Care Home: Clifford House

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What the care home does well The home provides personalised and sensitive care to people who have complex needs. The staff team is stable and has good knowledge and understanding of the individuals they support and their preferences. They work closely with other professionals to ensure people`s changing health needs continue to be met. Menus are varied and people enjoy the meals. Nutritional advice from professionals is sought and followed for people who require special diets. Clear systems are in place to make complaints and safeguard people from harm. The home is clean and comfortable and generally well maintained. There are good staffing levels and most staff have nationally recognised care qualifications. What has improved since the last inspection? Individual care plans are being recorded to a better standard to show how people are best supported to meet their needs. People living at the home, and their representatives are more involved in making choices and decisions about their lifestyles. The provision and recording of social activities that people engage in has improved, and there is a good level of contact with the community. Staff are now regularly supervised by management. What the care home could do better: People`s care plans and how they are helped to make choices could be improved by more use of pictures and photographs as aids to communication. Records that show how risks are assessed and managed are to be kept under regular review. Staff need to properly record the reasons when medication is not given to people. During recruitment interviews should be recorded, and professional rather than character references should be taken up. A programme needs to be introduced to show the training undertaken and planned for each staff member. Methods of monitoring the quality of the service are to be set out in an annual quality development plan. The provider should visit and write a report on the conduct of the home every month. Key inspection report Care homes for adults (18-65 years) Name: Address: Clifford House Lucy Street Blaydon Gateshead Tyne & Wear NE21 5PU     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: Elaine Malloy     Date: 1 5 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) 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 29 Information about the care home Name of care home: Address: Clifford House Lucy Street Blaydon Gateshead Tyne & Wear NE21 5PU 01914148178 01914148959 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Clifford House Homes Limited care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home Clifford House is a large two storey building converted into two large flats. Five people live in each flat. The home provides care for people who have learning and/or physical disability, some of whom are over 65, but cannot provide for people who need nursing care. It is situated in the Blaydon area of Gateshead and is close to a variety of local shops and other facilities and is near to transport routes, which give good access to Newcastle and Gateshead. Each flat has separate facilities including kitchen, dining and sitting areas. All service users share other parts of the building such as the laundry, gardens and patio areas. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 0 10 0 1 1 6 1 2 2 0 0 8 Brief description of the care home The design, layout and facilities provided in the downstairs flat are suitable for those people who have a physical disability. All necessary facilities are provided including an emergency call system and a lift that takes people to and from the first floor. The fees for living at the home vary and details can be obtained from the homes manager. Additional charges are made for toiletries, newspapers/magazines, and hairdressing. Items which are included in the cost, are listed in the homes terms and conditions. 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: The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. The inspection was carried out by: Looking at information received since the last key inspection on 16th December 2008. Getting the providers view of the service and how well they care for people. An inspector and an Expert by Experience visiting the home on 15th December 2009. Talking to the management and other staff about the service. Looking at records about the people who live at the home and how well their needs are Care Homes for Adults (18-65 years) Page 6 of 29 met. Looking at a range of other records that must be kept. Checking that staff have the knowledge, skills and training to meet the needs of the people they care for and support. Looking at the resources that the home has to operate the service. Getting the views of people living at the home and staff by talking to them, and from surveys they completed. Getting the views of health professionals who are involved in peoples care from surveys they completed. Checking if improvements required at the last inspection had been made. The inspection was carried out over seven hours. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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: Peoples care plans and how they are helped to make choices could be improved by more use of pictures and photographs as aids to communication. Records that show how risks are assessed and managed are to be kept under regular review. Staff need to properly record the reasons when medication is not given to people. During recruitment interviews should be recorded, and professional rather than character references should be taken up. A programme needs to be introduced to show the training undertaken and planned for each staff member. Methods of monitoring the quality of the service are to be set out in an annual quality development plan. The provider should visit and write a report on the conduct of the home every month. Care Homes for Adults (18-65 years) Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home demonstrates good capacity to support people in meeting their assessed and changing needs. Evidence: People living at the home told us they were asked if they wanted to move in, and received enough information about the home before moving in so they could decide if was the right place for them. There have been no new people admitted to the home in the period since the last inspection. In this event, the manager said she would make sure that the persons needs are fully assessed and he/she has a phased introduction the home. Most people have lived here for a number of years and their needs have changed over time. The home works closely with health and social care professionals to support people to meet their needs. Two health professionals told us that the homes assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. Staff told us they are given up to date information Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: about the needs of the people they support, and that the ways they share information about people work well. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning and supporting people to make decisions continues to be improved but management of risks was not kept up to date. Evidence: Since the last inspection the majority of peoples care records have been updated, and the manager said she expected this process to be completed by the end of the following month. Care plans addressed a range of often complex health, personal and social care needs. They were sensitively recorded and showed how best to support people, respect their dignity, and recognise non-verbal communication. Care plans could be further improved with pictures, symbols and photographs so they are easier for people living at the home to understand. Plans were not always routinely evaluated at least monthly. Records associated with planned care were also maintained, such as charts to monitor behaviour, specific health conditions, weight and fluid intake. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Profiles are in place to give information on the persons background, and strengths and individual preferences were well recorded. People now have care plans for support in making decisions, and are consulted on an individual basis, with the involvement of their relatives where possible. One person has had an assessment of their mental capacity relating to capacity to consent to medical treatment, and an advocate was involved in the process. People told us that they make decisions about what they do each day. They said they can do what they want during the day, in the evenings and at weekends. A member of staff said families are involved in making big decisions, that people can make simple choices and one person uses a picture board to help them with this. People had chosen the decoration and furniture for their bedrooms. A staff member said that they chose furniture by looking through catalogues and they went to a shop to choose wallpaper. Detailed risk assessments were recorded to identify and manage risks according to individuals vulnerabilities, but these had not been kept under regular 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with flexible support that gives them good opportunities to be part of the community and live their preferred lifestyles. Evidence: Each person now has a range of social care plans that detail what they like to do both in the home and in the local and wider community, and staff record daily how people have spent their day. There is flexible staff support to accompany people to activities and staff work later when people go out in the evenings. Good use is made of local facilities such as a nearby shopping centre, and a drop-in centre. Short breaks and day trips to places of interest are organised, usually on a one-to-one basis. Three people attend day centres during the week and the homes staff maintain good contact with staff at the centres. Staff were observed to interact well with people living at the home and had good Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: understanding of their interests and preferences. People told the Expert by Experience about their individual social activities and family contact and said indoor activities such as arts and crafts, games, ball games, darts, musical instrument sessions, television, DVD and music are offered. A room in the home is used for arts and crafts activities and peoples drawings and paintings are displayed on the wall. Visitors are welcomed and support to maintain links with family is recorded in care plans. Relatives are invited to attend individuals care review meetings. Routines are flexible, with an emphasis on staff supporting people to meet their needs as and when required, no matter what time of day or night. There is unrestricted access within the home and people can have a key to the front door if they wish. Bedrooms, bathrooms and toilets can be locked to ensure privacy. Care and treatment is provided in the privacy of the persons bedroom, and privacy and dignity issues are built into peoples personal care plans. The name that each person prefers to be called is recorded in their care file. Staff provide support with reading and managing mail, such as appointments. People are free to smoke in the designated area, and to buy and drink alcohol in the home and in pubs and clubs. People are encouraged to retain independent skills and help out in the home if they want to. Some people help with baking, washing dishes, setting tables, and putting laundry away. Two health professionals told us the service respects peoples privacy and dignity. They said it supports people to live the life they choose wherever possible and responds to the diverse needs of individuals. The menus are planned weekly in advance, and monitored by the manager. Most staff play a role in making meals, and are encourage to develop their cooking skills. Varied breakfasts are provided including full cooked breakfast. A lighter meal is served at lunch time, the main meal with pudding is at tea time, and snack suppers in the evening. There is a takeaway meal night each week. Lunch on the day was omelette and the main meal was mince cobbler and vegetables, followed by fruit and cream, and soup for supper. People spoken with said they enjoyed the food. Staff were observed to provide sensitive assistance with eating. Care records showed good evidence of staff recognising individuals nutritional needs, working to advice from dietitians, and monitoring weights. Independent eating is encouraged wherever possible. One person was being assessed by a speech and language therapist relating to consistency of food. All staff have been trained to assist Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: a person who takes food through a gastronomy tube. This training was recently updated and the persons feeding regime reviewed. Care Homes for Adults (18-65 years) Page 17 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 are provided with well planned support that is responsive to their changing health needs and makes sure medication is given safely. Evidence: People living at the home are supported to access a range of physical and mental health care services and have regular health checks. Staff know people well and are quick to pick up on any changes to their health and well-being. There was recorded evidence of prompt referral to health care professionals to ensure people receive treatment and medical advice, including specialist support. Individuals have their own aids such as moving and handling equipment, wheelchairs and special mattresses to aid pressure relief. The home is equipped with a passenger lift and assisted bathing facilities are provided. Two health professionals told us that peoples health care needs are properly monitored, reviewed and met by the home. They said the home seeks advice and acts on it to meet peoples health care needs and improve their well-being. New medication storage has been installed. Senior staff only administer medication Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: and they have undertaken medication training. The home uses a monitored dosage medication system and the supplying pharmacist provides pre-printed medication administration charts. The charts were generally well recorded, though advice was given that staff should always record the code to specify the reason why medication was not given, or record on the back page of the chart the reason, if it is not covered by the codes. The controlled drugs book was correctly recorded with double signatures for each entry, and stock checks were recorded. Care Homes for Adults (18-65 years) Page 19 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. There are good systems to protect people from harm and address any complaints about the service. Evidence: The procedure for making a complaint is included in the guide to the homes services. No complaints had been received in the past year. People living at the told us they know who to speak to if they are not happy and how to make a complaint. Staff told us they know what to do if someone has concerns about the home. There are policies and procedures in place for safeguarding vulnerable adults. These include guidance on how and who to report any safeguarding issues to, and whistle blowing (informing on bad practice). All staff have undertaken safeguarding training. No safeguarding alerts have been raised in the past year. People living at the home have care plans to show the support they need to manage their personal finances. Mental health professionals are involved with people who have challenging behaviours to make sure there are strategies to prevent them harming themselves and others. Training is provided for staff to help them understand individuals mental health needs. For example, a community nurse from the learning disability team has given staff training on caring for people with dementia. Care Homes for Adults (18-65 years) Page 20 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 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 home benefit from a clean and comfortable environment that is generally well maintained and meets their needs. Evidence: The home was clean and comfortable. People have personalised their bedrooms with their possessions, and are involved, where possible in choosing decoration and furnishings. A file is kept with details of repairs and maintenance, refurbishment, and tests and servicing of facilities in the building. Local contractors are used and servicing agreements are in place. The records also showed ongoing redecoration and carpet cleaning. Requirements about the building from the last inspection had been addressed. People living at the home told us the home is always fresh and clean. There are procedures for staff to follow to guide them on infection control, and training is provided. Protective equipment and hand washing facilities are available. Management are looking towards purchasing a washing machine with a sluice cycle to aid the laundering of soiled items. 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. People are supported by skilled and competent staff in sufficient numbers to meet their diverse needs. Evidence: People living at the home told us that staff treat them well, and listen and act on what they say. Staff said there was always enough staff to meet the individual needs of people. Two health professionals told us the homes manager and staff have the right skills and experience to support peoples social and health care needs. There is a stable staff team and staffing levels are flexible according to peoples activities. Male and female staff are employed. There are usually five to six staff on duty across the waking day and two staff at night. The managers hours are supernumerary to these levels. The majority of staff have achieved National Vocational Qualifications (NVQ) in care, at level 2 or higher. People living at the home are introduced to candidates when new staff are being employed, and details of feedback and non-verbal responses was recorded. Staff recruitment files showed that, in the main, appropriate information is kept and all staff Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: are employed subject to Criminal Records Bureau (CRB) checks being carried out. Records of interviews were not available. Whilst two references were obtained, including one from the last employer, wherever possible professional as opposed to character references should be sought. Individual staff training records and certificates are kept. A staff training programme that gives an overview of all training undertaken and planned had not yet been drawn up. During this process management are to check when mandatory training updates are due and book courses where needed. Training in the past year has included moving and handling, food hygiene and National Vocational Qualifications. In-house training on care planning and further dementia training was planned. Individual staff supervision had been brought up to date and sessions were planned for the coming year. The manager and her deputy take responsibility for providing supervision and a recording format was being introduced to ensure consistency. Staff told us that employment checks were carried out before they started work, and that induction training covered what they needed to know to do the job when they started. They said they are given training that is relevant to their role, helps them understand and meet the individual needs of people, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. Staff said their manager gives them enough support and meets with them regularly to discuss how they are working. They said they feel they have enough support, experience and knowledge to meet the different needs of the people who live at the home. Some staff told us what they think the home does well. Their comments included, Cares and supports the individual needs of residents, Clifford House cares for the residents very well. They do indoor activities if the weather is not good and the residents go out every day, even if it is to get shopping for the home, and, Provides sensitive and comprehensive support to meet the needs of all service users. It provides a friendly and comfortable environment for all service users, staff and visitors. No suggestions were made by staff on what the home could do better. 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 home is managed in the best interests of people who live there and promotes their health, safety and welfare. Evidence: The homes Registered Manager is Patricia Sowerby. She has worked at the home for many years and has gained care and management qualifications. Since the last inspection a deputy managers post has been created and the deputy supports the manager in the day to day management of the home. Systems to monitor the quality of the service were discussed with management. These are to be formalised and set out in an annual quality development plan. Visits and reports on the conduct of the home were carried out by the provider, though these were not consistently done on a monthly basis. The home has a health and safety policy and associated procedures, and staff receive health and safety training. Fire safety checks and tests were conducted at the required intervals and staff are provided with in-house fire instructions. Two members of night Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: staff needed their instructions brought up to date and management agreed to this as they came on duty. Accidents and incidents are reported and recorded, and outcomes are specified in individuals health care notes. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plan recording should continue to be improved to a consistently good standard and all plans should be evaluated at least monthly. The use of pictures, symbols and photographs in care plans should be considered to aid communication. 2 3 9 20 Service user risk assessments should be reviewed to make sure they identify current risks. Staff should make sure they record codes on Medication Administration Records to identify the reasons why medication is not administered. A second professional reference should be obtained wherever possible when recruiting new staff. Records of interviews should be made during recruitment. 4 34 5 35 A staff training programme should be introduced that identifies mandatory and other training completed and planned. An annual quality development plan should be devised and followed to monitor and improve the quality of the service. Page 27 of 29 6 39 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 Regulation 26 visits and reports by the provider to monitor the conduct of the home should be carried out every month. 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. 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. Care Homes for Adults (18-65 years) Page 29 of 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!