Care Home: Ayeesha-Raj

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What the care home does well The people who live at Ayeesha Raj are being encouraged to take part in the running of the home and have been involved in recent interviews for a new manager. People are supported to stay fit and healthy. They receive regular health checks, are supported to see dentists and opticians and encouraged to eat a healthy diet. One person said "The food is good but there aren`t a lot of puddings!" People living in the home know who to speak to if they aren`t happy with anything. Staff take people`s concerns and complaints seriously and act upon them. The people living in the home get on well with the staff team, one person said, "the staff look after you". What has improved since the last inspection? People`s support plans have been updated so that staff are aware of the kind of help and support each person needs. There are more staff working at the home so that people who need extra help to meet their needs receive it. All the bathroom windows now have blinds or curtains so that people can get washed in private. Staff have received training in how to support people with learning disabilities and people with mental health conditions. What the care home could do better: Some areas of the home still need re-decorating and some furniture and carpets need replacing. This would make Ayeesha Place a more pleasant place for people to live. Ayeesha Raj still does not have a registered manager. The service would benefit from a period of stable management to consolidate and build on the improvements that have been made in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Ayeesha-Raj 86 Loughborough Road Mountsorrel Leicestershire LE12 7AU     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: Ruth Wood     Date: 0 4 0 5 2 0 1 0 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 27 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) © 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 27 Information about the care home Name of care home: Address: Ayeesha-Raj 86 Loughborough Road Mountsorrel Leicestershire LE12 7AU 01509413667 F/P01509413667 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cherre Residential Care Ltd Name of registered manager (if applicable) Vacant Type of registration: Number of places registered: care home 20 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 Ayeesha Raj is a care home for 20 people with learning disabilities. Ayeesha Raj is on the main road running through Mountsorrel. It is close to the centre of the village. It has good access to public transport services to Leicester and Loughborough. It is a large, detached house. There are 16 single bedrooms and 2 bedrooms for 2 people to share. It has three living rooms on the ground floor. The garage has been converted into a games area for service users. There is a patio garden and off road parking for staff and visitors. Copies of inspection reports are kept in the office for people who live in the home and Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 20 0 3 0 9 2 0 0 9 Brief description of the care home members of the public. People pay different amounts of money to live at Ayeesha Raj. You should contact the owner of the service to find out about this. Care Homes for Adults (18-65 years) Page 5 of 27 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: Before we visited Ayeesha Raj, we looked at the information the people who own the home had sent us in their Annual Quality Assurance Assessment. This told us about how the home is run and the people who live and work there. We also looked at information sent to us about things that had happened in the home since our last visit. We sent out Have Your Say surveys to people who live in the home. Two people filled in the surveys and we have put some of the information they gave us into this report. We visited the home on 30th April 2010 for 7 hours and again on 4th May 2010 for 1 hour. We looked at some of the rooms in the house, including two peoples bedrooms. Care Homes for Adults (18-65 years) Page 6 of 27 We spoke to people living at Ayeesha Raj and watched how the staff spoke to and worked with people. We looked at three peoples care plans and spoke to two of them about how staff support them. We spoke to three staff members to find out if they understood how to meet peoples needs and how they helped them to make choices and decisions about their lives. We looked at staff records to see that the provider had done the proper checks before staff worked at Ayeesha Raj, to make sure that they were not a risk to the people living there. We also looked at records and spoke to staff to find out about the training that staff had done and how it helped them to support the people living at Ayeesha Raj. We looked at how medication is stored and given out and looked at the records staff keep about medication to see that they were filled in correctly. We spoke to the person who owns Ayeesha Raj about how the home is run. Care Homes for Adults (18-65 years) Page 7 of 27 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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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. Assessment procedures are in place to make sure that the service can meet peoples needs. Evidence: No new people have come to live at Ayeesha Raj since the previous key inspection. The provider told us in their Annual Quality Assurance Assessment that they would undertake their own assessment of need of a person before they came to live at the home. They would also monitor compatibility with the people already living in the home by encouraging new people to make visits before they moved in. We looked at the assessment information in place for the three people whose needs we looked at in detail during the inspection visit. This had been updated since the last key inspection to reflect the changes that had taken place in peoples needs. The three staff that we spoke to demonstrated a good understanding of how peoples needs had changed and how they should be met. Care Homes for Adults (18-65 years) Page 10 of 27 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. Staff have a good understanding of peoples needs and how to meet them and they support people to take reasonable risks and to make choices. Evidence: We looked at three peoples care plans and spoke to two of these people about their needs and how staff support them. We also spoke with three staff members about their knowledge and understanding of peoples needs and observed how staff members interacted with people. The information in care plans is consistent with peoples own explanations of their needs and the way that staff support them. All three staff members gave consistent responses about how they support people. Care plans contain sufficient information about how each persons needs should be met and the particular risks for each individual and how these should be managed, are also documented. Staff displayed a good understanding of how to manage risk without placing unnecessary restrictions on people. When managing a persons potentially challenging behaviour they spoke about Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: using diversion techniques and how they shared information with each other about what worked best. The registered provider told us that the format of peoples care plans is currently being updated so that they are produced in a more accessible format, for both service users and staff. One person told us about the photographs that had been taken to use in their new care plan. Plans would also benefit from some consolidation to remove the duplicated information, which again would make information easier to access. People are supported to make choices and decisions about their lives and for some people this is facilitated by being supported by staff members on a one to one or two to one basis. This enables people to have greater opportunities to go out and engage in activities. One person, whose care that we looked at in detail, had been on a regular shopping trip on the morning of the inspection and said that this is what they liked to do. People are supported to make choices and decisions in the home relating to their daily routine and what they eat and drink. A working party has also been set up in the home to look at how people living there can influence how the home is run. One of the service users is the chairperson of this group and spoke to us about how they thought it would run. Care Homes for Adults (18-65 years) Page 12 of 27 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 are supported to engage in a variety of activities, which take account of their needs and interests. Evidence: On the day of the inspection visit, four people were attending specialist day care services for people with learning disabilities. This included one of the people whose care that we looked at in detail. One person had gone to work at a recycling project and two other people were being supported by Ayeesha Raj staff, on a two to one or one to one ratio, access activities in the community. Two of the people whose care that we looked at in detail said that they didnt want to do any formal activities. One person likes to stay at home and read books and magazines, the other person said, Im not bothered about going out, I like to sit and relax. One person whose care that we looked at has special nutritional needs and these had Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: been effectively addressed by the service. We looked at menu records and these showed that people eat a varied and balanced diet. One person said, The food is good but there arent a lot of puddings, but we get a lot of fruit. We get roasts and things and some puddings like semolina. One person told us that they would like to go on holiday and the registered provider said that they were looking into this. People are supported to take part in leisure activities and there were photographs on the dining room wall of a party that had taken place on New Years Day that service users had gone to. People have keys to their own rooms and most people keep their rooms locked. Staff do not enter their rooms without permission. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met. Evidence: The three care plans that we looked at outlined peoples personal care needs and their preferred morning and evening routines. The three staff that we spoke with were well informed about peoples individual personal care needs. One of the people whose care that we looked at in detail needs a lot of support with their personal care and said that staff helped them with everything and also used the special toiletries recommended. Each person has a Health Action Plan and the registered provider told us that the format of these is being updated. We looked at how the service had responded to two peoples increasing health care needs since the last key inspection. Appropriate support had been sought from outside professionals such as the Community Dietician and a Consultant Psychiatrist. Staff had received additional training in how to meet one persons needs arising from their dementia and were well informed about another persons nutritional needs. The District Nurse had supplied the service with special equipment to help meet one Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: persons pressure area care needs. We recommend that a specific care plan be put in place in relation to this persons pressure area care needs and that staff receive training in this area. Each person living at Ayeesha Raj has the opportunity to have an annual health check at the local health centre and has access to GPs, opticians, dentists and chiropodists. We looked at the arrangements for the storage, administration and recording of medication. All of these were in good order. Two staff routinely administer medication, one observing the process and signing to say that it has been administered correctly. The service has obtained the correct storage for controlled medication. Staff were aware of the protocols for the administration of as required medication. The registered provider is currently seeking to update the written protocols in this area and is currently liaising with service users medical practitioners. Care Homes for Adults (18-65 years) Page 16 of 27 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. Good systems are in place to encourage people living in the home to voice their concerns and complaints. Staff have a good understanding of managing potential challenges and this contributes to ensuring that people are protected. Evidence: We looked at the record of complaints made in the home since the previous key inspection. Two of these had been made by people living in the home and concerned dissatisfaction about how some aspect of their care had been met. The complaints had been investigated, and a formal response made to the service users about changes that would take place to make sure their needs were met. Copies of the homes complaints procedure are displayed throughout the home and the two people who responded to our survey said that they knew who to speak to if they werent happy. This suggests that people living in the home know they can express their concerns and that they will be listened to. At the previous key inspection the behaviour exhibited by two people living in the home was having a negative impact on other people living there. The service has worked together with outside agencies to address these issues and additional staffing now enables these people to receive the additional support they need. The three staff that we spoke to displayed a good understanding of how to respond to peoples behaviour that may be challenging and said that they had received training in Non Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Abusive Physical and Psychological Intervention (NAPPI). Staff have also received training in the safeguarding of vulnerable adults and the services response to such incidents demonstrates that they understand the multi-agency protocols in place, and how to use these to ensure that people are kept safe. The service supports some people who live in the home to manage their finances. Transactions for each person are recorded and balances of money held are checked at the end of each shift to ensure that they are accurate. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, but improvements are needed to the decor and furnishings so that it is a pleasant environment for people to live in. Evidence: Improvements have been made to some areas of the environment; window coverings have been fitted to all bathroom windows to enable people living in the home to bathe in privacy, some peoples bedrooms have been redecorated and radiator covers have been fitted in some areas. Some of the fire doors in the home require adjusting as they close very quickly. Given that some of the people living in the home have impaired mobility this is a potential health and safety risk. The registered provider confirmed that the decor and furniture in the home still requires updating and there is currently an ongoing programme in place to enable this. Care Homes for Adults (18-65 years) Page 19 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive training that helps them to support people effectively. Good recruitment practices help to make sure that staff are safe to work with the people living at Ayeesha Raj Evidence: Staffing levels have been increased since the last key inspection so that people who require one to one or two to one support now receive this. During the inspection we observed that their were sufficient staff on duty to respond to peoples requests for attention or assistance. The two people who responded to our Have Your Say survey said that staff always or usually listened to them and acted on what they said. People spoken with on the day of the inspection were complimentary about the staff, They look after you well. Twelve of the eighteen staff working at Ayeesha Raj have completed National Vocational Qualifications (NVQ) in Care and Support at level 2. All senior staff in the home are enrolled on NVQ in team leading, which will start in May. We spoke with three staff about their experiences of training and support in the home. They confirmed that they had received or were due to receive training in key areas such as learning disability, mental health conditions and understanding the Mental Capacity Act. Staff had also received training in effective communication and epilepsy Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: awareness. The three staff we spoke with said that they had recently received an annual appraisal with the consultant/mediator who is currently working with the home. The registered provider hopes to put in place a regular system of ongoing supervision. Staff however said that they felt supported by the current systems in place. We looked at three staff members recruitment records and these contained the required information, including, Criminal Records Bureau checks, two written references and a record of the persons previous employment. Care Homes for Adults (18-65 years) Page 21 of 27 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. Recent improvements in the way the home is managed must be consolidated to ensure that the home is consistently run in the best interests of the people living there. Evidence: Ayeesha Raj has been run by the current owners, Cherre Residential Care since April 2005. During this time there has been no registered manager at the home. Requirements for a registered manager to be in place were made at a thematic inspection of the service in 2007 (this focused on safeguarding and protection) and at the last key inspection in September 2009. These requirements have not been met. An acting manager was appointed, who worked at Ayeesha Raj between July and mid August 2009, before leaving without giving notice. A new acting manager was appointed following the last key inspection but they too left the home in February 2010. At this time a staff member expressed concerns directly to the Commission about the morale of staff and the effect this was having on people living at Ayeesha Raj. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: Since the last acting manager left, the registered provider has been managing the home and has also employed an independent consultant to work with the staff team on team building and rebuilding working relationships within the home. Staff have been given opportunities to express their concerns, additional staff members have come to work in the home and a programme of re-training has also taken place. The people who live in the home have been affected by the instability of the management arrangements, one person commented to us that they were concerned that we havent kept a manager. The registered provider has worked hard to reassure people living in the home and set up a working party of service users to look at ways to improve how the home is run and increase the day to day involvement of people living in the home. Several people who live in the home told us that they had been actively involved in interviewing for the new manager. We spoke to people living in the home and to three staff members. Staff members said that they felt morale had improved and that the team had started to work well together. The provider and the consultant said that progress had been made but there remained work to do. The provider must keep the Commission informed about the arrangements for recruiting, inducting and registering a new manager for the home. A period of stable management is now required to consolidate the improvements made. There is currently no formal system of quality assurance in the home but the provider is seeking to put this in place working alongside people living in the home to develop a user friendly and accessible questionnaire. Staff confirmed that they are currently updating their training in food hygiene and infection control and that they have received training in fire safety, first aid and health and safety. We looked at records relating to fire safety. These showed that the fire systems and equipment are regularly serviced and tested and that the homes fire risk assessment was reviewed in March of this year. Care Homes for Adults (18-65 years) Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R 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 1 37 8 Confirmation must be received detailing the action being taken to register a manager for the home. There is an acting manager in place but she has not applied to become registered yet. Timescale of 01/12/07 not met. This matter will be brought to the attention of the link inspector for the service for consideration of further action. 14/05/2008 2 41 8 The registered provider must 18/09/2009 provide information outlining when the current acting manager will formally apply for registration. This is to ensure that there is clear and consistent leadership at Ayeesha Raj Care Homes for Adults (18-65 years) Page 24 of 27 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 39 24 The registered manager must put in place an ongoing system of quality assurance in the home. 31/07/2010 This is to ensure that the service takes account of the needs and opinions of the people living at Ayeesha Raj and to ensure that the service is run in their best interests. 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 Information in care plans should be consolidated, to ensure that there is only only one version of a particular care plan. This is should make information easier to access for people living and working in the home. A specific care plan should be put in place, addressing the identified service users pressure area care needs. Appropriate training should also be arranged for staff in this area of care. Page 25 of 27 2 19 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 24 Some fire door closures need adjustment to make sure that doors do not close too quickly which could present a risk to those people living at Ayeesha Raj whose mobility is impaired. Care Homes for Adults (18-65 years) Page 26 of 27 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. © 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. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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