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Inspection on 19/04/10 for Great Western Road, Flat 3, 22-24

Also see our care home review for Great Western Road, Flat 3, 22-24 for more information

This is the latest available inspection report for this service, carried out on 19th April 2010.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Flat 3 provides good support to six people, a number of whom have high needs, to take part in activities of their choice and to pursue their interests both at home and in the community. The personal and, in particular, the health care needs of people living at Flat 3 are well assessed and recorded. Staff work closely with the multi professional learning disability team and with other agencies to support residents communication, mobility, independence and psychological needs. Steps have been taken to introduce healthy eating, with meals freshly prepared. Residents commented positively on the meals provided, both in their surveys and in discussion. Residents` religious and cultural needs are identified and supported. Staff have access to NVQ2 training and to the Westminster Society`s in-house programme. The Society has comprehensive auditing systems, with regular visits to the home and collection of a range of management data.

What has improved since the last inspection?

The previous inspection and the Society`s own internal audit identified a number of areas where action needed to be taken. All of the requirements from the last inspection have been met and considerable improvements have taken place, including recording and follow up of residents` health care needs, recording of incidents and staff training. A more stable staff team has been established, with two vacant posts covered by care bank staff. An additional waking night post has been created to meet the needs of the newest resident, which has relieved staff of sleeping in duties.

What the care home could do better:

There is only one requirement from this inspection - that staffing levels be kept under review. The admission of two residents who use wheel chairs and need assistance with transferring has placed additional pressure on staff, together with reductions in the hours of people attending day centres. Staffing levels need to be monitored to ensure that staff time with residents is not eroded further. The Service Manager confirmed that additional care bank hours can be booked to ensure that residents` programmes are implemented.

Key inspection report Care homes for adults (18-65 years) Name: Address: Great Western Road, Flat 3, 22-24 22-24 Great Western Road London W9 3NN     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: Sheila Lycholit     Date: 1 9 0 4 2 0 1 0 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 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Great Western Road, Flat 3, 22-24 22-24 Great Western Road London W9 3NN 02072895041 02089645507 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Westminster Society for People with Learning Disabilities Name of registered manager (if applicable) Christine Quantock Type of registration: Number of places registered: care home 6 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: 6 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 Flat 3 is a purpose built, wheelchair accessible, first floor flat providing accommodation and support for people with a learning disability. The home can accommodate up to six service users. The service is provided by the Westminster Society for People with Learning Disability, a voluntary organisation. The home is located in a residential area of Westbourne Park, close to shops and transport links. The home is part of a small residential block that includes a second registered care home and six flats for people with a learning disability who are living independently. Each person living in the home Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 6 Brief description of the care home has his or her own bedroom. Communal areas, bathrooms and toilets are shared. The current weekly fee for the home is approximately £1300 per week. Care Homes for Adults (18-65 years) Page 5 of 26 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 unannounced inspection visit took place on Monday 19th April 2010 from 10.45am until 4.35 pm. The Manager had returned from maternity leave that day and was having a week long handover from the Agency Manager who had been at the service since September 2009. Four residents were at home and two were at day services returning later. The Assistant Manager and two support workers were on duty. The Agency Manager and Service Manager who made herself available throughout the inspection had completed an Annual Quality Assurance Assessment (AQAA) in detail prior to the inspection. Four staff and four residents completed feedback surveys. Residents and staff were spoken with during the visit and practice observed. Care Homes for Adults (18-65 years) Page 6 of 26 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 7 of 26 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 26 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. Residents are provided with up to date information about the service. A sound admission procedure, which responds to the needs of residents, is in place. Evidence: Information on residents files show that an up to date statement of purpose and service users guide is available, which people sign to confirm they have received. Clear contracts, which include a breakdown of fees and charges were also seen on file. Flat 3 had two vacant places last year following the sad deaths of two residents. Two new people have moved to the home, one in Septemberlast year and one ten days before the inpsection visit. The admission records of these two people were looked at. One person had moved to Flat 3 reluctantly when the environment at his previous home became unsuitable for his reduced mobility. He was supported to make the transition by his previous staff team and staff at Flat 3, who, with the involvement of the multi professional learning disability team, ensured that suitable equipment was provided and that all staff were aware of his needs. The Service Manager had visited him at his previous placement to discuss the move to Flat 3 and to arrange preadmission visits. A range of relevant information about his needs was seen on file.This Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: resident indicated in his survey form that he has settled into Flat 3. The person who had very recently moved to Flat 3 had been admitted at short notice. Information was available from his previous placement and staff were compiling their own assessment but a needs assessment from Westminster Council had not been provided. The Service Manager confirmed that she had requested a copy of the needs assessment on more than one occassion. The residents log book showed that in spite of the short time allowed for his admission, a number of visits had been arranged, which had included family members. Staff had taken time to discuss his reigious and cultural needs to ensure that they were recognised and supported. Care Homes for Adults (18-65 years) Page 10 of 26 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. Steps have been taken to improve care planning and risk assessments. The Societys new format, All About Me, encourages a person centred approach and introduces the use of multi media. Evidence: Three residents files were looked at, which showed that they had been involved in developing their own plans. The Westminster Society uses a standard person-centred format for care planning across all its homes. The care plan of the longest established resident was fully completed, with a range of photos to illustrate her interests, and to identify relatives and friends. Following a review in 2009, her Care Manager from the Royal Borough of Kensington and Chelsea, had asked for action to be taken regarding her communication needs and activity programme. Records show that improvements had been made, including the development of a communication plan with the Speech and Language Team. Staff had drawn up a care plan with the resident who was admitted in September 2009, although no photos were on file. Staff explained that the resident was Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: uncomfortable about having his photo taken. The care plan of the most recently admitted resident was still being developed, although essential information was available. This residents moving and handling risk assessment was not on file but was brought over later in the visit by the Training Officer who had been updating it following a training session with the staff team. Other risk assessments seen were up to date, although some would benefit from more detail and need to include relevant information that is recorded elsewhere on residents files. Visual displays of PCPs were seen in residents rooms. It is recommended that PCPs are developed further with all residents using multi media to include their views and aspirations. Residents meeting take place weekly, with notes recorded by staff in a book. It is recommended that these notes are produced in an accessible format and displayed in the home. Residents are also supported to take part in the Westminster Societys regular forum for service users both by attending and through conveying their issues and concerns to the resident who acts as the homes representative. Care Homes for Adults (18-65 years) Page 12 of 26 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. Residents take part in a range of activities in the community. Menus have been revised, with an emphasis on healthy eating, including more freshly cooked food. Evidence: Activity plans and daily logs show that residents take part in a range of activities in the community. A number of residents attend day services for part of the week, however hours of attendance have recently been reduced. Three of the four staff surveys received commented that there needed to be more opportunities for residents to go out. Records indicated that residents were now going out regularly. The Agency Manager said that there had been a problem with a lack of wheelchairs that were suitable for outdoor use but that three new ones have been obtained. Work on the pavements near the flat is also being carried out following complaints from the home about the difficulty in manoeuvring wheelchairs. The Service Manager said that care Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: bank staff can be booked to assist with outings and activities in recognition of the pressure on the staff team of the reduction in day service attendance and the higher needs of the new residents. The service has the use of a vehicle for outings but currently only the Manager is qualified to drive. Records and discussion with staff indicate that residents receive good support to maintain contact with families and friends, including visits to relatives who live in other parts of the country. The family of one resident were visiting on the day of the inspection. Photos around the home, including those loaded onto a digital photo frame, show residents enjoying outings and events. In their survey forms, residents commented positively on the food: they cook me good food, and they always cook good food. Observation of the preparation of lunch and discussion with the Agency Manager shows that food is freshly prepared with a cooked lunch and evening meal. Residents choose the menus from an illustrated folder of foods and dishes. The cultural needs of a resident who is Muslim are met through the avoidance of certain foods and the use of Halal meat, purchased locally. The fridge was clean and tidy, with opened and prepared food labelled and dated. Care Homes for Adults (18-65 years) Page 14 of 26 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. Residents receive good support with personal care in line with their wishes. The health care of residents is given a high priority, with health care needs identified and follow up action taken. A procedure for the safe handling of medication is in place and action has been taken to reduce the number of medication errors. Evidence: Well written day and night support guidelines contain detailed information about the residents needs and how they prefer to be supported. The advice of the Physiotherapist has been sought to ensure that people who use wheelchairs are transferred safely and recommended equipment and aids have been obtained. Residents commented on the good support provided - they look after me very well and they always support me whenever I want. Records show that staff recognise residents mental health needs and seek the advice of the Psychiatrist and Psychologist from the Learning Disability Team. Health action plans seen were fully completed and issues identified had been followed up, for example one new resident has been referred to an Optician and now has spectacles for the first time. Appointments with health care professionals are logged Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: with the outcome noted, including any follow up action. The home uses the Boots monitored dosage system and training records show that all staff receive training in handling medication. Medication is safely stored in a secure locked cabinet. No controlled drugs are held. Opened eye drops were being kept in a locked container in the kitchen fridge. Current MAR sheets were looked at, which were up to date and fully completed. Some medication errors have occurred since the last inspection, which have notified to CQC. The Service Manager explained that in order to reduce the number of errors throughout its services, the Society investigates each incident and takes disciplinary action if staff are found to have been at fault. Care Homes for Adults (18-65 years) Page 16 of 26 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 has a clear complaints procedure, in an accessible format. Steps have been taken to ensure that staff follow multi agency procedures for reporting any safeguarding concerns. Evidence: Copies of the Societys complaints procedure was seen on residents files. This is clearly written and in an accessible format. No complaints have been received in the past 12 months. The complaints book shows that previously, lower level concerns and inter resident disputes were recorded. It is recommended that this practice is reinstated so that all issues are captured and can inform the services quality assurance audits. Training records show that some staff have attended recent training in supporting service users to make a complaint. Training records confirm that staff receive training in safeguarding adults, including refresher training. There has been one safeguarding referral since the last inspection, which was investigated in line with Westminster Councils safeguarding procedures. The incident book contains detailed information about incidents and accidents affecting residents. The Agency Manager confirmed that body charts were available to note the site of any marks or bruises. The previous inspection report raised concerns about the lack of follow up regarding unexplained bruising, possibly caused during moving and handling. Records and discussion with Managers indicate that steps have been taken to ensure that procedures about reporting concerns are followed and professional advice sought Care Homes for Adults (18-65 years) Page 17 of 26 Evidence: regarding assisting residents with transfers. A new procedure for managing residents financial affairs has been introduced, with the Society holding individual accounts within a corporate account. Each resident has a cheque book with senior managers as co-signatories. The Service Manager stated that residents can have easy access to their accounts. Records show that receipts are obtained for all purchases made on behalf of residents and a running balance kept. Care Homes for Adults (18-65 years) Page 18 of 26 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. Flat 3 provides spacious, accessible accommodation, which meets residents needs. Evidence: Flat 3 is on the first floor of a block of flats in a busy area, close to Westbourne Park, the Harrow Road and the Grand Union Canal. There is a lift to all floors and an enclosed garden on the ground floor shared with other residents in the block. Each of the 6 bedrooms is of a good size and rooms seen, with residents permission, were personalised, reflecting peoples individual interests. There is a pleasant kitchen/dining room with sufficient space for all residents and staff to sit down together. The sitting area has French doors with a narrow balcony overlooking the rear of the building. Discussion took place with Managers about ways of making the room more attractive and less cluttered. It was explained that there is considerable resistance from residents, who each have their own spaces in the room, to any change. The flat has an assisted Parker bath and a separate shower room. The home was clean and tidy at this unannounced visit. Attention is paid to infection control, with colour coded cleaning tools and protective clothing. The Agency Manager confirmed that an order for paper towels has been made to replace the hand towels currently used at shared washbasins. Care Homes for Adults (18-65 years) Page 19 of 26 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. A relatively stable staff team that has access to regular training and support has been established. Although current staffing levels are satisfactory, they need to be kept under review to reflect residents changing needs and reduction in access to day services. Evidence: Training records and certificates show that new staff follow a structured induction, including time spent at the Societys head office. Staff have access to NVQ level 2 training, with the majority of staff having achieved the award. The Assistant Manager has partially completed nursing training. Core training is monitored by a regular print out, which indicates that the staff team is currently up to date. The staff team consists of a Manager, Assistant Manager, 7 full time and 2 part time support workers. The two support worker vacancies are covered by regular care bank staff. There are two staff on waking night duty following the recent admission of a resident who needs two staff to assist him. Rotas allow for 3 staff on duty on each AM and PM shift. The Manager is supernumerary to the rota on some days to allow for administrative tasks. Support staff carry out all cleaning and laundry in the flat. Staff expressed some concern about the adequacy of staffing levels in the surveys received. The Agency Manager commented that the service now had 4 residents who use wheel chairs and require more support and in addition the reduction in hours of clients Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: attending day services has eroded staffing ratios at the service. As discussed earlier under standard 13, the Service Manager confirmed that additional care bank staff can be booked for planned outings. An additional waking night post has been created to meet the needs of the newest resident at night, which has relieved staff of sleeping in duties. Rotas indicate that staffing levels are currently adequate but do need to be kept under review. Positive interactions between residents and staff were observed, with staff responding promptly to requests from residents, for example to go outside for a cigarette. Recruitment checks are undertaken by the Societys HR team who hold staff records at head office. Information seen on staff files at the home confirm that the Manager receives confirmation of criminal record (Independent Safeguarding Authority) checks. The AQAA states that one of the service users was supported to participate in an interview for the recruitment of support staff. Staff communication is supported by handovers and weekly meetings, which are recorded and by regular supervision. Care Homes for Adults (18-65 years) Page 21 of 26 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. Sound management cover was arranged during the recent absence of the Manager, to ensure the continued development of the service. The Westminster Society has a range of quality assurance systems, which include seeking the views of services users and of staff. Evidence: On the day of the inspection visit the Manager had just returned from maternity leave and was having a week long handover from the Agency Manager, who had been managing the service for the previous 6 months. The Manager confirmed that she will apply for registration with the Commission as soon as possible. Both Managers are experienced and well qualified to NVQ level 4 and above. The last audit report available undertaken by the Society in September 2009 indicated concerns in a number of areas. It is to the credit of the Agency Manager, the staff team and to senior managers that these concerns and all the requirements from the previous inspection have been addressed, as well as managing the admission of two new residents under less than ideal circumstances. The Society regularly seeks the views of its service users who are supported to give Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: feedback by independent staff from other services. Senior staff undertake quarterly audits which include unannounced visits. During these audits a range of records are checked, residents spoken with and practice observed. Checks of medication and a sample of residents finances are also carried out. The Service Manager who was present during the inspection visit also visits regularly and completed a monthly report. Record keeping seen during the inspection was of a good standard. Health and safety checks seen and information provided in the AQAA show that sound systems are in place. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 33 18 Staffing levels are currently adequate but need to be kept under review to relect changing needs and circumstances. To ensure that residents receive sufficient support at all times. 30/06/2010 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 Person centred planning has started at Flat 3 but needs further development, including the use of multi media to ascertain and express residents views and aspirations. It is recommended that the notes of residents house meetings be recorded in an accessible format and displayed in the home. Some risk assessments would benefit from more detail and in particular should include relevant advice from other professional colleagues. It is recommended that all concerns and complaints however minor are recorded. 2 8 3 9 4 22 Care Homes for Adults (18-65 years) Page 25 of 26 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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