Care Home: Lambton Grange

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lambton Grange New Lambton Village Fencehouses Houghton le Spring Durham DH4 6DE 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: Clifford Renwick Date: 1 3 0 2 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.csci.org.uk Information about the care home Name of care home: Address: Lambton Grange New Lambton Village Fencehouses Houghton le Spring Durham DH4 6DE 01913852206 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Richard Coltman,Mr Jason James Thompson Name of registered manager (if applicable) Sheila Allison Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: Date of last inspection A bit about the care home Lambton Grange is a registered care home providing personal care and accommodation for up to eight adults with a Learning Disability, some of whom may have an additional physical disability. The home is not registered to accommodate people who require nursing care. Lambton Grange is a twostorey building and domestic in design. Personal accommodation is located on both floors. A sensory stimulation room, communal space and kitchen facilities are located on the ground floor. It is located in private, well maintained grounds, next to a larger care home for older people and situated on the edge of the village of Fencehouses, County Durham. Both homes are owned by Mr R Coltman and operate within the private sector. The homes operate independently of each other. The current fees of the home range from 487.00 - 709.00 per week and include the cost of one annual holdiay. 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 We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspections may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 2 stars. This means that the people who use this service experience Good quality outcomes. The last inspection of this service took place in February 2007. Before the Visit. We looked at. Information we have received since the last inspection and annual service review that was completed in February 2008. How the service has dealt with any complaints or concerns. Any changes to how the service is run. The providers view of how well they care for people from information they provided in the annual quality assurance document (AQQA) that they sent to us. The Visit. An unannounced visit was made on the 13th February 2009. During the visit we. Met with some of the people who are currently receiving a service and also spoke with the staff who were on duty. Had lunch with the people who live in the home. We held discussion with the manager who was present during our visits. Observed staff working practises. Looked at information about the people who are receiving support and how well their needs are met. Looked at other records which must be kept in relation to health and safety and staffing. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around all areas of the home to make sure it was accessible, well maintained, safe and free of any hazards. We also gathered information from looking at, care records to assess how staff supports people with their assessed needs. We also focused upon looking at the records for the 2 people who are currently receiving a service we refer to this as case tracking. And this involves looking at all of the records for a named individual. We told the manager what we had found. The people who live in the home prefer to be know as clients therefore this term of reference is used throughout the report. What the care home does well The home ensures that no one is offered without first having a full assessment of need carried out. Assessments are then used to develop an individual written plan of care that demonstrates how staff will support people. The building is kept in good decorative order and repair and the clients have a good range of facilities that they can use. Staff receives appropriate training that ensures that they are kept up to date with their practises. And good recruitment practises are in place to ensure that only people who are suitable to be employed to work with vulnerable adults are employed. The staff ensure that the clients have a good range of activities available to them and the clients are supported to make good use of community facilities. Staff have a good understanding of individual clients needs and and have strategies in place to ensure they are supported in a way that they prefer. Good systems are in place for ensuring that clients health needs are met and the staff make good use of all services provided by the NHS. The clients are encouraged and supported to contribute to the menus in the home and this ensures that they receive meals that they like to eat. There is positive atmosphere within the home and the clients and staff are able to contribute their views as to how the service is run. What has got better from the last inspection Since our last visit refurbishment has been carried out in the home ans this is continuing with a number of improvements having been made. All of the corridors have been decorated and new pictures have been obtained. One of the communal lounges has been decorated and new leather suites have been provided in both lounges. More games have been obtained to be used in the games room. New curtains, bedding and carpeting have been provided in some of the clients bedrooms. And lighting has been improved in some areas of the home with new light fittings being installed. What the care home could do better The individual written plans of care should be developed and updated to include the level of support that people need. And what actions staff are carrying out to give this support. The manager when developing the individual plans of care should consider the use of pictorial symbols and photographs to make the care plans more accessible to the clients. Where people are unable to administer their own prescribed medicines. The manager should ensure that each client or their representative signs a consent form authorising staff to administer their prescribed medicines on their behalf. And a copy of staff signatures who are authorised to administer medicines should be kept in the front of the administration of medicines file. The manager should obtain a copy of the latest guidance from the Royal Pharmaceutical Society about the management of medicines in a care home and make this available to staff. This will ensure that staff are kept up to date with best practises and made aware of recent changes to the legislation about how medicines are to be managed in a care home. The manager should obtain a copy of the Local Authoritys policies and procedures on safeguarding adults. The manager should ensure that the lighting in bathrooms and toilets continues to be improved. And steps should be taken to ensure that the temperature in the games room is improved so that people can use this room at all times of the year. The manager should develop and implement an overall training and development plan that demonstrates what training is planned for the staff team as a whole. 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 Clifford Renwick St Nicholas Building St Nicholas Street Newcastle NE1 1NB 01912333600 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 . No one is admitted to the home without an assessment of needs being carried out. And the assessments are kept up to date to ensure that people receive the support they need. Evidence: On the day of our visit their were 8 people living in the home but only 3 people were present as other people were out at day centres or visiting families. There have been no new admissions since our last visit and everyone who currently lives in the home has now lived there for a considerable amount of time. Assessment documents are in place that confirm that peoples needs are assessed prior to admission. And these assessments are kept up to date and used to formulate the written care plans that are used by staff to demonstrate how an individual persons needs are met. These are discussed more fully in the next section of this report. 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 . Service users needs are assessed and they are supported to take risks as part of an independent lifestyle though the individual plans do not always reflect the positive actions being carried out by staff. Evidence: During our visit we looked at care files for two people and we refer to this process as case tracking which involves looking at all records of care. The files contain a range of information about the individual person though a lot of this information is now outdated and as such the files are bulky. Some of this older information would be better if it was archived in order to make the retrieval of information easier. In looking at the care plans they do identify some of the actions that staff are carrying out to meet the clients assessed needs. For some parts of the care plan however there is insufficient detail to show how someone is being supported with their meals and eating. Another aspect of one persons care plan states to to support someone with the their personal hygiene but does not include the detail as to how this is achieved. There is a dependency assessment document in place that is used by staff and which has accompanying instructions to review 6 monthly, however this had not been completed for one person since 2004. Evidence: The individual care plans are reviewed on a regular basis but these do not always show the progress that people may have made since living in the home. Though there is insufficient information in some parts of the care plans they are written in a way that is person centred and do focus upon supporting individuals in a way that suits them. Discussion with staff confirmed that they have a good understanding of individual clients needs and also their interests. Observation of staff practises also confirmed that staff work with people in a positive manner and include the clients in the day to day running of the service. Other documents such as risk assessments are completed out to ensure that the clients can be supported to take responsible risks whilst leading an independent lifestyle. The risk assessments are reviewed monthly. Though the risk assessments are in place the evidence to demonstrate how individual people are supported is not always reflected in the care plan. Though discussion with staff and observations made confirmed that staff are carrying out positive practises when supporting people. The individual care plans are currently in written format and as such are not easy to understand by the clients. And discussion was held with the manager about the possible use of pictorial symbols and photographs when developing the care plans. Individual clients are encouraged to make choices with the day to day routines in the home and this was evident throughout our visit. People chose what they wanted to eat and also how they spent their day. In discussion with staff it was confirmed that the clients engage in a range of social activities that they like though this is not always reflected in the care plan. Overall in was clear that the staff have a good knowledge of clients and an even better understanding of their individual needs. They know how to support people and what each persons individual preferences are. And it is this level of work that needs to be reflected in the written care plans. 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 staff support and enable the service users to achieve their goals, follow personal interests and leisure activities and be integrated into community life. Evidence: A client recently celebrated a birthday and their family brought a Chinese meal into the home for everyone who was living there so that they could take part in the birthday celebrations. There are no restrictions on families visiting the home and some clients go home to their relatives to stay overnight. Six of the 8 clients attend outside day centres on various days of the week where they take part in activities and also have the opportunity to make contact with their friends. A good range of activities are available for the clients to take part in and one person we spoke with stated that they look forward to the regular weekly trip to the local pub. Other weekly activities are a trip to a local community centre, bowling and the cinema. Activities tend to take place 1-1 between a client and their named key worker and sometimes activities are carried out in small groups where people share similar interests. Evidence: The clients take part in regular meetings with staff and are encouraged to contribute their views and ideas about the service. They also use these meetings to plan holidays and discuss matters such as meals. The clients receive one holiday that is paid for by the owner as part of the fee arrangements in the home. The home has their own activities room that is provided with a good range of games however the room is cold during the winter months and not used as often as it could be by the clients. Though staff do bring some of the games from this room into the main lounge so that they can be used. The clients depending on their ability are able to make use of the kitchen and are able to make snacks and drinks. Clients have a choice of meals and staff have amassed a range of knowledge so that they know what people like to eat whilst at the same time maintaining a healthy eating option. The clients are always asked what they would like to eat at each mealtime and if they wish they can have something different to that which is on the menu. Lunch was taken with the clients and the mealtime was an enjoyable experience. Some clients require support at mealtimes and staff offer this in a sensitive and discrete manner. The menus that are in place indicate a good range of meals and there a lot of home cooked items. The staff also ensure that clients individual nutritional needs are met and monitor if there are any problems with diet and nutrition. For those people who required specialised food implements to assist with eating The daily routines in the home are flexible and the clients choose how to spend their day. This was noted during our visit whereby one person preferred to spend time on their own in a separate lounge area. In discussion with staff it was confirmed that some people prefer to spend time on their own and where this is the case it is recorded in the individual care plan. The clients choose their own clothing and are involved in going shopping with staff. Each client is offered a key to their bedroom though none have chosen to have one. Evidence: There is a good rapport between staff and the clients and the atmosphere throughout the visit was good. 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 staff ensure that the service users receive care and support in the way they prefer and that their individual physical, emotional and health needs are met. And medication is administered in accordance with good practise guidance. Evidence: The clients receive support in a way that suits them and also meets their individual assessed needs. The individual plans of care identify the support that each person needs and though the care plans are not as detailed as they should be, they do identify the main areas of care. Personal and intimate care tasks are carried out in the privacy of clients rooms. The clients have a choice of who works with them and there are named key however it is not always possible to have someone of the same gender work with them. There are a number of men who live in the home and the staff team are all female. However in discussion with the manager it was confirmed that this has never caused any problems with all of the male clients being comfortable being supported by female workers. People can choose when they get up and when they go to bed but due to some people attending outside day centres then there are times when they have to be up for a certain time. Evidence: The clients choose their own clothes and also choose which hairdresser they want to go to. Records are available that confirm that each client has access to all NHS services and this ensures that individual health needs are met. A monitored dosage system is in place that records all prescribed medicines that the clients receive. None of the clients administer their own medicines and this is dealt with by staff. Only staff who have received training in the safe handling of medicines administer prescribed medicines. The medicines administration records and the storage of medicines are being dealt with appropriately. 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 . Appropriate policies and procedures are in place that ensure that service users are protected from abuse. And good systems are in place to ensure that any complaints are acted upon. Evidence: The home have a complaints procedure that is on display in the home. As well as being in written format it is also available in picture format and also using British Sign Language symbols. A copy of the complaints process is also contained in the service user guide a copy of which has been issued to each client. Though not every client uses speech to converse staff stated that if anyone was not happy with something the clients do have ways of making their feelings known. Staff stated that they would observe for changes in a clients behaviour to gauge whether they were dissatisfied and take appropriate action. Appropriate polices and procedures are in place that support staff in safeguarding adults and ensure that the clients are protected from abuse, neglect and self harm. In discussion with the manager it was confirmed that staff have received appropriate training in safeguarding adults and are aware of what action to take if they have any concerns. Discussion was held with staff on duty during our visit and they were clear about the different types of abuse and knew who to report to if they suspected abuse was occurring. The home do not have a copy of the Local Authorities guidelines on safeguarding Evidence: adults and the manager was advised as to how a copy of this could be obtained as this would assist in supporting the homes policies. 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 . The service users live in a building that is well maintained, clean and in good decorative order and this contributes to their health and well being. Evidence: During our visit we looked at all areas of the home including clients bedrooms. The lighting in toilets and bathrooms did not offer good illumination and this was discussed with the manager. The activities/games room was cold during our visit and in discussion with the manager it was confirmed that the room is rarely used during the winter months as a result of this. The manager also confirmed that she was looking into how heating in this room could be improved. A maintenance plan is in place and the home have their own maintenance person to deal with repairs and this ensures that matters are dealt with quickly. Hot water tested at bathing points confirmed that hot water temperatures are safe and meet the requirements for hot water. The staff also keep records of hot water temperatures every time someone is bathed in order to ensure their safety. Each client has been encouraged to personalise their bedrooms and each bedroom is well equipped. Most of the clients have televisions, stereos and DVD players. The clients have been involved in choosing their own colour schemes and furnishings Evidence: and some of the bedrooms have been supplied with new carpets and furniture. All rooms are lockable and each client has been offered a key but chosen not to have one. There a range of lounge facilities and the clients have a number of rooms to choose to spend time in. There were no noticeable safety hazards at the time of our visit. 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 . Sufficient experienced and trained staff are employed to meet the needs of service users. Evidence: Discussion with the manager confirmed that there is very little turnover of staff with many of the staff having worked in the home for a long period of time. Since our last visit 2 new staff have been employed and records available confirmed that robust recruitment practises are in place. All staff who do commence work in the home receive appropriate induction training. On the first day of employment a new staff member would receive basic induction in health and safety. Then after one week they continue their induction using the Skills for Care Induction programme and work through a work book. Individual staff files contain records of training for staff and these list training that has been completed. Discussion with the manager confirmed that a number of the staff have had training in first aid, moving and handling, epilepsy awareness, food hygiene, safe food better business, dementia awareness and behaviours that challenge. The manager has identified where some staff require updated or refresher training. Some of the training for staff is arranged in conjunction with the adjacent home that is owned by the same person, but the manager confirmed that she does have a separate training budget for the home. Though the staff have an individual training record there is no training and Evidence: development plan that shows what training is planned and this was discussed with the manager. Overall from the evidence available it was clear that staff have good training opportunities and this assists them to keep up to date with best practise. In looking at staffing rosters there are sufficient staff at different times of the day to meet the needs of the clients. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is managed by an experienced and qualified person who ensures that home is run in the best interests of service users. Evidence: It was evident from discussion with the manager that there is an open style of management within the service and staff are able to contribute to the management of the service. The manager is in receipt of the Registered Managers Award and has also completed NVQ level 4 training in care. In discussion the manager confirmed that they attend the same training courses as staff so that they can update their knowledge and skills. As part of the quality assurance processes the manager sends out questionnaires to families seeking their views on the service and how things can be improved. The manager holds regular meetings with the clients and these too are used to ensure that improvements continue to be made. Families are kept up to date with what is happening in the home and when planning holidays with the clients the families are also involved. The manager has good systems in place for ensuring that health and safety practises are followed by staff. Evidence: Regular fire drills take place and staff receives regular periods of fire instruction. Staff also receive training in health and safety and receive updated refresher training when required. Accident records are maintained recording any accidents in the home for either staff or the clients. And the records confirmed that staff take appropriate actions when dealing with any accidents. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The individual plans of care should be developed and updated to include the actions that staff are carrying out to support people with their assessed needs. When developing the individual plans of care consideration should be given to using pictorial symbols and photographs to make the care plans more accessible to the service users. The manager should ensure that each client or their representative signs a consent form authorising staff to administer their prescribed medicines. And a copy of staff signatures who are authorised to administer medicines should be kept in the front of the administration of medicines file. The manager should obtain a copy of the latest guidance from the Royal Pharmaceutical Society about the management of medicines in a care home and make this available to staff. The manager should obtain a copy of the Local Authoritys policies and procedures on safeguarding adults. 2 6 3 20 4 20 5 23 6 35 The manager should develop and implement an overall training and development plan that demonstrates what training is planned for the staff team as a whole. Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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