Care Home: Courtwick Park

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What the care home does well We did not find evidence of anything that service does well at this inspection. What has improved since the last inspection? There has been little improvement at this home since the last inspection. What the care home could do better: Issues of serious concern that affect the safety of the people who live in this home identified the at the key inspection undertaken by the CQC on the 11th May have not been addressed. Following the last inspection of this home the CQC wrote to the registered person in relation to these concerns outside of the inspection process to give them warning that if improvements were not made and sustained by the home then enforcement action would be taken. Management Review Meetings have taken place within CQC to establish what action, if any, shall be taken by the CQC. The local authority have now substantiated allegations into neglect, institutional abuse and financial abuse. There are ongoing investigations into further allegations of financial abuse, an alleged theft of property from a persons room, an allegation of physical abuse and an allegation of neglect. Serious shortfalls were identified again at this inspection in relation to the lack of support and resources that have been made available to the interim manager and staff at the home to enable the required improvements to be made. Whilst some monitoring of the homes performance has been undertaken by the responsible individual specifics in relation to who will rectify shortfalls and by when have not been recorded. The home currently has 3 members of staff suspended from duty at least two members of staff have left since the last inspection and two more are due to leave. The home is increasingly reliant on bank and agency staff to staff the home and often only have two or three permanent staff on duty at a time. When we visited the home we found that despite having training in safeguarding vulnerable adults, management and staff failed to raise an alert to the local authorities when bruising was noted someones body and when they discovered that property missing from a persons room. In addition to this a member of staff has since been suspended for pending investigations into financial abuse. At the last inspection we found that one person had been admitted to live at the home without a preadmission assessment been carried out and at this inspection it was still not complete. The registered person must ensure that no one is admitted to live there prior to a full assessment of need being completed by a person qualified to do so. The care plans we saw had not been updated since our last inspection, were not holistic or person centred were not up to date and did not accurately reflect the lifestyle of the person. The registered person must ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs. These must be reviewed and updated when changes occur. Peoples behaviour has been managed through the use of locked doors and restricting peoples access to the home and grounds.The registered person must ensure that people are supported to set, monitor and achieve both their long and short term goals and aspirations and that this is recorded. This must include community participation and be reflected in plans of care. The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the people who live there and not exclusively with each other. The registered person must ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where, when and with whom they eat. The registered person must ensure that peoples health care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. The registered person must ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. The registered person must ensure that the premises are well maintained. A maintenance and renewal plan must be implemented and the premises must be clean and free from offensive odours. The registered person must ensure that all staff receive the induction and training they require they need to carry out their role and that there is an effective staff team in place at the home at all times. The registered person must ensure that recruitment practises are robust and that 2 appropriate references are obtained prior to a person being offered employment. Staff performance must be monitored and all staff including the appointed manager must receive documented supervision a minimum of 6 times a year. The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. Key inspection report Care homes for adults (18-65 years) Name: Address: Courtwick Park Courtwick Lane Littlehampton West Sussex BN17 7PD     The quality rating for this care home is:   zero star poor 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 Green     Date: 2 1 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 39 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 39 Information about the care home Name of care home: Address: Courtwick Park Courtwick Lane Littlehampton West Sussex BN17 7PD 01903730563 01903730563 courtwick@consensussupprt.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Corich Community Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (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 (LD). Date of last inspection Brief description of the care home Courtwick Park is a large detached property owned by Corich Community Care Ltd. The Responsible Individual is Julie Bendelow. Courtwick Park is registered to provide a service to twelve people with severe and profound learning disabilities and associated challenging behaviour. Fees range from £1370.55 to £2369.00 per week. Care Homes for Adults (18-65 years) A Statement of Purpose and Page 4 of 39 Over 65 0 12 1 1 0 5 2 0 1 0 Brief description of the care home Service Users Guide is available to reference in the home. Care Homes for Adults (18-65 years) Page 5 of 39 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: zero star poor 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 home has been without a Registered Manager since April 2006. The appointed manager of the home is not currently working and will not be returning to work at the home. An interim manager has been appointed until a permanent manager is recruited and they are currently in day to day charge of the home and facilitated this inspection. This unannounced site visit was undertaken on the 21st June 2010 over 5 hours. Due to the level of concerns raised with us from other professionals through Safeguarding Adults procedures the site visit was undertaken by two compliance inspectors. Evidence obtained at this site visit, previous information regarding this service and information that we have received since the last inspection forms this key inspection report. Information has been shared with us through Safeguarding Adults procedures to assist us in this inspection. Due to the level of concerns raised within the service, all residents Care Homes for Adults (18-65 years) Page 6 of 39 care plans are being reviewed by their care managers and other professionals to ensure their immediate safety, some of these reviews took place prior to our visit whilst others are on going. There are eight people living at Courtwick Park. Seven people were present at the home throughout the inspection. We saw into the communal areas of the home and spoke to the person in day to day charge of the home and the staff on duty. Interaction between staff and the people who live in the home were observed throughout the day. The procedures in place for handling individual monies were viewed. We also looked at care records, medication and associated administration records, staff recruitment, staff training and staff personnel files. We will be undertaking management review meetings regarding this service to decide what further action we will need to take to ensure residents are safeguarded. The outcomes for the people who live in this home are poor for all but one area which is adequate. The overall quality rating of this home is Zero, no stars. Care Homes for Adults (18-65 years) Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: Issues of serious concern that affect the safety of the people who live in this home identified the at the key inspection undertaken by the CQC on the 11th May have not been addressed. Following the last inspection of this home the CQC wrote to the registered person in relation to these concerns outside of the inspection process to give them warning that if improvements were not made and sustained by the home then enforcement action would be taken. Management Review Meetings have taken place within CQC to establish what action, if any, shall be taken by the CQC. The local authority have now substantiated allegations into neglect, institutional abuse and financial abuse. There are ongoing investigations into further allegations of financial abuse, an alleged theft of property from a persons room, an allegation of physical abuse and an allegation of neglect. Serious shortfalls were identified again at this inspection in relation to the lack of support and resources that have been made available to the interim manager and staff at the home to enable the required improvements to be made. Whilst some monitoring of the homes performance has been undertaken by the responsible individual specifics in relation to who will rectify shortfalls and by when have not been recorded. The home currently has 3 members of staff suspended from duty at least two members of staff have left since the last inspection and two more are due to leave. The home is increasingly reliant on bank and agency staff to staff the home and often only have two or three permanent staff on duty at a time. When we visited the home we found that despite having training in safeguarding vulnerable adults, management and staff failed to raise an alert to the local authorities when bruising was noted someones body and when they discovered that property missing from a persons room. In addition to this a member of staff has since been suspended for pending investigations into financial abuse. At the last inspection we found that one person had been admitted to live at the home without a preadmission assessment been carried out and at this inspection it was still not complete. The registered person must ensure that no one is admitted to live there prior to a full assessment of need being completed by a person qualified to do so. The care plans we saw had not been updated since our last inspection, were not holistic or person centred were not up to date and did not accurately reflect the lifestyle of the person. The registered person must ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs. These must be reviewed and updated when changes occur. Peoples behaviour has been managed through the use of locked doors and restricting peoples access to the home and grounds. Care Homes for Adults (18-65 years) Page 8 of 39 The registered person must ensure that people are supported to set, monitor and achieve both their long and short term goals and aspirations and that this is recorded. This must include community participation and be reflected in plans of care. The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the people who live there and not exclusively with each other. The registered person must ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where, when and with whom they eat. The registered person must ensure that peoples health care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. The registered person must ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. The registered person must ensure that the premises are well maintained. A maintenance and renewal plan must be implemented and the premises must be clean and free from offensive odours. The registered person must ensure that all staff receive the induction and training they require they need to carry out their role and that there is an effective staff team in place at the home at all times. The registered person must ensure that recruitment practises are robust and that 2 appropriate references are obtained prior to a person being offered employment. Staff performance must be monitored and all staff including the appointed manager must receive documented supervision a minimum of 6 times a year. The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. 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 39 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 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home have not had their individual needs appropriately assessed. Evidence: The outcome for people who are currently living at this home was poor at the last inspection and a requirement was made that, the registered provider must ensure that no service users are admitted to the home prior to a full assessment of need being completed by a person qualified to do so. The date for the completion for this was the 15/06/2010. The Provider sent the CQC an improvement plan that stated We will ensure that for all future placements a full needs assessment is carried out with the MDT. For the client who moved in the last 12 months a care plan was completed by West Sussex County Council as the placing authority and given to the home. We will ensure that this is filed appropriately and that support plans reflect the assessment. We will ensure that consensus Referrals Manager is involved in any future placements working with them and the placing Authority on the needs assessment. The clients support plans will reflect the needs and care plan as provided by WSCC (West Sussex County Council). All new clients will have a comprehensive needs assessment completed by a person qualified to do so. This will be completed by the 15/06/2010 Care Homes for Adults (18-65 years) Page 11 of 39 Evidence: by the home manager on any future admission. Currently a suspension is in place by the Local Authority which prevents the home admitting any new people to Courtwick Park so it was not possible to assess whether or not assessments would be completed prior to anyone moving into the home. We asked to see the assessments that had been completed by the local authority for the person who had been admitted to the home within the last 12 months and this was not available to view. The home had started to complete their own assessments for this person which would form the basis of their care plan however there was no evidence to show that the person had been consulted or included in this process and the assessments were not complete. Care Homes for Adults (18-65 years) Page 12 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. That people are not supported to make choices in respect of how they spend their time or how they receive their care. That people are not treated with dignity and respect. Evidence: The outcome for the people who live in this home were found to be poor at the last inspection and requirements were made. The first requirement was that The registered person must ensure that peoples behaviour is not managed by restricting peoples access to the home and grounds through the use of locked doors. Care plans must contain guidelines for staff to follow in respect of supporting people to manage their behaviours. The timescale for the completion of this requirement was the 15/06/2010. The improvement Plan completed by the provider states that We will involve the Consensus Behavioural Specialist in the review of the Behavioural Support plans to ensure appropriate interventions to support individuals to manage their behaviours effectively. Individuals will have robust and clear behavioural support plans which are evaluated on a regular basis. This will be completed by the 15/06/10 by the Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: interim and supporting home manager. At this site visit we found that the majority of doors, including peoples own bedroom doors, are routinely locked throughout the home. We looked at care plans and they did not contain any information relating to why doors need to be locked in addition to this Deprivation of Liberty assessments had not been requested or completed in respect of restricting peoples access to the home. Some guidelines were in place for staff to follow in respect of managing peoples behaviour however they were not all up to date or been reviewed when needed. The interim manager told us that care plans had not yet been reviewed or updated and they would be liaising further with the behavioural specialist in relation to the writing of behavioural guidelines. We asked to see the risk assessments in place to see under what basis the decision was made that doors should be locked throughout the home but were told that they had not been completed so it was not possible to ascertain why the practise of restricting peoples access to all areas of the home continues. The second requirement made in this outcome area was that The registered person must ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs as specified in Standard 2. These must be reviewed and updated when changes occur. The completion date for this requirement was the 15/06/2010. The improvement Plan completed by the provider states that We will review all risk assessments and care plans, ensuring a person centred approach to planning. We will evaluate the plans and evidence that this has happened and the changes to the plan as a result. We will involve the Behavioural Specialist in the process. We will have evidence of evaluation of plans within each individuals file. Care plans will be robust and person centred and inform the support given to each individual. This will be completed by the 15/06/10 by interim and supporting home manager. We were told by the interim manager at the site visit that care plans had not been reviewed and person centred care plans had not been completed however some work had started in respect of updating the existing plans and that advice and input had been sought for some people from a Behavioural Specialist. Some of the records seen confirmed this but there was no evidence that the individuals concerned had been consulted or involved in this process. The interim manager told us that peoples support plans were based on staff feedback and that there had been no opportunity yet to consult with peoples families or Representatives. We saw that one Regulation 26 visit, which is a visit made by the provider to assess the homes performance, had been conducted since our last inspection. We looked at the report of this visit which took place on the 9th June 2010. The report highlights shortfalls that were identified in Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: support plans and risk assessments and the report states that one persons support plans have not been updated since put in place in October 2009 and that they need to be more detailed, specific and updated. Another persons support file was missing all background information i.e. pen portrait, life picture, over view of activities, that there are no evaluations on support plans and that the risk assessments need to be re written and made specific. The report does not state the person responsible for rectifying this or the date by which it must be rectified. The third requirement was that The registered person must ensure that people are supported to make their own decisions and manage their own finances. Where this is not possible an independent advocate or agent must be found. To be completed by the 15/06/201 The improvement plan received by the CQC states that We will seek to move appointee ship from the organisation to either the LA (Local Authority) or independent agent. Consensus use an independent agency and work has commenced on this process. An independent audit of clients financial transactions has been requested as part of safeguarding. The organisation will not be appointee for individuals once all appointeeship has been transferred. Clients finances will be managed in accordance with Consensus policies and procedures. Immediate action taken by interim and supporting home manager to ensure appropriate management of individuals monies. We were told at the visit to the home that the home was working with the local authority in respect of transferring appointeeship. Minutes from safeguarding meetings, at which the management of peoples finances were discussed and the allegation of financial abuse was substantiated, confirmed this. Further details regarding the management of peoples finances is covered in the complaints and protection section of this report. Care Homes for Adults (18-65 years) Page 15 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are not supported to lead the life they choose. People are not involved in the planning of meals or given a choice of food at meal times. Evidence: The outcome for the people who live at this home was found to be poor a the last inspection and requirements were made. The first requirement states that The Registered Person must ensure that people are supported to set monitor and achieve both their long and short term goals and aspirations and that this is recorded. This must include community participation. The improvement plan received by the QCQ States that We will ensure that each individuals care and support plans reflect goals and aspirations in a person centred way. Individuals will be afforded increased opportunity to access the community and have a full and varied programme of meaningful activities. Daily records and activity records will evidence increased Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: community participation. Individuals will have a greater presence in their local community. This will be completed by the 15/06/10 by interim and supporting home manager. As stated in the previous section of the report care plans have not been reviewed and people and their families and or representatives have not been consulted. We saw that there were activity plans in place for people but that these were not followed. For example we asked why one person had not attended the day centre as the activity plan stated we were told that they did not want to go however the reason for this and what they did instead this was not recorded. We saw records that the home supplies the local authority on a weekly basis in relation to the activities that people have taken part in and these confirm that weekly activity plans are not followed and people are left with nothing to do. The records seen state that on the week beginning the 11th of June the weekly activities for one person consisted of going out for a drive, refused all activities one day, went to hydrotherapy one day, going for a drive and listening to music another person went to a fun day at Worthing, went to the seafront for a walk and an ice cream and went to college for a class. The week beginning the 18th of June it states that one person was supported to clean his room, went out in the community and helped to get the car washed and got an ice cream when out, on another day this person refused all activities and spent the day walking around the garden with staff support when needed. A third persons activities for the same week was summarised as they were happy to be in the lounge and did not really want to go out so they completed some sing a long tapes and went into the garden they also helped staff to clean one of the vehicles out and then went for a drive. The summary of a fourths persons activities for the same week states that they went out for a drive to get the car washed and to get an ice cream on the sea front, and that over the last couple of days they have been interested in doing some gardening that staff have been supporting them to do in Courtwicks garden and that one afternoon they went out to town to look round and get a burger. It was noted on the regulation 26 visit report that there are rats in the garden at Courtwick Park. On the day we visited the home one person went out to college and one person was seen helping a member of staff clean the car. We saw no evidence of anyone else participating in any activity or participating in the running of the home on that day. The second requirement to be completed by the 15/06/2010 states that The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the people who live there and not exclusively with each other. The improvement plan received by the CQC states that We will monitor staff activities and interaction on a daily basis and take appropriate Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: action when needed. Increase management presence in the home will provide coaching mentoring role modelling. We will be providing staff training on values and person centred training. The range of activities being offered to individuals will demonstrate the appropriate support from staff to enable them to participate in their chosen activity fully.Staff will interact appropriately with the individuals living in the home. Individuals will receive support that is respectful and upholds their rights. This will be completed with immediate effect and be monitored by the interim and supporting home manager. On the day we visited the home we saw that the interim manager is based in the basement of the home which is an area to which access is restricted through the use of locked doors which means the people who live there cannot freely enter and the deputy manager is based in a room on the 1st floor from which communal areas of the home cannot be seen. The interim manager told us that they have had one, one to one supervision session with approximately half of the staff team. There was no evidence that staff are being monitored in any other way or of any mentoring taking place. References made in relation to the adults who live in this home on the activity reports supplied to the local authority uses terminology such as enjoyed playing in the garden and splashing in the water. The third requirement made at the last inspection to be completed by the 30/07/2010 states that The registered person must ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where when and with whom they eat. The improvement plan received by the CQC states that Menus will be presented in a format that is accessible and understandable to the individuals living in the home, including not only being in the kitchen dining room. Records will be maintained to evidence meals taken and food preferences. this will be completed by the 30/07/10 by the interim and supporting home manager. The date for the completion of this requirement is yet to be reached however there was no evidence in care plans that the home had started to record peoples preferences in relation to food or meal times or that risk assessments were taking place in relation to people being able to take part in the preparation of meals. Care Homes for Adults (18-65 years) Page 18 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are not met. People are not treated with dignity and respect. People do not always receive their medicines safely. Evidence: At the last inspection of this home the outcome for people living at this home were found to be poor. Three requirements were made. The first requirement was that The registered person must ensure that peoples health care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. The date this must be completed by was the 15/06/2010. The improvement Plan received by the CQC States that Each individual will have a detailed Health Action Plan that all staff are fully aware of. Care plans will evidence individual health care needs. Staff will sign to indicate their knowledge and understanding of the HAP. Records will be maintained to evidence health care appointments. This was to be completed by the 15/06/10 by interim and supporting home manager. We looked at care records and saw that Health Action Plans had not been completed. The interim manager explained that they had had difficulty in getting appointments Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: with health care professionals and that they were still working on this. We saw that a protection plan had been put into place for one person in relation to a safeguarding referral that had been made to the local authority. This protection plan states that the support plan for this person must be updated by the 13th May however, whilst some work has been done toward this it has not yet been completed. We saw that the epilepsy guidelines in place for staff to follow were dated as been written in April and so had not been updated since we made our last visit to the home in May. The second requirement was that The registered person must ensure that there is a clear support plan on the use of anti-convulsant medicines. To be completed by the 30/05/2010. The improvement plan received by the CQC states that We will ensure that support plans are written on the use of anticonvulsant medication and individuals support during seizure activity. Plans will include seizure type. Plans will be documented and evaluated and all staff will have signed to indicate their knowledge and understanding. With immediate effect completed interim and supporting home manager. We saw that guidance had been written for the use of anti-convulsant medicines however these had not been written by or agreed by the prescribing health care professional. Plans did specify seizure type but had not been signed by all staff to indicate their knowledge and understanding. The third requirement to be completed by the 30/06/2010 states that The registered person must ensure that MAR charts reflect the dosage directions that the doctor intended. The improvement plan received by the CQC states that The home will follow the administration policies and procedures to ensure that all aspects of medication storage, administration and recording is accurate Pharmaceutical and GP advice will be sought were needed. Medication will be monitored on a monthly basis. Medication will be administrated in accordance with policy and procedure. Medication will be stored and recorded in accordance with policy and procedure. Pharmaceutical and GP advice will be evidenced where needed. With immediate effect completed by the interim and supporting home manager. The timescale for the completion of this requirement is has not yet been reached however it was noted that guidance for in relation to when PRN or as and when medication could be given and how long for had been written but it had not been written or agreed by the prescribing health care professional and was not individualised for each person. We looked at the incidents that had been recorded in the home and saw that they do Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: not record what action were taken as a result of them happening. For example incident reports show that some people have self harmed, or displayed behaviour that can be challenging however there is nothing to show that care plans, support plans or risk assessments had been updated as a result. It was recorded that that one person had been slapping their face and crying, another was recorded as moaning and banging the floor and on the same day another person was recorded as screaming and biting their arm. On a subsequent day it was recorded that one person was twitching involuntarily head nodding and was non communicative. Other incidents recorded state that a person was pacing, slapping their face and crying, another person was recorded as screaming and biting their arm on the same day someone else was making screaming noises loudly and another was grabbing a wheelchair and grabbing at staff. There was no evidence to show that risk assessments had been reviewed in relation to these incidents or that any assessments had taken place to establish the impact they were having on the people themselves or the other people who live there. We saw that one Regulation 26 visit, which is a visit made by the provider to assess the homes performance, had been conducted since our last inspection. We looked at the report of this visit which took place on the 9th June 2010. The report highlights shortfalls in the management and administration of medication that the medication had been checked but did not add up to the medication carried forward and delivered, that Prescribed creams are stored with peoples toiletries and Medication Administration Sheets are not completed when used. The report does not state the person responsible for rectifying this or the date by which it must be rectified. Care Homes for Adults (18-65 years) Page 21 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are not protected from harm or the risk of abuse. There is a complaints procedure in place but people are not supported to use this. Evidence: There are on going safeguarding investigations into allegations of physical abuse by a member of staff at the home and of financial abuse by another member of staff and a theft of property from a persons room and these are being investigated by the police. Allegations of financial abuse, institutional abuse and neglect by the home have now been substantiated and protection plans have been put into place for some of the people who live there. Allegations of neglect of a person who lives at the home by a member of staff is still under investigation under safeguarding by the local authority. All staff members sited in these allegations have beens suspended from duty until the investigations are complete. At the last inspection of this home the outcome for people living here were found to be poor. A requirement was made that The registered person must ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. The improvement plan received states that We will ensure that all staff receive training on the Safeguarding of Vulnerable Adults. The WSCC Safeguarding Policy will continue to be displayed in the main office. Staff will receive 1 to1 meetings to discuss practise and revisit whistle blowing policy. Safeguarding alerts Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: will be made promptly and efficiently to WSCC Staff will receive training from WSCC Independent Safeguarding chair on 17/06/10 Regulation 37 reports will be made in a timely fashion to CQC in event of safeguarding alert. Incident reports will contain appropriate and accurate information and submitted to Safeguarding at time of alert. it states this was actioned with immediate effect by the interim and supporting home manager and is ongoing. We looked at the records relating to incidents in the home that affect the health and safety of the people who live there and found that some of the incidents that had occurred had not been reported to the CQC within the required 24 hours and some not at all. For example one incident report states a large bruise was observed on a person by a member of staff when they were assisting them with their personal care and yet this was not reported to the local authority under safeguarding or to the CQC. In addition to this an item discovered missing from a persons room was not reported to the police or the CQC until at least 12 days after it was discovered missing and there was no complaint on record in respect of the missing item. We looked at records relating to how peoples money is managed and the associated records and saw that whilst people were on holiday they had paid for staff meals out of their own money however this has now been reimbursed. We saw that there had been improvement in this area and that checks of money held, receipts for goods bought and associated records are now made on a daily and weekly basis. However, a safeguarding referral has since been raised in relation to an allegation that a member of staff doctored a receipt and this happened on the day we visited the home. This staff member has been suspended pending further investigation under safeguarding by the police. An independent audit is to be undertaken in relation to the management of peoples finances as agreed under safeguarding and the provider has agreed to pay back all monies misappropriated from the people who live at the home. We looked at records to establish whether or not issues relating to safeguarding and whistle blowing had been discussed and saw that whilst staff have received training in relation to safeguarding provided but the local authority, only half have had a one to one supervision session. Additionally only one staff meeting has been held since the last inspection at which the recent safeguarding meeting was discussed and the minutes of which state Team Leaders Meeting Confidential. This was not dated or signed by any staff members to show they had read and or agreed to their content. We saw that a further team meeting was scheduled however there was of evidence to suggest that issues of poor practise had been discussed with the staff team. As previously stated incident reports have been completed for when people have self Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: harmed or presented with behaviour that can be challenging to manage. One incident records the fact that someone was trying to go down the stairs by lurching themselves forward making no attempt to walk down stairs. Another that someone was grabbing food from others plates who were still eating. There are repeated incidents recorded for a person biting themselves and for another screaming. However, the impact that these incidents have on the people themselves and the other people who live there has not been assessed or evaluated and risk assessments and care plans had not been reviewed. Care Homes for Adults (18-65 years) Page 24 of 39 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. This home is not clean, hygienic or well maintained. Evidence: At the last inspection the outcome for the people who live at this home were found to be adequate and two requirements were made. The first requirement is to be completed by the 30/08/2010 states The registered person must ensure that the premises are well maintained. A maintenance and renewal plan must be implemented. The improvement plan received by the CQC states An audit of the environment will be completed and decoration and replacement plan submitted to Property services Monthly visits will include a review of environment. The communal areas of the home will be well maintained and homely. This will be completed by the 30/08/10 by the responsible individual and the operations manager. The second requirement was to be completed by the 15/06/10 states that The registered person must ensure that the premises are clean and free from offensive odours. The improvement plan received by the CQC states Incidents that result in offencive odours will be addressed immediately and appropriately. Floor coverings will be reviewed as above. Monthly visits will include a review of cleanliness.The home will be free from offencive odours and will be maintained to a clean and hygienic standard. With immediate effect ongoing interim and supporting home manager. Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: On the day we visited the home we found that there were offensive odours in the communal areas of the home. We saw that one Regulation 26 visit, which is a visit made by the provider to assess the homes performance, had been conducted since our last inspection. We looked at the report of this visit which took place on the 9th June 2010. The report highlights shortfalls in areas relating the the environment and states that externally the environment is not well maintained, that there are rats in the garden and that the internal needs to be updated. It highlights maintenance issues such as the main fridge in the kitchen running at 8 degrees and higher in the summer, that the heating will not be switched off and radiators stay warm, that there are issues with the water temperature and that an engineer was requested from the head office on the 1st June but that no one has attended, there remains an issue with the seal on the freezer and that the Portable Appliance Testing certificate has not arrived. Dates that the shortfalls would be rectified by and by whom are not stated. Care Homes for Adults (18-65 years) Page 26 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ineffective training and the lack of staff induction and supervision place the people who live here at risk. The registered person must ensure that all staff receive the induction, mandatory and specialist training they need to carry out their role. Evidence: The outcome for the people who live in this home in relation to this area was found to be poor at last inspection and three requirements were made. The first of which is to be completed by the 30/07/2010 The registered person must ensure that all staff receive the induction, mandatory and specialist training they need to carry out their role. The improvement plan received by the CQC states that We will implement a system to identify the training needs of staff and develop learning and development plans to meet these needs. Staff will receive training in administration of medicines and epilepsy. We will ensure that induction is completed and that appropriate records are kept on staff files. We will ensure that all staff receive supervision in accordance with policy. Rotas will ensure the appropriate levels and balance of staff on duty. Staff will have the appropriate skills knowledge and attitude to support individuals effectively and in a person centred way. There will be a demonstrable shift in culture and practise within the home. Staff supervision records will evidence that this happens regularly and of a good standard. To be completed by the 30/07/10 by the interim and supporting home manager with input from responsible individual and the training Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: department. As the completion date for this requirement is yet to be reached it was not possible to fully assess this requirement however there was evidence to suggest that some improvements have been made in relation to staff training being provided to existing staff and that further training was planned. The second requirement to be completed by the 15/06/2010 states that The registered person must ensure that recruitment practises are robust and that 2 appropriate references are obtained prior to a person being offered employment. The improvement plan received by the CQC states that The report indicates that current recruitment processes are robust with references x 2 obtained in all but 2 cases where friends provided references. Where an employee is new to the workforce or has been out of the workforce for some time obtaining a second employer reference can be an issue. We will continue to ensure that there are two references on file and check with HR department on appropriateness of references. Where a reference is not from an employer if member of staff has not been in workforce advice will be sought from HR department and record made on the employees file of advice given. This was with immediate effect and ongoing by the interim and supporting home manager and administrator. Other than the interim manager, whose references and employment checks were seen and agreed by the local authority, no new staff have been employed by the home since the last inspection however the home has not obtained appropriate references for all existing staff as highlighted in the last report. The third requirement was also to be completed by the 30/07/2010 and states The registered person must ensure that staff performance is monitored and that all staff including the appointed manager receive documented supervision a minimum of 6 times a year. The improvement plan received by the CQC states that Staff meetings will be held and minuted, with practise issues being on the agenda. Staff will receive regular supervision, which will be recorded and signed by both parties. The appointed manager will receive supervision on at least a monthly basis. A supervision schedule will be drawn up to demonstrate planning of supervision including any changes made and new date set. Supervision records and schedule will be checked as part of the monthly visit and will be completed by the 30/07/10 by the interim and supporting home manager and responsible individual for Home Manager supervision. Although the date for the completion of this requirement is the 30/07/2010 only half of the staff team have received supervision to date and only one staff meeting has been held. As previously stated the minutes for this meeting are not dated, is marked team leaders meeting confidential and has not been signed by any staff to show they have read or agreed these minutes. A further team meeting has been scheduled. Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: On the day of the visit to the home there were six staff members on duty and there are eight people living there. Two members of staff took one person out which left four members of staff to support seven people, many of whom require one to one support from staff and all of whom are funded for seven hours a day one to one support. We looked at the staff rota and saw that the week before our visit to the home, in addition to management and the activity person only four members of staff were on duty for four shifts in that week, five members of staff were on duty for seven of the shifts and on the remaining four shifts there were six staff on duty. We were told by the interim manager that in addition the appointed manager who is suspended and will not be returning to work at the home, a team leader and another senior member of staff are still suspended from work pending investigations. They also told us that since the last inspection two members of staff have left and a further two are leaving within the next few weeks. Following our visit to the home a further member of staff has been suspended pending investigation into allegations of financial abuse. We looked at staff rotas and saw that only two or three permanent members of staff were on duty on shift the majority of the time and that the home is increasingly reliant on the use of agency and bank staff. We saw that at weekends that support staff do the homes cleaning and albeit Saturdays meal is prepared in advance on the Friday the support staff prepare all other meals over the weekend. The interim manager explained that they are trying to block book agency staff in advance so that they can get to know the people who live at Courtwick Park and that are planning a recruitment drive. We looked at the report relating to the Regulation 26 visit undertaken on the 9th June and this highlights shortfalls in relation to staffing. It confirms that no supervisions had taken place at that point and that the interim manager was unsure as to how many staff had left the home. Care Homes for Adults (18-65 years) Page 29 of 39 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is badly managed. Poor practise has been allowed to continue unchecked due to the lack of effective monitoring and this has placed the people who live here are at risk of harm from abuse. The management and staff team have not been provided with the support or recourses they need to make the improvements required within the timescales set at the last inspection. Evidence: The outcome for the people who live at this home in relation to this outcome area were found to be poor at the last inspection. A requirement was made that The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. This was to be completed by the 15/06/2010. The improvement plan received by the CQC states The RI (Responsible Individual) will attend the service on a monthly basis to conduct Regulation 26 visits. An internal audit which takes place every year has been completed w/e 4th June and an action plan will be developed as a result with involvement from the staff team. Complaints and compliments will be reviewed as part of the monthly visit. Consensus uses a Dashboard approach to KPI which will further inform continuous quality Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: improvement.There will be evidence of continuous quality improvement within the home. This was to be completed with immediate effect by the interim and supporting home manager and be ongoing. We saw that one Regulation 26 visit, which is a visit made by the provider to assess the homes performance, had been conducted since our last inspection. We looked at the report of this visit which took place on the 9th June 2010. Shortfalls in the reporting of incidents were noted relating to the lack of clear procedure about incident and accident forms, support plans and risk assessments, medication, staffing, fire evacuations, monthly vehicle checks were not up to date and that the maintenance certificates were not all in date. It highlights shortfalls in the management and the only action stated in relation to all the shortfalls identified in the report was to work to the West Sussex Action Plan. It did not state who would be responsible for what, did no state any time frames for completion and had not been updated to show if any of the shortfalls had since been rectified. We were provided with a copy of the action plan that had been drawn up with the home and West Sussex and this does not cover all the shortfalls identified at the regulation 26 visit. Care Homes for Adults (18-65 years) Page 31 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 The registered provider must 15/06/2010 ensure that no service users are admitted to the home prior to a full assessment of need being completed by a person qualified to do so. To protect service users from harm and to ensure that the home can meet their needs. 2 6 15 The registered person must 15/06/2010 ensure that care plans are based on risk assessments are written in consultation with the individual and that they cover all aspects of personal and social support and health care needs as specified in Standard 2. These must be reviewed and updated when changes occur. To ensue that peoples assessed and changing needs and personal goals are reflected in their individual plan and that their preferences are taken into consideration. 3 6 12 The registered person must 15/06/2010 ensure that peoples bahaviour is not managed by restricting peoples access to the home and grounds through the use of locked Page 32 of 39 Care Homes for Adults (18-65 years) 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 doors. Care plans must contain guidlines for staff to follow in respect of supporting people to manage their behaviours. To ensure that peoples freedom is not restricted. 4 7 12 The registered person must 15/06/2010 ensure that people are supported to make their own decisions and manage their own finances. Where this is not possible an independent advocate or agent must be found. To ensure that peoples right to made decisions is protected and that people are protected from financial abuse. 5 12 16 The Registered Person must ensure that people are supported to set, monitor and achieve both their long and short term goals and aspirations and that this is recorded. This must include community participation. To ensure that people identify their own goals and are supported to develop skills to achieve maximum independence and fulfilment. 6 16 12 The registered person must ensure that peoples rights are respected, that people are treated with respect and that staff interact with the 15/06/2010 15/06/2010 Care Homes for Adults (18-65 years) Page 33 of 39 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 people who live there and not exclusively with each other. To ensure that people are treated with respect. 7 17 16 The registered person must 30/07/2010 ensure that the people who live at the home are involved with the planning and preparation of meals. People must be given a choice in relation to where, when and with whom they eat. To ensure that choice is given in relation to food and people enjoy their meals and mealtimes. 8 19 13 The registered person must 15/06/2010 ensure that peoples health care needs are assessed and monitored and that clear procedures are put in place to address them. This must be clearly documented. To ensure that people health care needs are met. 9 20 13 The registered person must ensure that there is a clear support plan on the use of anti-convulsant medicines. To give staff clear guidance on action to be taken when a resident has a fit. 10 20 13 The registered person must ensure that MAR charts reflect the dosage directions 30/06/2010 30/05/2010 Care Homes for Adults (18-65 years) Page 34 of 39 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 that the doctor intended. To ensure the health and welfare of the residents is protected. 11 23 13 The registered person must 31/05/2010 ensure that the local protocol in relation to safeguarding vulnerable adults are followed at all times. Information must be passed to the relevant authority without delay so decisions are not taken in isolation. To ensure that people re protected from harm at all times. 12 24 23 The registered person must 30/08/2010 ensure that the premises are well maintained. A maintenance and renewal plan must be implemented. to ensure the health safety and welfare of the people who live and work in the home. 13 30 16 The registered person must 15/06/2010 ensure that the premises are clean and free from offencive odours. To ensure that health safety and welfare of the people who live and work in the home. 14 32 18 The registered person must ensure that all staff receive the induction, mandatory 30/07/2010 Care Homes for Adults (18-65 years) Page 35 of 39 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 and specialist training they need to carry out their role. To ensure that staff have the skills they need to support people safely. 15 34 19 The registered person must 15/06/2010 ensure that recruitment practises are robust and that 2 appropriate references are obtained prior to a person being offered employment. To ensure that people are protected from harm and the risk of abuse. 16 36 18 The registered person must ensure that staff performance is monitored and that all staff including the appointed manager receive documented supervision a minimum of 6 times a year. To ensure that staff have the skills and underpinning knowledge they need to do their job safely and that gaps in training or understanding are recognised and support provided. 17 39 24 The registered person must ensure that effective quality monitoring of the performance of this home and its staff team. To ensure that shortfalls are identified without delay and actions are put into place to Care Homes for Adults (18-65 years) Page 36 of 39 30/07/2010 15/06/2010 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 rectify them. Care Homes for Adults (18-65 years) Page 37 of 39 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 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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