Care Home: The Pines

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What the care home does well The home is welcoming, relaxed, clean, and tidy.People and staff get on with each other.People who live at the home are given support to enjoy their leisure time and do things in the community.Some information has pictures and photos to make it easier to understand.Staff have been trained in how to care for people.There are good care plans for people. So that staff know what support and care people need.Not many staff leave so the same staff keep supporting people.There is good health and safety in the home. What has improved since the last inspection? People`s care plans and files have pictures and are on CD to help people understand and to help staff give the right care and support.Pictures and photos are used for planning the menus. What the care home could do better: The manager should visit people at home before they come to stay.Some risks have not been assessed. They should be managed so staff know what to do to keep people safe.Staff should help people start `life story` and `life history` books. This is so people can see photos and things that show what they have done in their lives.People need to be given support to develop their skills around the house.There need to be `as needed` plans for taking medication. This is to make sure that people have this medication safely.The manager needs to phone to check information about new staff.Page 14 of 35Care Homes for Adults (18-65 years) Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Pines 39 Portchester Road Charminster Bournemouth Dorset BH8 8JU The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Johnson Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 35 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: The Pines 39 Portchester Road Charminster Bournemouth Dorset BH8 8JU 01202555048 01202567682 the.pines@ntlworld.com 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) : Sandbourne House Ltd care home 13 Number of places (if applicable): Under 65 Over 65 13 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 13. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home The Pines is a large house in Charminster, Bournemouth. Up to 13 people can live at The Pines. 12 people live at the home and 1 bedroom is for people who come for short stays. Care Homes for Adults (18-65 years) Page 5 of 35 8 8 people have their own bedrooms. 4 people have to share 2 bedrooms. There is a local bus service into the town centre and a large car that people use. Care Homes for Adults (18-65 years) Page 6 of 35 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 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home The inspector looked around the house with someone who lives there. The inspector talked and Makaton signed with people who live at the home. Care Homes for Adults (18-65 years) Page 8 of 35 The inspector looked at care plans with people. The inspector looked at some of the paperwork about the home and the staff. The inspector talked to the staff and the manager. What the care home does well Care Homes for Adults (18-65 years) Page 9 of 35 The home is welcoming, relaxed, clean, and tidy. People and staff get on with each other. People who live at the home are given support to enjoy their leisure time and do things in the community. Care Homes for Adults (18-65 years) Page 10 of 35 Some information has pictures and photos to make it easier to understand. Staff have been trained in how to care for people. There are good care plans for people. So that staff know what support and care people need. Not many staff leave so the same staff keep supporting people. Care Homes for Adults (18-65 years) Page 11 of 35 There is good health and safety in the home. What has got better from the last inspection Peoples care plans and files have pictures and are on CD to help people understand and to help staff give the right care and support. Pictures and photos are used for planning the menus. Care Homes for Adults (18-65 years) Page 12 of 35 What the care home could do better The manager should visit people at home before they come to stay. Some risks have not been assessed. They should be managed so staff know what to do to keep people safe. Care Homes for Adults (18-65 years) Page 13 of 35 Staff should help people start life story and life history books. This is so people can see photos and things that show what they have done in their lives. People need to be given support to develop their skills around the house. There need to be as needed plans for taking medication. This is to make sure that people have this medication safely. The manager needs to phone to check information about new staff. Page 14 of 35 Care Homes for Adults (18-65 years) 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 Jo Johnson Telephone: 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 15 of 35 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 16 of 35 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 . Peoples needs are assessed and people are provided with some accessible information so that they have information about the home. Evidence: The Service User Guide is supported by pictures, which makes it easier for some people with learning disabilities to understand the services in the home. There are plans to make the guide available on DVD. One person and surveys from people told us that they were asked and had enough information before they moved into the home. One survey included the comment I looked around and I liked it. People who live at the home have a written contract that people have signed. This should be produced in a easy read format supported by pictures and photographs. This so that people fully understand the contract. We looked at the assessment information for the last person to start using the short stay service. There was an assessment completed by the funding authority and a pre Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: assessment completed by the manager and the individuals parent. The home has one bedroom that used for short stays. The manager told us that he meets prospective people at review meetings and completes a pre assessment to determine whether the home can meet their needs. Peoples relatives or carers also complete the pre assessment. It is recommended that pre assessments are completed with the individual and their relatives or carers in their own home. People then come and have tea twice at the home and then have an overnight stay. The other people at the home told us that they are asked about whether they want the individual to come for more stays. One social care professionals surveys told us that the care services assessment arrangements always ensure that accurate information is gathered and the right service is planned for people. Care Homes for Adults (18-65 years) Page 18 of 35 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 . The people living in this home are involved in decisions about their lives and play an active role in planning their care and the support they receive. Evidence: Three peoples assessments and care records were seen. The care plans and risk assessments included all the care and support they need. Care plans are supported by pictures and are available on a CD rom so they are easier to understand. We went through one persons care plan with them. They said staff talked to me about it when I moved in but I havent looked at it in a while. Other people told us that they had been involved in their care plans and had chosen pictures and music to go with them. There were good descriptions of how staff are to support individuals to make choices and decisions in their every day life. Risk assessments were in place and they had been reviewed during monthly care plan reviews. One person had an area of risk identified in their assessment in relation to allegations against males. To date there have been no allegations. However, there was Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: no risk assessment or management plan as to how any allegations would be managed. The advice of the the learning disability team should be sought in completion of this. There have been a number of incidents with one individual at a certain time of day when the home is very busy with people returning from day services and preparing the evening meal. A plan should be put in place so that staff support this individual at this time. This is so they are occupied at this time and this may reduce the amount of incidents. People have a one to one monthly review of their care plan and how they have been spending their time with a member of staff. This is good practice but it is written and it may not be accessible to all of the people at the home. People living at the home do not have ongoing life story books and when people where asked if they had photos or anything to show what they had been doing (apart from holidays and day trips) they did not have anything accessible. Life story books have photographs and items in them that show what the person has been doing in their lives. Life story books have photographs and items in them that show what the person has been doing in their lives. Staff should develop life story books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals. Life history books should be developed that includes details and photographs of their history such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. One social care professionals surveys told us that peoples social and health care needs are always properly monitored, reviewed and met by the care service, and that the care service always respects peoples privacy and dignity. Discussions with people and their surveys show that they make decisions about what they do each day. Care Homes for Adults (18-65 years) Page 20 of 35 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 . The people living in this home are supported to make choices about their lifestyle and to develop some life skills. Some daily living activities promote independence and opportunity for people to live ordinary and meaningful lives in the community where they are living. Evidence: On arrival at the home, half of the people who live at the home were preparing to go out on a day trip to Swanage with the staff. Two people did not want to go and stayed at home. Two people were on holiday and the remainder were at community day services. We returned another afternoon to spend time with all of the people at the home. People chose where to spend time in the lounge, activities room, garden or in their bedrooms throughout the inspection. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: All of the peoples surveys shows that they can choose how to spend their time during the week and that they can do what they want at the weekend. Half of the people attend community day services and the rest stay at home and or access the community. People told us that they go on day trips, use the computer, got to pottery, the gym and the library. Staff and people told us that no one who does not access the community day services goes to college or works at the moment. From information provided in the AQAA the manager told us that We had planned on offering two concurrent structured day service options at any one time, but we have since found it much more valuable to keep the alternative option unstructured and therefore flexible. This means that those people who choose not to take part in a structured activity can still access the community or spend time in any other way that they enjoy. There are a small number of people who actively take part in the day to day living in the house such as cooking, laundry and cleaning. There needs to be a more proactive and positive risk taking approach to more people being involved in the cooking of their main meals and doing their laundry. These are important life skills that people should be encouraged to develop. The manager and people told us that they do prepare their own packed lunches for the next day. The records show that people are provided with a well-balanced and nutritious diet. All food being stored in the kitchen looked fresh and was well within the use by date. People go food shopping with staff support at least once a week. People told us that they plan the menu once a week. Care Homes for Adults (18-65 years) Page 22 of 35 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 in this home receive is based on their individual needs. Staff respect the people and promote their dignity and privacy. Medication systems in place are largely safe. Evidence: There were positive relationships and interactions observed between staff and the people who live at the home. People commented that they know, get on well with the staff and they treat them well. One person said, Know the staff, like them another person signed good when asked about staff. All of the staff are booked on equality and diversity training, this means that they will have a good understanding of providing person centred care and support to the diverse group of people living at the home. Peoples wishes in terms of who supports them with intimate and personal care is respected. Peoples health records and care plan showed that their right to good-quality physical and mental health care is being promoted. The records show that as part of promoting Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: their health people make regular visits to a dentist, optician, specific health consultants, their GP and a chiropodist when needed. People have a health action plan completed and staff are now undertaking a monthly review of peoples health needs. Staff are trained in the medication policies and procedures during induction and there is a medication training programme. Records of administration of medication seen were correct and medication was stored safely. A number of people have PRN (as required) medication. Some of the plans for taking as required medication did not specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. PRN (as required) medication plans must be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as required medication. To date there have not to date been any controlled drugs in the home and there is not any controlled drugs storage. Care Homes for Adults (18-65 years) Page 24 of 35 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 . The people who live in this home are able to express their concerns and know whom to speak to if they are unhappy or feel unsafe. They are supported by a staff team who have a good knowledge of how to respond to any suspicion of abuse. Evidence: There have been no complaints or allegations of abuse received by the home or commission since the last inspection. People said and signed that they felt safe and would know whom to talk to if they were unhappy. People have access to a complaints policy, which is in picture and large print format and includes information about us. The survey shows that people know who to speak to if they are not happy and know how to make a complaint. There is a pictorial guide on how to keep safe and what things they need to report to staff. They all were able to explain that they felt safe and knew that they needed to talk to the manager or staff if they were worried about anything. An adult protection procedure is in place at the home so that staff know how and to who they can report any suspicions of abuse. The staff and manager spoken with were confident of how to use these procedures. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: People are supported to manage some aspects of their finances. One person chooses to go to the bank to collect their money. Other people have their personal allowance from the administrator. As the staff manage aspects of peoples finances it is recommended that teh transactions are periodically audited by the provider Care Homes for Adults (18-65 years) Page 26 of 35 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 well maintained and furnished so that people live in a clean, comfortable and homely environment to live in. Evidence: There is a warm and welcoming atmosphere in the home and at the time of the visits, it was homely, comfortable and safe. People living there were able to move around easily and freely and to go to their bedrooms if they chose. One of the people proudly gave a tour of the communal areas of the house. Six people showed us their bedrooms. The bedrooms reflected their individual lifestyles, interests and tastes. Two of the of bedrooms are shared. We spoke and signed with the four people who share the bedrooms. They told us that they liked who they share a room with, one person signed friend and happy. The home was clean and free from any offensive odours. A few people are involved in the daily chores of looking after the house. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: safe. Infection control training is included in mandatory training for all staff. Care Homes for Adults (18-65 years) Page 28 of 35 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 . The people living in this home are protected by safe recruitment practices and supported by a skilled and competent staff team. Evidence: The staff team consists of both male and female workers of a mixed age range and ethnic background. The home does not currently use any agency staff. Analysis of the rota and observation during the inspection indicated there were sufficient staff on duty at all times to meet peoples needs. The home has a low turnover of staff with only a few staff leaving since the last inspection. Staff sickness levels are also low and this means that a consistent staff team that they know well supports the people living at the home. Three staff files of the most recently recruited staff were seen. They included most of the necessary documentation to demonstrate that the staff are suitable to work with people living at the home. They all included CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks and references. References should be verified by telephone and any gaps in employment and/or adult working life explored. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: The training matrix shows that staff have accessed training in the full range of mandatory, health and safety related training, (e.g. first aid, food hygiene, adult protection and fire safety) as well as specialist courses, such as dementia, diabetes, epilepsy and Mental Capacity Act and Deprivation of Liberties training. There is an induction programme in place that is based on skills for care standards. We spoke with two new members of staff and they spoke highly of their induction so far. All of the staff are booked on Equality and Diversity training in August 2009. Staff spoken with said they had regular supervision and staff meetings. Staff surveys show that the manager meets and gives support regularly. People living at the home said they know all of the staff and who is working each day. People and the surveys told us that staff treat them well and they act and listen to what they say. the manger told us in the AQAA and during the inspection that he plans to actively involve people at the home in any future appointments of staff. Care Homes for Adults (18-65 years) Page 30 of 35 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 there. Evidence: From discussion with people living at the home, staff, the manager, the examination of records and observation of care practices show that a competent and skilled management team manages the home. There is quality assurance system in place, which includes formal consultation with people living at the home, their relatives and health and social care professionals. Information provided before the inspection, by the manager in the AQAA (Annual Quality Assurance Assessment) shows that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. Care Homes for Adults (18-65 years) Page 31 of 35 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 32 of 35 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 Individual PRN (as required) medication plans must be written that specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. This is so that staff know how and when to safely administer as required medication. 01/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that pre assessments are completed with the individual and their relatives or carers in their own home. This is so that an assessment is completed with people in their own home. Care Homes for Adults (18-65 years) Page 33 of 35 2 5 The contract should be produced in a easy read format supported by pictures and photographs. This so that people fully understand the contract. Staff should develop life story books/works with people living at the home, as these give a much more interesting picture of how people have been spending their time and people may find them easier to follow than written records. This means that people can be actively involved in the monthly reviews of their plans and goals. Life history books should be developed that includes details and photographs of their history such as family, friends, where they have lived, pets, work etc. These life history books will assist both the person and staff in remembering their past and will assist staff to have a greater understanding of them as an individual. A plan should be put in place so that staff support one individual at peak times when incidents have occurred. This is so they are occupied at this time and this may reduce the amount of incidents. Any risks identified in peoples assessments should be assessed and planned for. Where this relates to allegations against people the advice of health and social care professionals involved with the individual should be sought. There should be a more proactive and positive risk taking approach to more people being involved in the cooking of their main meals and doing their laundry. These are important life skills that people should be encouraged to develop. The prescribing practitioner or health professional should approve PRN (as needed) medication plans where possible. References should be verified by telephone and any gaps in employment and/or adult working life explored. This is to make sure that references are accurate and that full information is sought about staffs adult working life. 3 6 4 6 5 6 6 9 7 11 8 9 20 34 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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