Care Home: Mill Lane

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What the care home does well People are assured following the pre admission assessment that their needs will be met by the service. A care plan of support is provided by the placing agency. This is then developed into a detailed support plan based on day to day care required. The service have access to any of the professional and specialist agencies. This ensures that the peoples health needs can be monitored and met. We observed the staff interact with the people offering the opportunity to exercise their choice for the day regarding activities. The accommodation provided was well maintained, the communal areas and corridors had been decorated with tasteful pictures. Each of the bedrooms had been decorated to suit individuals interests and personality. Staffing levels were in sufficient numbers to meet the complex needs of the people living in the service. Recruitment procedures were robust, with the required checks made prior to employment. This ensures that people using the service are protected from abuse. Staff records identified that staff receive training to recognise and respond to any suspected abuse. The manager monitors the health and safety aspects of the service with audits. What has improved since the last inspection? This is new service registered in March 2009. What the care home could do better: Details in the Statement of Purpose, Services Users Guide need to reflect the service totally including the details of the commission. These documents were to be developed in a pictorial format. An appropriate controlled medications cabinet must be made available for storage of any controlled drugs that may be prescribed. The medication trolley needs to be secured to the wall to ensure the safe keeping of medication. The completion of the fitting of the peoples call system needs to be addressed. The complaints process was to be developed in a pictorial format. All the staff should undertake the required mandatory training. The manager should have supernumerary time from the rota. This would ensure that paperwork could be more structured and maintained for easy access.It was recommended that protocols were developed for any PRN medication and placed on the individuals file Key inspection report Care homes for adults (18-65 years) Name: Address: Mill Lane 76 Mill Lane W Midlands WS4 2BH     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: Wendy Grainger     Date: 2 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Mill Lane 76 Mill Lane W Midlands WS4 2BH 07951225488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): simoncoldrick@harmonycare.co.uk Harmony Care Name of registered manager (if applicable) Miss Louise Kearns Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to bee accommodated is 3 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 category ; Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home Mill Lane is registered to provide accommodation for three younger adults with a learning disability. Located near to local ammenities including shops and hairdressers the service also has access to the town of Walsall. There are three single en-suite bedrooms, accessed via the lift or stairs. Communal areas are on the ground floor including a conservatory opening onto a small garden. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 3 3 Brief description of the care home The present fees for the service are £1.800.00 per week, the reader may wish to contact the service to ensure these details remain current since the inspection Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the first key inspection following the services registration in March 2009. The quality rating for this service is 2 star. This means the people using the service experience good quality outcomes. This key inspection was unannounced. This means that the service was unaware that we were visiting. The inspection took place on the 26th August 2009 between 8am and 3:15pm. The inspection process concentrates on how well the service operates against the outcomes for the key national minimum standards and how the people using the service experience a chosen lifestyle and that their needs are met. Prior to the inspection taking place we looked at all the information we had for this new service. This included the registration, notifications and the Annual Quality Assurance Assessment document. This assists us to see how the service is developing. An Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned to Care Homes for Adults (18-65 years) Page 6 of 29 us within the required timescale. This document provides us with information on how well the service thinks it is performing, improvements to be made in the future and some statistical information about staffing and people. During the inspection we used a range of methods to gather information and evidence on how well the people using the service are supported. We conducted the inspection in the large kitchen with the people who choose to sit there. We observed the interaction between the staff and the three people living in the service. Verbal communication was limited for each person, this was evidenced not to be a problem for the staff who were very aware of the needs of the people. We looked at the premises, care plans, records, staff files, and risk assessments. We chose one care plan to case track this means we read and gather evidence from daily records, risk assessments and health care to enable us to make a judgement that the persons needs are being met. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Details in the Statement of Purpose, Services Users Guide need to reflect the service totally including the details of the commission. These documents were to be developed in a pictorial format. An appropriate controlled medications cabinet must be made available for storage of any controlled drugs that may be prescribed. The medication trolley needs to be secured to the wall to ensure the safe keeping of medication. The completion of the fitting of the peoples call system needs to be addressed. The complaints process was to be developed in a pictorial format. All the staff should undertake the required mandatory training. The manager should have supernumerary time from the rota. This would ensure that paperwork could be more structured and maintained for easy access. Care Homes for Adults (18-65 years) Page 8 of 29 It was recommended that protocols were developed for any PRN medication and placed on the individuals file If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service cannot be sure that they are provided with all the information about the service they would require to make a choice. They can however be assured from the assessment that the service can meet their needs. Evidence: The completed AQAA sent to us prior to the inspection told us that the service had in place a suitable process to assess any prospective person who wanted to move into the service. The assessment and review we evidenced had included the persons representative it also included other professional agencies. Care plans are developed from the single assessment on file completed by the placing agency and from observation and while assisting the individual. The Statement of Purpose and Service Users Guide while available was not always reflective of the service. The current fees were not indicated in these documents they were however displayed in the persons care file tracked during the day. These issues were part of the discussions and feedback with the provider and manager. The service had not created the Statement of Purpose or Service Users Guide in an alternative Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: format to enable people using the service to have a more comprehensive overview of what is available to them. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service can be assured that their health and personal care will be met by the committed staff team. Evidence: The completed AQAA told us that each person had a care plan, which is person centred and included risk assessments. They have a specific aim and plan of support for each individual. From observations made on the day of the inspection the people living at the service were relaxed and comfortable with the staff who supported them. Staff demonstrated their awareness of individuals needs, the support needed was clearly identified in the care plans including risk assessments. Staff also met individuals needs from knowledge they had gathered while caring for the people on a daily basis. Records demonstrated that each person had full access to other professional agencies including specialist nursing/consultants. Within the tracked care plan and observations made, the manager needs to ensure the chosen method for administration of medication placed on the top of the person Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: morning yoghurt was clearly recorded. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to experience new social and leisure activities. Contact with families is maintained as they wish. Meals were well presented a healthy diet is promoted. Evidence: The completed AQAA told us that people attend a local day centre, where an option to take part in activities was offered. Staff at the commencement of the inspection was assisting people to make a choice for their breakfast, cereal and toast options were offered and chosen by two of the people. People were encouraged to undertake regular social and new experiences. This included swimming for the first time ever for one person. One person is looking forward to a holiday with family. One person maintains contact with his family at weekends when the service provides transport to his family home some miles away. Staff during the inspection constantly interacted with the people, asking their preference and their choice for the day. Records of Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: activity and outings were maintained in the daily reports. It was suggested that an option would be to have a monthly activity record for a quick overview. We sat in the kitchen during the inspection and observed staff take a person out to the library to collect a selection of Cds including classical, which was his preference. One person was taken out to have their hair cut, she indicated on her return that she was happy with the result. Places at the local day centre will cease in the future due to the funding by the placing authority. Arrangements will be made to stimulate the people at the service. The AQAA told us that meals are balanced and based on choice. Specialist feeding was in place for one person, one person had a pureed diet, the remaining person had a normal diet. Records we evidenced identified that for a period of nine days two people had been served a quantity of fish in some form on a daily basis. Staff had failed to recognised the previous days records. Records since this time demonstrated that this had been rectified with a more balanced diet. A weekly menu which included a pictorial format was suggested with personal choice being recorded. We were told that the service were unaware what the two people attending the day centre were served at lunch. This is a failing of the service, when meals could be repetitive without the service being aware. The manager will look into obtaining menus from the centre while the people attend; she will also discuss menus with the staff. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service can be confident their health and personal care needs will be carried out by caring competent staff. Medication systems and security need to be reviewed to ensure the safety of all concerned. Evidence: The completed AQAA told us that staff follow care plans devised by using a person centred format and essential lifestyle plan. We evidenced in the care plan tracked that the person and from other records made available to us, individuals had full access to other professional agencies, that were relevant to their well-being and health care. This demonstrates that the service has considered the health and personal needs of individuals ensuring the support required is to their preference. Each of the people were well presented. During the inspection we observed the people who remained at the service, they were extremely comfortable with the support, interaction and care they received. Staff asked and explained what they were going to do before completing the task. Personal care for each person was seen as a priority for all the staff and manager. Medication storage needs to be reviewed to ensure the locked trolley is secured to the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: wall at all times when not in use. The provider agreed to purchase a controlled drug cupboard and small medical fridge. No prescribed or topical medication should be stored in the domestic fridge. Staff confirmed and records identified that they had received training in the safe administration of medication. Observations of the medication process the manager was advised to review the system to record medication taken at the time administered and not when each individual had taken their prescribed medication. This will ensure the records were current and the safe handling of medication. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service can be assured that their complaints will be addressed by the systems in place to protect them from risk and abuse. Evidence: The completed AQAA told us there had been no complaints made to the service since it opened in March 2009. We have had no referrals made to us or to the safe guarding team. The complaints process is displayed in the office, not always clearly available to visitors or families. The manager plans to develop a pictorial format for the people using the service. The details in the Statement of Purpose and Service Users Guide need to be reviewed this will ensure people, staff visitors or families will have the current address of the Commission. The manager operates an open door policy and is readily available to staff, families advocate and people using the service. Staff spoken to during the inspection included the night staff who were aware of the procedures to follow to protect the people living in the service. We were told by the staff spoken with that they would not hesitate to use them. This practice would support and protect the people using the service. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service were provided with a warm and comfortable surroundings to live in. To wedge open fire doors puts people at the service at risk and should cease to protect the people Evidence: Registered and opened in March 2009 Mill Lane is located in a residential area near to local shops including a large supermarket, hairdressing and public houses. The town of Walsall and Birmingham can be accessed by the people using the service. The hallway upon entering is small, converted from a shop into domestic premises; Mill Lane is well maintained with quality fixtures and fittings. The decoration in the communal areas was plain but enhanced with pictures. Communal areas include the kitchen ,which was used by the people. The small lounge is used as a quiet room and the conservatory overlooks the small garden. The service had a homely ambiance, people were relaxed and comfortable. The service is registered to care for three people each with complex needs. Bedrooms with large en-suite facilities were personalised to suit individuals personality and interests. When we entered the service we identified to the manager that fire doors were wedged open this included the kitchen door. This practice puts people using the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: service at risk and is not acceptable. We were told by the manager that arrangements had been made for the following day for a company to estimate the fitting of further door closures. We identified that while the service had been registered wiring had been left unfinished to connect the call system. Discussions with the provider and manager at feed back, who agreed to continue with the completion of the system. This will ensure that staff are able to summon others in the event of an emergency. The service was a credit to the staff who maintain it to high standards throughout. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff on duty to meet the personal needs of the people using the service. Procedures for the recruitment of staff ensured that people who use the service were protected. Evidence: The completed AQAA told us that the recruitment process was based on transparency of the process. People are cared for by a staff team that are getting established as a team since the service was opened in March 2009. The manager is part of the hands on team, staffing levels to meet the personal, emotional and health needs of the people was satisfactory. This ensures that the people are well supported and cared for. Records for the recruitment and selection for employment were seen in two staff files. These records identified that the appropriate checks including Criminal Records Bureau (CRB) Protection of Vulnerable Adults (POVA) training certificates were seen in the files. One file was incomplete, the manager on the day was unable to locate the second reference. We were confident that the recruitment and employment process protected the people at the service from having unsuitable staff meeting their needs. when discussing with the staff their training achievements, we identified that the night staff and some of the day staff did not have the required First Aid qualification. The Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: lack of this training puts people using the service at risk. The manager is recommended to explore implementing this training as soon as possible or to rearrange the rota ensuring there is one person on duty at all time with current training. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and safe guarded by competent management and the staff team. To further support the service systems need to be developed further. Evidence: The completed AQAA told us that the manager is suitably qualified to manager the service. Her qualifications included a registered nurse for people with a leaning disability and complex needs. She is undertaking the Learning and Management Qualification, her knowledge continues to be updated with current legislation awareness and mandatory training. We discussed with the manager and the provider that supernumerary time should be built into the managers rota to ensure that the paperwork was a little more structured. This will ensure issues of training was identified and that staff files were complete. Staff demonstrated their commitment to the service and manager, who was part of the newly established working team, we evidenced a relaxed atmosphere created by the manager. Fire records in general were satisfactory, The manager needs to further audit the system to ensure that weekly fire tests are undertaken. In the event the responsible person is on annual leave the role Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: should be delegated to another person. Further development of the fire prevention system needs to include a contingency plan in the event of an emergency where people using the service had to be evacuated away from the service/area. This development will ensure the safety of the people living at the service. A number of checks were made to ensure the safety of the people, this included the servicing of portable, electrical equipment and the lift all of which were part of the registration process in March and remain current. Any health and safety issues are monitored and action would be taken to address the concerns. We were told that a number of verbal complimentary comments had been made by families and other professional agencies about the care and service. The manager is planning to develop a more formal satisfaction surveys for families, other professional agencies and for the people using the service. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 2 6 To enable people and or their representatives to make a choice of the service, documents need to be reviewed. To ensure that clear guidelines are recorded in the care plan ensuring staff including any agency/new staff are aware of the manner to which medication is administered for one person To ensure that at all times a balanced diet is prepared based on individuals daily choice. To create a weekly menu for guidelines for the staff, thus preventing repartition To ensure the safe storage of medication is in line with the relevant legislation. The trolley should be secured to the wall at all time it is not in use. Controlled medication must be stored in an appropriate medications cabinet. No medication shall be stored in a domestic fridge only in the recommended medical fridge. To consider developing a pictorial complaints format for the people using the service To ensure the completion of the call system, thus protecting the staff. Page 27 of 29 3 17 4 20 5 6 22 30 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 7 8 30 35 To ensure the fixture of magnetic door closures, thus protecting staff and people using the service. To ensure the safety of the people using the service, training should be reviewed to ensure it was current and provided for all the staff To ensure a system is in place to protect the people using the service by testing the fire system weekly. 9 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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