Care Home: Stables, The

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What the care home does well The overall findings of the inspection were good. The Stables is a small home located in a residential area of Crosby, Merseyside.People are supported to use the local community and to go out for a meal, go to the pub, and go shopping. People living at the home are supported to use their independent skills whenever possible.Staff support people living at the home to visit their doctor, dentist, nurse, optician and other important appointments on a regular basis.Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. The home is managed in the best interests of the people who live there. What has improved since the last inspection? Mencap have started a new way of checking that the home is being run properly . This has been started to make sure that things like care plans, staff meetings and health and safety checks are up to date. What the care home could do better: Care plans need to be improved so that it is easy to see what the person`s needs are and to make sure that all of the information in care plans is up to date and right. The way that medication is looked after needs to be improved and staff need to check the stock of medication on a regular basis and write this down.People living at the home should be provided with greater opportunites to experience activities and past times.The manager needs to make sure that he knows what training staff have had and what training they need. The manager needs to make sure that all staff records are kept at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Stables, The 4 The Stables Crosby Liverpool Merseyside L23 9YT 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: Debbie Corcoran Date: 2 8 0 9 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 32 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 32 Information about the care home Name of care home: Address: Stables, The 4 The Stables Crosby Liverpool Merseyside L23 9YT 01519315787 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.mencap.org.uk Royal Mencap Society care home 4 Number of places (if applicable): Under 65 Over 65 4 4 0 0 learning disability physical disability Additional conditions: Service users to include up to 4 LD and up to 4 PD. Two staff on duty at all times. One staff to be alone with service users only in the event that all the guidelines and risk assessments agreed by the NCSC are adhered to. Night staffing conditions of two sleep in staff to remain as previously agreed. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The Stables is registered to provide support and accommodation for four adults who have a learning disability. It is owned and run by Mencap a national organisation that provide a variety of support services to people who have a learning disability. The home is a detached bungalow in a cul-de-sac in a quiet residential area of Crosby and fits in well with surrounding houses. The house has been adapted to accommodate people who have restricted mobility. Care Homes for Adults (18-65 years) Page 5 of 32 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 32 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The manager and staff did not know that we were going to visit the home before we arrived. During the visit the four people who live at the home were met. Two members of the care staff team were spoken with during the visit. Care plans, staff records, health and safety records and other relevant records were looked at. A tour of the home was carried out and most areas were checked. The manager returned a self assessment of the service and we have used some of the information in this help us decide how the home is doing. We call this self assessment the AQAA. Surveys were sent to staff before the visit for them to make comments on the home. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well The overall findings of the inspection were good. The Stables is a small home located in a residential area of Crosby, Merseyside. People are supported to use the local community and to go out for a meal, go to the pub, and go shopping. People living at the home are supported to use their independent skills whenever possible. Staff support people living at the home to visit their doctor, dentist, nurse, optician and other important appointments on a regular basis. Staff carry out regular safety checks so that people living at the home are provided with a safe place to live. The home is managed in the best interests of the people who live there. Care Homes for Adults (18-65 years) Page 8 of 32 What has got better from the last inspection What the care home could do better Care plans need to be improved so that it is easy to see what the persons needs are and to make sure that all of the information in care plans is up to date and right. The way that medication is looked after needs to be improved and staff need to check the stock of medication on a regular basis and write this down. People living at the home should be provided with greater opportunites to experience activities and past times. Care Homes for Adults (18-65 years) Page 9 of 32 The manager needs to make sure that he knows what training staff have had and what training they need. The manager needs to make sure that all staff records are kept at the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Debbie Corcoran Care Homes for Adults (18-65 years) Page 10 of 32 3rd Floor Unit 1 Tustin Court Port Way Preston Lancashire PR2 2YQ 01772730100 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 11 of 32 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 12 of 32 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 are only admitted to the home when it has been established that their needs can be met and when they have had the opportunity to experience the home for themselves. Evidence: Information about the service, a service user guide is available to assist people in deciding if the service is right for them. This information includes the use of some pictures / diagrams. The manager advised that he intends to produce the guide in alternative formats more user friendly for the people using the service, for example an audio or video guide. We recommend that the manager does this, as providing accessible information would better inform some people about the services and facilities provided. There have been no new people to the home for a number of years and therefore the assessment and referrals processes could not be practically assessed. The manager did describe what happened when the newest person moved to the home and this included attaining information as to the persons needs, carrying out an assessment of their needs and arranging for introductory visits to the home. This is aimed at ensuring that the persons needs can be met at the home. Page 13 of 32 Care Homes for Adults (18-65 years) Evidence: The manager has told us in their self assessment (AQAA) We have policies and processes that guide staff in ensuring that people receive good and reliable information before they move and are supported in making a successful transition. We have an assessment process that involves gathering information from the person we are supporting, people who mare important to them and any other professionals involved in their support (including assessments completed by care management). Along with general assessment information risk assessments are carried out and these identify potential risks to people using the service and include guidelines to inform staff on how to best manage those risks. Care Homes for Adults (18-65 years) Page 14 of 32 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 plans describe the care and support needs of the people living at the home. People are listened to and supported to make choices in line with their individual needs. Evidence: Each of the people living at the home has a care plan which provides staff with guidance on what the persons needs are and how these should be met. The care plans were looked at for two people. These outline the skills and needs and preferred routines which people have in matters such as their personal care, taking their medication, keeping safe, maintaining and developing relationships, daily routines. These are a means of communicating the needs and choices of the person to care staff. There were also communication guidelines in place which provide guidance on how a person may demonstrate their needs or choices. We found that there were inconsistencies in care planning and some of the information in Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: one of the care plans was out of date and inaccurate. This was brought to the attention of the manager. The manager stated that he is in the process of introducing new care plans with each of the people living at the home and that the new tool for care planning should ensure consistency. Discussions with staff indicated that they have had the opportunity to get to know the individual needs of the people they support and are able to pick up on the persons verbal and non verbal communication. In response to a question about including people in decision making the manager has told us in the self assessment (AQAA) We try to know and understand their preferences by being with them, listening to their expressions of happiness and unhappiness, observing their intersest and participation in everything, discussions with keyworkers and as a team. We try to involve and listen to families. We also listen to other professionals involved in their lives and others with whom they come into contact Where a person is involved in activities which pose a risk to their safety then this is recorded in a risk assessment along with information on what steps need to be taken to prevent the risk from occurring. A risk assessment was looked at was found to have been completed a number of years ago and had been reviewed on one occasion only. The manager should ensure that risk assessments are reviewed and update on a regular basis. This is to ensure the safety and wellbeing of the person is promoted. We asked the provider to tell us how they ensure that they promote equality and diversity across the service. The manager told us Mencap as a service provider organisation are linking diversity into our training on person centred approaches. We believe that this will promote improved awareness of the diversity of the people we support and how we recognise this as part of person centred planning and working. Care Homes for Adults (18-65 years) Page 16 of 32 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 the home are supported to use and their skills and to be involved in their local community. Evidence: Discussions with staff indicated that people living at the home are supported to take part in activities on a regular basis. These include supporting people with personal shopping, going out for meals, going to the cinema, attending a day service. However, these activities are limited and there is room to improve the range of activities and provide people with a variety of experiences. This is an area which should be explored by the manager. Information on activities was not well documented even though there was a report book for this purpose. It is recommended that this information is clearly documented as a means to demonstrate that people living at the home are supported to undertake activities, be involved in interests and be part of the local community. Staff have information on the contact details for people who are important to the people living at the home. Staff were reported to maintain good links with relatives of people Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: living at the home where this is possible. People are supported to build relationships through the use of community resources, the use of local facilities and day services. In assessing the diet and meals available to people living at the home menu records were looked at. These indicated that the people have a good choice and variety of food and meals. People are encouraged to use their skills during mealtimes. One mealtime was observed and people were seen to be relaxed and appeared to enjoy their food. Staff have referred for specialist advice and support where it has been felt that a person may become nutritionally compromised and information on food and diets are recorded in the persons care plan. One recommendation is that when staff prepare meals for people who require a blended diet then the portions of food are not mixed together and people can then have a greater variety of taste during their meal. Food hygiene practices need to be improved as it was noted that a number of opened food products were being stored in the fridge and these had not been appropriately wrapped or date labeled as to when opened. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are well supported with their personal, emotional, physical and health care needs. Evidence: Care plans for two of the people living at the home were looked at. These provide information on how to meet the persons needs with relation to their health and personal care. We found that some of the information in care plans had not been appropriatley updated. The manager reported that new care plans are going to be introduced and this will therefore be addressed. The manager told us in the self assessment of the service (AQAA) As part of a person centred approach to support planning, we actively encourage the people we support to be health aware and provide support in healthy eating and lifestyles, particularly where someone has identified a need or wish to improve their health. During discussions with staff we asked them to explain some of the health and personal care needs of people living at the home and to explain how they ensure they maintain peoples privacy and dignity. Staff gave appropriate answers and answers which indicated that they knew the needs of the people they support well. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Records showed that people living at the home are supported to remain healthy. People are regularly supported to see their GP, district nurse, dentist, optician etc. People are also supported to see other health professionals as appropriate to their needs. Procedures for managing and administering medication were looked at. We looked in more detail at the medication procedures in relation to two people. Care plans include information the persons medication needs and patient leaflet information was available with medication administration records. We found that medication was being ordered and administered as per instructions with the exception of one medication for one person as we found there were no signatures to indicate that a particular medication had been administered. Whilst it may have been possible that this was no longer required there was no information on the medication administration record to indicate this and of concern was the fact that both the manager and staff were not able to explain why the person had not been administered the medication over a period of time. The manager has since advised that he has looked in to this matter and will be introducing a clearer system for recording medication. We noted that medication was not being appropriately audited and this must be addressed as a means to prevent such occurrences and protect the health and wellbeing of people living at the home. Care Homes for Adults (18-65 years) Page 20 of 32 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. Policies procedures and practices are in place for dealing with complaints and for aiming to protect people against abuse or neglect and systems are in place for dealing with allegations of abuse. Evidence: A complaints procedure is in place and this is time scaled appropriately. Information on how to make a complaint and an overview of how complaints are dealt with is provided in the homes statement of purpose and service user guide. We noted that a small number of complaints had been dealt with by the manager. However, the means by which these are recorded was not appropriate. The manager should ensure a clear, comprehensive record / log of complaints is maintained. This is to safeguard people living at the home and staff and visitors. The manager told us in the self assessment of the service (AQAA) Our policies and processes around feedback and complaints actively encourage all our staff to be receptive and respond positively to any identified shortfalls. We have built feedback and complaints into our quality assurance framework to ensure that we act on feedback and learn from this and As a service to people with communication difficulties we are always observing interpreting guessing and advocating. We also listen and involve other professionals and people who come into contact with them. At the moment we have involved one advocate for one service user. An Adult protection policy and procedure is in place. This includes information on Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: responsibilities for contacting relevant authorities. Care staff have been provided with training in adult protection. Two members of staff were asked how they would respond to a complaint or concern and they were able to provide an appropriate response to this question. There has been one safeguarding investigation since the last key inspection visit. This had been appropriately reported, investigated and the manager provided information as to the outcome of this. Care Homes for Adults (18-65 years) Page 22 of 32 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. There are areas to improve on the home environemnt but generally people are provided with a comfortable, safe home environment. Evidence: A tour of the home was carried out. Accommodation is provided at ground floor level. The home has one lounge and combined dinning area and five bedrooms, one of which is a sleep in room / staff office. Each person living at the home has their own bedroom and a sample of these were looked at and found to be well presented. Furnishings and fittings were also noted to be of an appropriate standard. Bedrooms were personalised with peoples own belongings. Three of the four bedrooms used by people living at the home were noted to be small. Whilst these do not meet current new registration standards they are within the requirements for homes registered prior to 31st March 2002. However, we noted that the size of the rooms was impacting on the moving and transferring needs of some of the people living at the home. We recommend a reassessment of those peoples needs by an Occupational Therapist. The home has a large rear garden which provides a good amount of outdoor space for peoples use. We found the home to be comfortable, clean and generally appropriately maintained. We did note however, room for improvement to the kitchen as one cupboard in particular was broken and the external appearance on the approach to the house could be improved. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: The home has health and safety practices and procedures which are aimed at ensuring the home is clean and free from hazards to the health and safety of people living at the home and staff. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is little evidence that people living at the home are supported by a well qualified and trained staff team. Evidence: The manager does not record or plan staff training well and few staff are appropriately qualified. We looked at a number of staff files to in order to assess the staff recruitment and selection procedures and ensure these are in line with good practice and aim to safeguard the people living at the home. We found that the files for two of the newest members of staff contained no recruitment information. The manager reported that this was kept at the head office and he was in the process of attaining this. We therefore could not determine that staff had been appropriately recruited. The manager was advised to ensure this information was in place for inspection purposes. The manager told us in the self assessment of the service As a service provider organisation, we recognise that the people who provide support critically influence the quality of service that people receive. Our policies and processes in recruitment and training, guide and inform effective recruitment practices that include thorough pre employment checks, induction and on-going training to ensure that staff fully understand their responsibilities and how to effectively support people with a learning disability. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: We looked at a sample of staff files and we could see some information on staff training within these. However, for some staff we could see little evidence of training and the manager was not able to provide us with up to date training information for members of the staff team or for the staff team as a whole. The manager must identify what training staff have had and ensure that he puts plans in place to ensure staff training needs are met. This is to ensure that staff have the required skills and competence to meet the needs of the people they support. The staff team consists of nine people and only two of these staff hold a relevant qualification, for example a National Vocational Qualification, (N.V.Q) in care. The target of 50 of staff to have attained a relevant qualification has therefore not been met. The manager should address this and ensure the staff team are appropriately qualified. Discussions with members of the staff team indicated that they are supporting the aims and objectives of the home in encouraging people to make choices, use their skills, and use their local community. Staff turnover has been relatively high over the past twelve months. The details of this were discussed with the manager. The manager reported that a good compliment of staff are now in post and have been working well to get to know the needs of the people they support and build relationships with them. During discussions with two members of the staff team they confirmed that they are being provided with the opportunity of supervision meetings and team meetings were reported to take place on a regular basis. These meetings provide an opportunity for staff to explore their practice, explore new ways of working and to make and communicate decisions as to how to develop the service. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live in it. Evidence: The home is run in the best interests of the people living there. However, there are a number of practices which need to be addressed so as to protect peoples health, welfare and safety. These include improvements to care planning, risk assessments, the management and auditing of medication and ensuring staff are provided with appropriate training. The manager of the home has worked for Mencap for numerous years and has been managing this service for approximately three years. The manager was available throughout the duration of the inspection visit. There was evidence of a quality assurance process which includes regular visits from a representative employed by Mencap. This shows that the quality of the service is being monitored. The manager of the service told us in the self assessment of the service that Mencap has a Continuous improvement framework that sets out how we promote and assure the quality of service to the people we support. This begins with the way we work Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: with people everyday using person centred planning. We also have clearly defined processes for gaining feedback from service users and stakeholders, meeting our compliances, monthly monitoring visits and annual reviews of the service. Mencap as a service provider organisation is currently undertaking a review of the way that we seek and gain feedback from the people we support. To date we have used accessible paper based questionnaires, but feedback from the people we support indicates that these do not always give the scope for people to comment on what is important to them in the support they receive. We are moving towards a more flexible process for facilitating and recording discussions with people based around what we believe to be best practice. The home has numerous policies and procedures in relation to the health and safety. We looked at a sample fire and health and safety checks and we found these to be up to date with the exception of a fire risk assessment which was dated 29/07/2004. This needs to be reviewed and updated as appropriate so as to safeguard all people concerned with the home. The manager should ensure that a safe working practice risk assessment is carried out and reviewed on a regular basis. This is to ensure safeguard the health, safety and wellbeing of people living at the home, staff and visitors. Care Homes for Adults (18-65 years) Page 28 of 32 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 Care Homes for Adults (18-65 years) Page 29 of 32 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 Medication must be safely managed at all times. 28/10/2009 To protect the health and welfare of the people living at the home. 2 34 17 Information relating to the recruitment and selection of staff must be in place. 28/10/2009 To safeguard the people living at the home. 3 35 18 Staff must be provided with training as appropriate to their role. 28/01/2010 To promote the health, safety and wellbeing of people living at the home. Care Homes for Adults (18-65 years) Page 30 of 32 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 1 The service user guide should be produced in alternative formats which are more accessible to people using the service. The manager should aim to ensure a consistency in the quality of information contained within care plans so as to ensure they are all to a good standard. Care plans need to be reviewed and developed to ensure they accurately reflect the needs of the person. People living at the home should be provided with greater opportunities to experience new interests and be supported to have a more varied and interesting social and recreational life. Safe food hygiene practices should be carried out at all times so as to protect the health and wellbeing of the people living at the home. Meals for people who require blendid foods should be provided more appropriatley. The manager should ensure that complaints information is recorded appropriatley and this record should include details as to the outcome of the complaints investigation. The manager should ensure all areas of the home are appropriately maintained and presented. An occupational Therpaist should be commissioned to assess the needs of the people living at the home in relation to the provision of aids and adaptations. The manager should aim to achieve the target of 50 of the staff team to attain a relevant qualification. The fire risk assessment should be reviewed as updated as appropriate. A safe working practice risk assessment should be carried out to promote the health, safety and wellbeing of people living at the home and staff. 2 6 3 4 6 13 5 17 6 7 17 22 8 9 24 29 10 11 12 32 42 42 Care Homes for Adults (18-65 years) Page 31 of 32 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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