Care Home: Gallagher Residential Care Limited

What the care home does well People said that staff were friendly and attentive in general and welcomed visitors. People liked their bedrooms. They thought the food was good and they could choose what they wanted for meals. What has improved since the last inspection? Care plans now have more detail and staff read them so they are able to provide relevant care for people. Staff references are taken up before they commence employment to protect people from unsuitable staff. What the care home could do better: Residents welfare could be more effectively met by ensuring that: Assessments are detailed and contain all aspects of individual needs to make sure staff can meet those needs from day one of a persons admission. That all aspects of care e.g. stated dates of health checks, a full record of daily living wishes etc are detailed in Care Plans to assist staff to meet all residents needs. Action is taken to meet activity needs by way of more outings and more varied activities. The Complaints Procedure needs to be clearer for residents and their representatives so that complainants can initially go to the Lead Agency to reach a proper resolution. The home needs to be refurbished and that it is warm enough for people who live there. The staff training programme becomes more comprehensive through ensuring all staff receive thorough training to increase their skills in delivering good quality care for people. Management need to take action if issues are identified through quality assurance questionnaires. People need to have a safe environment through management ensuring that full fire safety is observed and that there are Risk Assessments for all safe working practices in place to eliminate risks for people who live in the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Gallagher Residential Care Limited 212 Charnwood Road Shepshed Leicestershire LE12 9NR     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: Keith Charlton     Date: 0 8 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 30 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 30 Information about the care home Name of care home: Address: Gallagher Residential Care Limited 212 Charnwood Road Shepshed Leicestershire LE12 9NR 01509503113 01509507239 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Gallagher Residential Care Limited care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is:10 The registered person may provide the following category 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 disabilities - Code LD Date of last inspection Brief description of the care home The last key inspection of this service was in December 2008. Gallagher Care Residential Home is located on the outskirts of Shepshed, with easy links to Coalville and Loughborough and within easy reach of local facilities. The home is registered for ten adults with a learning disability. The property comprises of eight single and one shared bedroom located on the ground, first and second floors. On the ground floor there is a lounge, and a dining area. Another lounge is on the second floor. Bathrooms/shower rooms and toilets are sited on all floors. The house has a large rear garden. The range of fees currently charged is #1416 to#6968 every four weeks. Extra Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 1 8 1 2 2 0 0 8 Brief description of the care home charges for services such as hairdresser and chiropodist are made on an individual basis. This information was given on the day of the inspection. Care Homes for Adults (18-65 years) Page 5 of 30 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 Two Stars. This means the people who use this service experience good quality outcomes. We as it appears throughout the Inspection Report refers to The Care Quality Commission. The inspection process consisted of pre-planning the inspection which included reviewing the Annual Quality Assurance Assessment (AQAA), which is self-assessment tool completed by a representative of the service. We have sent surveys to people who use the service along with staff which were largely positive regarding the standard of care the service provides with a small number of suggestions to improve practice. The unannounced site visit commenced on the 8th December 2009 and was carried out by Keith Charlton Care Homes for Adults (18-65 years) Page 6 of 30 The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Gallaghers. Three people were selected and discussions were held with four people by a person we asked to accompany us - the Expert by Experience (who is a person with learning disabilities who has experience of using care services), and with four people by the Inspector, the Manager, the joint Manager and two members of staff. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Gallagher have had their needs assessed before moving into the home but this needs to be more detailed so that staff can provide care that meets all their needs. Evidence: Some surveys said people had not enough information at the time of the admission to make up their minds about the home. We case tracked a person living in the home who had moved into Gallagher in the past year. We checked that he had received information to help with the choice of home, and he said he could not remember though he did visit the home before he came to live there. The Manager said he would follow up the issue of people having user friendly information so they have enough information about the services. We saw that people had their needs assessed prior to moving in, to ensure that the staff at the home could meet their needs and we found that the assessment system had detail of these needs though not all issues had been covered, e.g. no specific information as to health checks - e.g. optical, dental, hearing checks etc so as to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: prompt a check to improve the health of rpeople, and details of lifestyle, hobbies etc was scarce. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of people living at Gallagher need to be actively promoted. Evidence: We looked at the care records of three people living at Gallagher Home. We found care plans to support the care given to people who live at the home. There was a variety of useful information available to staff though Person Centred Plans, and Daily and Weekly Activities Logs, were not yet fully recorded. The Manager said these were issues which he was due to complete. There are also a number of risk assessments so that everyone can be protected from all identified risks, though some were not specific and one was negative, not to be trusted in the kitchen. Care Plans contain detail as to how to encourage peoples independence - the ability to wash and dress themselves even where they have physical disabilities. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Staff said that they read Plans to ensure they can meet peoples needs and keeping up to date with the Plans is encouraged by management. there were some comments that people would like to have a key worker to confide in if they have any worries. The Manager said he would look into setting up this system. We saw that care plans were not reviewed on a six monthly basis to ensure they properly reflected the changing care needs of people living in the home. There are no regular Residents Meetings which people can attend if they wish and make suggestions about how the home is run - the Manager was asked to progress this so that people can express their views as to the running of the home and get swift action to fix things they identify. During our visit we observed staff being friendly to people and there was evidence that residents are able to live their own lives, e.g. going out to places in the community, choice of meal, choice of activity etc. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Gallagher have some opportunities to have a varied lifestyle though this needs to be extended. Evidence: There were a number of comments in surveys and to the Expert by Experience that there were not enough activities and outings, particularly at the weekend: It would be nice to have trips out to the pub, or pictures or to museums, was one comment. The Expert by Experience said that people had told him that there were few activities. There were a number of suggestions - have a games console, going to the pictures etc. The Manager said that the people who would like to go out usually had spent all their money so would not be able to afford outings but this would be reviewed. We looked at the care plans of people who live at Gallagher. These contain details of what people like to do and where they attend the day centre, drop in places, discos, Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: college, clubs etc though there were no completed weekly activity sheets or daily activities to show what they are doing to ensure peoples needs needs are met. Plans showed us that people are able to experience a social life if they choose. Some people go to college to learn life skills, and others have activities in the community to choose from. One person likes to go to Loughborough most days to meet his friends, have a drink, go to church etc. Another person said she was able to get her own food twice a week and use the kitchen to make cups of tea for herself. Staff said that another person likes to stay in his bedroom listening to music and he choose to sleep on top of his bed and not in it, which is evidence that people can choose their own lifestyle. Some concern was expressed that the hut that was used in the yard so that people had a place to go to smoke was very small, had no heat and little light. The Manager said that these issues would be followed up. People have annual holidays and staff said that people had been to Skegness. We saw that staff are sensitive to the needs of people living at the home and we saw staff talk to and interact well with people who live at the home. Staff said there were no rules that people had to follow and could choose what they wanted to do. We saw that there were three choices for tea and people said that they enjoyed the food. The Manager said that people choose what they want to eat. Menus were in place and had sufficient variety. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Gallagher receive good support in their personal and healthcare needs. Evidence: Yes, I get taken to the doctor if I am not well, one person said. The Expert by Experience also had comments saying this. We looked at the personal and healthcare records of people who live at Gallagher. We saw that they have access to healthcare services to meet their personal and healthcare needs as described in Care Plans. On talking to staff as well as looking at the records, we found that staff act on concerns they have about peoples needs. We looked at medication management and found that staff are administering medication appropriately to people who live at Gallagher with no instances seen where medication was not signed as given. The Manager is to check that all people have regular medication reviews to ensure peoples health is fully promoted. We also looked at how medication is stored and this was stored safely. We saw staff records and these showed us that staff have undertaken training in the administration of Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: medication. The Manager said staff must be trained and competent before they are able to issue medication. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Gallagher can be confident that their concerns are noted and acted upon, though they are protected from abuse. Evidence: One person told the Expert by Experience that they did not know how to make a complaint if the home does nothing about their concerns and said if a concern was raised that nothing gets done. The Manager said that this was unfair and if there was a delay in doing something that people would be informed of this, though did acknowledge that there were currently no Residents Meetings. We looked at the complaints procedure and saw that this was written in a format which is not helpful for people living at Gallagher to understand. The Manager said this issue would be followed up. The procedure does not give the complainant the choice to go directly to the Lead Agency if they wish, instead of the home. The Manager said this would be quickly rectified. We looked at Complaints record and the Manager said there had been a number of complaints in the past twelve months and that they had been properly followed up by management. We saw by looking at staff training records, and by talking to staff, that staff have an Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: awareness of safeguarding policies and procedures and know what to do if they suspect that a person who lives in the home is being abused in any way. We checked the financial records of two people living at the home, and found good recording of money transactions apart from two staff not being involved to witness everything is correct. The Manager said this would be followed up and produced a form that showed that this will be included. There was a discrepancy with one persons money though this was later rectified. Care Homes for Adults (18-65 years) Page 20 of 30 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 at Gallaghers have a comfortable environment, which needs to be further upgraded. Evidence: Yes, I like my bedroom. I can have all my own things there, one person said. Other people agreed this was the case. We looked at the communal areas of the homes and some of the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and furnished, though they are beginning to look worn. The Manager said that the home is to be refurbished as from now, and that he planned to continue changing the decor in the home in line with peoples preferences. The bedrooms were decorated to reflect the personalities and preferences of the people using them. The only aspects that needed attention was that people said they wanted a working shower. Two of the bathrooms are being refurbished at the time of the inspection. The Manager said he would make sure that there are two working showers in the near future and that he would see what equipment was needed so that two people with physical disabilities can safely use the toilet. There were also comments that the home was not always warm as windows were ill fitting and Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: draughty. The Manager thought this was not the case but agreed to test windows and to get staff to check that people were warm enough in cold weather. If this is not the case the central heating system needs to be looked at to increase heat as needed. The garden to the rear is a good size with vegetable patch for people to help with gardening if they choose. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have generally satisfactory staffing levels and support from a motivated staff team, though more training needs to be in place to fully support residents welfare. Evidence: Staff are nice. They help us when we need them, one person said. The Expert by Experience also confirmed that staff were praised for their friendliness by people who live in the home. The staff rota showed that normally there iare two staff when people are in the home though there was a comment when the joint Manager is one of the workers in the morning there is too much work as this Manager cannot fully assist with personal care - the Manager said this had already been identified as an issue and staffing would be increased on this shift. We talked to staff and saw them supporting people who live in the home. We saw good interaction between staff and people who live in the home, and staff demonstrated good general understanding of the needs of people living there. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Some staff said they were not always supported well to do their job by management. The Manager acknowledged that this could have occurred as a number of practices needed to improve but he also said that staff were praised, though this issue would be looked into to ensure they were praised for good work, to maintain and improve morale. Staff also said that they got in trouble with management if they spoke to an Inspector about any concerns. The Manager said that this was not the case and he would inform staff of this. We looked at training records and this confirmed that staff have undertaken relevant training to help them in their roles. Training included health and safety, medication management, working with challenging behaviour (though not all staff had relevant training). The Manager stated in the AQAA that they had identified a gap in staff training and this will be provided as not all staff had received training in essential issues such as learning disabilities, mental health, infection control and challenging behavior etc, which could hamper the ability to provide appropriate care to people. There is detailed induction training and on going training relating to the job staff do, with supervision, which we found to be the case in staff records with staff either completing or working towards staff National Vocational training. We looked at a sample of staff records, and saw that all the necessary checks were made to safeguard people who live at the home as there were references and criminal checks in place for staff before they commenced employment. Care Homes for Adults (18-65 years) Page 24 of 30 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. Health and safety systems are in place but need to be extended to fully protect peoples welfare. Evidence: There is Manager for the home, Paul Gallagher, though Shaun Simpson is also the joint Manager and had applied to the CQC to be formally registered as such. Shaun said an application for the registered manager role has been sent to the CQC and he hopes to have an interview in the near future. There are quality assurance and monitoring systems in place, and we saw the questionaires that go out to people (though not to all relevant parties - GPs, Social Workers etc) to ascertain peoples views of the service so that improvements can be made if needed. An Action Plan was not in place to progress suggestions made. The Manager said this would be followed up. The AQAA informed us of the policies and procedures the service works to, to ensure good health and safety practice in the home, though temperatures of water were not Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: seen to be regularly checked to ensure people are protected from scalding water. The water was tested and was seen to be satisfactory, as per the risk assessment for this in peoples care plans. Risk assessments are in place for safe working practices, though not for window restrictors to ensure safety and security for people. Fire risks were seen to be covered by regular fire drills and a fire risk assessment is in place, though fire bells stopped having the weekly testing in October 2009 - the Manager said this would be rectified. There was also a comment received that staff had to ring the Manager before the fire brigade, which could well endanger peoples safety. The Manager said this was not the case and he would clarify this with staff. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 2 1 2 Management need to provide user friendly information so that people can understand what services that are on offer. The assessment needs to include all relevant details of people so that staff can provide proper individual care to that person. Care Plans need to be fully detailed and focus on peoples strengths, not weaknesses, and be reviewed every six months to ensure they are up to date and staff always give relevant care. The setting up of a keyworker system needs to be followed up. There needs to be evidence that people are regularly consulted, through either Residents Meetings or individually, and that their views are listened to and acted upon. That people are consulted about what further activities and outings they want and that these are swiftly provided. There needs to be a Complaints Procedure that is easy for people who live in the home to follow and that it gives people the choice to go to the Lead Agency at the first Page 28 of 30 3 6 4 7 5 6 12 22 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 stage. 7 24 Management need to ensure that working showers are provided, that people are warm enough and furniture is reviewed to see if it needs replacement. Staffing needs to increase in the early morning period to ensure that two care staff are in place to deal with peoples personal needs. A Staff Training Matrix is needed to check that all staff have received essential training such as training in learning disabilities, mental health and challenging behavior and to prompt this training to be arranged. Quality assurance surveys need to be supplied to all parties and analysed to produce an Action plan to make improvements to the service. Management need to clarify with staff what the fire procedure is, to do regular fire bell testing, and to ensure all risk assessments are in place to protect peoples health and safety, e.g. for window restrictors. 8 33 9 34 10 38 11 42 Care Homes for Adults (18-65 years) Page 29 of 30 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 30 of 30 - 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!