Inspection on 08/12/09 for Gloucester Road (22)

This is the latest available inspection report for this service, carried out on 8th December 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gloucester Road (22) 20/12/07

Gloucester Road (22) 08/11/05

Gloucester Road (22) 12/04/05

Gloucester Road (22) 09/11/04

Gloucester Road (22) 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Gloucester Road (22) 22 Gloucester Road Kingston Upon Thames Surrey KT1 3SJ     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: James OHara     Date: 0 8 1 2 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 28 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 28 Information about the care home Name of care home: Address: Gloucester Road (22) 22 Gloucester Road Kingston Upon Thames Surrey KT1 3SJ 02085470610 02085463832 pm-gloucesterroad@together-uk.org www.together-uk.org Together Working for Wellbeing Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 22 Gloucester Road is a large detached property situated on the outskirts of Kingston upon Thames. Town centre facilities are within easy reach and the service is conveniently situated for access to public transport networks. The property is owned by the Local Authority, the Royal Borough of Kingston but the project is managed by Together Working for wellbeing. The service has a contract with a local Primary Care Trust. The local primary care trust also contributes to the funding of the project. The house has six bedrooms on the ground floor and a further ten bedrooms on the first floor. There is a large garden to the rear with a range of mature trees and shrubs. The current fee for a placement at the service is £548.00 per week. 1 4 0 1 2 0 0 9 16 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We spent three and a half hours at the service and talked with four people who use the service and the manager. Records and documents examined during the inspection included needs assessments, care plans, activities, medication, staff recruitment and training, quality assurance, and health and safety records. Requirements and recommendations from the previous inspection were discussed with the manager. Care Homes for Adults (18-65 years) Page 5 of 28 What the care home does well: What has improved since the last inspection? All of the requirements set at the last key inspection have been met. People who use the service have files that include up to date information on their care needs and personal goals. Boots the pharmacist have visited the service and audited the medication administration and procedures. Staff have completed training on safeguarding adults. All of the toilets and bathrooms have been completely refurbished and new radiator Care Homes for Adults (18-65 years) Page 6 of 28 covers fitted throughout the house. The manager told us that in January 2010 all of the communal areas and peoples bedrooms will be decorated, the house will be fitted with new carpets and people will have new sinks in their bedrooms. The kitchen will also be fully refitted. 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 7 of 28 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 8 of 28 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 planning to use the service are provided with up to date and accurate information about the service. This will enable them to make an informed decision about whether or not the service can meet their needs. The admission procedure ensures that people would have a thorough assessment of their needs and aspirations before they move in. Evidence: The manager showed us a folder that included the Statement of Purpose. They told us that the Statement of Purpose was currently under review. The manager also showed a brochure, this had very good information about the service. The brochure is given to people when they move in or show an interest in moving into the service. The brochure included pictures of the house and the local area and information about living there, registering with a General Practitioner, peoples rights as a service user, financial information, making a complaint, the staff and an application form. Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: One person has recently moved into the service. The manager showed us this persons file. The file included an assessment of their needs, risk assessments, a mental health and a mental capacity assessment carried out by their care manager, an occupational therapy assessment and a needs assessment carried out by the service. The manager told us that the services needs assessment was a pre planning tool used to develop a care plan and risk assessments. The file also included a contract and a licence agreement. Care Homes for Adults (18-65 years) Page 10 of 28 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. People who use the service have files that include up to date information on their care needs and personal goals. Risk plans are completed so that people can live as independently as possible. Evidence: Requirements were set at the last inspection that each resident should have a comprehensive needs assessment that covers all areas of their needs including their cultural needs. These assessments should be reviewed at least annually and care plans revised and updated appropriately. Risks that have been identified in the risk assessments should be specifically addressed in the care plans in order to minimize the risks to the residents. Care plans should contain specific care plan objectives that relate to the needs assessments and to the Care Programmed Approach documentation where appropriate Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: and state how care aims are intended to be met. Care plans must be reviewed and updated regularly, at least once annually, or as the needs of the resident change. Residents and other parties should sign and date the care plans. We selected three peoples personal files at random and examined them. Each file had a needs assessment, a care plan, risk assessments, key worker session reports and copies of care managers reviews. The care plans indicated the persons need, an action plan, by whom and when the actions were to be carried out and a review date. The care plan indicated how peoples needs would be met in areas such as their mental health, medication, physical health, personal hygiene, daily living skills, social inclusion, religion and culture, health and safety and advocacy and communication. The care plan also included details of family and carer involvement and a crisis relapse management plan. Risk assessments had been kept under regular review by the service and peoples care managers. The manager told us that if people had other specific needs this was included in their care plans. Care Homes for Adults (18-65 years) Page 12 of 28 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. It is evident that people are encouraged to be as independent as possible both within the service and in the local community. People are supported to engage in appropriate personal relationships. Evidence: There was a relaxed atmosphere in the house, we observed people sitting in the lounge watching television, some people sitting together chatting and some people coming in and going out. The manager told us that most people living at the service have their own routines and most are able to maintain their own independence. Some people go shopping, swimming, to the local library or visit local cafes, some people go to day centres and drop in centres and one person works at a charity shop. Information is also provided Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: to people about local activities that they may be interested in. The manager told us that during the summer the service had arranged activities such as barbeques, parties and day trips. They had tried to encourage people to go on a holiday but this had not been a success. One person however did go on a holiday with their family to Eastbourne. They told us that some people will stay with relatives over the Christmas holiday however the service has arranged a party as well as a Christmas lunch for those that remain. People who use the service are encouraged and supported by the team to maintain relationships with their family and friends if they wish to do so. People have keys to their own rooms and to the front door. People are registered to vote in elections and are supported by staff to do so if they wish. We looked at the food offered to people who use the service. The manager showed us a four weekly rolling menu with two evening meal options. They told us that people had told staff what they would like on the menus however if they had a request for something not on the menu that evening they could have it as long the food stuff was available. There is a separate kitchen just off the lounge for people to use, the manager told us that during the day people help themselves to breakfast, lunch and snacks. We spoke to four people who use the service. One person told us that they did what they liked to do and they go out when they want to. They told us that staff treated them well and the house was very comfortable. Another person showed us their bedroom. They told us that they had it just the way they wanted it, but were looking forward to the room being decorated. They said the food offered to them was very good and the staff were nice. All of the people we spoke to told us that they were treated well and they liked the new bathrooms. One person was sitting in the designated smoking area, they told us that they had lived at the house for a long time and considered the place their home. They said they were looking forward to the Christmas party. One person we spoke to briefly told us, they had never had it so good. Care Homes for Adults (18-65 years) Page 14 of 28 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 arrangements for meeting the health care needs of people who use the service are good, medication is well managed, they have good access to appropriate healthcare professionals and they receive personal support in the way they prefer. Evidence: All of people who use the service are registered with a General Practitioner and some are registered with local dentists. The manager told us that people are supported to keep well through accessing appropriate healthcare and mental health care support. The manager told us that annual health checks take place at the General Practitioners surgeries. Peoples care plans indicated how their needs would be met in relation to their mental health, medication, physical health and personal hygiene. Their personal files also included records of their appointments with Consultant Psychiatrists, Community Psychiatric Nurses and other health care professionals. Medication is stored in a locked cabinet in the office. The manager told us that the cabinet had recently been installed and bolted to the wall, there was a small cabinet Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: inside for storing controlled drugs. The manager told us that there were no controlled drugs stored at the house at this time. Medication administration records were examined. The majority of peoples records were up to date and accurate however one person had been prescribed eye drops to be administered four times daily, this persons records showed that on some occasions they had not been administered the eye drops. The manager told us that this person had occasionally refused the eye drops or had been out however the reason for not receiving the eye drops had not been recorded. The manager told us that they would discuss this with the staff concerned and ensure that staff records the reason for the non administration of medication on the medication administration records. It is recommended that the manager discuss medication administration recording with the staff team at the next team meeting. The manager told us that some people are administered medication by Community Psychiatric Nurses at the house or at the General Practitioners surgeries. The manager showed us that the Community Psychiatric Nurses had signed medication administration records at the house. The manager told us that the Community Psychiatric Nurses had always advised staff at the house when people had been administered medication at the surgery. Some people are able to self medicate. The manager told us that risk assessments and guidelines had been completed. They told us that their medication was checked and monitored weekly. We observed one person being supported by staff to decant and take their medication. People who use the service are able to take their repeat prescriptions to the General Practitioners and pick up their medication. The manager showed us the medication ordering system and told us that because people are registered with seven different General Practitioners it was important to keep track of medication being received into the house and returned to the pharmacist. The manager showed us the administration of medication and loose medication procedures. The amount of loose medication is checked and recorded every evening. Staff training records showed that all staff had attended training on the administration of medication. It was strongly recommended at the last inspection that once the new medication procedures were in place that Boots the pharmacists were asked to review the Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: effectiveness of the procedures. The manager produced documentary evidence that a pharmacist from Boots visited the service and audited the medication administration and procedures. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that their complaints and concerns are listened to because there is a complaints procedure that that they can understand. People can be sure that they are protected from harm and abuse because policies are in place for safeguarding adults. Staff has completed training on safeguarding adults. Evidence: The service has a complaints procedure. The procedure is included in the Statement of Purpose and the service brochure. The complaints record was examined, the manager told us that no complaints had been received since the last inspection visit. The Commission has not received any complaints about the service. We asked two people who use the service if they knew how to make a complaint, both told us that they did if they needed to. The manager has kept the Commission informed of any incidents and accidents that have occurred at the service. The service has a copy of the Royal Borough of Kingston adult protection policy and procedures and the services own Safeguarding Adults Policy. A requirement was set at the last inspection that all staff should receive Protection of Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Vulnerable Adults training from an outside recognised trainer at least once every two years. Staff training records showed that this requirement has been met. Records also showed that the manager had attended training on the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. A requirement was set at the last inspection that an inventory of residents valuable belongings that are kept in their bedrooms must be drawn up, maintained and kept up to date by key workers. We selected three peoples personal files at random and examined them. Each file had an up to date inventory of the persons belongings. Care Homes for Adults (18-65 years) Page 19 of 28 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 building is well maintained so that people can live in a clean, comfortable, homely and safe environment. Evidence: Requirements were set at the last inspection that two toilets needed attention and radiator covers were needed throughout the house. All of the toilets and bathrooms have been completely refurbished and new radiator covers fitted throughout the house. All of the people we spoke to told us that they were very happy with the new bathrooms and toilets as they were a big improvement on the old ones. At the last inspection it was recorded that the rear back stairway needed redecoration as it was stained and the paintwork needed renewal. The manager told us that in January 2010 all of the communal areas and peoples bedrooms will be decorated, the house will be fitted with new carpets and people will have new sinks in their bedrooms. The living room had comfortable furniture, a large television and a large fish tank. One Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: person we spoke to told us that the living room was comfortable; they liked the new settees and watching the catfish. There is a large kitchen and dining area. The manager told us that the kitchen will also be fully refitted in January 2010. There is a large pleasant garden to the rear of the house. There are appropriate laundry facilities separate from the kitchen and the preparation of food. The washing machine is capable of washing clothes at high temperatures, which helps with the control of infections. One persons room was seen. They had good quality bedroom furniture and a television, the room was obviously arranged the way they wanted it. They told us that they had it just the way they wanted it, but were looking forward to the room being decorated. We looked around the premises and found it to be clean, bright and well ventilated. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can have confidence in the staff because checks have been done to make sure that they are suitable to care for them. People who use the service are supported by well trained staff that understand their needs. Evidence: The staff team consists of a manager and four full time staff. The manager told us that regular relief bank staff covers the remaining shifts. The manager showed us staff training records. Staff had attended training on moving and handling, fire prevention, first aid, health and safety, food hygiene, risk assessments, the protection of vulnerable adults, care planning, mental health awareness and medication. All staff had completed an NVQ level 2 in care and had either completed or were completing an NVQ level 3 in care. A requirement was set at the last inspection that documentary evidence required under Standard 34 of the National Minimum Standards be gathered for all the staff members at Gloucester Road and be held on the staff files for review and inspection. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: The manager told us that one member of staff had recently been recruited and was currently completing training and an induction. The manager showed us this persons file. The file included an Independent Safeguarding Authority check, two written references, and a copy of their passport, a company medical health check and a completed application form. The manager told us that they had applied for a Criminal Records Bureau Check and that this person would not be permitted to work unsupervised with people who use the service until the Criminal Records Bureau check had been obtained. The manager produced Criminal Records Bureau checks for all other members of staff including relief bank staff currently working at the service. Records showed that all full time staff are receiving regular supervision and annual appraisals. Relief bank staff also attends team meetings and receive regular supervision and annual appraisals. Records showed that team meetings take place once a month. A team building day has been arranged for the 17th of December 2009. The manager told us that the team would be looking at the aims and objectives of the service and how they could make improvements. Care Homes for Adults (18-65 years) Page 23 of 28 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. People can be sure that their needs are met and wishes are taken into consideration because the service is well managed. People can be sure that hey are protected from harm because good health and safety arrangements are in place. Evidence: The manager has four years experience of managing various mental health services and has completed NVQ level 4 Management Award. They took over the management of Gloucester Road in October 2008. They told us at the last inspection that they were in the process of registering as manager with the Commission. They told us that they had not applied to the Commission to be the registered manager because there had been some restructuring of the organisation and they were not sure if they would still be in the same post. Now that the restructuring has been completed they plan to apply to the Commission to become the registered manager for the service. The manager must apply to the Care Quality Commission to become the registered manager for the service. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The manager showed us regulation 26 visit reports for May, June, July and August 2009. The manager told us that since then the organisation had developed a new system for monitoring the service and showed us that a service manager had visited the house on a regular monthly basis to carry out spot checks and had completed monthly monitoring reports. The manager told us that an annual review of the service had been completed in September 2009. Satisfaction surveys had been provided to people who use the service, their relatives, staff, care managers and commissioners. The manager told us that they were still compiling the information returned to them before completing a report. It is recommended that the manager send a copy of the annual review of the service to the Commission. The manager produced a Landlords Gas Safety certificate dated 16th of June 2009, evidence that portable appliances had been tested on the 21st of July 2009 and evidence that the water system hade been checked for Legionellas in October 2009. The weekly fire alarm testing record was examined. Records indicated that the fire alarm had been checked on a regular weekly basis. The services fire risk assessment was reviewed in July 2009. Fire fighting equipment was checked by an engineer in August 2009 and the fire alarm system was checked by an engineer in October 2009. Staff training records showed that all staff had completed fire safety training. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 37 8 The manager must apply to 31/03/2010 the Care Quality Commission to become the registered manager for the service. So that people benefit from a well run service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that the manager discuss medication administration recording with the staff team at the next team meeting. It is recommended that the manager send a copy of the annual review of the service to the Commission. 2 39 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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