Care Home: Birwood

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What the care home does well The health care needs of people who live in the home were recorded so that care needs were fully met. Support that required the expertise of external professionals was requested. Staff tried to make sure that they provided the support described by any external professionals. The staff team was well established and staff are keen for high standards to be maintained, so that people who live at Birwood receive good quality care. Observations during the visit demonstrated that staff showed a genuinely caring attitude to the people living in Birwood. A relaxed atmosphere was maintained and "banter" appropriate to the people living there was in place maintaining a friendly and happy relationship with staff. The staff and manager were keen to make sure that they could improve standards and stated that they were supported by CIC the company that runs Birwood. What has improved since the last inspection? There has been maintenance on areas of the service including work on the rear garden with plans to replace the paving and the ramp to the front of the building. Both these areas when fully completed will help the people who live in the service access all areas of the service easily. Since the last visit the manager has been registered with us and is settling well into the post. Staff spoken with felt that he supported them well and was easy to get along with. Staff training has been monitored and actions have been taken to increase the training in order to maintain the safety of the people living in Birwood. What the care home could do better: The service needs to look at how it supplies information to both the people using the service and the staff. Written instructions to staff on how to support people know as care plans, essential lifestyle plans and risk assessments are very complex and are not always specific to the needs of the individual they are written to support. This does not support staff to provide consistent care. Information for the people using the service is not in formats that met their individual needs. As such it does not help them make informed choices about the support they would like. The building is not owned by CIC but by a housing association. records of maintenance have not been available from the housing association to allow the manager to be confident that the building is safe to be used by people living in the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Birwood Wheathills Road Huyton Knowsley Merseyside L36 5UR     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: Julie Garrity     Date: 0 9 0 6 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 29 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 29 Information about the care home Name of care home: Address: Birwood Wheathills Road Huyton Knowsley Merseyside L36 5UR 0151-449-3758 01514493758 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.c-i-c.co.uk Community Integrated Care Name of registered manager (if applicable) David Richard Kelly Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home Birwood is a three bed-roomed bungalow that is situated in Wheathills Road, Huyton and is close to local amenities. The service is provided by Community Integrated Care and is registered to provide personal care and support to three younger adults with a learning disability. The property has three bedrooms, a lounge, kitchen dining area and a small spare room that is used as an office by the staff. There are gardens to the front and rear of Care Homes for Adults (18-65 years) Page 4 of 29 3 Over 65 0 Brief description of the care home the property. Care Home Fees range from GBP1,132.08 per week and depend on the needs of the individual. Information about the services provided is availiable in the managers office in Birwood. Care Homes for Adults (18-65 years) Page 5 of 29 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: This unannounced visit was carried out over one day and took a total of six hours. The service was sent a self-assessment to complete before the visit. The self assessment is known as an AQAA this gave the service the opportunity to state what areas they had improved on and what plans they had to develop quality in the future. The inspector completed the visit by looking at the records such as care records, risk assessments, care assessments, medication records, staff training records, staff files, staff recruitment, policies and procedure, services quality assurance, competency assessments of staff, supervision evidence, minutes of staff meetings and complaints records. We also spoke with the staff and the people who live in the home. We reviewed information from previous visit reports and information sent to us during the last 6 months. Surveys were sent to staff and people who live in the service none were returned. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that Care Homes for Adults (18-65 years) Page 6 of 29 the service uses to support staff to promote equality and diversity. Feedback was given to the manager during this visit and at the end of the day. Care Homes for Adults (18-65 years) Page 7 of 29 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. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information in Birwood and assessment arrangments are not sufficent to make sure that staff and the person can be confident that Birwood can meet their individual needs.All people wishing to move into the home are offered an oppertunity to see if they would like living there. Evidence: The AQAA for the service told us Anyone moving into a placement with Community Integrated Care would receive a support assessment first, and this would be carried out by as many of our relevant partners as appropriate. At this stage of the assessment, it is likely that the individual, their family and friends, care management and relevant paid support would all have good information and ideas to contribute. We would like prospective service users to have the time to visit us and the other people living at Birwood to see if this is the right step for everyone who could be potentially affected. Each service user has an individualised pre-admission assessment to ascertain whether the home can meet their needs. The service had not had anyone else move in for over nineteen years. There was a Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: plan for a new person to move into the service in the future. The individual has made several visits both escorted and unescorted. The manager told us that they have not started a pre-admission assessment (find out the persons needs before they move in) and there was no information available in the service about this persons needs. On some occasions the person stays in the Birwood for a few hours without an escort who does know them well. During those times the staff in Birwood take full responsibility for the person but have no written guidance on what the persons needs are. The preadmission assessment had not been started the manager to us that he has not done an assessment before and will seek guidance from his manager in order to make sure that he can determine the persons individual needs. We looked at the information in the service available for people moving in or who already live there. This is called a statement of purpose (what services Birwood supply) and service users guide (how the services will be put into place). The information did not included a number of areas such as a full explanation of how to make a complaint. The service users guide is available in printed format only, pictures are included. We discussed with the manager whether that met the needs of people living in the service or the one person wishing to move in. The manager thought that it did not. He suggested that in the future he would make a DVD that could be viewed on the television and used to help people moving in make a choice about the home. Once in place this would be good practice as it would make sure that the people living in the service were fully aware of their rights. Contracts are available for the people who live in the service that includes areas such as part funding a mini bus. The contracts are not in formats that meet the individuals assessed needs and there is no evidence that the peoples best interests have been looked at. The contracts are updated as changes occur, the manager told us when a new person moves in the contracts will also be changed to share the running costs of the mini-bus Care Homes for Adults (18-65 years) Page 12 of 29 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. The needs and choices of people living in the home are met. Staff have worked with the people living in the home over many years and have learned what their individual choices and needs are most likely to be. Evidence: We looked at the care records of the two people who live at the home to check on the support that they were receiving. These showed some details of the areas of support that was needed and how this was going to be provided by the staff. The plans had been updated by the manager since our last visit and included some clear information about the people living there personal choices. Records were very complex and repetitive they were not available in formats that would assist the people that they were written for to access them. One person needed staff to provide a specific support this was repeated in six different places. As a consequence the support that staff needed to take was not easily identifiable. Daily record sheets are completed and these were signed by staff to confirm who had written them. These were detailed and gave an overview of how each person spent their day. During discussions with staff it Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: was clear that they have worked there for several years and had plenty of opportunities to get to know the people they support very well. Staff were easily able to detail what they thought peoples individual needs were and the ways that they can support them. We observed staff during our visit and saw that people who live in the home are helped to make their own decisions about their daily lives. Individual choices are briefly recorded in the care records and gave the staff some idea of what peoples preferences are. Risks are assessed and assessments are produced to make sure that people are safe in what they do. Some of the risk assessments were also repetitive and unnecessary increasing the burden of paperwork on staff. The manager stated that he had to complete these but had not had any training in writing risk assessments so was unsure if his approach was correct. A range of assessments are available and these were up to date at review. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are improvements in peoples lifestyle opportunities. There are still opportunities to better determine and use their individual choices and preferences to provide a lifestyle very much of their own choosing. Evidence: There was no information available in the service about the activities that people living there liked to do. None of the people living at Birwood attend day services for people with learning disability. People can go out to local shops in the mini-bus with a staff member and it was recorded that each person goes out at least once a week. The manager said that are now able to go out for the day if thats what the people living in the service want. The people living at Birwood had not had a holiday in several years and there were no plans available for a holiday in the future. The manager discussed with us some ideas for a holiday but as yet there are no particular plans for when this will happen. T Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: People who live in the service are offered choices in various ways, such as in the time they get up or go to bed, what they wear or by deciding what they do each day. This gives people some control over their own lives and helps them to stay as independent as possible. The people who live in the home are unable to communicate verbally but staff are aware of non-verbal communication and gestures to enable them to make these choices. We looked at the records about peoples choices and found very little information it was not possible to determine in the records what activities people liked to do, how they liked to spend their days or what food items they particularly liked. No menus were seen, staff told us that they ask people each day what they would like to eat. Both people living in the service have non-verbal communication that staff say they understand and can know if someone wants a drink or something too eat as example. There was no description available in the care records that told staff what peoples non-verbal gestures meant. Staff say that they have know what they mean from years of supporting the individuals. This is likely but does not support new staff or new people when they wish to move into the home. We looked at how the service supports people with special diets. This information was available in the care records. There was evidence that external professionals had been consulted with to make sure that a proper diet was decided on. We discussed with staff how the person received their food. The persons food was not presented in a manner that promoted appetite, we discussed with the manager ways that he intended to make sure that this was improved. Care Homes for Adults (18-65 years) Page 16 of 29 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. People who live in the service have their Healthcare needs met. Evidence: We looked at the care records and discussed with the staff how they supported people who live at the home. The records viewed were not specific to the individual, showed little or no evidence that the person had been consulted with, were repetitive and presented the staff with a challenge to keep up to date. Staff observed and spoken with had a very clear and consistent view of the support that each individual needed. They explained that people are supported to access external professionals such as doctors as needed. This was reflected in the care records that showed suitable contact with medical experts when guidance was needed. The medicines for the people who live at the home were looked at. This review showed that the people living in the service received the prescribed medications at the correct times and in line with the prescribers instructions. Medication administration record sheets (MARs) were completed when medication was given. When we looked closely at these records we notice that there was no specific instructions in either the MARs or the care records that instructed staff when to give as needed medication or Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: creams. We discussed at length with the manager other good practice areas such as medications labels, ordering, audits and handwritten entries in order to help prevent any potential errors. All staff had received training in medication awareness so they know who to give medication to and are able to do this safely without making mistakes. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service can be confident that the service will take all reasonable steps in order to protect them from any potential abuse. Evidence: The complaints procedure was reviewed and gave information on how to raise a concern and what actions the company would take to resolve this. The AQAA for the service told us that had not received any complaints since our last visit and we had not received any concerns about Birwood. Records in the service also supported that no complaints have been made. Policies were available regarding the safeguarding of vulnerable adults and included physical intervention, whistle blowing, dealing with bullying, and adult protection and prevention from abuse. All of the staff working at the home had received up dated training and in discussion demonstrated an understanding of how to deal with any concerns of this nature. Care Homes for Adults (18-65 years) Page 19 of 29 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. Improvements in the garden and access to the home have been made. Information to inform the manager that the building is not available and without this the manager can not be sure that he is able to fully maintain the safety of the people living in Birwood. Evidence: during our visit we looked around Birwood and saw all the shared areas and the bedrooms. All the bedrooms are single the decoration was chosen by the people living in the service and reflected their personalities. One person had a fish tank in their room and the manager told us how delighted the person had been when it arrived. All the people who live at the home had new bedroom furniture in place. Birwood was clean and well-maintained. Work had started on the gardens at the rear of the home and there are plans to remove the uneven pathways and steps to make it a more suitably adapted for use by people in who live in Birwood. The budget given to the manager for the maintenance of the gardens has been increased. The front garden area has continued to be improved by the staff with pots of plants and small shrub. A set of garden furniture has been purchased and staff said that they sit out here with the people who live at the home when the weather is suitable. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The building is owned by a housing association. The manager has not been supplied with a copy of the last electrical checks that show that the wiring in the house is safe. It is the responsibility of the registered service (CIC) to make sure that the building is safe for the people living their and the staff. The ramp leading from the front door has been repaired and has been made safe. Care Homes for Adults (18-65 years) Page 21 of 29 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 are recruited and trained to support the needs of people living in Birwood. Evidence: We looked at the levels of staff available in the service. At our visit the manager and a support worker were available they confirmed that there was always a minimum of two staff available. Overnight there is one waking staff. There was no evidence that additional evening/night staff had been put into place if people living in the home wanted to go out. This was not possible with one member of staff. The manager told us that if an event was planned an extra member of staff would be made available. Birwood has not employed any new staff with the exception of the manager for several years. The newest staff member was the manager his file was available for review. We also looked at another member of staffs work file. Staff files showed that proper checks such as police check and references had been undertaken prior to the people starting work. Information looked at with regard to staff training showed that staff had received up to date training on moving and handling, safeguarding, health and safety and medications. There has not been any competency assessments that show that staff understood their training are were able to undertake their job role safely, such as Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: giving out medications. We spoke to the manager and staff about areas of training that they needed. The manager identified that he had not had training in undertaking assessments, risk assessments or the Mental Capacity Act. He planned to talk to his line manager about this in the future and to arrange additional training for all staff in mental capacity and deprivation of liberty. Staff spoken with confirmed that training was available and that there was an elearning facility on the services computer that they could access as needed. Care Homes for Adults (18-65 years) Page 23 of 29 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. The service has improved in a number of areas detailed in this report. This is due to the hard work and enthusiasm of the manager and his staff team. Evidence: The registered manager of Birwood has been in post since March 2008. His recruitment records and the AQAA show that he is an experienced manager and staff spoken with said he is very supportive. The manager acknowledge that there are areas of his leaning that he would like to progress and will make arrangements to discuss this with his line manager. During our visit he was warm, helpful, honest and keen to improve the service. There is an established quality assurance process used by the company and this is completed by the service manager, who visits the home every month. The manager said that part of this review looks act medications but this is not formally recorded. He advised that he would undertake his own monthly audits to make sure that medications were managed safely and staff were competent. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Policies and procedures are available on the intranet. these can be difficult to locate . Policies and procedures are intended to guide staff, it is difficult for them to access quickly if needed without hard copies available in the home. copies of policies and procedures relevant directly to the people who live in the home were not available in a format to meet their needs. Staff reported that regular meetings are held at least every two months and full discussions take place regarding the support of people living in Birwood. Minutes of these are available. Staff are also included in six monthly care reviews of people living in the service. Care Homes for Adults (18-65 years) Page 25 of 29 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 29 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 24 23 A copy of all certificates including the recommended date of renewal need to be available for the manager and staff. This is in order to make sure that the manager can be satisfied that the building is suitably maintained and safe for all people accessing Birwood. 30/07/2010 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 1 The managers plans to make the service users guide in a format to meet the services needs should be put into place. This will provide another means to meet met peoples equality and diversity needs. The manager needs to be trained in admission and assessment in order to make sure that person wishing to move in can have their needs recognised and planned for. Care records , Essential Lifestyle plans and risk 2 2 3 6 Care Homes for Adults (18-65 years) Page 27 of 29 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 assessments are repetitive, not personal to the individual and are a significant burden for staff to complete. Ways to reduce the excessive paperwork should be explored in order to provide plans that support people in clear manner, do not take take up too much staff time and are accessible by people for whom the plan is written. 4 14 Consideration needs to be made to make sure that people personal preference, choices and social opportunities are fully explored. Lifestyle choices can then be made available to meet their personal preferences. Review the pharmaceutical Society guidelines and put into place their advice for records and record keeping for medications. written actions need to be in place for as needed medications and creams that instruct staff exactly when, how and where to use the medication. 5 20 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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