Care Home: Wortley Lodge

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What the care home does well The home keeps generally good standards. Care planning and risk assessment is carefully undertaken, and health needs are properly addressed. Service users enjoy varied opportunities within and outside of the home. Their independence is encouraged. Record keep is of a high standard. What has improved since the last inspection? The home has met requirements of the previous inspection regarding adult protection and some environmental issues which were pointed out . It has partially met the requirement regarding staff training. What the care home could do better: The inspection resulted in four statutory requirements and eight good practice recommendations. The home needs to address medication administration to ensure that it is safe and secure. It needs to ensure that all staff are fully trainined in core basic topics. Key inspection report Care homes for adults (18-65 years) Name: Address: Wortley Lodge 26 Wortley Road East Ham London E6 1AY     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: Anne Chamberlain     Date: 1 0 0 7 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 25 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 25 Information about the care home Name of care home: Address: Wortley Lodge 26 Wortley Road East Ham London E6 1AY 02084729974 02084729974 pretim.singh@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pretim Singh care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home Wortley Road was registered in July 1995 as a 3 bedded home. It offers permanent accommodation for 3 adults with learning disabilities aged 18 to 65 years. The home comprises three single bedrooms, two bath/shower rooms, lounge, large kitchen/diner, office and pleasant paved garden. It is situated within the Upton Park area of East London, close to amenities and served by many bus routes to the area. The proprietor is also the manager of the establishment. The home is not able to offer placements to adults who have severe mobility problems, are doubly incontinent or who exhibit severe challenging behaviour. The fees at the home range from #780 to #1404 per week. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 3 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection and it took place over one day. However the proprieter was not present and we consulted with her on her return from holiday some two weeks later. We spoke to residents and staff and viewed key documentation and recording including two service user files. We undertook an inspection of the medication administration arrangements and a general tour of the environment of the home. We would like to take this opportunity to thank the service users and staff of the home for their support and co-operation with the inspection. Care Homes for Adults (18-65 years) Page 5 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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 6 of 25 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 7 of 25 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. The home makes a good assessment of prospective service users and offers placements only to individuals whose needs it can meet. Evidence: We viewed two service user files. They contained a great deal of information about the service users. The original assessment information had been removed as the service users have been in the home some time. However our impression was that the service understands their needs well and is able to meet them. Our observations of the service users was that they got along well and formed a compatible group. We spoke to the manager and pointed out that one service user has more developed language skills than the other two. She agreed and said that the service user has many opportunities to socialise with others outside of the home, and gets along well with her contemporaries in the home. Based on the general standards of care in the home we would expect the home to only offer placements to people it had thoroughly assessed. Care Homes for Adults (18-65 years) Page 8 of 25 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 home ensures that the individual needs and choices of service users are met. They are encouraged to make everyday decisions and risks are assessed. Evidence: We viewed two service user plans. The first covered a wide range of needs including, communication, community participation, eating and drinking, psychology, leisure and finances. The second covered varied topics including personal care, eating, cultural, safe environment and education and occupation. The plans had goals and gave guidance to staff. They were individualised, comprehensive and carefully written. We noted that the service user plans had been signed by them or their representatives, also that they had been reviewed. There was evidence in daily logs that service users are encouraged to make decisions where possible. One service user has profound learning disabilities and her decision making capacity is affected by this. The service user plan for the second service user Care Homes for Adults (18-65 years) Page 9 of 25 Evidence: listed the various activities she undertakes outside and inside the home. Service users attend meetings where activities are discussed and we viewed the minutes of the meetings. We were also shown a list which had been produced of activities the residents would like to undertake during the summer, and places they would like to visit. We viewed the risk assessments for the two service users. They were graded, high, medium and low and there were strategies identified for managing the risks. The service user plans and risks assessments were well written, typed and clear. We noted in files out of date information, and suggest that these are archived and only current plans and assessments are kept on file. Care Homes for Adults (18-65 years) Page 10 of 25 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. Service users are supported to have contact with their families and friends. They have a variety of educational and recreation opportunities. Meals are of their choice and are taken in pleasant surroundings. Evidence: We noted from the service user plan that one service user visits her family and stays overnight and longer at times. Another service user had a timetable which showed the various activities she undertakes during the week. Daily logs for service users evidenced that they are supported to clean and tidy their rooms on Saturdays.Service users also attend college, day care services and clubs. They socialise with service users at a sister home. On the day of the inspection one service user went to a day centre and two others went to the cinema with a care worker. We noted from a service users daily record that she had done some baking with staff at the weekend. A staff member confirmed that this service user likes to help with cake making. We Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: also noted that one service user had expressed a desire to attend a certain service and this had been arranged promptly for her. Service users daily records evidenced lots of trips out and about to places of interest. A service user had been supported to attend her mothers funeral and we saw the invitation she had received to this. We felt that service users at this home have many opportunities to attend a wide variety of educational, recreational and leisure activities. We also observed positive interaction between service users and staff. The staff were warm and approachable to the service users. Service users had been asked at a residents meeting about the menu and had said that the one they have could continue. We viewed a pictoral menu in the kitchen. It looked rather static and unused. Care staff said that the service users like most foods. We felt that perhaps food should be a regular item on the agenda of the meeing and that residents need encouragement to think about different foods. Pictoral information would help with this. The home has a pleasant kitchen dining room with a table large enough for the service users to sit down and eat together. The kitchen cupboard and refrigerator and freezer contained a variety of wholesome foods. Care Homes for Adults (18-65 years) Page 12 of 25 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. Service users at the home have their personal support needs and healthcare needs well met. The medication practice was generally sound but had an important shortfall. Evidence: Service user plans gave evidence of personal support but in addition to these service users had health action plans. These evidenced that their emotional, psychological and behavioural needs had also been addressed. One service user had had significant input from speech and language and psychology professionals, to address her challenging behaviour on community transport. She can now travel escorted on public transport quite safely. A care worker said her behaviour is much improved. Health appointments for a range of professionals including psychiatrists, occupational therapist, physiotherapist, dentist and optician had been recorded in the health action plans we viewed. We noted that service users had had health checks and medication reviews and influenza vaccines. Appointments had been properly written up by staff and weight charts had been kept. We formed the view that the approach to healthcare is pro-active and conscientious. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: Health care, physical and mental, is well planned and recorded. We inspected the arrangements for the administration of medication. The medications are kept in the office in a small freestanding lockable cabinet. These arrangements are not satisfactory. The cabinet cannot be freestanding. It must be attached to the wall. We viewed the medication folder where Medication Administration Record (MAR) charts are kept. The MAR charts are the homes own design and they are clear and easy to read and audit. We noted that it did not contain specimen signatures for staff who administer medication. We had noted on the file of one service user that she is allergic to penicillin. However her MAR chart stated no allergies. We pointed this out to the deputy manager who immediately amended the charts, and also the computer held record chart which generates the MAR charts for this service user. The deputy manager stated that the general practitioner is aware of the service user having this allergy to penicillin. She stated that all the staff are also aware. Later we asked a staff member if she knew who in the house has an allergy to penicillin. She stated that she did not know. We asked another member of staff and she was able to answer with the correct name. The manager must make sure that all staff are aware of this allergy. We spoke to the manager after the inspection and she said that the home would raise the issue with the G.P. and that she is aware the home has a responsibility to ensure that any professionals working with the service user are aware of the allergy. We checked the balances of several medications. Most of the medications are dispensed in blister packs and these balanced. However one medication was dispensed in loose tablets. We could not balance this because no brought forward balance had been recorded on the MAR chart. We asked the deputy manager to ensure that brought forward balances are recorded on MAR charts so that all medications can be audited. Care Homes for Adults (18-65 years) Page 14 of 25 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 home is open to complaints and has a process for dealing with them Service users are safeguarded and protected in the home. Evidence: We viewed the complaints policy. It states that the home welcomes complaints and that they will be acknowledged within 2 days and investigated within 14. It states that complainants will be responded to in writing. The home keeps a complaints book. There is a statement inside it which states that complaints will be responded to within 48 hours and that the proprietor will investigate and report the outcome back to all parties within 5 days. There were no complaints recorded in the book. We felt that there was a satisfactory process for dealing with complaints. We asked one of the care staff how the service users are supported to manage their money. She explained the system to us and we viewed the arrangements. Service users have a lockable box each and a record is kept of their expenditure in individual records. We counted the cash in one tin and found that it balanced with the book. Receipts are all retained and we saw them. We felt that service users monies were safeguarded. We viewed the safeguarding policy which was dated September 2008. The policy Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: states that social services must be informed of any allegations and are to take the lead in any safeguarding issue. The policy was clear and contained all necessary information. The home has a copy of the local authority safeguarding policy, which we viewed. Care Homes for Adults (18-65 years) Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and hygienic, well furnished, comfortable and homely. Evidence: We toured the environment of the home. It was clean and comfortable with decent carpets and curtains. The sitting room has a television set and we noted games and puzzles as well as a box of sensory materials, which one service user likes to handle. We were pleased to see photographs of service users on the wall. The bedrooms were all well furnished and we found no hazards. The kitchen diner is an asset to the home being light and airy, well furnished and spacious. The fitted kitchen units were clean. The bathroom on the first floor was adequate and clean. The wet room on the ground floor was also of a good standard. However neither washing area had towelling towels or paper hand towels on the day of the inspection. The home was clean and hygienic and has no issues with control of infection. Care Homes for Adults (18-65 years) Page 17 of 25 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. Recruitment practice at the home is safe and robust. The level of staff qualification n the home is good, but there are some shortcomings in training. Evidence: We were not able to access the personnel records on the day of the inspection. However we viewed the recruitment policy which refers to equal opportunities. It states that for a vacancy a job description should be produced, the post should be advertised and a short list drawn up. The policy states that cnsideration should be given to whether candidates would fit into the culture of the home and advises interviewers not to pick the best of a bad bunch. It advises them to clarify any vague areas and not to ignore their instincts. The policy states that two professional references must be obtained from previous employers or colleges and teachers. It also emphasises the importance of correct immigration documentation. At the last inspection we found that the recruitment practice at the home was robust and safe. We discussed current practice with the manager of the home and are of the view that this is still the case. We did remind the manager that staff should be started on Protection of Vulnerable Adults (POVA) first check only with supervision and if there is a good reason for this. It should not be the habitual practice. Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: The home has a procedure for starters which contained a list of what should be included in a personnel file. This was appropriate. The home has a training policy which states that regulation 35 of the Care Homes Regulations must be adhered to. The training and development records were not accessible to us on the day of the inspection, but we discussed training with the manager on the phone on her return from holiday. A requirement had been made at the previous key inspection with a timescale of 01/01/2008 and this has been partially complied with. All staff have had up to date training in first aid and fire and three staff have had health and safety training and medication. However three staff have not trained in safeguarding since 2005. Safeguarding should be renewed once in two years so the requirement is partially restated. The proprietor is the registered mananger of the home and there is a deputy manager and three other workers. We were told by the deputy manager that all the care workers have NVQ level 2 and the deputy manager herself has level 3 and is currently undertaking her registered managers award at level 4. The deputy manager stated that the courses carers undertake include health and safety and medication. She said that some courses are undertaken out of the home. The home has a racial harassment policy and we suggest that this be developed and expanded to address diversity from a positive perspective too. Care Homes for Adults (18-65 years) Page 19 of 25 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 undertakes quality assurance work but this could be further developed. The safe working practices in the home are satisfactory. Evidence: We viewed the evidence of quality assurance. There were completed surveys from professionals, relatives and service users. These were all positive. However there was no other quality assurance evidence. The manager needs to develop a range of quality assurance tools, for example audits and regulation 26 (of the Care Homes Regulations) visits. The manager told us she has a business plan but unfortunately we did not see it at the inspection. The home has appropriate policies to carry out its work. However we noted that some of these were overdue for review, including the training policy which should have been reviewed in October 08, the health and safety policy dated 1/6/08, the food hygiene policy dated 14/10/07 and the whistleblowing policy dated Nov 2007. We felt the record keeping in the home was of a high general standard. The daily logs Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: kept for service users had entries for a.m. and p.m. and they were meaningful and demonstrated that the service users have variety and choice in their lives. We viewed the evidence of safe working in the home including the health and safety policy. The home keeps an accident book. The accident rate is low, around one a year and these had been well reported. There was a fire risk assessment dated 30/1/09 and a fire safety policy dated 2/10/08. An outside contractor had called on 8/1/09 to maintain the fire extinguishers. There was evidence of regular fire drills. The home has two smoke alarms and we were told by staff that they are checked regularly. There is a fire exit sign at the back door. However a staff member told us that usually the home evacuates through the front door. We believe that the front door should therefore be signed as a fire exit. The gas safety certificate was viewed and was dated 9/2/09. The electrical safety certificate was dated 4/10/06. The home had two first aid kits in the kitchen. They both had products in them which had expired and needed to be replaced. The manager told us subsequent to the inspection, that the home has two new first aid kits. Staff should know where the up to date kits are and the expired products should be disposed of. Care Homes for Adults (18-65 years) Page 21 of 25 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 22 of 25 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 20 13 Loose medications must have a brought forward quantity recorded on the MAR chart so that they can be audited. To safeguard service users. 15/08/2009 2 20 13 The medication cabinet must 01/09/2009 be securely attached to the wall. To prevent its being removed and to store medication securely. 3 20 13 The manager must ensure that all staff know that one service user is allergic to penicillin and who it is. The manager must further ensure that any prescriber is made aware of this information. To safeguard the service user. 15/08/2009 Care Homes for Adults (18-65 years) Page 23 of 25 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 35 18 Staff should train in and renew from time to time Safeguarding Adults. This requirement is restated. To ensure the safety and wellbeing of service users. 01/09/2009 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 6 We recommend that out of date plans and assessments are archived, and only current information is kept on the files of service users. We recommend that menu planning is a regular agenda item at residents meetings and pictoral information is provided to stimulate discussion. We recommend that a list of specimen signatures for staff who administer medication is kept in the medication file. All washing facilities should have towelling or paper towels available in them. We recommend Regulation 26 quality assurance visits and audits, especially medication audits. We recommend that the manager updates the homes policies where this is needed. The manager should have a fire exit sign above the front door which is the usual evacuation route for the home. Staff should be able to access first aid boxes with up to date items in them. 2 17 3 4 5 6 7 8 20 24 39 40 41 41 Care Homes for Adults (18-65 years) Page 24 of 25 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. 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