Care Home: Patrick House

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What the care home does well The care plans are clear about each individual who lives there.People receive support with personal and health care in the way they want and need. On their forms people told us things like, "Help and support here is good"People told us they liked all their meals at the home. They choose what they want.Some people liked to be in their own rooms and others liked the shared lounge and told us, "Its alright here, we have Sky TV". The rooms are clean and well furnished.The staff in the home are friendly and meet each person`s needs well. People told us, "Staff are helpful". What has improved since the last inspection? There is a new manager at the home and she gave thus the information we asked for.Staff have received support from the manager.Individual support plans contain more information about individual preferences and support needed.The Lifestyles folder in the lounge gives a lot of information to people about health and relationships as well as lifestyle choices.People`s bank cards are now kept separately from their PIN numbers. One person told us on the returned survey form that they "feel a lot safer" at the home. What the care home could do better: Staff must make sure people are always given their prescribed medicines before they leave the premises in the morning. This is to keep people well. A second person should check and sign when staff add something to medicine records so that people always receive their medicines as a doctor has prescribed.The manager must make sure all staff receive up to date training in safe working practices so that they work safely at all times.The provider must visit the home once a month and write a report on the conduct of the home to make sure it is always run well for people living there. Key inspection report Care homes for adults (18-65 years) Name: Address: Patrick House 2 Patrick Road West Bridgford Nottingham NG2 7JY 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: Meryl Bailey Date: 1 4 1 0 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Patrick House 2 Patrick Road West Bridgford Nottingham NG2 7JY 01159215523 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John William Nunn Name of registered manager (if applicable) Mrs Wendy Hallam Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code 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 Code LD Date of last inspection 1 1 1 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Patrick House is close to the shops in West Bridgford and on a bus route to Nottingham City Centre. The accommodation is homely and comfortable and spreads over three floors. Everyone has there own room. One bedroom is on the ground floor. There is no lift. It can cost between £812 and £1193.02 to live there and have support from the staff. Care Homes for Adults (18-65 years) Page 5 of 31 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 Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home The inspector talked to the people who live at the home and the staff that work there. Some people completed survey forms for the inspector during the visit and these helped us to understand what it is like at Patrick House. The inspector looked at documents that have to be kept. She looked at: Care plans. Staff files. Medicine records. Care Homes for Adults (18-65 years) Page 7 of 31 The inspector looked around the home. This was to make sure it was safe and comfortable. What the care home does well The care plans are clear about each individual who lives there. People receive support with personal and health care in the way they want and need. On their forms people told us things like, Help and support here is good Care Homes for Adults (18-65 years) Page 8 of 31 People told us they liked all their meals at the home. They choose what they want. Some people liked to be in their own rooms and others liked the shared lounge and told us, Its alright here, we have Sky TV. The rooms are clean and well furnished. The staff in the home are friendly and meet each persons needs well. People told us, Staff are helpful. Care Homes for Adults (18-65 years) Page 9 of 31 What has got better from the last inspection There is a new manager at the home and she gave thus the information we asked for. Staff have received support from the manager. Individual support plans contain more information about individual preferences and support needed. The Lifestyles folder in the lounge gives a lot of information to people about health and relationships as well as lifestyle choices. Care Homes for Adults (18-65 years) Page 10 of 31 Peoples bank cards are now kept separately from their PIN numbers. One person told us on the returned survey form that they feel a lot safer at the home. What the care home could do better Staff must make sure people are always given their prescribed medicines before they leave the premises in the morning. This is to keep people well. A second person should check and sign when staff add something to medicine records so that people always receive their medicines as a doctor has prescribed. Care Homes for Adults (18-65 years) Page 11 of 31 The manager must make sure all staff receive up to date training in safe working practices so that they work safely at all times. The provider must visit the home once a month and write a report on the conduct of the home to make sure it is always run well for people living there. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 31 If you want to speak to the inspector please contact Meryl Bailey Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 31 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 14 of 31 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. People who want to live in the home have their needs properly assessed so they can be assured that the home is suitable to meet their needs. Evidence: We looked at the files relating to three people and found there was full assessment information on each of them. People had each been fully assessed by Adult Social Care and Health staff prior to moving into the home. There were other assessments from specialists which gave more specific information about individual needs. Staff had used the information to plan the care and support needed with each person. People told us they had key workers and regularly discussed their needs with them. Care Homes for Adults (18-65 years) Page 15 of 31 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. Care and support is fully planned with people and appropriate action is taken to reduce any risks. Evidence: There were full care plans for each person and we looked at three in detail. One of these was in a new format that made it easier to follow, but they all contained a good standard of care planning. Peoples individual needs and preferences were clearly specified. We saw a seven point plan for going out alone that one person had devised for herself. This contained the actions to take to reduce personal risks. The plans contained clear direction for staff, for example there were action points about what to do and what not to do in order to manager behaviour and deal with one individuals choice of relationships. Specific instruction of Do not rush her was clear for another person. There was reference to the Lifestyle folder that is kept in the lounge for people to have full information about their choices in issues around forming and maintaining relationships. This folder contained all relevant information in clear formats. On individual files there were detailed risk assessments for such things as offending behaviour, self harm, road safety, bathing/showering, using the microwave oven, use of toaster, unsupported Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: outings, fire safety, choking, falls. All areas were reviewed at least every six months and on some earlier review timescales were specified. Mental capacity reviews were carried out every three months. A Deprivation of Liberty Safeguards assessment had been carried out with respect to one person to look whether any legal order was needed to support staff to protect someone. The external assessor concluded that the home had a duty of care to reduce risks, the planned actions were appropriate and there was no need for an order in this case and circumstances. The manager had received training about the Mental Capacity Act. People told us they knew about their care plans and discussed changes with key workers and the manager. They had signed the plans. In survey forms returned to us two people made positive comments about the planned support they received. Care Homes for Adults (18-65 years) Page 17 of 31 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 enabled to make choices about their lifestyle and supported to develop their life skills. Increased appropriate recreational activities are being promoted. Evidence: In the Annual Quality Assurance Assessment the manager told us that support is given for people to attend college and day centres etc. Most people are out each day in various activities. One person at home at the start of the inspection visit and was receiving help from a staff member in sorting out television reception. Other people arrived back from various places during the afternoon. One had been shopping alone and others had been to a various day centres. Support was given as needed to some people to access the community using public transport. People told us they liked going shopping and others liked going to college, swimming and the library. There were daily records about activities and contacts with families. People told us they liked to watch Sky TV in the lounge in the evenings. Two staff felt their should be more group activities and day trips offered. The manager said that people liked different things and individual activities were preferable, but she aimed to increase activities on offer in the evenings. Attempts to have Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: House meetings had not been successful, as people were not interested in meeting together. The manager had records of individual discussions with each person about the running of the home instead and activities were discussed within these. The Lifestyles folder in the lounge gave a lot of information to people about health and relationships as well as lifestyle choices. This has been developed since the last inspection. People were encouraged to help to prepare their own meals, though staff cooked the main meal. On a survey form one person specifically stated Food is good. There was a menu folder, giving nutritional information about food and meal plans. There were separate records of food eaten. Care Homes for Adults (18-65 years) Page 19 of 31 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 health and personal care that people receive is based on their individual needs and the recording of medication has improved so that people to receive their tablets as prescribed by a doctor. Evidence: Peoples preferences for support needed with personal care and grooming were specified in the individual plans. There was a choice of male or female staff. The plans demonstrated that health care needs were assessed well and specific information given about individual conditions, such as supporting one person with needs relating to Diabetes. There was evidence of regular optical health checks, blood pressure and weight for this person and various regular health checks for others. Separate files held further information and correspondence with health professionals and daily notes confirmed contacts and appointments. There was full and up to date information in care plans about medication. At the front of Medicine Administration Records there were sample staff signatures and the full medication policy and procedure. There was a photograph of each person. The Medicine Administration Records themselves were mostly very well completed, but the reason given for one tablet that was not taken was forgot. The staff person had recorded that Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: the person forgot before going out that morning, but it is the responsibility of staff to administer the tablet so that people do not forget to take them. The manager discussed this with the staff member concerned and assured us that action would be taken to prevent medication being forgotten in future. There were some handwritten additions on the Medicine Administration Records with no signatures to confirm they were as prescribed by a doctor. Care Homes for Adults (18-65 years) Page 21 of 31 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 know their concerns and complaints will be listened to and feel safe at the home. Evidence: The manager told us that no complaints had been received and our own records showed that no one had contacted the Commission with any concern since the last inspection. The three people that returned surveys to us stated that they knew how to make a complaint and during our visit one person told us that the manager is the person to speak to about any concerns. People each had a copy of the complaints procedure, which was included in a new service user welcome pack that the manager has put together. She told us that she will be sending updated information to families. There were records to show that all staff had been thoroughly checked before commencing work at the home and they had received training in Safeguarding Adults. The up to date procedure was available in the staff office with a new policy. Since the last inspection arrangements have been made so that peoples bank cards are kept separately from their PIN numbers. One person told us on the returned survey form that they feel a lot safer at the home. Care Homes for Adults (18-65 years) Page 22 of 31 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 home is clean, well maintained and provides comfortable accommodation for the people who live there. Evidence: We found all communal areas to be well furnished and clean. New sofas had been provided for the lounge in March and some rooms had been decorated within the last six months. The sample of bedrooms we saw contained all items needed for individuals. People told us they have everything they want in their rooms. All areas were clean, though we found no paper towels in the shared toilets. One person identified a leaking shower tray and the manager started to make arrangements for a repair immediately. Care Homes for Adults (18-65 years) Page 23 of 31 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 are supported by trained staff in sufficient number to meet their needs. The staff have been safely recruited. Evidence: The current staff rota showed that there were always two people on duty during the day time to support the five people that were living in the home. This meant that people could have some individual support when needed. The managers hours were in addition to this for three full days each week. On other days she was part of the support team. At night there was one staff member on duty with the manager available on call. In returned surveys and on the day of the visit people told us they were happy with the support they receive from staff. At the last inspection visit we recommended that all new staff should undertake the common induction training to make sure they understand their role, their responsibilities and follow best practice. One new staff member told us in our survey that there had been no induction, but the new manager had made up for it. The manager had been trained to train others and staff we spoke with told us they found her very supportive. The manager told us that she had established a new induction package 1st Steps Induction Process to use for the next new staff member that commences at the home. In the Annual Quality Assurance Assessment form the manager stated that two of the current seven staff had completed the National Vocational Qualification (NVQ) at level 2 and two more had Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: almost completed it. We looked at a sample of staff records and found evidence of all the information and documentation required by Law to make sure people are suitable to work with vulnerable people. We found evidence that staff have had training in Non Abusive Physical and Psychological Intervention techniques (NAPPI), and recent training in Epilepsy, safe handling of medication, 1st Aid, Safeguarding Adults, Food Hygiene. The manager had identified some needs for training in Moving and Handling and Infection Control. These subjects are mandatory for all staff. There were written notes of supervision meetings taking place between the manager and each of the staff every two to three months and records of structured staff meetings. The manager and staff that we spoke with also said that they had other informal supervision and handover discussions on a daily basis. Care Homes for Adults (18-65 years) Page 25 of 31 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 manager currently ensures the home is being run well and in the best interests of the people who live there, but the absence of monitoring by the provider could pose risks of consistency of the service in the long run. Evidence: There has been a new manager at the home since the last inspection. Wendy Hallam was appointed in November 2008. She is now registered with the Commission. She completed the Annual Quality Assurance Assessment (AQAA) when we requested it and provided us with comprehensive information. She described the Quality Tree system that uses questionnaires on an annual basis. This was last used in March 2009. The manager has individual meetings with people living at the home as they do not wish to attend house meetings. She told us that through listening to people staff have improved opportunities for people to develop their independence skills and take part in the day to day running of the home. Some people told us they have been happier recently and enjoy staff supporting them in the kitchen, for example. The manager told us plans have begun to help people arrange individual holidays. There were no records of visits to the home by the registered provider, Mr No reg 26 Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: visits by provider, Mr Nunn. One of the staff told us he had visited in March when the new furniture arrived, but another staff member told he had never met Mr Nunn. Providers are required to visit and assess the quality of the service on a monthly basis. A report of each visit must be provided. No such reports were available at this inspection visit. We found that the Health and Safety checks and tests had been undertaken to make sure people living at the service are safe. Care Homes for Adults (18-65 years) Page 27 of 31 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 1 23 13 The safeguarding policy must 31/12/2008 be rewritten to ensure it is in line with No Secrets and the local safeguarding policy and that it offers protection to people living at the service. 2 37 26 There must be a report by the provider done once a month about how the home is being managed and conducted. A copy of these reports must be sent to us every month to meet legal requirement. 31/12/2008 To show that the service is being managed effectively and is improving and to prove the fitness of the provider. This requirement is partially met. Timescale of 11/7/08 not fully complied with. Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Arrangements must be made 31/12/2009 to ensure people are always given their prescribed medicines before they leave the premises in the morning. This is to ensure the health and wellbeing of people living at the service. 2 35 18 Ensure all mandatory 31/03/2010 training in the safe working topics is updated and complete for each member of the staff team. This is to ensure staff trained appropriately to work safely and in the interests of people living in the home. 3 39 26 The provider must visit the 31/12/2009 home once a month to interview people, inspect the premises and prepare a written report on the conduct Page 29 of 31 Care Homes for Adults (18-65 years) 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 of the home. A copy of each report must be sent to the Commission and the registered manager. This is so that the provider can demonstrate that the service is being consistently managed effectively and run in the best interests of people living there. 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 20 When an additional handwritten entry is added to a Medicine Administration Record, the name of the doctor or other prescriber who gave the new instructions should be recorded and the date of the entry and signature of staff should be included, together with the signature of a witness in order to verify the instruction is correct. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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