person living at the home achieve the task. Care Homes for Adults (18-65 years) Page 8 of 28 Food and fluid charts should be maintained to record the food and drink offered or taken by a person as they become frail and are unable to eat a normal diet. A policy must be written for the use of the personal monitors outlining when they can be used and who should carry them in order to maintain the privacy and dignity of service users. Staffing levels should be kept under review to ensure the needs of people living at the home are met as individually as possible and to ensure their safety. Staff supervisions should be carried out every two months. 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 9 of 28 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 10 of 28 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. There are good arrangements in place to ensure that prospective people wanting to live at the home can make an informed choice about the home and that the home can meet their needs. Evidence: Records for three people living at the home showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. The resident and relevant people who knew them were involved in the initial assessment. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender,culture,religion,spirituality,educational and social history,preferred daily routine and preferences. It also looks at mood,speech,behaviour,mental health, risks, sexuality and living skills. This information and the care managers assessment of the persons care needs were used to ensure all the needs of the resident could be met by staff. The records contained a range of information. Residents have the opportunity to visit the home as often as they need in order to Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: decide if they wish to live there. A prospective resident may come for meals, have overnight stays and be introduced to other people living at the home at a pace suitable to the individual. People already living at the home are involved in deciding who may come to live with them when a vacancy occurs. Care Homes for Adults (18-65 years) Page 12 of 28 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. There are good arrangements in place to ensure that the care and support needs of people living at the home are recorded and to ensure that they are involved in decision making in their lives. Evidence: There are detailed assessments in the care plans of people living at the home. Staff are allocated responsibility for a small number of people and are known as their key worker. The key worker together with the resident are responsible for updating the care plan at least three monthly or sooner if a residents needs change. Care plans are person centred, however they do not show the amount of support that is required to assist the person. The tasks are not broken down to give new staff clear instructions about the amount of care and support that is required to assist the person living at the home to become more independent or to maintain their current level of independence. People living at the home are asked individually and consulted about decisions involving themselves and the running of the home. Meetings are held weekly with Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: people about the running of the home, choice of food,activities and outings. A care manager said :The clients I have at Ardgowan House are very happy with their care. The home supports people living at the home to remain independent and take risks in order to live a more fulfilled lifestyle and up to date risk assessments were present in peoples care records. Residents care records all contained statements of confidentiality to remind staff what information could or could not be disclosed about a resident. Care Homes for Adults (18-65 years) Page 14 of 28 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. Residents have access to a variety of activities which helps them to enjoy a good quality of life. Residents are also supported to keep in touch with their families. Evidence: Records and meeting minutes provided evidence that all people living at the home are consulted and asked their opinion and encouraged to make decisions. Conversation with people and staff show that they are provided with the necessary levels of support to help the resident maintain some level of independence and retain some skills to be more self sufficient in aspects of everyday living. Most people at the home attend some day services or a drop in centre if they wish to on a part time basis if they havent retired. People are encouraged to pursue their own interests and hobbies and are supported to do so. These include listening to music,shopping,art,cookery,reading, attending church, bingo,quizzes, dominoes,jigsaws,board games,kareoke,relaxation,exercises. People also enjoy meals out at local pubs, day Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: trips and whatever is of interest to the resident. People are supported to holiday in this country or abroad. Within the home peoples bedrooms are equipped with their own televisions,radios, books,pictures and whatever is of interest to the resident. The care plans and case records of people living at the home detail any family involvement. Conversation with people living at the home and staff also provided evidence that they are encouraged to maintain contact with family and friends, if they wish to do so, with staff providing any support that may be required. One person commented: Sometimes on Saturday I go to see my grandma who is 95 years of age. People living at the home are asked individually what they wish to eat each day. A light snack is available at lunch times and a larger cooked meal is served in the evening. A record was not available to show the food served each day to people living at the home. On the day of inspection lunch available was chicken noodle soup or baked beans on toast followed by cake or yoghurt. The evening meal was chicken curry or pork chops and chips. Care Homes for Adults (18-65 years) Page 16 of 28 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. There are good arrangements in place to ensure that the health and social care needs of people living at the home are met. Evidence: Three care plans and case records were inspected. The daily records detailed the care and support required for different needs. They reflected the changing needs of service users as they become older. The home respects the wishes of an individual when dealing with their increased dependency. Fluid and food charts must be maintained if a person is unable to eat a normal diet due to illness or frailty. The majority of people living at the home need minimal help with personal care tasks, such as bathing and dressing. Privacy and dignity are respected at all times. Discussion took place about the use of the personal monitors and the need to ensure written guidelines were available to advise staff. This will help ensure the privacy of the two people who needed to have them due to their increased level of dependency. This will help to protect their privacy and inform staff when they can be used. Records showed when people living at the home had seen health professionals e.g doctors,community nurses,psychiatrists,psychologists. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Residents are referred for specialist health care if appropriate. A professional commented; the service is quite good with communication if they have concerns about my clients. Records also showed when residents had seen opticians and dentists. Staff who have completed training administer medication, medication training has been up dated for staff who administer medication to people living at the home. A new medication cabinet was in use. A sample of medication records was examined and they were found to be in order. Clear directions were recorded and each dose of medication was signed for, or a code entered to verify the reason not given. No resident administers their own medication currently. A system could be put in place to oversee the medication of residents if they were able to retain and administer their own medication. The environment is becoming much better equipped as the people at th ehom ebecome older .Although there is no through floor passenger lift some bedrooms are available on the ground floor for a person if required. Staff have received training to give them more understanding about the ageing process and the needs of people living at the home as they may become incapacitated due to illness and older age. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear,user friendly complaints and protection system to ensure the views of people living at the home are listened to and acted upon. Evidence: There is a complaints procedure that includes what complainants should do if they are not happy with the homes investigation and response it does include how to complain as required by the Care Home Regulations 2001. The home keeps a record of complaints. Two complaints have been received since the last inspection which have been investigated and resolved. One incident has also been reported and investigated using the Trusts multi-agency safeguarding procedures. Staff training about Protection of Vulnerable Adults and Prevention of Abuse has been up dated. Staf have received some awareness training about dementia. People living at the home can deposit money for safe keeping in the homes safe and records are kept of accounts. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable environment for those living there and all areas are well maintained,clean,tidy and free from offensive odours. Evidence: There is a programme of redecoration and improvement around the home. Major refurbishment is taking place and plans have been submitted to the relevant planning department to add some more bedrooms and two flats,thereby increasing the size of the home. Since the last inspection a number of physical changes have taken place to the building to make the home more comfortable for people living there, these changes include: the whole building has been rewired, five en-suites have been added to existing bedrooms, five bedrooms have been extended, the kitchen has been refitted.The hallway, lounge, staircase and bedrooms have been decorated or are currently being redecorated. Fires have been replaced in the lounge and dining room, furniture in the dining room had also been replaced. Carpets have been replaced and blinds have been fitted. Some bedding and curtains have also been replaced. A ramp has been made to gain access to the back of the building and other adaptations have been made to the building to make it more accessible for people who have mobility needs and are becoming more dependent. The home was clean and becoming well decorated. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home has a lounge,combined lounge/dining room, quiet area and a conservatory. People can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in good condition. Lighting was bright and domestic in design. Residents bedrooms were personalized according to individual taste. All people living at the home enjoy their own bedrooms apart from a married couple who had a double room and another two people who had chosen to share a bedroom. There was emergency lighting throughout the home. The home was clean and free from offensive odours. Care Homes for Adults (18-65 years) Page 21 of 28 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. There are enough staff for the current needs of the residents living in the home, the staff have been properly recruited. Evidence: Examination of staff rosters and discussion with the person in charge showed that the numbers of staff are as follows: 8:00am- 4:00pm 2 staff members 4:00pm- 10:00pm 2 staff members 10:00pm- 8:00am 2 waking night staff. On the day of inspection, the two staff on duty were were very busy attending to a number of tasks including : attending to service users, one who was very ill, making lunch, giving out medication, helping me at inspection and dealing with workmen and attending to other service users. Staff numbers do not include the manager.Staff members also carry out cooking duties. A stable staff team is being created with a management structure. Staff stated that Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: they enjoyed working in the home and were observed to be kind, caring and respectful to residents. There is a good level of staff training. 10 staff members have achieved National Vocational Qualifications at level 2 and 4 staff members are planning to study or are studying for level 3. Staff and their records showed that they also receive training or advice in other areas such as equality and diversity,food hygiene, safe handling of medication,bereavement and palliative care, moving and handling, introduction to dementia,sensory deprivation awareness,adult literacy,mental capacity act and safe guarding adults awareness.Training is planned about person centred planning. A sample of staff files were examined and it was evident all the necessary checks are being carried out prior to workers being appointed or starting work at the home. Two written references were available on staff files examined. An application form had been completed for each staff member. Employment histories were available. CRB checks are carried out before a person is appointed. Staff photographs were available on staff files examined. Staff receive supervision and six monthly appraisals to look at their development and training needs. Care Homes for Adults (18-65 years) Page 23 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems are in place to ensure the smooth running of the home and to ensure the safety and protection of people living at the home. Evidence: Previous requirements and recommendations have been addressed from the last inspection. As stated the home is undergoing a considerable amount of refurbishment and structural work to make the accommodation more comfortable and accessible for people people living at the home as they become older and more dependent. The proprietor is creating a staff team and a management structure has been created to run the home in her absence.The home is becoming better run and run for the benefit of the people living there most of the time. Documents detailing fire safety, risk assessments in the environment,water temperatures and maintenance contracts for equipment were up to date. There is an improved standard of record keeping. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Staff training relating to health and safety was up to date. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 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 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 Care plans should be broken down to give clear instructions to staff to show the amount of care and support that is required for the task A record should be kept of all food prepared and served each day to people living at the home in the interests of health and safety. A policy should be written for the use of the personal monitors for the two people so staff know when they can be used and that they should be kept on the person to ensure the privacy and dignity of the people concerned. Fluid and food charts must be maintained if a person is unable to eat a normal diet due to illness or frailty. Staffing levels should be kept under review to ensure the needs of residents can be met at all times and as they become more dependent. Staff supervision should be carried out every two months. 2 17 3 18 4 5 18 33 6 35 Care Homes for Adults (18-65 years) Page 27 of 28 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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