Care Home: Clearview

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What the care home does well Six people live at Clearview. The staff get to know them very well, so they know what they like to do.They each have their own bedroom.They have good food.The home has a minibus and a car shared with another home (next door). What has improved since the last inspection? Some people are feeling much better, and going out more.There is a new Manager, who is good at organising things. What the care home could do better: They need more staff, especially at weekends, so that people can do what they want. Key inspection report Care homes for adults (18-65 years) Name: Address: Clearview 48 Lipson Road Lipson Plymouth Devon PL4 8RG 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: Stella Lindsay Date: 2 0 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 33 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 33 Information about the care home Name of care home: Address: Clearview 48 Lipson Road Lipson Plymouth Devon PL4 8RG 01752 256980 NONE clearviewpl4@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Amanda Jane Nicholson, Mr Jeffery John Nicholson care home 7 Number of places (if applicable): Under 65 Over 65 7 7 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 7 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Physical disability (Code PD) Date of last inspection 1 4 0 8 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Clearview is a home that accommodates six people with Learning Disability and Challenging Behaviours. The residents require a high level of support. Mr Jeffery Nicholson and Mrs Amanda Nicholson own the home. A Manager has been appointed. Clearview is in the Lipson area of Plymouth within easy access to shops and parks. The home is a large terraced house, which has a lounge, adjoining dining room and small kitchen and utility room. Residents all have single bedrooms, three with en-suite facilities. There is a patio at the back of the house. Care Homes for Adults (18-65 years) Page 5 of 33 The home owner said that the fees at Clearview vary according to each persons care needs. Fees range between 500 and 1500 pounds. The fee does not include: transport, hairdressing, chiropody, toiletries, holiday spending and tobacco. The home has a Service User Guide and a Statement of Purpose, which provide information about what is provided at Clearview. These documents are available in the office, and each Service User has a copy of the information in a form that is suited to their needs. Care Homes for Adults (18-65 years) Page 6 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Care Homes for Adults (18-65 years) Page 7 of 33 How we did our inspection: This is what the inspector did when they were at the care home We visited Clearview on Thursday 20th August. During our visit we spoke to three people who live at Clearview, and two people who work there as well as the Manager and the home owner. We saw other residents in the lounge and dining room. We looked at some care plans. Care Homes for Adults (18-65 years) Page 8 of 33 We checked that the home had safe policies in place. We sent questionnaires to people who live at the home, and to people who work there. All this information helps us to develop a picture of what it is like to live at Clearview. What the care home does well Six people live at Clearview. The staff get to know them very well, so they know what they like to do. Care Homes for Adults (18-65 years) Page 9 of 33 They each have their own bedroom. They have good food. The home has a minibus and a car shared with another home (next door). Care Homes for Adults (18-65 years) Page 10 of 33 What has got better from the last inspection Some people are feeling much better, and going out more. There is a new Manager, who is good at organising things. Care Homes for Adults (18-65 years) Page 11 of 33 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 33 If you want to speak to the inspector please contact Stella Lindsay Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was good practice in providing information to people according to their needs and interests. The homes procedure for admission was satisfactory. Evidence: A Service User Guide had been made individually for prospective residents. It would need reviewing again for any new person, as useful information about local services had been included, and changes had happened (such as the closure of the Post Office). There had been no new admissions since the previous inspection. The homes admission procedure is satisfactory, with assessments expected from a range of professionals. Visits to the home had previously been arranged for people to meet the staff and residents before they were offered accommodation, and to see the room available and the rest of the house. One resident remembered their first visit, having supper with the people in the house, and staff remember them being exuberant at this time. New contracts were being produced at the time of this inspection. They had not yet been signed. The Manager considered that some residents could sign for themselves, while others would have support from family members. Care Homes for Adults (18-65 years) Page 15 of 33 Care Homes for Adults (18-65 years) Page 16 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were reliable and up to date, but would benefit from development with person centred planning. Evidence: Care plans that we sampled had been reviewed recently to maintain accuracy. They included information on residents health and medication, on their methods of communication, mobility, and continence needs. They included residents particular trigger signs for disturbed behaviour, and clear advice for staff on how to deal with it. There was a keyworker system in place, which had been useful in giving residents opportunities to express their views. There was not evidence that residents had been personally involved in drawing up their care plans. We were told that a professional social care worker had offered to help the home develop person centred care planning. Good work had been done in arranging Post Office accounts for residents, who could be actively involved in managing their own money. This had been undermined by the closure of the local Post Office, so that at the time of this inspection the home owner was collecting cash on behalf of residents from another branch. We saw that quarterly Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: statements were provided. Small amounts of cash were kept safely in the office on behalf of residents. All transactions were recorded, and the sample we checked were accurate. The Manager told us that she audits them every month. We found that residents had paid for some basic items such as chair raisers and mattress covers which should be provided as part of the service to meet their needs. The Manager undertook to ensure that the service will provide for peoples basic needs. The home owner told us that all residents’ allowances were paid into their Post Office accounts. The Manager agreed to re-introduce a system of recording each residents use of the transport provided, and giving them monthly bills, which had previously been in place till 2008. We found that staff had attended training on the Deprivation of Liberty safeguards, but not yet on other implications of the Mental Capacity Act. This training should be provided, to enhance staff understanding of residents rights with respect to making decisions of different sorts. The Manager told us that she was introducing a new risk assessment procedure, to make these assessments more specific. Care Homes for Adults (18-65 years) Page 18 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines were maintained, but there was little opportunity for introducing changes. Planned activities were maintained, but there was little scope for impromptu outings. Evidence: Staff told us that they try to maintain a regular daily routine, though this had sometimes been put in jeopardy by lack of staff. Planned activities had been maintained, with staff being rostered to enable attendance at the Orbit Club which was paid for by the home, and some discos. The Manager told us that one resident who had previously been unmotivated and increasingly withdrawn, had been encouraged to attend the club with his peers. This had resulted in positive improvements in their behaviour and also in their communication with other residents. The rota for October showed that outings were planned for three days per week. Staff made sure that residents did not miss out on family events that were important to them. Residents were happy with their activities. They said they like going out on the minibus, watching football with a beer, meeting their mother in the market for a bacon sandwich, Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: and playing tennis. One said, I go to the gym now, which shows that a change had been introduced. One had expressed interest in doing laundry, but this had not yet happened, we were told it was still in the planning stage. At weekends there were often only two staff on duty, which did not allow for activities outside the home, unless everybody went out for a drive together. Staff in surveys reported that this was often unsatisfactory, in view of the differing needs and interests of the six people living at Clearview, and behavioural problems that may be exacerbated by other members of the group. It would not be safe to get out of the vehicle to engage in an activity with this level of support. Staff were not available to enable unplanned outings such as a visit to a pub or the sea front on a summer evening. Residents who wished to spend time with their families were encouraged in this, and transport was provided to enable residents to spend time with their relatives at home. The home had continued to provide an annual holiday, when residents had 1;1 support, which meant that although they were staying at the same place they could have their own choice of daily activities. We saw that there was plenty of fresh food available. Staff cooked the main meal for the early evening, and ate with the residents. Residents said, I like cottage pie and roast potatoes, - another said I like milk shakes. The home sometimes pays for take-aways, for a treat. Care Homes for Adults (18-65 years) Page 20 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had worked well in line with professional advice to maintain and improve the health and well being of residents. Residents medication was administered carefully, to support their good health. Evidence: We saw that the care plans included residents preferred daily routine. This included advice on how to decide whether one or two staff were needed on any morning, and when to ask for help. Staff told us that residents always dress well, their clothes are cleaned and pressed every day, and their hair and nails are done regularly. A keyworker system was in place to ensure that staff were alert to changes in residents needs, and that staff paid attention to their particular needs and requirements. Health Action plans had helped staff keep a good overview of residents health care needs. There was good evidence of professional advice being followed with respect to residents health conditions. Guidance had been received with respect to the care of people with diabetes and epilepsy, with specific care plans for the safe administration of drugs. Staff agreed that, following a drugs review, the condition of one resident had improved. Its brilliant, said one Support Worker, they have conversation now. The Manager said Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: the changes are making a hugely positive difference to his quality of life, and the staff team are finding these positive changes inspiring, and are trying new ideas for things he may wish to experience. There had not been incidents of disturbed behaviour, or a need for intervention from the Community Behaviour Support Team for the past year. There was a monitored dose system for the administration of medication. Medicines were checked as they were delivered to Clearview, and as they were administered. When a medicine had been given PRN (as required) it could be seen from the daily records that this had been useful and effective. It is good practice to record on the medication administration record (MAR sheet) who had made the decision to give any PRN medication, and why, as residents may not be able to make this decision for themselves, and the Manager agreed that this would be done in future. Care Homes for Adults (18-65 years) Page 22 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had a good complaints procedure, but no record of minor concerns and action taken. Residents are protected by the staffs good awareness of safeguarding procedures, and by their good knowledge of the residents. Evidence: The home had a suitable policy and procedure with respect to dealing with complaints. Though not all residents said they would know how to make a formal complaint, all five who returned surveys to us said they knew who to speak to if they were unhappy. No complaints had been made to the home or to the CQC since the last inspection. There was no record of minor concerns. The Manager undertook to start such a record, in order to show people that their voice has been heard, to recognise if the same problems recur, and to show what has been done in response. The home had a good policy on Abuse of Vulnerable Adults. It gave instructions on what to do in the event of any allegation being made, including the contact details of the people who must be informed. Staff had received training in the Protection of Vulnerable Adults, and knew what to do if they became aware of any abuse towards residents. The staff handbook included the homes whistle blowing policy. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clearview provides an attractive, comfortable, and safe home for its residents, apart from some kitchen surfaces. Evidence: The house was in good decorative order throughout. We saw that residents bedrooms had been personalised, with family photos, and music. The dining room and sitting room were large, airy and domestic in character. Some residents had en suite toilets and bathrooms, and others had their own bathroom close by. The showers had been checked professionally and had built-in safety devices to prevent any risk of scalding. Suitable locks were in place, for privacy, but accessible to staff in an emergency. We saw that suitable furniture was in place to meet individual needs, eg for wide beds, and raised chairs. There were four steps to the patio to the rear of the house. We were told that all residents could manage these steps. We saw that residents had accompanied staff to buy plants, and we saw flowering plants in pots and tomatoes ripening on the vine. The laundry was in good order. The walls were tiled and easily cleanable. We saw that protective gloves were provided where personal care was given, for control of infection. A cleaner was employed two days per week. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The kitchen was small and not ideal for involving residents in meal preparation. The worktops were awaiting replacement. There were cracks in the floor tiles. We were told that these were due to an uneven surface below, and a way of dealing with it was being investigated. This problem also affected the bathroom next door. A good non-slip surface must be provided, which is easily cleanable. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not enough staff were employed to provide for individual care consistently, or to cover for absences in the regular workforce. Staff did not feel well supported. The recruitment process itself was seen to be sound, and training was being provided. Evidence: The Manager produced monthly rotas, after gathering information about residents planned activities and staff availability. This showed that there were often only two staff on duty, particularly at weekends. A third member of staff was rostered in when there were planned outings, such as the regular club or disco. We did not see that 1;1 care had been contracted for any resident. The Manager said that rotas were organised in such a way that all residents at some time have received 1;1 support enabling them to choose venues or activities that they wish to do. A Night care worker was employed because of funding for one resident who had need of this staff provision, and there is also a staff member sleeping in. During this inspection the Manager was on duty with one new member of staff whose Criminal Records Bureau clearance had been applied for but not yet arrived. An established member of staff was on duty during the day, to enable residents to go to their planned activities. At the time of this inspection, the home owner had been finding difficulty in appointing enough staff to cover the rota and to be available to cover for absences. Some staff told Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: us they were feeling anxious and demoralised. Staff completing surveys said that, Since the reduction in staff... I feel that we dont have enough staff in place to meet residents changed needs, while another said, at times we struggle to cope when staff go off sick and are on holiday. However, one staff member said, Overall the teamwork is good and nearly all the other staff are good to work with and will help out if needed. The Manager worked alongside the Support staff, and was well aware of these issues. She had raised the subject of staff morale at a recent staff meeting, and staff who spoke to us said they felt they were doing their best through a difficult period. The recruitment process had involved residents, who had met candidates when they visited Clearview. We met a recently recruited Support Worker who had been shown around the house by a service user when they visited, and chatted with residents in the lounge. We examined the files of two staff, one established and one recently recruited. We found that the checks needed to protect residents from potential harm had been carried out, and that a full induction programme had been booked for the new Support Worker to attend. The Manager said they were proud to have been a part of the new Learning Disability course being piloted in Plymouth. Recently provided training had included Social Role Valorisation, recording skills, and dementia care. The essential epilepsy care training had been booked for new staff. Training had been provided in Challenging behaviour. All staff had received training in Moving and Handling. The homes policy on staff supervision said that the Manager should hold an Annual Review with each employee, and six individual supervision sessions per year. She told us she had booked in one such session with each employee in April of this year, but not kept any records. Her plan was to achieve the six sessions as per the policy. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed in the best interests of the residents. Health and safety was well managed. Evidence: A Manager was appointed, who had not yet registered with the Care Quality Commission. Staff were pleased to tell us that they felt the service was better organised since the Managers appointment, and that she was enabling them to make progress. Paper work/admin side is tidied up, said one carer in a survey, more ordered. The home had distributed questionnaires annually to gather feedback from service users and their families. The Manager was in the process of producing a more user-friendly version, including pictures of what people might like to do. We looked at the Fire log book. This showed that the fire alarm system had been serviced professionally on 22/01/09. Staff training had been provided on 11/08/09. A safety check was carried out in the house every month. This included checks on window restrictors and hot water. An Environmental Health Officer had visited on 03/06/08. Their report had required a new freezer, which had been provided promptly, and new kitchen surfaces, which were Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: still awaited. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 30 13 Kitchen and bathroom floors must be non-slip and free from cracks to avoid risk of contamination. The Kitchen worktops and floor must be replaced in order to provide a safe place for food preparation. 18/12/2009 2 30 13 18/12/2009 3 33 18 Enough staff must be 18/12/2009 provided, including at weekends in order to ensure that good practice continues in the home and to enable residents to participate safely in more activities outside the house. 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 Care Homes for Adults (18-65 years) Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Person centred care planning should be developed, to involve residents more in thinking about their service and their own plans. Training on the implications of the Mental Capacity Act should be provided, to enhance staff understanding of residents rights to make decisions and of the support available to them. Management should enable more flexible and individual activities for residents, within and outside the home, including weekends. When PRN medicines are given, the reason should be recorded, so it is clear who has made this decision and why. It would be good practice to keep a record of minor concerns that are brought to the Managers attention, in order to show a good response, and to see whether problems recur. The Manager should ensure that she holds supervision sessions regularly, in order to provide support to the staff team. The Manager should register with the Care Quality Commission, as this is a legal requirement. 2 7 3 12 4 20 5 22 6 36 7 37 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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). 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. 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