Care Home: Rowan Court

Similar services:

• Larch Avenue
• Alderson Road 12
• Cranworth Close Registered Care Home
• Pennine Camphill
• Muston Road (70)
• Grayling
• The Cornerstone
• John Street Nursing Home

What the care home does well The home is run in the best interests of the people who live there. The accommodation is good. It is well equipped, clean, comfortable and very well maintained. Anyone who is thinking of moving into Rowan Court is properly assessed before a place is offered. This makes sure that staff are able to provide the care and support people need. There is information about the service in the `Service User Guide` people visit the home before they move in so they can decide if it is the right place for them. Staff at the home work with people to help them to improve their skills and give them opportunities to be involved in the community and different activities. Staff are enthusiastic and enjoy their jobs. Staff are receiving training that is relevant to their role. Staff recruitment procedures are robust. This means that staff are suitable and safe to work with vulnerable people. What has improved since the last inspection? This was the first inspection of the service since it was registered in July 2009. What the care home could do better: Risk assessments must be completed and kept up to date for each individual. This will make sure that staff can demonstrate that they have taken appropriate action to eliminate or reduce any area of risk to people. The care plans must contain more detail about people`s care and support needs. This will make sure that people`s care and support is delivered in a consistent way. The medication system needs to be managed properly and staff need extra training about administering medication. This will make sure people get the right medication at the right time. Information must be recorded and risk assessments put in place regarding the management of people`s finances. This will make sure that people are protected from any financial abuse. Staff need to look at how they get laundry from people`s bedrooms to the laundry rooms to make sure that they are doing this safely and there are no cross infection issues. Staff at the home must notify us of any death, illness or other event which we need to know about. This will make sure that we can check they are taking appropriate action. Key inspection report Care homes for adults (18-65 years) Name: Address: Rowan Court Holme Valley Memorial Grounds off Huddersfield Road Thongsbridge Huddersfield Yorkshire HD9 3TQ     The quality rating for this care home is:   one star adequate 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: Paula McCloy     Date: 2 4 1 1 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 31 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 31 Information about the care home Name of care home: Address: Rowan Court Holme Valley Memorial Grounds off Huddersfield Road Thongsbridge Huddersfield Yorkshire HD9 3TQ 01484686530 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hollybank Trust Name of registered manager (if applicable) Miss Deborah Suzanne Clark Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accommodated is 15 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Brief description of the care home Rowan Court is a care home providing personal care and accommodation for 15 younger adults with learning disabilities and associated physical disabilities. The home is set in the Holme Valley Memorial Grounds, Thongsbridge behind the hospital. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 15 Brief description of the care home The home has been purpose built and the accommodation is arranged over three floors. Each floor has a lounge, kitchen/diner, bathroom and five bedrooms all with ensuite bathrooms. There is a small garden area and car parking to the front of the building. There is disabled access to the home and there is fixed equipment provided such as hoists to make sure peoples physical disabilities can be met. A passenger lift services all three floors. 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: one star adequate 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: The charges at Rowan Court are individually calculated based on each individuals specific needs. Additional charges are made for hairdressing and aromatherapy. This inspection was carried out to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since it first opened as well as a visit to the home, which lasted approximately 6 hours. During the visit we spoke to 5 members of staff and the team leader. We also observed staff delivering care and support, looked at various records and looked around the home. Care Homes for Adults (18-65 years) Page 6 of 31 e have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Risk assessments must be completed and kept up to date for each individual. This will make sure that staff can demonstrate that they have taken appropriate action to eliminate or reduce any area of risk to people. The care plans must contain more detail about peoples care and support needs. This will make sure that peoples care and support is delivered in a consistent way. The medication system needs to be managed properly and staff need extra training about administering medication. This will make sure people get the right medication at the right time. Information must be recorded and risk assessments put in place regarding the management of peoples finances. This will make sure that people are protected from any financial abuse. Staff need to look at how they get laundry from peoples bedrooms to the laundry rooms to make sure that they are doing this safely and there are no cross infection issues. Staff at the home must notify us of any death, illness or other event which we need to know about. This will make sure that we can check they are taking appropriate action. Care Homes for Adults (18-65 years) Page 8 of 31 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 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 10 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. Staff carry out a comprehensive assessment of peoples needs before they move into Rowan Court. This helps to make sure the home is the right place for them. Evidence: There is a written Service User Guide available that provides people with information about the home and the service that it provides. Rowan Court is owned and managed by the Hollybank Trust. People who have moved there have previously attended the residential school or lived in one of the trusts other homes. Before Rowan Court opened staff went to work with people in their previous homes so that they could get to know them and see how people liked to be cared for and supported. Once Rowan Court opened people went to visit and stayed for meals so that they could get used to their new home before they moved in. We found that staff had completed very in depth assessments of peoples needs and their personal preferences. This is very important because a lot of people living at the home have limited verbal communication skills so staff need to understand the way Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: they make their wishes known. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The written care plans lack detail and do not reflect the care and support that is being delivered. Evidence: We looked at the care plans and risk assessment records for two people living at the home. The care plans were disappointing and lacked the detail that was contained in the assessment document. For example in one of the assessments there was detailed information about someones preference for certain toiletries this detail wasnt in the care plan. People using the service on the whole were not able to express their views to us directly. However, our observation of interactions between individuals and staff showed us that staff have a good awareness of peoples needs and know them well. One care plan contained a number of risk assessments but the other didnt. It is important that staff make sure that risk assessments are completed so that they can Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: demonstrate that the have identified the risk and taken any necessary action in order to remove or reduce the risk. In the handover between staff it was clear that they are identifying any new risks to people in their care and taking appropriate action. They also need to make sure that this information gets written down in peoples care plans. Care Homes for Adults (18-65 years) Page 14 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 living at Rowan Court are able to make choices about their lifestyle and are supported to develop their life skills. They have good opportunities to experience different activities and develop new interests. Evidence: People living at Rowan Court are well supported to follow their own interests and encouraged to try new things. People can go out on a one to one basis with staff and there is plenty of transport available to ensure that people are not limited by availability of suitable vehicles. Some people are attending college and others attend a resource that Hollybank Trust have set up themselves The Vision Project. This is because of the difficulty in getting college places. People are involved in a rage of activities here for example, a film club, games, dungeons and dragons, photography, flower arranging and sailing. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: This year people have been on holiday to a variety of destinations including Blackpool, Tenerife and Edinburgh. Next year some people are planning to go to Florida and one person is going to Australia. People use the local doctors surgeries, local shops and hairdressers. Staff are also exploring the possibility of using the local swimming pool with one person. Staff told us that people in the local community are getting to know people living in the home from these visits. Staff told us that peoples families and friends visit regularly. The evening before our visit one person celebrated their birthday with a very large cake and a party. People also go out supported by staff to visit family and friends in their homes. Meals are prepared by staff and people living at Rowan Court are encouraged to help as far as they are able. Worktops can be raised and lowered so that people who use wheelchairs can participate more easily. There are really good care plans in place for people in relation to eating and drinking that clearly inform staff exactly what support people need. This means that people get the help they need. We saw that people were offered a choice of food and one person clearly choose the member of staff that they wanted to support them. Care Homes for Adults (18-65 years) Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To make sure people get the health and personal care they require, better systems need to be in place to ensure a consistent and safe approach. Evidence: When we talked to staff and listened to the staff handover between the shifts it was clear that staff have a clear knowledge of peoples individual support needs and preferences. However, the care plans we looked at hadnt been completed in detail. If a carer was expected to provide care and support based on what is written down they would not be able to deliver what is needed. People have the equipment they need in order to maximise their independence, such as electric wheelchairs and switches to help communication and environmental controls. For example a switch can be used to enable someone with limited movement to switch on electrical devices. People are supported to access NHS health care facilities and to visit their GP. Rowan Court also has access to physiotherapy, occupational therapists and speech and language therapists to meet peoples health care needs. One person was unwell when Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: we visited. Staff called the GP and made sure that the person was kept comfortable. The medication system is not well managed and we saw from the incident reports that staff have made seven errors regarding medication in the last two months these included people being given the wrong medication and medication not being given at all. We looked at the medication records. Medication is not always being recorded when it comes into the home, this means that it is not possible to establish how much of any one type of medication has been received. There were gaps on the medication administration records where staff had not signed to confirm that medication had been given or entered a code to state the reason it was not given. We wanted to check to see if one person had been given their epilepsy medication as there was no signature on the sheet. We counted the medication that was left in the packet to try and find out if someone had forgotten to sign the sheet. We were unable to make a conclusion as the number of tablets in the box added to the number of tablets that had been taken did not tally with the number dispensed. It must always be possible to establish exactly what medication is being held to make sure all medication can be accounted for. We looked at the homes medication policy that clearly states that if medication is received with instructions to be given as directed it should be returned to the pharmacy as instructions must be explicit. We found medication with an as required label, this is not clear as it does not tell the staff how much and how often the medication should be give. This is in contravention of the homes own policy. To keep people safe staff must follow the homes procedures. There were no photographs of people with the medication records or details of how they like their medication administered or about the level of support they need to take it. There was also no specimen signature for the staff who are giving medication so that it is easy to find out who has signed the medication administration records. Staff who are responsible for giving out medication have received training, however, with the number of errors that have been made they need to have additional training to make sure that the medication system is being managed properly and that people get the right medication at the right times. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are generally good systems in place to make sure people living at Rowan Court are kept safe. Evidence: The complaints procedure is available in picture format and is widely available in the home. Staff told us that they have not received any complaints since the home opened. There is a system in place to make sure that if a complaint is received a record is made of that complaint together with the action taken to resolve it and the outcome. This should make sure that any complaint will be dealt with properly. Because of the disabilities facing some of the people at Rowan Court it is difficult for them to raise issues independently. Speech and language therapists support people to enhance their communication. Staff also receive training in being alert to such things as peoples body language as part of their training about adult protection. Staff look after money for some people and assist them to make use of their bank accounts. We looked at the records of money that is being held. We found that receipts were available for all purchases and that the records were accurate. The team leader told us that some people have cash point cards and the two senior members of staff have access to the PIN (personal identification number) to withdraw cash on their behalf. When cash is withdrawn it is brought back to the home and entered onto the record sheet. We asked to see the written records of agreements that had been made Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: with people about the management of their money. There was very little information recorded. It is important that agreements made about finances are recorded and that risk assessments are put in place. This will make sure people are protected from any potential financial abuse. Care Homes for Adults (18-65 years) Page 20 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 new, well equipped, comfortable, clean and tidy. Evidence: The home is purpose built and is very spacious, with wide corridors and tracking system in each room to help people move around using a hoist. The accommodation is arranged over three floors. Each floor has its own lounge, kitchen/dining room, utility room, bathroom and five bedrooms all with en-suite bathrooms. Peoples bedrooms are situated away from the communal areas, which is good for privacy. Bedrooms are very individual and reflect peoples personalities and interests. The kitchen work surfaces are height adjustable so that wheelchair uses can use them. The home was awarded 5* by environmental health for hygiene. This means they have excellent standards of hygiene. Staff all receive infection control training as part of their induction. The home was clean and tidy and there were no offensive odours. At the moment there are no housekeeping staff and the support workers do all the cleaning. However, the home intends recruiting a house keeper at the beginning of next year. The utility rooms are all located off the kitchen dining rooms. This means that all laundry has to be carried Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: through areas where food is either prepared or eaten. Staff are not currently using linen skips or special bags for the laundry and this is causing a potential risk of cross infection. Care Homes for Adults (18-65 years) Page 22 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. There are enough staff to make sure that people get individual support for care and activities. Staff are well trained and confident in their work. Evidence: The Hollybank Trust has a good commitment to staff training. It has achieved the Investors in People award and also won an award last year from Skills for Care for recruitment and staff retention. All new staff complete an induction and foundation programme, which gives them a good basis upon which to build their skills in the work they are expected to do. Staff at Rowan Court are all encouraged to achieve National Vocational Training (NVQ) level 2 in care. At the time of our visit there were 43 support staff and 23 of them have achieved this award. this means that over half of the staff are qualified and have been assessed as being competent in their role. In addition to the core training staff have access to a wide range of other courses for example rebound therapy, good practice in intimate care, Makaton, sexuality and play and leisure for disabled people. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Staffing levels in the home are generally good and staff told us that there are enough staff to provide individual support for care and activities. The recruitment files for staff are held centrally by Hollybank Trust who work to robust procedures to make sure staff are suitable and safe to work with older people. There are good support systems for staff. There is a daily handover meeting at the change of shift. Staff meetings are held and people receive supervision and support from senior staff. Staff we spoke to were enthusiastic and demonstrated a commitment to their work. Care Homes for Adults (18-65 years) Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there, but the management of some of the systems needs to be improved. Evidence: The registered manager is qualified and has achieved her registered managers awards, which means she has been assessed as competent to manage a care home. There are quality monitoring systems in place, but no formal monitoring of people using surveys has been completed yet as the home has only been open for a few months. Staff are aware that a report needs to be made when they complete their quality audit and made available to people using the service and other interested parties. The home is visited every month by the responsible individual for Hollybank Trust so that she can monitor the quality of the service and make sure the home is being managed properly. There have been seven errors at the home regarding medication (see section on Personal and Health care Support) at the home that staff should have told us about Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: but havent. The team leader didnt know that there are certain events that she needs to inform us about. We discussed this with her and told her that the guidance and forms can be found on our web site. Staff must report any incidents that are listed under Regulation 37 of the Care Homes Regulations 2001 to us so that we can check that they are taking appropriate action. The home is new and all of the equipment is still under warranty. Staff we spoke to all confirmed that they receive training to make sure they are working safely. Care Homes for Adults (18-65 years) Page 26 of 31 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 27 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 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 9 12 Risk assessments must be completed and kept up to date for each individual. This will make sure that staff can demonstrate that they have taken appropriate action to eliminate or reduce any area of risk to individuals. 24/12/2009 2 18 12 The care plans must contain more detail about peoples care and support needs. This will make sure that peoples care and support is delivered in a consistent way. 31/12/2009 3 19 18 Staff must receive medication training to make sure they are competent. This will make sure that the medication system is managed properly. 24/12/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 4 20 12 Arrangements must be put in place to ensure that all medication is administered correctly as directed by the prescriber. This will make sure that people get the right medication at the right times. 24/12/2009 5 20 18 Arrangements must be put in place to ensure that accurate records are kept of all medication received, administered and disposed of. This will make sure all medication can be accounted for. 24/12/2009 6 23 17 Information must be recorded and risk assessments put in place regarding the management of peoples finances. This will make sure that people are protected from any financial abuse. 24/12/2009 7 30 16 A safe system of getting 24/12/2009 soiled laundry to the laundry rooms must be implemented. This will reduce the possibility of any cross infection Care Homes for Adults (18-65 years) Page 29 of 31 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 8 42 37 Staff at the home must 24/12/2009 notify us of any death, illness or other event which is covered by this regulation. This will make sure we are kept informed about incidents 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 20 Photographs of people who take medication should be put with their medication administration chart. This will make sure staff can check peoples identity. The homes medication policy should be reviewed. This will make sure that the policy contains up to date guidance for staff to refer to. There should be an authorised list of staff who have been trained to administer medication. This list should be put with the medication records and contain their specimen signature. This will make sure that it is easy to identify the signatures on the medication administration records. There should be a medication profile for each person that tells staff how they like to have their medication administered. This will make sure people receive their medication in a consistent way. Staff must make sure that any as directed medication is dealt with in line with their own policy and procedure. This will make sure that there are explicit instructions for these types of medication for staff to follow. After the quality audit takes place a report should be made telling people about the findings and what action staff are going to take to address any issues made. This report should be made available to people using the service and other interested parties. Page 30 of 31 2 20 3 20 4 20 5 20 6 39 Care Homes for Adults (18-65 years) 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. 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!