Care Home: Highfields Care Home

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Highfields Care Home Highfield Road Swadlincote Derbyshire DE11 9AS two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Barker Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Highfields Care Home Highfield Road Swadlincote Derbyshire DE11 9AS 01283224658 NOTGIVEN highfields@unitedhealth.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Health Limited Name of registered manager (if applicable) Mr Stuart Kenny Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: Date of last inspection 0 2 0 3 2 0 0 7 A bit about the care home Highfields is a purpose built care home. This means it is accessible to people using wheel chairs and people with severe learning disabilities and physical disabilities. The building has special equipment for people with disabilities and each person has their own bedroom. They each share a bathroom with one other person. Corridors are very wide and communal areas are large enough for people to move around comfortably. 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 How we did our inspection: This is what the inspector did when they were at the care home The inspector visited at short notice. The last key inspection at this service was on 2nd March 2007. We had asked the Manager to complete a questionnaire about the home, before this inspection. We had asked other people to tell us what they think about the home. One member of staff sent us their views. The people living at the home all needed a lot of help from staff. They were not able to give us their views about what life was like at the home. But we saw how staff treated people. And we looked at what staff had written about two peoples lives, at their bedrooms and talked to staff about them. We were only able to meet one of these two people. We spoke to the Manager and one staff member. We looked at what staff had written about peoples lives and we walked around the home looking at rooms and equipment. The weekly fees at the time of this Inspection were from £1586 to £1659 pounds. What the care home does well The home is good at finding out what people need and writing this down. Staff read these reports so that they can help people to keep healthy and as active as possible. People were helped to have interesting lives. Staff gave them individual attention and they were treated with respect. The home’s policies and procedures kept people safe. Policies are rules about how to do things. Procedures tell people how to follow the rules. People were living in a homely, comfortable and safe environment. The home finds out a lot of information about new staff before they start work there. They have training so they understand how to meet people’s needs. The home was well managed. People were safe and their rights were recognised. What has got better from the last inspection The dining room and corridors had been redecorated. Records were better at this Inspection and staff had had more training. What the care home could do better People’s medicine records must be clearer and more accurate. Staff must be trained in moving people. Staff must trained in fire safety. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Barker CSCI CPC1, Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual written needs assessments were in place before people were admitted to the Service so that their diverse needs were identified and planned for. Evidence: The Services Statement of Purpose and Service Users Guide were examined to see if they had improved since the last inspection. The Services physical environmental standards were recorded in the Statement of Purpose but not in the Service Users Guide. The latter gave an address and telephone number for the Commission that was out of date. The last person to be admitted to the Service had arrived five weeks before this Inspection. An examination of records indicated that a full assessment of their needs was made prior to their admission. 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 . People who use the Service had comprehensive and individual plans of care which demonstrated that their health, personal and social care needs were being met and they were enabled to make decisions about their lives. Evidence: The care plans of the people case tracked were examined. They were clear, comprehensive and up to date. All but the care plan relating to the recently admitted person had been changed to a well worded person centred format. One case tracked persons care plans were being reviewed every six months or more frequently if changes occur. The Manager said he plans to increase the frequency of reviews to sixmonthly for the other people who live at the Service. Minutes from the last two formal care plan review meetings, relating to one case tracked person, were examined. These were held in September 2008 and March 2009 and the funding authoritys social worker had attended both. Neither set of minutes were dated or signed. Information supplied by the Manager before the inspection stated that, We have life books written in the first person. One case tracked persons Life Book was examined. This was a comprehensive document and was a valuable guide to staff, ensuring that peoples needs were being met. The Manager said that new staff would read this document, and the person centred care plan, first. Information supplied by the Manager before the inspection stated that, One service user chooses the member of staff to assist them. The Manager said this is done by the person looking at a particular member of staff at every main mealtime. He also pointed out, in the pre-inspection questionnaire, that, We recognise a service user may make choices that differ each time. At the Inspection, he added that, We dont Evidence: base decisions about likes and dislikes on single experiences. The social care worker spoken with gave an example of one person making a decision about the clothes they wear each day, for example, by pointing. The staff member added that this person chose where to go on a birthday outing. There was a range of up to date, recorded risk assessments. These included Moving and Handling and use of the trampoline. Also, the general Risk Assessment file included risks relating to the people who live at the Service. These documents showed that the Service was aware of potential risks to which people were exposed. The social care worker spoken with showed a good understanding of the concept, and use, of responsible risk taking in order to increase peoples independence. For instance, one person who lives at the Service, who needs to eat pureed food, is sometimes given a soft biscuit to eat as, the staff member said, we like to give them experiences that we all have. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service provided activities and services that were age-appropriate and valued by the people who live here, and promoted their independence. Evidence: Information supplied by the Manager before the inspection stated that, Service users are involved in regular daily activities, mainly through sensory input. There was evidence at the inspection to support this. For example, we saw a trampoline in the rear garden, craft equipment in a store room, a musical keyboard in the dining room and a range of sensory equipment in the sensory room. This included skittles for use in the lounge - an alternative to going to the bowling alley, said the social care worker spoken with. This worker was able to provide evidence that people living at the Service find activities valued and fulfilling. He said one person loves to go out and, as a way of showing this pleasure, will yell excitedly. He added that one of the case tracked people enjoys listening to music, particularly Asian music. During a tour of the premises this person was enjoying whistling music - another of their pleasures, the social care worker said. He confirmed that the Activity Coordinator had expanded the activity programme and said that activities are more personalised now. We saw photographs of activities and holidays in peoples Life Books. Activity Reaction Sheets were in use, providing a valuable way of monitoring peoples reaction to activities and a basis for modifying these and introducing new ones. The social care worker spoke of plans to do the same with Holiday Activity Reaction Sheets. The social care worker gave examples showing that the people living at the Service Evidence: have a positive involvement in the local community. He spoke of one of the case tracked people attending an organ recital in a local shop and all the people who live at the Service attended a carol concert. He added that local people have come to know the people living at the Service and walk up and speak to them when out in the community. The social care worker said that all people who live at the Service, have good contact with relatives...Mothers Day cards were sent out this week. Also, all the people are involved in preparing for the annual party which, this year, will be a jungle theme. It was noted from one persons Activity Plan that staff were supporting them to e-mail their parents on the afternoon of this Inspection. The social care worker said that the Services telephone now has a speaker phone facility so that staff can take part in the conversations that people have with relatives, if considered appropriate, to improve communications. The social care worker spoken with gave examples of how routines, at the Service, are flexible to meet peoples individual needs and circumstances. For instance, one case tracked person prefers to have a lie in in the mornings and staff are sensitive to (the person) not being a morning person and put music on to gently wake (the person). The social care worker also gave examples of routines at the Service promoting peoples independence. For instance, all are involved in food shopping and staff encourage one person living at the Service to take part in simple kitchen tasks. In the past this same person has been given the vacuum cleaner cable to hold, so as to help the person feel more involved in domestic activities. The Services menus indicated that people living at the Service were being provided with a varied and nutritious diet. The social care worker spoken with said he had received training in Nutrition Awareness and had, with the help of a dietician, reviewed these menus. Records of the food eaten were also seen. Food stocks were found to be at a satisfactory level. The evening meal was observed on the day of this Inspection and each of the people was being helped to eat by an individual member of staff. 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 . The Service was providing people with personal support in the way they preferred and required and was meeting their physical, emotional and health needs. Evidence: At this Inspection we observed positive interaction between staff and the people living here - with their dignity needs clearly being recognised. The social care worker spoken with showed a good grasp of good caring practices. He gave examples of how staff meet the dignity and privacy needs of people living at the Service. For example, people are encouraged to, change behind closed doors and closed curtains and, we let them know what were doing at each step so its not a shock. Information supplied by the Manager before the Inspection referred to bath times can be made sensory so its not just personal care. The social care worker spoken with described how one case tracked person has a red rope light in their bedroom - this was bought to address the persons ability to see the colour red better than other colours. This rope light is brought into the bathroom, at bath time; music is played and a sweet-smelling bath bomb or bath gel is used. Outside the premises there is a sensory garden. There was evidence of equipment in place that maximises peoples independence. For instance, each bedroom is provided with an overhead hoist to assist with the transferring of the people who live here to their adjoining bathroom and to their wheel chairs. All people living at the Service had been diagnosed with cerebral palsy and epilepsy and use wheelchairs. Care plans provided good evidence of each persons health care needs being met. There were monitoring records relating to seizures, pressure sores, nutrition and dependency level and recorded evidence of annual medical reviews. There was evidence on one case tracked persons records of involvement of a range of external health professionals, including speech and language therapist, occupational therapist, physiotherapist, dietician and nutritionist. An aroma-therapist was visiting Evidence: the Service every other week and the Deputy Manager was undertaking Indian Head Massage with the people who live at the Service. Small format, person centred, ring files called My Health File had been in place for six to nine months, the Manager said, for each person living at the Service. These were partially completed. There was some lack of clarity between health recording systems as, for example, medical appointments were recorded elsewhere rather than on the My Health File. The Medication Administration Record (MAR) sheets, of the people who live at the Service, were examined. There was an inconsistent system of recording the administration of as and when required (prn) medicines such as paracetamol and epistatus. Entries were either N (offered, not required) or were left blank. There was also inconsistent records across one case tracked persons MAR sheet and their Bowel Record, regarding administration of Bisacodyl suppositories. Two lunchtime tablets had been administered today to one person but had not been recorded on the MAR sheet. This had been due to the lateness of return to the Service after a visit to the local Zoo, the Manager said. For the same person, their fortifying/thickening powder had not been recorded on two consecutive days. The standard of recording on the MAR sheets was otherwise satisfactory. Attached to the MAR sheets were the photographs of people living here and a record of staff signatures/initials, to ensure that signatures can be cross-referenced against staff names. Medicines were securely stored. No controlled drugs were prescribed. The Manager stated that the Services pharmacist makes three-monthly inspections and that all staff had, or were in the process of receiving, training in the safe use of medicines. Information supplied by the Manager before the Inspection referred to having implemented a better internal medication audit. The new quarterly medication audit sheet, dated December 2008, was examined. 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 . Good procedures for handling complaints and abuse were in place ensuring that people were fully protected. Evidence: A copy of the Services complaints procedure was examined in the Statement of Purpose. It made reference to the Commission but did not include any contact address or telephone number. Information supplied by the Manager before the Inspection referred to two complaints having been received, with one of these being upheld, during the past 12 months. Both of these were from parents of people living at the Service and the Manager described a satisfactory process leading to their resolution. The Service had a complaints record in place but this had not been used with respect to these two complaints. The Service had a written policy and procedure regarding Safeguarding Adults and a well-worded whistle blowing policy. The social care worker spoken with showed good awareness of these policies and procedures and he felt that the people living here, and staff, were safe. It was noted that the Service had acquired a copy of the Public Interest Disclosure Act 1998, as recommended at the last inspection. The Manager stated that staff were expected to read the General Social Care Councils Codes of Practice with regard to adhering to policies and procedures about accepting gifts and money from service users and carers. However, United Healths policy on Gifts to Staff made no mention about staff benefiting from wills drawn up by carers or on behalf of the people living at the Service. The social care worker confirmed that he had been provided with training, on the subject of Safeguarding Adults, during 2008. All other staff except one had also been provided with this training within the past three years. That person was due to undertake this training on 1 April 2009. There had been one Safeguarding Adults referral to the local Social Services office since the last inspection. This had been dealt with in an appropriate and professional way. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People were living in a most comfortable, homely and safe environment. Evidence: The Services environment was homely, well furnished and nicely decorated. Information supplied by the Manager before the Inspection referred to the dining room and corridors having been recently redecorated. The bedrooms were found to be very well personalised and bathrooms were shared between two people only - so were able to reflect individual needs. Each person, apart from the person very recently admitted, had their own individually designed easy chair in the lounge. The Service is commended on the high standard to which the premises continue to be maintained. From the tour of the premises there was evidence of good standards of cleanliness and hygiene throughout, with no unpleasant odours. The social care worker spoken with described good practice regarding the transportation of soiled articles of clothing and bedding within the premises. Appropriate soiled waste disposal bags were seen in the bathrooms. The questionnaire completed by the Acting Manager referred to all staff having completed Infection Control training. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service had a group of well-recruited, and generally well trained, staff to ensure that the needs of people living here were met. Evidence: The Manager stated, in the pre-inspection questionnaire, that 9 of the 14 care staff had achieved a National Vocational Qualification (NVQ) in Care to level 2 or above. The Manager added that six of these staff have this qualification at level 3 and one at level 4, and three staff were working towards this qualification at level 2. The Service therefore meets the National Minimum Standard to maintain a staff group with at least 50 qualified staff. The file of a member of care staff recently appointed was examined. It was found to contain all of the elements, required by current Regulations, regarding recruitment practices. The social care worker spoken with described a very good range of training he had received during the past 12 months. Training records confirmed that... * all staff had been provided with Basic Food Hygiene training, * all but one staff had been provided with First Aid training, * seven staff had not been provided with Moving & Handling training within the past 3 years. The Manager said a specialist trainer was needed for this, * three staff had not been provided with Fire Safety training for more than 2 years. Also, the Manager confirmed that night staff are not provided with six-monthly interim Fire Safety training. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Service was well managed so that people living here were protected and their best interests were promoted by the systems in place. Evidence: The Manager had worked with people with learning disabilities for 19 years, and had been in management for eight years, including two years managing this Service. He had achieved the Registered Managers Award. The social care worker spoken with described the service as, friendly...family like...worthwhile to work in. Monthly independent audit visits to the Service, on behalf of the Registered Provider, as required by Regulation 26, were taking place. The last two visits were in February and March 2009, the Manager stated, although the last recorded visit was on 17 December 2008. The Services Business Plan and Aims for 2009 were examined. The latter addressed a range of topics though it contained no target dates through which the progress of these aims could be monitored. Quality assurance questionnaires were being sent annually, by United Health, to staff, with feedback being sent to Managers. Relatives were sent quality assurance questionnaires two years ago. The preinspection questionnaire referred to there being, monthly team meetings and a newsletter. A copy of the latter was examined - this was compiled in January 2009. Good food hygiene practices were noted including the regular daily recording of refrigerator and freezer temperatures. The safe storage of cleaning materials was observed, along with the product data sheets required by the Control Of Substances Hazardous to Health (COSHH) Regulations. The pre-inspection questionnaire, completed by the Manager, indicated that equipment at the Service was being maintained and good Health and Safety practices followed. A Gas Safety Record, dated Evidence: 11 March 2009, was examined. Fire alarm tests were carried out weekly but there was none relating to fire drills. The Manager said that the Fire Officer visited the Service in January 2009 and made no recommendations regarding fire drills. However, the Manager spoke of plans to provide evacuation training followed by a fire drill. The Services environmental risk assessment, addressing Fire Safety, Health and Electrical matters, was examined. No Health and Safety hazards were found at this inspection. An Incident Form had recently been completed that related to one case tracked person. It was noted that the Form did not have a space for an outcome to be recorded. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 13(2) The medicine records of people living at the Service must be completed clearly and accurately. 01/05/2009 This will ensure that they receive the correct levels of medication prescribed for them. 2 35 23 23(4)(d) All staff must attend regular fire safety training - twice yearly for those who work at night. 01/07/2009 This will ensure that the safety of people living at the Service is not compromised in the event of a fire. 3 35 13 13(5) Moving & Handling 01/07/2009 training must be provided for all staff that work with people who have been assessed as having difficulty in moving themselves. This will ensure the safety of staff and of the people they support. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Services Statement of Purpose and Service Users Guide should include the Services physical environmental standards as set out in National Minimum Standard 1.1. These documents should include up to date contact information relating to the Commission. Minutes from formal care plan review meetings should be dated and signed. Health recording systems should be reviewed to ensure clarity of use. The administration of prescribed medicines should be recorded consistently across MAR sheets and other recording systems. The Services complaints procedure should include the Commissions contact address and telephone number. Staff should be informed that they should not benefit in any way from wills drawn up by carers or on behalf of the people living at the Service. The Services annual Aims should contain target dates through which their progress can be monitored. Quality assurance questionnaires should be sent to external professionals, for their views on the quality of service provided. A written report should be made of all monthly independent audit visits to the Service, as required by Regulation 26. The Manager should follow through his plans to hold fire drills. These should be held at least twice a year. The Services Incident Form should include a record of the outcome of an incident. 2 3 4 6 19 20 5 6 22 23 7 8 39 39 9 10 11 39 42 42 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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