Care Home: Onkar Care Home

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What the care home does well People who live at Onkar Care Home get on well with the acting manager and the staff who support them and are very positive about the support that they receive, " All staff is very good and look after people nicely." People have the opportunity to talk about any concerns they have at regular meetings and what they say changes the way things happen in the home. There are sufficient staff available to support people to go out shopping, to visit the temple or to go to social events. People are also able to take part in day to day activities such as cooking and doing their own laundry. People`s healthcare needs are well met. They are supported to visit the doctor, dentist and optician and also receive other healthcare services such as chiropody. Staff receive good training so that they can meet people`s needs and they also receive regular supervision and support from the acting manager and other senior staff. What has improved since the last inspection? The acting and registered manager, the registered provider and staff team have worked hard to address the requirements and recommendations made at the previous key and random inspections. This has led to a considerable improvements in the service over a relatively short space of time. Information about the home is now available in an easy read format so that it is accessible to a wider range of people who live at or may want to live at the home. Each person living in the home has an assessment of their needs and a support plan which says how their needs should be met. Both of these are regularly reviewed with the person and changes made when necessary. Staff have received training in understanding people`s pressure area care needs and in managing diabetes; people`s specific needs in these areas are being met. All staff have also received training in safeguarding vulnerable adults and in how to understand the needs of people with a learning disability or a mental disorder. Recruitment practices have also improved and all staff now have two written references and their names are checked against the vulnerable adults register before they start work in the home. Outstanding repairs in the home have been completed. What the care home could do better: The Statement of Purpose, which outlines the services the home provides, still needs some additional information to make sure that it provides all the information that people need. Some information about how people`s needs are being met, or how particularly risks are manged, needs to be written down more clearly. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Onkar Care Home 15 Portman Street Leicester Leicestershire LE4 6NZ     The quality rating for this care home is:   two star good service 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: Ruth Wood     Date: 0 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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. 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: Onkar Care Home 15 Portman Street Leicester Leicestershire LE4 6NZ 01162516443 01162246952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Harjap Singh Riyat care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: No person to be admitted to Onkar Care Home in categories LD, PD or MD when 10 persons in total of these categories/combined categories are already accommodated in this home. Service user category: No person falling within category MD may be admitted to Onkar care home unless that person also falls within category LD - ie dual disability. Service user category: No person falling within category PD may be admitted to Onkar care home unless that person also falls within category LD - ie dual disability. Service user numbers: No one falling within category LD may be admitted into Onkar Care Home where there are 10 persons of category LD already accommodated within this home. Service user numbers: No one falling within category MD may be admitted into Onkar Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 0 10 10 3 Care Home where there are 10 persons of category MD already accommodated within this home. Service user numbers: No one falling within category PD may be admitted into Onkar Care Home where there are 3 persons of category PD already accommodated within this home. To specify suitable facilities: The service users admitted to Onkar Care Home who fall within category PD may only be accommodated on the ground floor. Date of last inspection Brief description of the care home Onkar Care Home is registered to provide care for 10 adults with learning disabilities, all of whom may have additional mental health problems and three of whom may have a physical disability. The home is located in a residential area with easy access to public transport and the city of Leicester. The property consists of two floors and has ten single bedrooms, all with en-suite facilities, three of which are on the ground floor. There is a large lounge on the ground floor and a separate dining room adjacent to the kitchen. At the time of the inspection, fees ranged from £344 to £1050 per week. Additional charges are made for chiropody and hairdressing. 0 8 1 0 2 0 0 8 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 inspection visit took place on a weekday between 12:20 and 16:50. In addition to the information gathered at the visit we took account of information sent to us by the service about how they had met requirements made at the previous key inspection and two random inspections and feedback from other agencies, such as the Local Authority Contract Monitoring Service. During the visit we spoke to two people who live in the home about their experiences of moving in and the support that they received. We spoke to three other people and observed the interaction between staff and the people living in the home. We looked at three peoples support plans and other records in the home, which help staff to meet their needs. We spoke to two staff members about their experiences of training and recruitment Care Homes for Adults (18-65 years) Page 6 of 29 and looked at their training and recruitment records. We also spoke to a visiting trainer about the kind of training she has been undertaking with staff. We looked at most of the communal areas in the home and some peoples bedrooms. We also looked at records relating to health and safety, such as fire records. We looked at the way in which medicines are looked after and administered in the home and spoke to staff about their understanding of this. What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose, which outlines the services the home provides, still needs some additional information to make sure that it provides all the information that people need. Some information about how peoples needs are being met, or how particularly risks are manged, needs to be written down more clearly. Care Homes for Adults (18-65 years) Page 8 of 29 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 –03000 616161. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good assessment procedures ensure that the home can meet peoples needs. Some improvements are needed to the Statement of Purpose so that people have the information they need about the service. Evidence: The Service User Guide and Statement of Purpose have been re-written to more accurately reflect the service offered at Onkar Care Home. The Service User Guide is available in an easy read format with additional pictures, to make it more accessible for people with learning disabilities. Information in the Statement of Purpose about the categories for which the home is registered needs improving as it does not currently reflect all of the categories of need for which the home is registered and providing a service for. We looked at the admission process for someone who had recently come to live at the home. This included looking at the their assessment documents, speaking to the person themselves and to the acting manager. The person said that they had previously stayed at the home on a respite basis about 2 years ago. The acting Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: manager had visited them in their existing setting and obtained current assessments about their needs from their social worker, and had used these and her own observations to put together an initial support plan. The placement had been reviewed after the first month and the person had been fully involved in this process. 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 receive support to make choices and to take responsible risks. Evidence: We looked at three peoples support plans, including someones who had recently come to live at the home. Two of the plans followed a person-centred format with information being written directly from the perspective of the person themselves. The persons history formed part of the plan as well as their likes and dislikes. Plans generally gave good information about how needs should be met and discussion with one person directly and observation of the other two people confirmed the accuracy of the information they contained. Daily notes are kept and people are encouraged to write or contribute to these, if they are able. People are able to make choices with regards to food, clothing and social activities and receive appropriate support to carry out these choices. One person, whose care we looked at in detail, does not go out of the home regularly but is always supported to Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: go out if they suddenly wish to do so. One person has an external advocate. Improvements have been made in the quality of written risk assessments and managers and staff were able to explain the process behind assessing risk for individuals and supporting them to take responsible risks. Sometimes not all the steps outlined were actually recorded and it is recommended that peoples written assessments are reviewed to ensure that they accurately reflect the actual process followed by staff. This should help to ensure consistency of approach. 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. Peoples social and vocational needs are met and they are well supported in maintaining contact with their family and friends. People enjoy good quality, home cooked food. Evidence: Staff have received training in understanding diabetes and suitable provision is made to meet the dietary needs of the two people in the home who have diabetes. Suitable food is served for the person needing a soft diet and for those people requiring a vegetarian diet. Generally two menus are served a vegetarian, Indian menu and a traditional English menu, which includes meat. Each persons individual diet is recorded. A good variety of fresh produce is used for both menus. Some people living in the home like to get involved in preparing and cooking food and cupboards are labelled with their contents to make it easier for people to find things. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: One person told us that they liked to help with chores as it keeps me busy. Some people have shrines in their own bedrooms and staff support people to attend places of worship. Increases in staffing levels since the last key inspection means that people are supported to attend social activities, such as shopping, going out for meals and special celebrations. Several people spoke to us about the Valentines Dance they attended saying how much fun it had been, we didnt get home until 2am in the morning! There is a tradition of celebrating all major festivals and the family and friends of people living in the home are invited to these celebrations. The New Year party had live music and again people reported their enjoyment of this. People receive support to maintain contact with their families and staff accompany some people on visits where necessary. People are involved in a variety of day time activities such as attending college and day centre or going to a local womens group. 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. Peoples health and personal care needs are well met. Evidence: Peoples personal care needs are reflected in their support plans; this includes whether a person requires direct support or prompting. A moving and handling assessment is in place for a person with physical disabilities, which includes the equipment that should be used and the number of staff to be involved in their care. All staff have received training in pressure area care and were able to explain the steps taken to ensure the integrity of this persons skin; these included moving their position, managing continence, good personal hygiene and use of creams. All of the stages that staff follow should be written down as part of the persons support plan. Staff have also received training in managing and understanding diabetes and were able to explain the support given to one person if they had low blood glucose. Staff were aware of the optimum range for blood glucose levels but this should be recorded as part of the persons support plan, together with the action to be taken if levels fall outside of this range. One person who has insulin dependent diabetes said that they administered their own insulin and that this was then recorded by staff. Staff also Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: supported them to measure and record their blood glucose levels. The three peoples files that we looked at contained evidence that people have regular access to health professionals such as GPs, dentists, chiropodists and opticians as well as more specialist services such as speech therapists and diabetic nurses. One person told us that they had visited the dentist regularly since moving to the home and were now going to receive some specialist dental care at the Leicester Royal Infirmary. A referral has also been made for a specialist Occupational Therapy assessment for additional equipment for a person with a physical disability. As part of maintaining a healthy lifestyle, two people have enrolled at and now attend the gym and are keeping food diaries. One person is being actively supported by Community Nurses to improve their diet and lifestyle. All staff who administer medication have received external training in this area and confirmed that their competence was also monitored by the acting manager and other senior staff. Medication Administration Records were completed fully as were records dealing with medication received into and leaving the home. The required storage for Controlled Medication was delivered to the home during the inspection visit. Some people take as required medication and the circumstances under which they are given this medication should be clearly stated in the Medication Administration Record and in their Support Plans. 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. Peoples concerns are listened to and staff are well informed about how to protect people from abuse. Evidence: The complaints procedure is available in an easy read format and there are good systems in place so that people can express any concerns they have. Residents meetings are held on a monthly basis and these are well attended and recorded. One meeting dealt with concerns raised by the Commission and how the home was trying to address these. At another meeting a person suggested a way to make drinks more available, and this had been followed up. People were observed to have an open and friendly relationship with the staff and the acting manager and feel comfortable raising any concerns with them. All staff have received training in safeguarding vulnerable adults and the acting manager and three further staff have received additional training in this area delivered by the City Council. Staff have also received training in how to manage challenging or aggressive behaviour. Good systems are in place for managing peoples monies and all receipts and transactions are kept and recorded. Recruitment practices have improved and now all staff have the required checks Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: before they start work, to ensure that only suitable people work at Onkar Care Home. Care Homes for Adults (18-65 years) Page 20 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 live in a clean and comfortable environment which meets their needs. Evidence: We looked at most peoples rooms and the main communal areas. All areas of the home seen were clean, warm and comfortable. Outstanding repairs identified at the previous key inspection have been completed. It is recommended that the acting manager keep a log of all repairs, entering the date that they were identified, when they were reported for repair and the date the repair was completed. A representative from Leicestershire Fire Authority visited the home in October 2008 and was satisfied with the arrangements in place to ensure fire safety. All staff have completed training in infection control and standards of hygiene in the home appeared high. Alcohol rubs are in place in the entrance to the home and staff and visitors are encouraged to use these. Food in fridges and freezers is dated and covered and all staff have received training in food hygiene. During the tour of the home we noted that the door to the cellar had been left unlocked; this was pointed out to the Deputy Manager who immediately locked it and said that she would arrange for a sign to be placed on the door reminding people to keep it locked. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good support from well- trained staff Evidence: A requirement was made at the previous key inspection for staff to receive training relating to learning disability and mental disorder, the key registration categories for the home. All staff have completed introductory training in this area and a staff member said that it had improved their understanding of how to meet peoples needs. Staff have also undertaken training in areas relating to safeguarding vulnerable adults and statutory training such as fire safety and food hygiene. The registered provider, who is actively involved in the home, also undertakes training alongside the staff team. He and the staff team are also undertaking National Vocational Qualifications. Staffing levels have been increased to take account of the individual needs of the people living in the home and to allow staff to have appropriate time off duty. The people in the home were very complimentary about the staff team and there is an open and friendly relationship between the two groups. One person commented, All staff is very good, all staff is nice people and look after people nicely. Staff receive regular supervision, which also takes account of their professional development needs. This is documented and discussion with staff confirmed that the Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: meetings take place approximately once every two months. All staff now undertake an induction programme. Recruitment practice has also improved; staff complete an application form, two written references are obtained and their names are checked against the vulnerable adults register before they start work in the home. Enhanced Criminal Records Bureau checks are also obtained. These checks ensure that only suitable people work at the home. 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. Good management ensures that the home is run in the best interests of the people living there. Evidence: The registered manager has informed the Commission that he intends to remain in this position for the foreseeable future and has been actively involved, alongside the acting manager, in improving the quality of the service in the home. The registered provider is also actively involved in the home, working several shifts on the rota and taking part in training, including undertaking a National Vocational Qualification in care at level 2. The acting manager is in day to day control of the home and holds a National Vocational Qualification in care at level 4. She has undertaken a range of training since working at the home to improve her skills and knowledge of people with learning disabilities and mental disorder. Two deputy managers are also employed by the home and staff said that they felt well supported in their work. Staff meetings are held regularly and recorded and staff receive one to one supervision. A questionnaire is in place to gather information from people living in the Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: home, their relatives and other stakeholders about their views about the service. Residents meetings are also regularly held and suggestions made by people living in the home have led to changes in certain areas such as the kind of food served. All staff have received training in moving and handling, food hygiene, fire safety, health and safety and managing substances hazardous to health (COSH). The fire risk assessment was reviewed on 29/01/09 and fire systems and equipment are regularly updated. All electrical systems were checked on 11/12/08 and a gas safety check was completed on 08/07/08. 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 1 1 4 The registered person must 30/04/2009 ensure that information in the Statement of Purpose accurately reflects the categories of need that the home is registered for and is able to meet. This is to ensure that people have accurate information about the service provided before they decide to live in the home. 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 9 Written risk assessments should more accurately reflect the actual process of assessment and the action taken to minimise and manage risk. Information about the optimum range for the identified persons glucose levels should be recorded in their support plan, together with the action to be taken should levels fall outside of this range. 2 19 Care Homes for Adults (18-65 years) Page 27 of 29 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 3 4 19 20 The steps taken to ensure the identified persons skin integrity, should be recorded in their personal support plan. Protocols should be in place in relation to as required medication. These should state the name of the prescribing physician, under what circumstances the medication should be administered and by whom. The protocol should also state the arrangements for the review of the prescribed medication. It is recommended that the acting manager keep a log of all repairs, entering the date that they were identified, when they were reported for repair and the date the repair was completed. 5 24 Care Homes for Adults (18-65 years) Page 28 of 29 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. 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. 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